Does 11C-choline PET-CT contribute to multiparametric MRI for prostate cancer localisation?

BACKGROUND AND PURPOSE: The aim of this work was to determine whether 11C-choline positron emission tomography (PET)-computed tomography (CT) makes a positive contribution to multiparametric magnetic resonance imaging (MRI) for localisation of intraprostatic tumour nodules. PATIENTS AND METHODS: A total of 73 patients with biopsy-proven intermediate- and high-risk prostate cancer were enrolled in a prospective imaging study consisting of T2-weighted (T2w), dynamic contrast-enhanced (DCE) and diffusion-weighted (DW) MRI and 11C-choline PET-CT before radical prostatectomy. Cancerous regions were delineated on the whole-mount prostatectomy sections and on the different MRI modalities and analysed in 24 segments per patient (3 sections, 8 segments each). To analyse PET-CT images, standardized uptake values (SUV) were calculated per segment. RESULTS: In total, 1,752 segments were analyzed of which 708 (40.4%) were found to be malignant. A high specificity (94.7, 93.6 and 92.2%) but relatively low sensitivity (31.2, 24.9 and 44.1%) for tumour localisation was obtained with T2w, DCE and DW MRI, respectively. Sensitivity values significantly increased when combining all MRI modalities (57.2%). For PET-CT, mean SUVmax of malignant octants was significantly higher than mean SUVmax of benign octants (3.68±1.30 vs. 3.12±1.02, p<0.0001). In terms of accuracy, the benefit of adding PET-CT to (multiparametric) MRI was less than 1%. CONCLUSION: The additional value of 11C-choline PET-CT to MRI in localising intraprostatic tumour nodules is limited, especially when multiparametric MRI is used.

Whipple's disease. A classic case report and review of the literature.

We report the case of a 43-year-old carpenter with abdominal complaints and progressive weight loss. The HLA-B27 positive male had been suffering migratory arthropathy for five years, only partially under control with corticosteroids and methotrexate therapy. Endoscopic investigation showed dark staining of the duodenal mucosa and the ileal mucosa had an erythematous aspect with multiple white spots. Abundant periodic acid Schiff positive macrophages were seen on histologic examination of biopsy samples. This is a classic presentation of Whipple's disease, a rare multisystemic disease caused by the Tropheryma whipplei. Typical symptoms are arthropathy, weight loss, abdominal pain and diarrhea, but also systemic and neurological manifestations may occur. The otherwise lethal disease can be treated with long term antibiotics.

Tissue engineering in space.

The purpose of this paper is to present the status of that part of the [Microgravity Application Program] project related to the study of cartilage formation from pig chondrocytes. The work carried out so far followed two lines: (i) chondrocytes were incubated for up to three weeks in the RPM; (ii) a module developed for in-vitro cartilage formation will be tested in a sounding rocket flight (MASER 9, November 2001).

Motor learning and Parkinson's disease: refinement of within-limb and between-limb coordination as a result of practice.

Even though the basal ganglia have been assigned a role in motor learning, few studies have addressed motor learning capabilities in Parkinson patients. In the present experiment, improvement of bimanual figure drawing across practice was compared between Parkinson patients and normal age-matched controls. At regular intervals during acquisition, performance was assessed under normal vision and blindfolded conditions. At initiation of practice, the typical signs associated with Parkinson's disease became evident, such as bradykinesia and hypometria. Moreover, reduced synchronization between the force-time specifications of both limbs was observed. When vision was withdrawn, Parkinson patients showed a larger drift of drawing performance across the workspace, indicative of a decline in proprioception. In spite of the aforementioned deficits, Parkinson patients made marked improvements in the speed of execution, the consistency of the spatial trajectories, and the synchronization between the limbs across practice, even though they never reached the performance levels obtained in elderly controls. The findings demonstrate that Parkinson patients do benefit from practice to refine their upper limb control and to alleviate their most basic motor deficits.

Addition of bupivacaine to sufentanil in patient-controlled epidural analgesia after lower limb surgery in young adults: effect on analgesia and micturition.

BACKGROUND AND OBJECTIVES: The usefulness of adding bupivacaine to an opioid administered by the epidural route is controversial. This study examines both the quality of pain relief and side effects, in particular urinary retention, during patient-controlled epidural analgesia (PCEA) with sufentanil alone or in combination with two different concentrations of bupivacaine. METHODS: In a double-blind randomized study, 60 healthy young adults undergoing open knee or ankle surgery with combined spinal-epidural anesthesia received postoperative analgesia via PCEA with sufentanil alone or with 0.06% or 0.12% bupivacaine. In addition to pain scores at rest and during mobilization, bladder function was evaluated. Strict criteria were respected in scoring the occurrence of problems suggestive of urinary retention. The 24-hour analgesic consumption and the incidence of other side effects were also recorded. RESULTS: Patients receiving bupivacaine had better pain relief than those receiving only the opioid, but this difference was more pronounced when measuring dynamic pain scores. The consumption of sufentanil was significantly higher in the group receiving the opioid alone than in the group receiving 0.06% bupivacaine. The bupivacaine dose requirements were twice as high with the 0.12% concentration. Bladder problems occurred significantly more frequently in patients treated with the highest bupivacaine concentration. Motor impairment was not a major problem. CONCLUSIONS: A 0.06% bupivacaine-sufentanil combination offered the best results in terms of analgesic quality and lower side effects, mainly micturition problems, which may be explained by the higher consumption of local anesthetic at the higher bupivacaine concentration. Analgesic quality could not be improved by increasing the bupivacaine concentration.

Gastric involvement with Anisakis sp. larva in a Belgian patient after consumption of cod.

A case of acute episode of gastric anisakiasis in a patient, which was acquired through the consumption of infected cod meat and could be successfully resolved by endoscopic extraction, is described and discussed. This is the first report of cod as infection source as well as an authentic case of gastric anisakiasis in Belgium.

Wolfram syndrome: a clinical study of two cases.

Two unrelated patients with two different images of Wolfram (or 'DIDMOAD') syndrome are presented: a 19-year old woman suffering from all the important features of this syndrome, and a 38-year old man showing two major characteristics but several minor abnormalities. This syndrome should be considered in young diabetic patients with unexplained visual loss or with polyuria and polydipsia in the presence of adequate blood sugar control. An early diagnosis is important to prevent unnecessary diagnostic investigations.

Palmar fasciitis and arthritis associated with cancer of the prostate.

A case of palmar fasciitis and arthritis (PFA) is described in a man with both a prolactinoma and metastatic cancer of the prostate. This rare condition is mainly described in women with ovarian cancer and our case is the first reported association of PFA with cancer of the prostate.

VISTECH contrast sensitivity and pattern-VEP in multiple sclerosis patients.

In 12 known multiple sclerosis patients with a visual acuity of 7/10 or better in both eyes, optic nerve function was tested by means of contrast sensitivity measurement (VISTECH technique) and pattern-VEP. The results were compared with those of an age related control group. The VISTECH contrast sensitivity measurement is a useful tool in evaluating the remaining visual discomfort after the resolution of an optic neuritis. However, to detect a subclinical optic neuritis, the pattern-VEP is more sensitive.

A new universal electrode for ERG recording.

The authors introduce a contact lens for flash and various pattern ERG's. The main properties are: annular shape, blepharostatic effect, central opening. The electrode is well tolerated and sterilisable.