A Case of Primary T-Cell Central Nervous System Lymphoma: MR Imaging and MR Spectroscopy Assessment.

Primary central nervous system lymphomas (PCNSLs) are mainly B-cells lymphomas. A risk factor for the development of PCNSL is immunodeficiency, which includes congenital disorders, iatrogenic immunosuppression, and HIV. The clinical course is rapidly fatal; these patients usually present signs of increased intracranial pressure, nausea, papilledema, vomiting, and neurological and neuropsychiatric symptoms. PCNSL may have a characteristic appearance on CT and MR imaging. DWI sequences and MR spectroscopy may help to differentiate CNS lymphomas from other brain lesions. In this paper, we report a case of a 23-year-old man with T-primary central nervous system lymphoma presenting with a mass in the right frontotemporal lobe. We describe clinical, CT, and MRI findings. Diagnosis was confirmed by stereotactic biopsy of the lesion.

Combined use of percutaneous cryoablation and vertebroplasty with 3D rotational angiograph in treatment of single vertebral metastasis: comparison with vertebroplasty.

INTRODUCTION: This study aims to assess the effectiveness of combined procedure of cryoablation and vertebroplasty (CVT) for reduction of pain and improvement of the quality of life in patients with single painful metastatic vertebral fractures. METHODS: We retrospectively analyzed data from 23 patients with single vertebral metastasis treated with combined procedure of CVT, compared with those obtained in 23 patients treated by vertebroplasty. Pain intensity was evaluated by a visual analog scale (VAS) score administered before and 1 day, 1 week, and 1, 3, and 6 months after procedure. Quality of life was evaluated by an Oswestry Disability Index (ODI) score administered before and at 3 and 6 months after procedure. RESULTS: Procedural success was achieved in all patients without any complications. The VAS and ODI scores showed a reduction in both groups during follow-up (VAS score, p < 0.05 and p < 0.001, respectively; ODI score, p < 0.0001). No difference of the VAS and ODI scores were observed before treatment (p = 0.33 and 0.78, respectively). VAS score showed a difference at 1 week and 1, 3, and 6 months after treatment (p < 0.001). ODI score showed a difference at 3 and 6 months after treatment (p < 0.001). CONCLUSION: Our findings suggested that combined procedure of CVT is safe and effective for pain relief in single metastatic vertebral fractures, especially when other standard palliative treatments have failed, and improves disability. Careful needle positioning and accurate fluoroscopic and CT guidance are mandatory for a complication-free treatment.

Value of hepatic arterial phase CT versus lipiodol ultrafluid CT in the detection of hepatocellular carcinoma.

OBJECTIVE: To evaluate the role of hepatic arterial phase (HAP) spiral computed tomography (CT), as compared with iodized oil (Lipiodol ultrafluid [LUF]) CT for revealing nodular hepatocellular carcinomas (HCC). METHODS: Twenty-four cirrhotic patients underwent two-phase HCT examination: HAP 25 seconds and portal phase 70 seconds after injection of 1.5 mL/Kg contrast medium. All patients also underwent hepatic angiography and intraarterial infusion of iodized oil; LUF CT was performed 3-4 weeks after infusion. HCT images were compared with LUF CT images for detection of hepatic nodules. RESULTS: We found no significant difference between the sensitivity of HAP CT and LUF CT for nodules >10 mm, while HAP CT was more sensitive than LUF CT in revealing nodules <10 mm (47 vs. 27, p < 0.001). CONCLUSIONS: HCT should be considered as the first method for the detection of HCC, whereas LUF CT should be used only for therapy.

Simultaneous reduction of nitrate and selenate by cell suspensions of selenium-respiring bacteria.

Washed-cell suspensions of Sulfurospirillum barnesii reduced selenate [Se(VI)] when cells were cultured with nitrate, thiosulfate, arsenate, or fumarate as the electron acceptor. When the concentration of the electron donor was limiting, Se(VI) reduction in whole cells was approximately fourfold greater in Se(VI)-grown cells than was observed in nitrate-grown cells; correspondingly, nitrate reduction was approximately 11-fold higher in nitrate-grown cells than in Se(VI)-grown cells. However, a simultaneous reduction of nitrate and Se(VI) was observed in both cases. At nonlimiting electron donor concentrations, nitrate-grown cells suspended with equimolar nitrate and selenate achieved a complete reductive removal of nitrogen and selenium oxyanions, with the bulk of nitrate reduction preceding that of selenate reduction. Chloramphenicol did not inhibit these reductions. The Se(VI)-respiring haloalkaliphile Bacillus arsenicoselenatis gave similar results, but its Se(VI) reductase was not constitutive in nitrate-grown cells. No reduction of Se(VI) was noted for Bacillus selenitireducens, which respires selenite. The results of kinetic experiments with cell membrane preparations of S. barnesii suggest the presence of constitutive selenate and nitrate reduction, as well as an inducible, high-affinity nitrate reductase in nitrate-grown cells which also has a low affinity for selenate. The simultaneous reduction of micromolar Se(VI) in the presence of millimolar nitrate indicates that these organisms may have a functional use in bioremediating nitrate-rich, seleniferous agricultural wastewaters. Results with (75)Se-selenate tracer show that these organisms can lower ambient Se(VI) concentrations to levels in compliance with new regulations proposed for release of selenium oxyanions into the environment.

