A multiparametric MRI-based CAD system for accurate diagnosis of bladder cancer staging.

Appropriate treatment of bladder cancer (BC) is widely based on accurate and early BC staging. In this paper, a multiparametric computer-aided diagnostic (MP-CAD) system is developed to differentiate between BC staging, especially T1 and T2 stages, using T2-weighted (T2W) magnetic resonance imaging (MRI) and diffusion-weighted (DW) MRI. Our framework starts with the segmentation of the bladder wall (BW) and localization of the whole BC volume (Vt) and its extent inside the wall (Vw). Our segmentation framework is based on a fully connected convolution neural network (CNN) and utilized an adaptive shape model followed by estimating a set of functional, texture, and morphological features. The functional features are derived from the cumulative distribution function (CDF) of the apparent diffusion coefficient. Texture features are radiomic features estimated from T2W-MRI, and morphological features are used to describe the tumors' geometric. Due to the significant texture difference between the wall and bladder lumen cells, Vt is parcelled into a set of nested equidistance surfaces (i.e., iso-surfaces). Finally, features are estimated for individual iso-surfaces, which are then augmented and used to train and test machine learning (ML) classifier based on neural networks. The system has been evaluated using 42 data sets, and a leave-one-subject-out approach is employed. The overall accuracy, sensitivity, specificity, and area under the receiver operating characteristics (ROC) curve (AUC) are 95.24%, 95.24%, 95.24%, and 0.9864, respectively. The advantage of fusion multiparametric iso-features is highlighted by comparing the diagnostic accuracy of individual MRI modality, which is confirmed by the ROC analysis. Moreover, the accuracy of our pipeline is compared against other statistical ML classifiers (i.e., random forest (RF) and support vector machine (SVM)). Our CAD system is also compared with other techniques (e.g., end-to-end convolution neural networks (i.e., ResNet50).

EARLY ASSESSMENT OF RENAL TRANSPLANTS USING BOLD-MRI: PROMISING RESULTS.

Non-invasive evaluation of renal transplant function is essential to minimize and manage renal rejection. A computer-assisted diagnostic (CAD) system was developed to evaluate kidney function post-transplantation. The developed CAD system utilizes the amount of blood-oxygenation extracted from 3D (2D + time) blood oxygen level-dependent magnetic resonance imaging (BOLD-MRI) to estimate renal function. BOLD-MRI scans were acquired at five different echo-times (2, 7, 12, 17, and 22) ms from 15 transplant patients. The developed CAD system first segments kidneys using the level-sets method followed by estimation of the amount of deoxyhemoglobin, also known as apparent relaxation rate (R2*). These R2* estimates were used as discriminatory features (global features (mean R2*) and local features (pixel-wise R2*)) to train and test state-of-the-art machine learning classifiers to differentiate between non-rejection (NR) and acute renal rejection. Using a leave-one-out cross-validation approach along with an artificial neural network (ANN) classifier, the CAD system demonstrated 93.3% accuracy, 100% sensitivity, and 90% specificity in distinguishing AR from non-rejection . These preliminary results demonstrate the efficacy of the CAD system to detect renal allograft status non-invasively.

Clinical predictive factors of sildenafil response: a penile hemodynamic study.

Phosphodiestrase-5 inhibitors are an important line of treatment for erectile dysfunction (ED). To detect the clinical and hemodynamic predictors of sildenafil response, we conducted this study on 124 Egyptian men with ED. All patients were evaluated by thorough history and clinical assessment with measurement of the abridged international index of erectile function-5 (IIEF-5) score. All patients were then subjected to intracavernosal injection (ICI) of trimix and pharmaco-penile duplex ultrasonography (PPDU). Patients were then classified into sildenafil responders and non-responders after six consecutive doses of 100 mg sildenafil. On doing the binary logistic stepwise regression analysis, only ED duration, IIEF-5 score, and response to ICI were the significant independent predictors of sildenafil response. These three parameters together correctly predicted the sildenafil response by 81.5% (p value <0.001). With the receiver operator characteristic curve analysis, the cut-off value of ED duration was 2.5 years and it was 14 for the IIEF-5 score. These findings indicate that ED duration, the IIEF-5 score and response to ICI are more significant predictors of sildenafil response than the more expensive and time-consuming PPDU testing.

