CT Noise-Reduction Methods for Lower-Dose Scanning: Strengths and Weaknesses of Iterative Reconstruction Algorithms and New Techniques.

Iterative reconstruction (IR) algorithms are the most widely used CT noise-reduction method to improve image quality and have greatly facilitated radiation dose reduction within the radiology community. Various IR methods have different strengths and limitations. Because IR algorithms are typically nonlinear, they can modify spatial resolution and image noise texture in different regions of the CT image; hence traditional image-quality metrics are not appropriate to assess the ability of IR to preserve diagnostic accuracy, especially for low-contrast diagnostic tasks. In this review, the authors highlight emerging IR algorithms and CT noise-reduction techniques and summarize how these techniques can be evaluated to help determine the appropriate radiation dose levels for different diagnostic tasks in CT. In addition to advanced IR techniques, we describe novel CT noise-reduction methods based on convolutional neural networks (CNNs). CNN-based noise-reduction techniques may offer the ability to reduce image noise while maintaining high levels of image detail but may have unique drawbacks. Other novel CT noise-reduction methods are being developed to leverage spatial and/or spectral redundancy in multiphase or multienergy CT. Radiologists and medical physicists should be familiar with these different alternatives to adapt available CT technology for different diagnostic tasks. The scope of this article is (a) to review the clinical applications of IR algorithms as well as their strengths, weaknesses, and methods of assessment and (b) to explore new CT image reconstruction and noise-reduction techniques that promise to facilitate radiation dose reduction. ©RSNA, 2021.

Benefits of iterative metal artifact reduction and dual-energy CT towards mitigating artifact in the setting of total shoulder prostheses.

OBJECTIVE: To determine the utility of iterative metal artifact reduction and 130 keV dual-energy virtual monoenergetic images to improve bone and soft tissue visualization in CT scans affected by metal artifacts. MATERIAL AND METHODS: Thirteen females and 6 males with a history of total shoulder prosthesis who underwent dual-energy shoulder CT were included. Four sets of images were reconstructed for each patient: (1) original polychromatic kV images reconstructed with weighted filtered back projection; (2) polychromatic kV images with iterative metal artifact reduction; (3) 130 keV dual-energy virtual monoenergetic; (4) combined iterative metal artifact reduction and 130 keV dual-energy virtual monoenergetic. Three readers blindly reviewed all image sets and graded the extent of artifact and image quality. RESULTS: Mean artifact score and median overall image quality score were better in 130 keV dual-energy virtual monoenergetic with iterative metal artifact reduction compared with those in original polychromatic kV images (3.02 vs 4.28, P < 0.001 and 3.00 vs 4.33, P < 0.001, respectively). The median difference in CT numbers between regions affected by artifacts and normal regions was lowest in 130 keV dual-energy virtual monoenergetic with iterative metal artifact reduction compared with that in original polychromatic kV images (72.28 vs 252.08, P < 0.001 for bony regions and 15.09 vs 324.38, P < 0.001 for soft tissue). CONCLUSION: In patients with metal artifacts due to shoulder replacement surgery, the use of dual-energy monoenergetic images and iterative metal artifact reduction reconstruction significantly improves both subjective and objective indicators of image quality.

Automated radiomic analysis of CT images to predict likelihood of spontaneous passage of symptomatic renal stones.

PURPOSE: To evaluate the ability of a semi-automated radiomic analysis software in predicting the likelihood of spontaneous passage of urinary stones compared with manual measurements. METHODS: Symptomatic patients visiting the emergency department with suspected stones in either kidney or ureters who underwent a CT scan were included. Patients were followed for up to 6 months for the outcome of a trial of passage. Maximum stone diameters in axial and coronal images were measured manually. Stone length, width, height, max diameter, volume, the mean and standard deviation of the Hounsfield units, and morphologic features were also measured using automated radiomic analysis software. Multivariate models were developed using these data to predict subsequent spontaneous stone passage, with results expressed as the area under a receiver operating curve (AUC). RESULTS: One hundred eighty-four patients (69 females) with a median age of 56 years were included. Spontaneous stone passage occurred in 114 patients (62%). Univariate analysis demonstrated an AUC of 0.83 and 0.82 for the maximum stone diameter determined manually in the axial and coronal planes, respectively. Multivariate models demonstrated an AUC of 0.82 for a model including manual measurement of maximum stone diameter in axial and coronal planes. The same AUC was found for a model including automatic measurement of maximum height and diameter of the stone. Further addition of morphological parameters measured automatically did not increase AUC beyond 0.83. CONCLUSION: The semi-automated radiomic analysis of urinary stones shows similar accuracy compared with manual measurements for predicting urinary stone passage. Further studies are needed to predict clinical impacts of reporting the likelihood of urinary stone passage and improving inter-observer variation using automatic radiomic analysis software.

A new modality for the estimation of corrected flow time via electrocardiography as an alternative to Doppler ultrasonography.

BACKGROUND: Evaluation of corrected flow time (FTc) via ultrasonography is one of the suggested modalities for the assessment of intravascular volume status. This study aimed to compare the results of FTc of carotid artery measured via ultrasonography, as a measure of mechanical outcome of the cardiac cycle, with the results of FTc estimation from a new modified formula via electrocardiography (ECG), as a measure of electrical function of the cardiac cycle. METHODS: Healthy volunteers were evaluated before and after a passive leg raising (PLR) maneuver. FTc was measured concurrently before and after PLR via a modified method from ECG and via ultrasonography of the carotid artery. RESULTS: A total number of 98 healthy volunteers (51 women and 47 men) with a mean age of 30.69 ± 6.28 years were included. There was a significant correlation between FTc measured by ultrasonography and estimated by ECG both before PLR and after PLR (r = .878, p < .0001 and r = .797, p < .0001, respectively). Changes in FTc were slightly higher in measurements by ultrasonography compared to estimations by ECG (22.33 ± 17.15 ms0.5 vs. 15.86 ± 14.25 ms0.5 , p = .001). CONCLUSION: Estimation of FTc via ECG is potentially an effective and feasible method for the assessment of volume status at the clinical settings. Further investigations should determine the significance of differences that may be observed between ultrasonography and ECG in patients with either dehydration or volume overload and in the need of real-time volume status assessment.