[Neural network based detection of pulmonary nodules on chest radiographs]. / Identificazione mediante reti neurali dei noduli polmonari nel radiogramma del torace.

PURPOSE: We investigated the capabilities of an artificial neural network-based Computer-Aided Diagnosis (CAD) system in improving early detection of pulmonary nodules on chest radiographs. MATERIAL AND METHODS: We used a data-set of 145 digitized chest films. Two different radiologists read the radiographs to detect the sites of possible nodules. The system uses two neural networks trained on a training-set of 100 radiographs selected from the data-set. The first network is used to focus attention on the sites of potential nodules while the second calculates the likeliness of nodule presence in ROIs. The clinical test was performed on 45 more radiographs from the training-set, but different from those in the data-set, which were positive for both benign and malignant nodules. These latter plain films showed 65 nodular lesions which differed by shape and acquisition technique. RESULTS: Sensitivity was 89% in all radiographs while specificity, evaluated by ROI, and accuracy, were 98%. CONCLUSIONS: There are potential limitations in nodule detection on plain radiographs. Some of them are operator-dependent, such as nonsystematic investigation, lesion underestimation, and poor reading, and some are technique-dependent, such as X-ray beam/tube, low voltage, patient positioning, focus-film distance and development process. CADs may contribute to improving detection of pulmonary nodules because the false-negative rate is decreased and sensitivity consequently increased. The high sensitivity and specificity rates of neural networks encourage further trials on wider data-sets to help the radiologist in the early detection of pulmonary nodules.

Bacillus arsenicoselenatis, sp. nov., and Bacillus selenitireducens, sp. nov.: two haloalkaliphiles from Mono Lake, California that respire oxyanions of selenium and arsenic.

Two gram-positive anaerobic bacteria (strains E1H and MLS10) were isolated from the anoxic muds of Mono Lake, California, an alkaline, hypersaline, arsenic-rich water body. Both grew by dissimilatory reduction of As(V) to As(III) with the concomitant oxidation of lactate to acetate plus CO2. Bacillus arsenicoselenatis (strain E1H) is a spore-forming rod that also grew by dissimilatory reduction of Se(VI) to Se(IV). Bacillus selenitireducens (strain MLS10) is a short, non-spore-forming rod that grew by dissimilatory reduction of Se(IV) to Se(0). When the two isolates were cocultured, a complete reduction of Se(VI) to Se(0) was achieved. Both isolates are alkaliphiles and had optimal specific growth rates in the pH range of 8.5-10. Strain E1H had a salinity optimum at 60 g l-1 NaCl, while strain MLS10 had optimal growth at lower salinities (24-60 g l-1 NaCl). Both strains have limited abilities to grow with electron donors and acceptors other than those given above. Strain MLS10 demonstrated weak growth as a microaerophile and was also capable of fermentative growth on glucose, while strain E1H is a strict anaerobe. Comparative 16S rRNA gene sequence analysis placed the two isolates with other Bacillus spp. in the low G+C gram-positive group of bacteria.

Morphometric analysis of the acromioclavicular joint.

The width of the articular space of the acromioclavicular (AC) joint was investigated to evaluate normal range values and any possible variations in relation to age and sex. Radiographs of the AC joints of 72 males and 28 female (age range: 38-83 yrs) were studied. The articular space width of the AC joint was measured using a semiautomatic computerized system. The measurements were performed bilaterally at the level of smallest distance between the articular surfaces in all the radiograms. The mean value of the articular space width was calculated for all the subjects as a single group, for that of the males and for that of the females. The films were then divided into four groups according to age (< 50; 50-59; 60-69; > 70 yrs) and the mean value per group was calculated. The values obtained were studied using variance analysis. No significant difference were found in the mean values of the articular space width when males and females were compared as regards to age. However, even if the articular space width diminished, in both sexes, with an increase in age, the differences between age classes were not statistically significant.