Role of diffusion-weighted MRI in diagnosis of acute renal allograft dysfunction: a prospective preliminary study.

OBJECTIVE: The aim was to evaluate the effects of diagnostic performance of diffusion-weighted (DW) MRI in the assessment of acute impairment of transplanted kidneys. METHODS: From January 2009 to January 2010, 49 patients with stable renal allograft function (Group 1) and 21 patients with acute graft impairment (Group 2) were included in the study. All patients were evaluated with coronal T(2) weighted (T(2)W) and DW MRI of the kidney. Patients in Group 2 underwent graft biopsy to determine the underlying histopathological aetiology. Apparent diffusion coefficient (ADC) was calculated and the kidneys were studied for any areas of diffusion restriction. Two radiologists, who were blinded to the results of histopathology, independently interpreted the T(2)W and DW images. RESULTS: The histopathological diagnosis of Group 2 (21 patients) was acute cellular rejection (ACR) in 10, acute tubular necrosis (ATN) in 7 and immunosuppressive toxicity in 4 patients. ADC values in Group 1 were significantly higher compared with Group 2 (p<0.001), patients with ACR (p<0.001), patients with ATN (p<0.001) and patients with drug toxicity (p<0.001). Using 2 × 10(-3) mm(2) s(-1) as a cut-off, there was no overlap between the ADC values of patients with normal graft function and those with ATN. Both ACR and ATN had a low ADC value, but on the ADC map the kidney in cases of ATN appears heterogeneous with a characteristic mosaic pattern resembling the Tiger skin. There was no significant T(2)W morphological difference between the two groups. CONCLUSION: These results show how DW MRI is a promising new technique for the diagnosis of acute renal transplant dysfunction.

Risk factors of erectile dysfunction and penile vascular changes after surgical repair of penile fracture.

This study was conducted to determine the preoperative and intraoperative risk factors of ED and the underlying penile vascular abnormalities among patients with penile fracture treated surgically. In all, 180 patients with penile fracture were treated surgically and followed up in one center. None of our patients had ED before the penile trauma and only two of them had risk factors for systemic vascular diseases, such as diabetes mellitus (one patient) and hypertension (one patient). After a mean follow-up of 106 months, 11 patients (6.6%) developed ED, 7 had mild ED and 4 had moderate ED. The main risk factors for subsequent ED were aging, >50 years, and bilateral corporal involvement. Among the 11 patients with ED, color Doppler ultrasonography (CDU) showed normal Doppler indices in 4 (36.4%), veno-occlusive dysfunction in 4 (36.4%) and arterial insufficiency in the remaining 3 (27.2%) patients. CDU assessments from the injured and intact sides were comparable. ED of either a psychological or vascular origin can be encountered as a long-term sequel of surgical treatment of penile fracture. Aging, >50 years, at presentation and bilateral corporal involvement is the main risk factors for subsequent development of ED.

Nonoperative management of grade 5 renal injury in children: does it have a place?

BACKGROUND: Nonoperative treatment of blunt renal trauma in children is progressively gaining acceptance; grade 5 renal trauma is associated with a significant rate of complications. OBJECTIVE: To assess the feasibility and outcome of initial nonoperative management of grade 5 blunt renal trauma in children. DESIGN, SETTING, AND PARTICIPANTS: This retrospective study included 18 children (12 boys and 6 girls; mean age: 8.4+/-3.4 yr) who presented to the authors' institutes with grade 5 blunt renal trauma between 1990 and 2007. MEASUREMENTS: An intravenous contrast-enhanced computed tomography (CT) scan demonstrated grade 5 renal trauma in all patients. Associated major vascular injuries were suspected in four patients. All were initially managed conservatively. Indications for intervention included hemodynamic instability, progressive urinoma, or persistent bleeding. Dimercaptosuccinic acid (DMSA) scans were performed at a mean time of 3.1 yr (range: 1-17) following the injury in nine patients. RESULTS AND LIMITATIONS: Four patients (22%) with suspected major vascular injuries required nephrectomy 1-21 d following the trauma. Two patients with continuing hemorrhage required selective lower-pole arterial embolization (11%). Three patients (17%) had their progressive urinoma drained percutaneously, and two of them required delayed reparative surgery for ureteropelvic junction (UPJ) avulsion. Nine patients (50%) were successfully managed nonoperatively. Kidneys were salvaged in 78% of patients. DMSA scanning showed a split function >40% in 44% of evaluated kidneys. Two patients (22%) had split function <30%. At last follow-up, none of the children were hypertensive or had any abnormality on urine analysis. CONCLUSIONS: Nonoperative management of grade 5 renal trauma is feasible. Prompt surgical intervention is required for those with major vascular injuries. Superselective arterial embolization can be an excellent option in patients with continuing hemorrhage and who have pseudoaneurysms. Patients with UPJ disruption can be salvaged by initial drainage of the urinoma followed by deferred correction.

