Prevalencia y trascendencia de los hallazgos extracardíacos encontrados en resonancia magnética de corazón / Prevalence and significance of extracardiac findings in cardiac magnetic resonance imaging

Objetivos: Valorar el número de lesiones incidentales detectadas por resonancia magnética (RM) cardíaca, establecer el porcentaje de hallazgos incluidos en el informe y definir el porcentaje de lesiones extracardíacas con implicancia en el manejo del paciente. Materiales y métodos: Se revisaron retrospectivamente 918 RM de corazón, realizadas desde mayo de 2006 hasta marzo de 2015, en busca de hallazgos extracardíacos. Estos fueron clasificados en nada/poco relevantes o relevantes, y en relación causa-efecto con la sintomatología cardíaca. Resultados: Se encontraron 271 hallazgos extracardíacos. El 35,7% resultó relevante y el 18,8% tenía una relación de causa-efecto con la sintomatología cardíaca. Los hallazgos extracardíacos relevantes fueron informados en el 58,4% de los casos y los poco/nada relevantes en el 26,6%. Discusión: Diferentes muestras poblacionales y protocolos de RM cardíaca pueden condicionar los porcentajes de los hallazgos extracardíacos detectados. Además, el análisis de estas imágenes tiene peculiaridades que requieren conocimiento y entrenamiento para una correcta valoración. Conclusión: Se detectaron hallazgos extracardíacos de diversa relevancia en un 26,4% de los pacientes. Analizar estos hallazgos y establecer su valoración es parte fundamental del informe radiológico de la RM cardíaca.

Objectives: To assess the number of incidental lesions detected on cardiac magnetic resonance imaging (MRI), in order to establish the percentage of findings included in the report and evaluate the percentage of extracardiac lesions that have implications on patient management. Materials and methods: A retrospective review was conducted on 918 cardiac MRI (performed from May 2006 to March 2015) to search for extracardiac findings. These were classified in not relevant or relevant, and in relation with cause-effect cardiac symptoms. Results: A total of 271 extracardiac findings were observed, of which 35.7% were relevant, and 18.8% had a cause-effect relationship with the cardiac symptoms. Relevant extracardiac findings were reported in 58.4% of cases, and not relevant findings in 26.6% of cases. Discussion: Different sample populations and protocols (performing cardiac MRI) can determine differences when establishing percentage of extracardiac findings. Furthermore, analysis of cardiac MR images has peculiarities that require knowledge and training for proper assessment. Conclusión: Extracardiac findings of distinct relevance were detected in 26.4% of patients. To analyse and to assess the importance of these findings is a fundamental part of the cardiac MRI report.

[Serpiginous calcifications in breast filariasis: A descriptor not included in the BI-RADS classification system]. / Calcificaciones serpiginosas en la filariasis mamaria: un descriptor no incluido en el sistema BI-RADS.

Filariasis is a parasitic disease with a benign course caused by nematodes. Filariasis is endemic in some tropical regions, and immigration has made it increasingly common in some centers in Spain. The death of the parasites can lead to calcifications that are visible in mammograms; these calcifications have specific characteristics and should not be confused with those arising in other diseases. However, the appearance of calcifications due to filariasis is not included in the most common systems used for the classification of calcifications on mammograms (BI-RADS), and this can lead to confusion. In this article, we discuss the need to update classification systems and warn radiologists about the appearance of these calcifications to ensure their correct diagnosis and avoid confusion with other diseases.

[Intracranial hypotension syndrome: a review of the magnetic resonance findings]. / Sindrome de hipotension intracraneal: revision de hallazgos en resonancia magnetica.

INTRODUCTION: Intracranial hypotension syndrome (IHS) is a syndrome with a variable aetiology and clinical presentation that is, in most cases, caused by leakage of cerebrospinal fluid (CSF) through the thecal sac. Orthostatic headache associated to the typical magnetic resonance imaging (MRI) findings, secondary to depletion of CSF, is the key to a correct diagnosis. AIMS: To show the imaging findings that, within a suitable clinical context, allow this condition to be identified and diagnosed. DEVELOPMENT: Decreased CSF volume plays an important role in IHS, which leads to an increase in the compensatory volume of blood, essentially dependent on the venous system. MRI is a sensitive technique in the diagnosis of IHS. Yet, separate findings are unspecific. The MRI findings include diffuse and homogeneous dural enhancement, the presence of small bilateral subdural collections, caudal displacement of the encephalic structures (pseudo-Chiari), dilatation of the cortical and medullar veins, and the recent sign of venous distension. This last sign is a highly sensitive finding of IHS, which tends to disappear following the patient's clinical improvement even before the disappearance of the pachy-meningeal enhancement, and could be used as a marker for response to treatment. CONCLUSIONS: IHS is a condition that is difficult to diagnose clinically for which several typical MRI findings have been reported; both neurologists and radiologists must be familiar with these findings.

