Dynamic Contrast-Enhanced MRI to Differentiate Parotid Neoplasms Using Golden-Angle Radial Sparse Parallel Imaging.

BACKGROUND AND PURPOSE: Conventional imaging frequently shows overlapping features between benign and malignant parotid neoplasms. We investigated dynamic contrast-enhanced MR imaging using golden-angle radial sparse parallel imaging in differentiating parotid neoplasms. MATERIALS AND METHODS: For this retrospective study, 41 consecutive parotid neoplasms were imaged with dynamic contrast-enhanced MR imaging with golden-angle radial sparse parallel imaging using 1-mm in-plane resolution. The temporal resolution was 3.4 seconds for 78.2 seconds and 8.8 seconds for the remaining acquisition. Three readers retrospectively and independently created and classified time-intensity curves as follows: 1) continuous wash-in; 2) rapid wash-in, subsequent plateau; and 3) rapid wash-in with washout. Additionally, time-intensity curve-derived semiquantitative metrics normalized to the ipsilateral common carotid artery were recorded. Diagnostic performance for the prediction of neoplasm type and malignancy was assessed. Subset multivariate analysis (n = 32) combined semiquantitative time-intensity curve metrics with ADC values. RESULTS: Independent time-intensity curve classification of the 41 neoplasms produced moderate-to-substantial interreader agreement (κ = 0.50-0.79). The time-intensity curve classification threshold of ≥2 predicted malignancy with a positive predictive value of 56.0%-66.7%, and a negative predictive value of 92.0%-100%. The time-intensity curve classification threshold of <2 predicted pleomorphic adenoma with a positive predictive value of 87.0%-95.0% and a negative predictive value of 76.0%-95.0%. For all readers, type 2 and 3 curves were associated with malignant neoplasms (P < .001), and type 1 curves, with pleomorphic adenomas (P < .001). Semiquantitative analysis for malignancy prediction yielded an area under the receiver operating characteristic curve of 0.85 (95% CI, 0.73-0.99). Combining time-to-maximum and ADC predicts pleomorphic adenoma better than either metric alone (P < .001). CONCLUSIONS: Golden-angle radial sparse parallel MR imaging allows high spatial and temporal resolution permeability characterization of parotid neoplasms, with a high negative predictive value for malignancy prediction. Combining time-to-maximum and ADC improves pleomorphic adenoma prediction compared with either metric alone.

Detection of immunoglobulin antibodies in the sera of patients using purified latex allergens.

BACKGROUND: Latex allergy is largely an occupational allergy due to sensitization to natural rubber latex allergens present in a number of health care and household products. Although several purified allergens are currently available for study, information on the usefulness of these purified, native or recombinant allergens in the demonstration of specific immunoglobulin (Ig) E in the sera of patients is lacking. OBJECTIVE: To evaluate the purified latex allergens and to demonstrate specific IgE antibody in the sera of health care workers and spina bifida patients with clinical latex allergy. METHODS: Two radioallergosorbent and an enzyme-linked immunosorbent assay (ELISA) using latex proteins Hev b 1, 2, 3, 4, 6 and 7 along with two glove extracts and Malaysian nonammoniated latex (MNA) were evaluated to demonstrate IgE in the sera of health care workers and spina bifida with latex allergy and controls with no history of latex allergy. RESULTS: ELISA using the purified latex allergens demonstrated specific IgE in 32-65% health care workers and 54-100% of spina bifida patients with latex allergy. The corresponding figures for RAST were 13-48 and 23-85 for RAST-1 and 19-61 and 36-57 for RAST-2. These results were comparable with the results obtained with glove extracts and crude rubber latex proteins. CONCLUSIONS: When used simultaneously, latex proteins Hev b 2 and Hev b 7 reacted significantly with specific serum IgE in 80% of health care workers and 92% of spina bifida patients with latex allergy by ELISA technique, while this combination gave lower positivity when the RASTs were used. By the addition of Hev b 3, specific IgE was detected in all spina bifida patients with latex allergy. Both RASTs failed to show specific IgE in the control subjects, while the ELISA showed significant latex-specific IgE in 22% of controls.

A clinico - histopathological outcome of 4 weeks methotrexate pluse therapy in psoriasis.

A clinico-histopathological study was carried out In 50 patients of psoriasis to see clinical and histological outcome and/or correlation of weekly methotrexate pulse therapy. Clinically, results of therapy were evalutated by estimating the percentage of total body coverage with psoriasis. Prior to therapy, average involvement was 47.5% which after 4 weeks methotrexate therapy reduced to 8. 3%. A complete clearing of psoriasis occurred in 40% of patients after methotrexate therapy. The clinical response started as early as I week in most of patients. Only 2 patients failed to respond even after 4 weeks of therapy. Histopathologically in pretreatmenl biopsy, 34 showed classical psoriatic pathology while in 16 biopsy was suggestive of psoriasis but not confirmative. Histopathological examination after 4 weeks treatment showed that 41 still showed one or more histological evidence of psoriasis, although only two patients had classical, psoriatic pathology, in rest 9 patients there were complete regression. Thus, with methotrexate, clinical clearance was much faster than histopathological clearance.

IgE down regulation and cytokine induction by Aspergillus antigens in human allergic bronchopulmonary aspergillosis.