MRI in patients with chronic obstructive uropathy and compromised renal function: a sole method for morphological and functional assessment.

The aim of this study was to assess the role of MRI as a single modality for anatomical and functional evaluation of obstructed kidneys in patients with compromised renal function. The study included 96 adults with unilateral or bilateral chronic obstructive hydronephrosis and compromised renal function (serum creatinine >or=1.8 mg dl(-1)). Patients were subjected to gadolinium-enhanced MRI (Gd-MRI), which determined the anatomy of both renoureteral units, as well as their function, through selective calculation of the glomerular filtration rate (GFR) of each kidney. All patients underwent a technetium-99m diethylenetriamine-pentaacetic acid renal scan. Moreover, a correlation was made between the GFR determined by Gd-MRI and the isotope GFR. The study comprised 59 males and 37 females. A comprehensive MRI study detected the cause of obstruction in all kidneys with non-calcular obstruction (sensitivity of 100%) and in 21 kidneys with calcular obstruction (sensitivity of 70%). The overall sensitivity of MRI combined with plain X-ray of the abdomen and ultrasound in the detection of various causes of obstruction was 97%. A comparison between the isotope GFR of the obstructed kidneys and the corresponding magnetic resonance urography (MRU) GFR showed perfect correlation. In conclusion, combined static and dynamic MRU is a promising technique that allows anatomical and functional evaluation of obstructed kidneys in patients with impaired renal function but, owing to the possible risk of nephrogenic systemic fibrosis in patients with a GFR <30 ml min(-1), the lowest possible dose of the most stable Gd-macrocyclic chelates should be used if a functional MRI study is required.

Bacterial isolates from mechanically ventilated patients with nosocomial pneumonia within intensive care unit of a tertiary care center.

Nosocomial pneumonia is a common complication in mechanically ventilated patients. A study was carried out to determine the incidence, common bacterial etiologic agents and their antimicrobial susceptibility, and outcome of such pneumonia in an Intensive Care Unit (ICU) of a tertiary care center. In Surgical ICU (SICU) 176 patients required mechanical ventilation for more than 72 hours. A total of 39 (22.1%) of these patients developed nosocomial bacterial pneumonia as determined by microbiological assays. Endotracheal aspirate cultures detected a single bacterial isolate in 22 (56.4%) patients while two and three organisms were isolated from 10 (25.6%) and 7 (17.9%) patients respectively. Fifty three (84.1%) of a total of 63 isolates were Gram negative bacilli. The most frequently encountered pathogens were Pseudomonas aeruginosa, Klebsiella pneumoniae and Acinetobacter species among the Gram negative bacilli and Staphylococcus aureus among the Gram positives. Resistance of bacterial isolates varied from 24 to 90% against commonly used antibiotics. Amikacin had the best profile, with 14% to 55% resistance against various isolates. Twenty three (59%) of 39 patients with pneumonia expired in the ICU. P. aeruginosa (25.6%) and K. pneunmoniae (17.9%) were the predominant isolates in these patients. Nosocomial pneumonia with high mortality is a frequent occurrence in mechanically ventilated patients in our ICU setting. Gram negative organisms with high levels of antimicrobial resistance are the most common isolates. Regular surveillance and monitoring of changes in antibiotic susceptibility of bacterial pathogens and appropriate therapeutic measures are likely to reduce the mortality in these patients.

Late renal functional and morphological evaluation after non-operative treatment of high-grade renal injuries in children.

