Targeted MRI/TRUS fusion-guided biopsy in men with previous prostate biopsies using a novel registration software and multiparametric MRI PI-RADS scores: first results.

PURPOSE: To evaluate a novel system for MRI/TRUS fusion-guided biopsy for detection of prostate cancer (PCa) in patients with previous negative prostate biopsy and determine diagnostic accuracy when using the Prostate Imaging Reporting and Data System (PI-RADS) for multiparametric magnetic resonance imaging (mpMRI) as proposed by the European Society of Urogenital Radiology. METHODS: Thirty-nine men with clinical suspicion of PCa and history of previous prostate biopsy underwent mpMRI on a 3-T MRI. In total, 72 lesions were evaluated by the consensus of two radiologists. PI-RADS scores for each MRI sequence, the sum of the PI-RADS scores and the global PI-RADS were determined. MRI/TRUS fusion-guided targeted biopsy was performed using the BioJet™ software combined with a transrectal ultrasound system. Image fusion was based on rigid registration. PI-RADS scores of the dominant lesion were compared with histopathological results. Diagnostic accuracy was determined using receiver operating characteristic curve analysis. RESULTS: MRI/TRUS fusion-guided biopsy was reliable and successful for 71 out of 72 lesions. The global PI-RADS score of the dominant lesion was significantly higher in patients with PCa (4.0 ± 1.3) compared to patients with negative histopathology (2.6 ± 0.8; p = 0.0006). Using a global PI-RADS score cut-off ≥4, a sensitivity of 85 %, a specificity of 82 % and a negative predictive value of 92 % were achieved. CONCLUSIONS: The described fusion system is dependable and efficient for targeted MRI/TRUS fusion-guided biopsy. mpMRI PI-RADS scores combined with a novel real-time MRI/TRUS fusion system facilitate sufficient diagnosis of PCa with high sensitivity and specificity.

Treating hearing loss in patients with infantile Bartter syndrome.

OBJECTIVES/HYPOTHESIS: Most existing studies about infantile Bartter syndrome (BS) have focused on renal function, and deafness has not been closely studied. Our objective was to evaluate the treatment of hearing impairment in children with infantile BS and analyze relevant, unexplored issues. STUDY DESIGN: Retrospective chart review. METHODS: The present study was conducted in a tertiary referral center over a 20-year period involving children with infantile BS. Demographic factors, general health status, genetic information, features of hearing loss, and the outcome of cochlear implantation as determined mainly by the categories of auditory performance (CAP), as well as imaging of the temporal bones, were evaluated. RESULTS: Six children with infantile BS were identified, four girls and two boys. One child had terminal renal insufficiency and one had undergone kidney transplantation; all children had several hospital admissions due to renal dysfunction. Sensorineural hearing loss was congenital, bilateral, and profound in all children. Five patients were treated with cochlear implants resulting in improved speech perception and development without any exceptional performance (CAP scores, 4-6), mainly because of the delayed treatment and the comorbidities. Anatomic ear anomalies were not observed in any case. CONCLUSIONS: Hearing loss in children with infantile BS is congenital and profound but not related to inner ear malformations. Although cochlear implantation results in certain benefits, general health status and delayed referral to cochlear implant centers have a negative impact on speech perception and development.

Heart-lung and lung transplantation in grown-up congenital heart disease: long-term single centre experience.

OBJECTIVE: Because of considerable progress in paediatric cardiac surgery life expectancy of patients with congenital heart disease (CHD) has improved significantly over the years. There are a growing number of adults with CHD presenting with progressive decline of cardiopulmonary function and Eisenmenger's syndrome. We analysed our experience with heart-lung and lung transplantation in this patient group. METHODS: Since 1988, a total of 46 heart-lung transplantations and 5 double lung transplantations have been performed in adults with CHD at our institution. Underlying diagnoses were: ventricular septal defect, atrial septal defect, persistent ductus arteriosus and others. Pulmonary hypertension was present in all patients. Twelve patients had undergone previous cardiac procedures. All patients were included in this retrospective analysis. Mean follow up was 5.1+/-4.7 years. Patient survival was estimated with the Kaplan-Meier method and analysed using the log-rank test. RESULTS: Thirty-day mortality was 11.8% (n=6). Survival was 80% at 1 year, 69% at 5 years and 53% at 10 years. Major causes of death were infection and sepsis, chronic rejection, initial graft failure and acute rejection. Compared to the overall mortality after lung and heart-lung transplantation for other indications at our institution there was no significant difference (1 year, 5 years, 10 years: 76%; 60%; 45%), but a tendency towards a better long-time survival of the CHD patients. CONCLUSIONS: Lung and heart-lung transplantation can be performed with an acceptable risk and a favourable long-term outcome in patients with grown-up CHD. Careful patient selection and planning of the surgical strategy is essential in this high-risk patient population.

Quick proximal arch replacement with moderate hypothermic circulatory arrest.

BACKGROUND: The aim of this study is to evaluate the safety of proximal arch repair using only moderate hypothermic circulatory arrest (HCA) at a temperature of 25 degrees C to 28 degrees C without any adjunctive cerebral protection in comparison with those with moderate HCA and selective cerebral perfusion. METHODS: Thirty patients who underwent proximal arch repair using moderate HCA without selective cerebral perfusion (SCP) were retrospectively examined and defined as the SCP (-) group. As a control group, 31 patients who underwent moderate HCA and SCP within 10 minutes were included in this study and defined as the SCP (+) group. RESULTS: Mean circulatory arrest time was 9.4 +/- 0.8 minutes and 7.5 +/- 1.8 minutes (p = 0.0001) and mean nasopharyngeal temperature at the induction of the circulatory arrest was 26.0 +/- 1.2 degrees C and 26.8 +/- 1.3 degrees C (p = 0.014) in the SCP (+) group and SCP (-) group, respectively. Operative mortality was 3.2% in the SCP (+) group and 3.3% in the SCP (-), and neurologic complications were found in three (9.7%) patients in the SCP (+) group and two (6.7%) patients in the SCP (-) group (p = 0.69). CONCLUSIONS: It was possible to perform proximal arch replacement in selected patients using moderate HCA without any adjunctive cerebral protection with excellent results, and no advantage of the use of SCP was found in patients who required short HCA for proximal arch replacement.

Interhemispheric imbalance during visuospatial attention investigated by unilateral and bilateral TMS over human parietal cortices.

We used single-pulse transcranial magnetic stimulation (TMS) to study visuospatial attention. TMS was applied over one hemisphere, or simultaneously over both the right and left posterior parietal cortex (PPC), at two different interstimulus intervals (ISI) during a visual detection task. Unilateral TMS over the right and left PPC, respectively, impaired detection of contralateral presented visual stimuli at an ISI of 150 ms. By contrast, simultaneous biparietal TMS induced no significant changes in correct stimulus detection. TMS at an ISI of 250 ms evoked no changes for magnetic stimulation over either the right or the left parietal cortex. These results suggest that both PPC play a crucial role at a relatively early stage in the widely distributed brain network of visuospatial attention. The abolition of behavioral deficits during simultaneous biparietal TMS underlines the common hypothesis that an interhemispheric imbalance might underlie the disorders of neglect and extinction seen following unilateral brain damage.