Allergic bronchopulmonary aspergillosis (ABPA), occurring primarily in patients with asthma or cystic fibrosis (CF), is a hypersensitivity reaction to Aspergillus fumigatus (Af), and is characterized by increased serum IgE levels and peripheral blood and pulmonary eosinophilia. We evaluated the IgE and cytokine profile in ABPA through enzyme-linked immunosorbent assay (ELISA), and evaluated eosinophil activity with the eosinophil peroxidase (EPO) assay. IgE and cytokines were measured in supernatants from cultures of peripheral blood mononuclear cells (PBMC) from three subject groups: ABPA patients, patients with asthma, and healthy individuals. All cultures for the three subject groups were studied in the presence and absence of two purified Af antigens (the 35-kD antigen and heat shock protein 1). We found that increased in vitro levels of IgE in unstimulated PBMC culture supernatants correlated significantly with serum IgE concentrations in ABPA patients. We measured a decrease in IgE levels of up to 75% of baseline values in supernatants from PBMC cultured with Af antigens. Interleukin-2 (IL-2) and interferon-gamma (IFN-gamma) concentrations in cultures with Af were increased in ABPA, whereas concentrations of IL-4 did not differ in the three subject groups. An inverse relation was noted between the changes in IgE and IFN-gamma measured in 4 of 5 ABPA patients. The PBMC supernatants also promoted EPO activity in purified eosinophils from ABPA patients, and to a lesser extent in purified eosinophils from healthy subjects. These results show that the 35-kD antigen and HSP1 from Af downregulate IgE in vitro but are capable of inducing eosinophilia in ABPA. Further studies could result in the characterization of epitopes leading to these disparate effects. An identification of the IgE-down-regulating epitopes in Af antigens might have therapeutic significance.

Thickening of peripheral nerves in neurofibromatosis.

A 14-year-old boy presented with multiple asymptomatic swellings all over the body. Cutaneous findings were classical for neurofibromatosis. Interesting and unusual finding was generalised thickening of peripheral nerve trunks. Biopsy from thickened nerve had features of neurofibromatosis.

Favus in a non-endemic area.

A typical case of favus of scalp in a 60-year-old female, resident of a village in district Udaipur (Rajasthan) is being reported for its rarity and occurrence in non-endemic zone. Some of the nails were also involved. Fungal hyphae were demonstrated in KOH examination from scalp and nails. Culture on Sabourauds agar medium grew Trichophyton violaceum.

A piebald family.

Piebaldism is an uncommon congenital hypomelanotic disorder characterized by a white forelock and vitiligo like amelanotic macules. We report a family with piebaldism affecting four successive generations. The disease was present in 16 members of the family.

Comparison of topical phenytoin with normal saline in the treatment of chronic trophic ulcers in leprosy.

BACKGROUND: Trophic ulceration, one of the most common complications of leprosy, is disabling, distressing, and demoralizing for the patient. METHODS: The wound healing effects of topical phenytoin powder were compared with those of normal saline in a controlled in-patient study of 100 patients with 110 trophic leprosy ulcers of varying chronicity, over a 4-week study period. Fifty patients were assigned to the topical phenytoin group and 50 to saline therapy group. Ten patients had two ulcers each, and, in these cases, one ulcer was treated with phenytoin and the other with saline. RESULTS: Over the 4-week treatment period healthy granulation tissue appeared earlier, and mean percentage of ulcer volume reduction was greater, in the phenytoin group (72.1 +/- 19.9% versus 55.5 +/- 21.6%) compared with the control group. CONCLUSIONS: This difference was statistically significant at the level of P < 0.001. Phenytoin appears to be a useful agent for the promotion of healing of trophic leprosy ulcers.

Characterization of latex antigen and demonstration of latex-specific antibodies by enzyme-linked immunosorbent assay in patients with latex hypersensitivity.

Two latex antigens, one extracted from surgical gloves (GE) and the other from the sap of Hevea brasiliensis plant (RPE) were characterized by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and two-dimensional gel electrophoresis. These antigens were used to detect latex specific IgE and IgG antibodies by enzyme-linked immunosorbent assay (ELISA) in the sera of patients with meningomyelocele (spina bifida) and of normal controls. Of the 36 patients studied, 26 had wheal-and-flare skin-prick test reactivity to latex antigen with 11/26 having had a history of anaphylaxis to latex products. Twenty three of the 26 sera from skin-test positive patients and 10/11 patients with history of anaphylaxis demonstrated significant levels of latex specific IgE and IgG in the sera, whereas only 1/14 normals showed significant antibodies to latex. The remaining 10 patients, all skin-test negative with latex antigens, showed only low levels of antibodies. The findings indicate that the ELISA used in the present study employing partially characterized antigens has sensitivity and specificity to detect latex specific antibodies in the sera of suspected patients and can be used for presumptive diagnosis of latex allergy.

Dapsone syndrome--a case report.

A 31-year-old male patient with lepromatous leprosy developed fever, malaise, nausea, anorexia, lymphadenopathy, hepatitis, exfoliative dermatitis and ainhum like lesions while on multidrug therapy comprised of dapsone, clofazimine and rifampicin. The provocation tests confirmed the dapsone to be cause of this event.

Bone changes in leprosy. A study of 50 cases.

The radiological bone changes have been studied in 50 patients comprising of lepromatous, tuberculoid, mixed (borderline lepromatous, borderline tuberculoid, dimorphous) and polyneuritic (neural) types of leprosy of which the former formed the largest group. The overall incidence of non-specific bone changes is higher as compared to specific bone changes. These were found to have highest incidence in the lepromatous type of leprosy, in the occupational group of manual workers and from 3rd to 6th decade of life. With the longer duration of the disease, the incidence of non-specific bone changes is also more.

Lipoid Proteinosis (urbach-wiethe Disease).

A case tf lipoid proteinosis is being reported because t)f its rare occurrence. A brief review of literature is given.