Auditory evoked potentials (AEPs), early (BAEPs) and long latency components (LLCs) in Parkinson's disease: a 12 month follow-up study.

In 14 untreated informed patients (5 M, 9 F, mean age 62 yrs) with initial idiopathic Parkinson's disease AEPs, early (BAEPs) and long latency components (LLCs) were studied. In 10 subjects experimental session were carried out before treatment (L-Dopa plus Carbidopa, 0.25-0.50 g/die) and at 2, 6 and 12 months intervals. At the same time all patients underwent clinical assessment by Webster Rating Scale evaluation. BAEPs. The IPLs prolonged (greater than 2.5 SD) in 6 patients: in 3 the III-V, in 2 the I-V and in 1 the I-III. The absolute latencies were abnormally prolonged in 11 subjects: V wave in 4, III wave in 3, II wave in 2 and I wave in 3. The absence of one or more components were observed in 12 out of 14 patients, the most frequently absent was the II wave (12 patients). LLCs. The absolute latencies of P1 and N1 waves were prolonged respectively in 4 and in 3 subjects. The P1-N1 IPL was prolonged only in one patient. A follow-up study demonstrated transitory improvement of the AEPs previously observed abnormalities. The improvement was partially in agreement with clinical assessment.

Auditory and somatosensory evoked potentials (AEPs and SEPs) and ballistic movements in Parkinson disease.

In five patients with initial idiopathic Parkinson disease AEPs (early and late components of auditory evoked potentials), SEPs (somatosensory evoked potentials) and arm ballistic movements (abduction of the humerus) were studied. Experimental sessions were conducted before starting treatment (L-Dopa plus Carbidopa) and at two and six month intervals. Before treatment evoked potential abnormalities were found in four out of five patients; EMG patterns underlying ballistic arm abduction movements were altered in all patients; corresponding prolonged duration of initial movements and low mean velocities were found. After treatment AEP and SEP showed a reduction of previously observed abnormalities and both EMG patterns and kinematic variables consistently improved. It is suggested that the electrophysiological investigations employed in this preliminary study may be a useful tool in clinical and pharmacological researches on Parkinson disease.

Pseudoperiodic paroxysmal discharge in a case of hemorrhagic shock.

We report a case of hemorrhagic shock associated with an EEG pattern resembling pseudoperiodic lateralized paroxysmal discharges, repeated focal motor seizures on the opposite side of the prevalent EEG abnormalities and consciousness disturbances in the absence of a demonstrable cerebral lesion occurring in a 45 year-old woman without a personal or familial history of epilepsy. This unusual electroclinical picture appeared inexplicably several days after the hemorrhagic shock when the laboratory data had already normalized. The only cause of this picture seemed to be brain hypoxia and the metabolic disorders consequent upon hemorrhagic shock.

[Electrophysiologic studies (auditory and somatosensory evoked potentials) in Friedreich's ataxia]. / Indagini elettrofisiologiche (potenziali evocati acustici e somestesici) nell'atassia di Friedreich.

Auditory and somatosensory evoked potentials were recorded from 10 patients suffering from Friedreich's ataxia. All patients were subjected to audiological tests and EMG-ENG study. Acoustic evoked potentials recordings included brainstem acoustic evoked potentials and long latency components. Peripheral and central components of somatosensory evoked potentials were obtained by stimulating the median nerve at the wrist and elbow. Various abnormalities of the cortical components were observed in all patients for both acoustic and somatosensory evoked potentials. Analysis of brainstem acoustic evoked potentials and of the early components of somatosensory evoked potentials showed a different incidence of abnormalities. The main feature of brainstem acoustic evoked potential changes was the frequent absence of one or more waves; the greatest abnormalities occurred in patients whose disease was of long duration. Long latency components (N85) were significantly prolonged in all but one patient. There was often an absence or reduction of early somatosensory evoked potentials with normal or near normal latencies, even though cortical responses were markedly prolonged. The sensory conduction velocity between stimulation sites at wrist and elbow was normal in all patients. Clinically brainstem acoustic evoked potentials may prove to be a reliable means of monitoring the progression of the disease, while long latency components and somatosensory evoked potentials could be used as complementary procedures in early diagnosis.