OBJECTIVE: To assess the long-term results in children with high-grade renal trauma who were managed without surgery, as such treatment was initially successful but little is known about the late ipsilateral renal function and morphology. PATIENTS AND METHODS: The study included 13 children (nine boys and four girls; mean age 8 years, sd 5) with high-grade renal injury who were managed without surgery between 1997 and 2001, and followed for a mean (sd, range) of 3 (2, 0.5-7) years. The trauma was caused by a motor-car accident in five and falling from a height in eight children, and was on the right in 10 and on the left in three. There was gross and microscopic haematuria in 10 and three patients, respectively. The trauma was graded according to the American Association for Surgery of Trauma, with grades III, IV and V renal injury in six, four and three children, respectively. All patients were treated initially by observation; one required super-selective embolization because of continuing haemorrhage. Three children with progressive urinary extravasation were treated with a percutaneous tube drain and JJ stent for 6 weeks. Patients were discharged after a mean (sd) hospital stay of 9 (6) days. Ultrasonography then showed resolving haematoma in all patients with a mean (sd) size of 7 (2) cm(2). At the last follow-up patients were re-evaluated by a clinical examination, renal scintigraphy and computed tomography angiography. RESULTS: None of the children was hypertensive nor had any abnormality on urine analysis; all had normal serum creatinine levels, and scintigraphy and angiography showed normal contralateral kidneys in all. Ipsilateral abnormalities were detected in 12 patients, and included a single scar in five, multiple scars in six and a cystic lesion with multiple septa in one. There was no vascular complication or hydronephrosis, and no significant functional loss, with all affected kidneys having a split function of 41-50% at the last follow-up. CONCLUSION: Although there is no late functional loss there are residual morphological changes in almost all children with high-grade renal injury. This study provides objective support for the non-operative management of high-grade renal injury in children, but a prolonged follow-up is warranted to assess the risk of progression of these abnormalities.

Drug resistant Haemophilus influenzae from respiratory tract infection in a tertiary care hospital in north India.

Haemophilus influenzae is an important respiratory pathogen. Emergence of resistance to various antibiotics is a major problem in patient management. A total of 90 strains of H. influenzae were characterized from specimens obtained from patients of acute respiratory tract infection; 13 (14.4%) belonged to type beta. On biotyping, 90% strains belonged to biotype II. The frequency of resistance to various antibiotics was as follows: cotrimoxazole 33.3% ampicillin 21.1%, cephalexin 7.8%, chloramphenicol 7.8%, ciprofloxacin 2.5% erythromycin and tetracycline 5% each. All the ampicillin-resistant strains produced beta-lactamase as detected by nitrocefin disc method. None of the strains exhibited resistance to cefaclor and third generation cephalosporins. The present study showed emergence of variable resistance to ampicillin, cotrimoxazole and other antibiotics. It is important for the clinical microbiology laboratory to monitor drug resistant strains for instituting appropriate antibiotic therapy of respiratory infections due to H. influenzae.

In vitro fertilization and embryo transfer in Egypt.

The introduction of medically assisted human reproduction (MAHR) in the Arab world had to overcome initial resistance because of cultural, social, religious and financial limitations. The paper discusses the problems associated with the practice of in vitro fertilization (IVF) and embryo transfer (ET) and the limitations in Egypt through the authors' experience during the period March 1986 to March 1989. The results of the management of 359 patients scheduled for the IVF and ET program at the Egyptian I.V.F. and E.T. Center, Maadi, Cairo, using different protocols are discussed. The maximum pregnancy rate achieved using the GnRH analogue agonist protocol for stimulation was 20.13 per transfer. It is concluded that in developing countries prevention of the tubal factor of infertility is better than treatment, which is uncertain and expensive. Also some techniques of MAHR that may improve the results cannot be implemented in the Arab and Islamic World.

Infertility: a health problem in the Muslim world.