Anatomy of the brainstem: a gaze into the stem of life.

The brainstem has an ectodermal origin and is composed of 4 parts: the diencephalon, mesencephalon, pons, and medulla oblongata. It serves as the connection between the cerebral hemispheres with the medulla and the cerebellum and is responsible for basic vital functions, such as breathing, heartbeat blood pressure, control of consciousness, and sleep. The brainstem contains both white and gray matter. The gray matter of the brainstem (neuronal cell bodies) is found in clumps and clusters throughout the brainstem to form the cranial nerve nuclei, the reticular formation, and pontine nuclei. The white matter consists of fiber tracts (axons of neuronal cells) passing down from the cerebral cortex--important for voluntary motor function--and up from peripheral nerves and the spinal cord--where somatosensory pathways travel--to the highest parts of the brain. The internal structure of brainstem, although complex, presents a systematical arrangement and is organized in 3 laminae (tectum, tegmentum, and basis), which extend its entire length. The motor pathway runs down through the basis, which is located at the most anterior part. The cranial nerve nuclei are settled into the middle layer (the tegmentum), just in front of the 4th ventricle and are placed, from medial to lateral, on the basis of their function: somatic motor, visceral motor, visceral sensory, and somatic sensory. All the somatosensory tracts run upward to the thalamus crossing the tegmentum in front of the cranial nerve nuclei. The tectum, formed by the quadrigeminal plate and the medullary velum, contains no cranial nuclei, no tracts and no reticular formation. The knowledge of precise anatomical localization of a lesion affecting the brainstem is crucial in neurological diagnosis and, on this basis, is essential to be familiar with the location of the mayor tracts and nuclei appropriately. Nowadays, current magnetic resonance imaging techniques, although still macroscopic, allow the fine internal structure of the brainstem to be viewed directly and make it possible to locate the main intrinsic structures that justify the symptoms of the patient. In this article we discuss the anatomy of the brainstem and highlight the features and landmarks that are important in interpreting magnetic resonance imaging.

Yeast populations on Spanish fermented sausages.

Yeast populations on 24 lots of Spanish fermented sausages, made by four factories (F1, F2 and F4, artisanal; F3, industrial) were investigated throughout manufacture and the influence of different variables evaluated. In addition, 41 yeast strains were identified at the species level using two miniaturised systems: ATB32C (API System) and Vitek Yeast Biochemical Card (Vitek YBC). Levels of yeasts found in the sausage mixture (mean counts around 4 log units/g) were similar to those described by other authors. In sausages from factories F1 and F2, a further increase was noted, reaching 5.5 log units/g after fermentation. Counts subsequently decreased to 3.6 and 5 log units/g, respectively. In sausages from factories F3 and F4, decreasing counts were observed from the beginning, particularly in sausages from F3, where yeasts were almost absent in the finished product. Type of manufacture and sausage diameter, were the variables most influencing yeast counts. Debaryomyces hansenii (teleomorph of C. famata) was the dominant species, being found at all stages of manufacture. Trichosporon ovoides (formerly T. beigelii), Yarrowia lipolytica (perfect form of C. lipolytica), C. intermedia/curvata, C. parapsilosis, C. zeylanoides and Citeromyces matritensis (teleomorph of C. globosa) were also present. Direct identification was possible only with 50% of the total of strains investigated, although a higher number of strains was identified using the API than the Vitek YBC system.

Numbers and species of motile aeromonads during the manufacture of naturally contaminated Spanish fermented sausages (longaniza and chorizo).