[Neurophysiological (evoked auditory and somatosensory potentials) and neuroradiological (cranial CT) study in patients with olivopontocerebellar atrophy]. / Studio neurofisiologico (potenziali evocati acustici e somestesici) e neuroradiologico (TC cranica) in pazienti affetti da atrofia olivopontocerebellare.

Thirteen patients affected by either dominant or recessive and/or sporadic olivopontocerebellar atrophy were studied. All patients were subjected to auditory evoked potential recordings including early and long latency components, CT scans, vestibular and EMG-ENG examinations. In nine patients somatosensory evoked potentials were also recorded. Clear-cut abnormalities in brainstem auditory evoked potentials were observed in only two patients while a slight reduction of the IV-V/I amplitude ratio was found in seven cases. N85 was increased in two patients. The main feature of somatosensory evoked potentials abnormalities was a delayed N20 in association with prolonged N13-N20 central conduction time (five patients). For all patients the CT scan varying degrees of cerebellar and brainstem atrophy. There was no clear correlation between the abnormalities revealed by neurophysiological and neuroradiological investigations and the severity and duration of the illness. It is noteworthy that auditory and/or somatosensory evoked potential changes were found in all dominant olivopontocerebellar atrophy patients.

Auditory evoked potentials (early, middle, late components) and audiological tests in Friedreich's ataxia.

A functional assessment of the acoustic pathways in a group of 9 patients with Friedreich's ataxia was performed. In none of them was symptomatic auditory impairment noticeable. All patients were submitted to audiological tests and AEP recording. AEPs included early (BAEPs), middle (MLCs) and long (LLCs) latency components. The absence of one or more BAEP waves was observed in 5 out of 9 patients. N85 latency was significantly increased in all but one patient. MLCs, particularly P12, N15, P25 were often normal in amplitude and latency, scarcely showing a positive relationship with abnormalities of preceding and following waves. Pure tone audiometry revealed cochlear or neural impairment only in 2 patients. Speech audiometry showed deficits in all patients. These investigations, taken as a whole, showed a prevalent involvement of the brain-stem acoustic pathways, presumably at different levels, seldom associated with eighth nerve impairment. In some cases LLC (N85) abnormalities could not be interpreted as a consequence of impaired function in peripheral and brain-stem acoustic sites and might suggest a cortical dysfunction. Major BAEP abnormalities were observed in patients with longer disease duration, while N85 changes were unrelated to the duration and the severity of the illness. The former may prove to be a reliable means of monitoring the progression of the disease, the latter could be employed as a complementary procedure in its early diagnosis.

Gynecomastia in epileptics treated with phenobarbital, phenytoin and fluoresone: two case reports.

Gynecomastia developed in two epileptic patients some months after the addition of oral fluoresone 750 mg daily to the phenobarbital and phenytoin already being administered. The common systemic diseases that may give rise to gynecomastia were excluded. One of the patients presented hyperprolactinemia and a raised estrogen/androgen ratio but the hormone levels were not raised in the other. The onset of symptoms after fluorescence in both cases is highly suggestive, although the pathogenetic mechanism is not clear.

Electrophysiological investigations of the brainstem in the vertebrobasilar reversible attacks.

A total of 70 selected patients affected by reversible ischemic attacks in the vertebrobasilar system were studied. 50 patients presented transient ischemic attacks (TIA), while the other 20 patients suffered from 1-2 protracted transient ischemic attacks (PTIA). All patients underwent brainstem acoustic evoked potentials (BAEP) and electrooculography (EOG) 7-20 days from the last reversible ischemic attack, when all signs and symptoms completely disappeared. The combination of BAEP and EOG gave objective evidence of brainstem dysfunction in 61 out of 70 patients. BAEP resulted abnormal in 26 patients (16 TIA, 10 PTIA), EOG in 49 (36 TIA, 13 PTIA). Serial controls at 3, 6, and 12 months were conducted in 27 patients. 5 patients showed a normalization for BAEP and 7 for EOG 12 months after the first examination.

[Continuous partial epilepsy in a case of cerebral abscess of long duration]. / Epilessia parziale continua in un caso di ascesso cerebrale di lunga durata.

A patient affected by continuous clonus of the right half of his tongue and face with dysphasia and right hemiparesis is described. Partial continuous epilepsy of Kojewnikow was diagnosed. The CT scan showed a spreading lesion surrounded by intense oedema in the left central region, as well as a longstanding subdural hematoma complicated by osteitis. This finding lead to a diagnosis of cerebral abscess which was confirmed by surgery. In this paper it is also analyzed the cortical and/or subcortical origin of this peculiar type of epilepsia.