PIP: Between November 1980-August 1989, physicians in Cairo, Egypt followed 1488 infertile couples. The study reported the extent of infertility, its etiology, and problems related to its management. Primary and secondary infertility affected 70.7% and 29.3% of the couples, respectively. Length of infertility ranged from 1 to 23 years (mean = 7.18 for primary infertility and 6.05 for secondary infertility). 306 husbands (20.6% of the couples) had either an insufficient sperm count (20 X 1 million), insufficient sperm motility (40%), or 40% abnormal sperm. Both the husband and wife of 181 couples (12.2%) suffered from infertility. The physicians could not identify the cause of infertility in 49 couples (3.3%). 952 wives (64% of the couples) were infertile. Tubal problems were mainly responsible for female infertility (42%) followed by ovulatory disorders (25.3%), multiple factors (23.4%), pelvic endometriosis (5.6%), and cervical effects (4.2). Various treatments included laparoscopic adhesiolysis in 30 patients, tubal microsurgery in 523 patients, induction of ovulation and monitoring (e.g., clomid and HCG) in 224 patients, in vitro fertilization (IVF) and embryo transfer (ET) in 256 patients, artificial insemination with husband's capacitated sperm along with ovulation induction in 114 couples, intrauterine synechia and septa via hysteroscopy in 17 patients, and abdominal myomectomy in 57 patients. The follow-up pregnancy rate for 523 microsurgery patients was 55.2% and 38% went full term. Only 51-63% of the couples could afford to pay for IVF and ET, induction/monitoring of ovulation, or artificial insemination with husband's sperm all of which only the private sector provided. Patients had to wait for laparoscopy and microsurgery which were also available through government hospitals. These results demonstrate that prevention of infertility is preferable to treatment particularly in developing countries such as Egypt. Islam's view of infertility and family is also addressed.^ieng

Ultrasonic device localization: an evaluative approach.

PIP: This study examines the practical validity of ultrasonography in the management of IUD problems or complications. Ultrasonography was performed in 201 IUD users using a standard gray tone scanner (Unirad Sono 3, model 849, GZD). Of these, 53 cases presented with missing loop, 99 with abnormal bleeding, 17 with persistent pain; 23 following postpartum insertions, and 9 after difficult insertions. Ultrasonography was effective in detecting intrauterine location of the Lippes loop in 23 of 26 cases (88.5%) and of Gravigard in 7 of 16 cases (43.8%). In some cases, ultrasonic hysterography increased the diagnostic accuracy to 100%. The value of sonar in the elucidation of the causes of IUD-associated bleeding and pain was rather limited. Scanning was helpful in excluding uterine perforation after difficult insertions and in predicting the possibility of spontaneous expulsion after post-partum insertions. Ultrasonography has value in the management of many IUD-related clinical problems.^ieng

Control of snail hosts of bilharziasis in Egypt. 3. Effect of the organophosphorous insecticide, dursban, on carbohydrate metabolism of the snails Biomphalaria alexandria and Bulinus truncatus.

The effects of the organophosphorous insecticide, Dursban, on aerobic oxidation, glycolysis, glucose utilization and gluconeogenesis in snails tissues were determined. Dursban had a biphasic effect on the aerobic oxidation of succinate, glutamate + malate and TMPD + ascorbate while it had only an inhibitory action on pyruvate oxidation. The compound significantly inhibited glycolysis, glucose utilization and gluconeogenesis when used at high concentrations (ten times higher than its LC50). However, it had a slight effect on thepreviously mentioned process when its concentration was equal to or approximated its LC50. The relationship between the metabolic effect of Dursban and its molluscicidal activity is discussed.

Control of snail hosts of bilharziasis in Egypt. 2. Effect of triphenyltin hydroxide (Du-Ter) on carbohydrate metabolism of the snails Biomphalaria alexandria and Bulinus tuncatus.

Previous work has shown that the aerobic oxidation of certain intermediates of Krebs cycle by the snail B. alexandrina and B. truncatusis inhibited by TPT. This paper reports data on the effect of TPT on glucose utilization, glycolysis, glycogen content, and glucone ogenesis in snail tissue preparations. The compounds at its LC50 inhibited gluconeogenesis, stimulated glycolysis and markedly reduced the glycogen content and glucose utilization in both snails. However, the effects were more pronounced in B. truncatus than in B. alexandrina. Possible interpretations of these findings are discussed with reference to published arrangements for regulation of gluconeogenesis and glycolysis, coupling of electorn transport to ATP synthesis and also to our present knowledge of the chemical and biological specificity of TPT.