Hearing loss due to urate deposition in the middle ear: A case report and literature review.

Gout is the most common cause of monoarthritis in men occurring classically in the great toe and the knee. Extra-articular gout manifestations are rare. Only a few cases of head and neck urate crystals deposits have been described in the literature. Precipitations in the middle ear cause conductive hearing loss with common otoscopic anomalies and difficult imaging diagnosis. We report a case of a healthy 58-years-old man with a middle ear urate deposit causing a progressive hearing loss as the very first symptom of gout. The nature of the deposit was unsure on computer tomography (CT) due to atypical density. The final diagnosis was revealed after surgical procedure and histologic examination. A review of the literature is also presented. Seven cases of middle ear urate deposit as the first symptom of gout were found and compared. Progressive conductive hearing loss in middle-aged patients with abnormal otoscopy and middle ear atypical density mass on CT scan must lead to a minimal surgical procedure with a histologic examination to exclude urate crystals deposits.

Comparison of surface coil and knee coil for evaluation of the patellar cartilage by MR imaging.

PURPOSE: The aim of this work was to compare the knee coil and the surface coil for the visualisation of the patellar cartilage. MATERIALS AND METHODS: In 28 patients (17 women, 11 men) with an average age of 40 years (range 14-76) with knee pain MR was performed. Transverse images were obtained using a fast spin echo proton density weighted sequence on a Philips Gyroscan Intera 1.5 T clinical system. Transverse images were obtained at the level of the patellar cartilage using both the surface and the knee coil. All images were evaluated by consensus of two radiologists. They evaluated a number of quality criteria on a 4-point scale. Criteria for artefacts were also graded on a 4-point scale. RESULTS: For the visualisation of fluid there was no significant difference between the knee coil and the surface coil (P=0.021). For all other criteria regarding image quality and presence of imaging artefacts there was a significant difference between both coils (P<0.001) with the surface coil obtaining the better result. CONCLUSION: The use of the surface coil in the visualisation of the patellar cartilage can be recommended at knee MR.

CAM26, CAM29 and mucin-like carcinoma associated antigen in epithelial ovarian cancer.

The levels of CA125 (reference values [RVs] 35 U/mL and 65 U/mL), CA15.3 (RV = 32 U/mL), Mucin-like carcinoma associated antigen (MCA; RV = 15 U/mL), CAM26 (RV = 75 U/mL) and CAM29 (RV = 15 U/mL) were preoperatively assayed in blood samples drawn from 42 patients with ovarian carcinoma and 101 patients with benign ovarian pathology undergoing laparotomy at the Department of Gynecology and Obstetrics of the University of Pisa. With 65 U/mL as RV, CA125 had a sensitivity (SE) of 80.9% and a specificity (SP) of 89.1% for ovarian carcinoma; with 35 U/mL as RV, CA125 had a SE of 85.7% and a SP of 66.3%; CA15.3 had a SE of 57.1% and a SP of 96.0%; MCA had a SE of 59.5% and a SP 86.1%; CAM26 had a SE of 21.4% and a SP of 96.0%, CAM29 had a SE of 64.3% and a SP of 97.0%. The association of CA125 with each of other antigens did not improve the SE of CA125 assay alone in the detection of patients with ovarian carcinoma. In conclusion, the present data showed that the measurement of CA15.3, MCA and CAM26 did not give any additional information with respect to CA125 assay in the diagnosis of ovarian carcinoma. The good SE and the very good SP and diagnostic accuracy of CAM29 could suggest further investigation in order to evaluate the role of this antigen in the management of patients with this malignancy.

Detecting clustered microcalcifications in the female breast: secondary digitized images versus mammograms.

We compared the detection of clustered microcalcifications by means of conventional mammograms and by means of secondary digitized images with a spatial resolution of 2048 x 1684 pixels and a contrast resolution of 12 bit. A Receiver Operating Characteristic (ROC) study was carried out using a cadaver breast showing phantom microcalcifications. A set of 100 mammograms was evaluated by two experienced senior radiologists. The ROC scores obtained with the digital images were 10% lower than those obtained with the conventional images. This difference however does not reach statistical significance. The use of a digital zoom function based on pixel duplication is also investigated. This zoom function does not produce a change in the diagnostic accuracy of the digital method. Attention is also paid to the advantages and disadvantages encountered by the radiologists when working on the digital viewing system. The most important drawback seems to be that it is considerably more time consuming than the conventional procedure, and this is especially due to the long loading time of the images and to the absence of window and level preselections.

Detection of anti-contractile antibodies after cardiac surgery using ELISA assay.

Sera from 196 patients were collected before and after cardiac surgery to measure antibodies against heart tissue and against actin and myosin. In the post-operative period antibodies were found in 87 patients (44%) producing a cross-striated fluorescence pattern in heart tissue. Antibodies against the major contractile proteins were found in 91 patients (46%), anti-actin antibodies in 49 patients (25%) and anti-myosin antibodies in 65 patients (33%). We found a significant correlation (P less than 0.0001) between the antibodies producing a cross-striated fluorescence pattern and antibodies recognizing contractile proteins. These results suggest that contractile proteins evoke an immune response after cardiac surgery and that this response may compromise cardiac function.