The prevalence of aeromonads in the initial mixes of 14 batches of chorizo and longaniza obtained from three small- and middle-sized factories was 78.5%, with counts ranging from >1.00 to 4.47 log10 CFU/g. Only 2 of 10 mixture samples prepared at a large and modern processing plant yielded these organisms, with levels below 1 log10 CFU/g. The hygienic status of factories significantly affected incidence and counts. Of 39 presumptive isolates from glutamate starch penicillin agar, 36 were confirmed as motile aeromonads and allocated to Aeromonas hydrophila (n = 24), A. veronii biovar sobria (n = 10), and A. caviae (n = 2). All of them were beta-hemolytic and capable of growing at 5 degrees C. Regardless of initial contamination, aeromonads were rapidly inactivated during the early stages of manufacture.

Behaviour of Listeria spp. in naturally contaminated chorizo (Spanish fermented sausage).

Counts of Listeria spp. were determined during the manufacture and drying of 21 lots of five chorizo varieties produced by three different manufacturers. Presumptive Listeria were not isolated from any of the batches produced in a large factory (F3) using starter, sorbate and controlled ripening at high temperatures. Initial levels in factory 1 (F1), with no starter added, but controlled ripening at low temperatures, were ca 3.5 log10 cfu/g while those in factory 2 (F2), with no starter added and ripening under natural climatic conditions, were 1.17 log10 cfu/g. Numbers of listeriae in batches obtained from F1 remained almost constant before decreasing by ca 0.5 log units/g in the finished product (32 days), while the levels in F2 increased by 1.47 log units/g after 11 days of ripening and declined further to levels above the original amount. Manufacturing procedure and smoking significantly affected presumptive listeriae counts. Thirteen strains recovered from F1 batches were identified as: Listeria monocytogenes (three strains of serovar 1/2c), Listeria innocua (eight strains of serovar 6b) and Listeria welshimeri (two strains of serovar 6b). Listeria strains from F2 were assigned to L. innocua and L. welshimeri.

Evaluation of different systems for the identification of Bacillus strains isolated from Spanish fermented sausages.

Sixty-nine isolates obtained during the manufacture and ripening of Spanish fermented sausages were identified to species level using the Vitek Bacillus biochemical card, the dichotomous key and table proposed by Berkeley et al. ((1984). In Methods in Microbiology, Vol. 16. Academic Press, London, p. 291), morphological and physiological tests and the API 20E miniaturized system. None of the tested systems was entirely satisfactory and the final identification was mainly done on the basis of cellular morphology and the table of test results. Our isolates belonged to the species: B. subtilis (37), B. megaterium (22), B. pumilus (5), B. circulans (3) and unidentified (2). Forty-five cultures (65.2%) were accurately identified with the dichotomous key. A similar figure for the Vitek Bacillus biochemical card was 36%. The results of the API 20E system were very reproducible, especially those of the Voges-Proskauer test. Most of the strains of B. megaterium were misidentified as B. subtilis with the dichotomous key. On the other hand, a high percentage of the cultures belonging to B. subtilis were misidentified as B. megaterium with the Vitek system.

Circulating glucose, insulin and ketone bodies and enzymes of ketone body utilization in brain mitochondria from suckling rats treated with high L-thyroxine doses.

The neo-T4 syndrome was induced by subcutaneous administration of a total dose of (150 micrograms) L-thyroxine (T4) to rats from their first day of live. Neo-T4 animals and their controls were sacrificed at 2, 4, 8, 11, 14, 22 and 25 days of age. A decrease in body weight was observed from the second day of life, and a decrease in brain weight from the eighth day of life in the neo-T4 animals. Blood glucose and plasma insulin levels were decreased from 2nd day through 22nd day of life. Total plasma ketone bodies and beta-OH butyrate levels increased in the neo-T4 animals with respect to controls. until 8th day, although acetoacetate increased only until 4th day. The activity of key enzymes in the ketone bodies utilization pathway (3-hydroxybutyrate dehydrogenase, 3-oxoacid CoA-transferase and acetoacetyl-CoA thiolase) were also measured in the animals brain. We found an activation of 3-hydroxybutyrate dehydrogenase until 11th day and 3-oxoacid CoA-transferase until 14th day, but no change in acetoacetyl CoA-thiolase was observed. Ketone bodies play a key role as energy substrates and precursors of brain lipids during the period of intense growth and myelination of the CNS. Considering the alterations described in this paper it seems that neo-T4 syndrome could be an interesting model for studying metabolism of those substances in brain.