Cilostazol adjunctive therapy in treatment of negative symptoms in chronic schizophrenia: Randomized, double-blind, placebo-controlled study.

OBJECTIVE: To evaluate the efficacy and safety of cilostazol, a selective inhibitor of phosphodiesterase III, as an adjunctive to risperidone in alleviating the negative symptoms of schizophrenia. METHODS: Eighty-four in-patients with diagnosis of chronic schizophrenia participated in a randomized, placebo-controlled trial and underwent 8 weeks of treatment with either cilostazol (50 mg twice a day) or placebo as an adjuvant to risperidone. Participants were assessed using the positive and negative syndrome scale (PANSS) at baseline and at weeks 2, 4, 6, and 8. The primary outcome measure of the trial was to evaluate the efficacy of cilostazol compared to placebo in improving the PANSS negative subscale score. RESULT: General linear model repeated measures demonstrated significant effect for time × treatment interaction on negative subscale scores (p < .001) and PANSS total (p = .006) but did not demonstrate significant effect on the PANSS positive (p = .37) and general (p = .06) subscales. Frequency of adverse events was not significantly different between the 2 treatment groups. No serious adverse event was observed. CONCLUSION: An 8-week course of treatment with cilostazol as an adjunct to risperidone showed a favorable safety and efficacy profile in patients with schizophrenia.

The Epidemiology of Migraine Headache in General Population of Tehran, Iran.

BACKGROUND: Migraine as one of the most common types of headache is known to cause serious intervention with routine activities of affected individuals due to the devastating nature of attacks. The aim of this study was to provide epidemiological data of migraine in Iranian general population. METHODS: In this cross-sectional general population study, migraine diagnoses (both episodic and chronic) were based on the International Classification of Headache Disorders. Face-to-face interviews were performed by 5 trained medical interns on a sample size of 2,300 people aged 12-65 years. RESULTS: A total number of 2,076 subjects were enrolled for final analysis. The mean age of the subjects at the time of the study was 36.27 ± 14.56 years (age range 12-65 years). The 1-year prevalence of migraine was 27.6%. The prevalence of migraine among female subjects was significantly higher than among male subjects (36.7 vs. 21.6%, p < 0.001). The mean age of the subjects with migraine was 35.9 ± 12.96 years. Totally, 49.9% of migraine sufferers experienced at least one episode of aura. The most prevalent type of aura was numbness reported in 32.4% of migraine subjects. CONCLUSIONS: Despite the higher prevalence of migraine among Iranian general population compared to most of the other populations investigated by previous studies, these individuals experience a less severe course of disease.

The effects of pioglitazone adjuvant therapy on negative symptoms of patients with chronic schizophrenia: a double-blind and placebo-controlled trial.

OBJECTIVE: The evident central role of inflammation, oxidative stress, and metabolic derangement in pathophysiology of negative symptoms of schizophrenia has opened new insights into probable pharmacological options for these symptoms. Pioglitazone is an antidiabetic agent with anti-inflammatory and antioxidant properties. In this study, we evaluated the efficacy of pioglitazone as an adjunct to risperidone for reduction of negative symptoms in schizophrenia. METHODS: In this randomized, double-blind, placebo-controlled trial, 40 patients with chronic schizophrenia and a minimum score of 20 on the negative subscale of Positive and Negative Syndrome Scale (PANSS) were randomly allocated to receive risperidone plus either pioglitazone (30 mg/day) or placebo for 8 weeks. Patients' symptoms and adverse events were rated at baseline and weeks 2, 4, 6, and 8. The difference between the two groups in decline of PANSS negative subscale scores was considered as the primary outcome of this study. RESULTS: At the study endpoint, patients in the pioglitazone group showed significantly more improvement in PANSS negative subscale scores (p < 0.001) as well as PANSS total scores (p = 0.01) compared with the placebo group. CONCLUSION: These findings suggest the probable efficacy of pioglitazone as an augmentation therapy in reducing the negative symptoms of schizophrenia.

Central Obesity and Liver Iron Content: A Noninvasive Assessment in General Population by Magnetic Resonance Imaging.

BACKGROUND/AIM: Existing evidence points to an altered status of iron metabolism in obesity. We aimed to investigate whether central obesity is independently associated with estimated liver iron content (liver T2* value) in general population that used the noninvasive assessment method by MRI. METHODS: The study was carried out on 200 subjects randomly selected from the Golestan Cohort Study who underwent abdominal MRI. Quantitative T2* maps of entire cross-sectional area of liver were calculated using a semi-automated software for estimating the levels of iron content. Segmentation and calculation of visceral (VFA) and subcutaneous fat area (SFA) were also performed. RESULTS: There was no significant difference in mean liver T2* values between obese (body mass index, BMI >30 kg/m2) and non-obese (BMI ≤30 kg/m2) subjects. After controlling for other covariates, no statistically significant association was detected between liver T2* values and VFA, SFA and VFA/SFA ratio. The drop in the relative signal intensity as an indicator of steatosis and serum ferritin predicted liver T2* values that almost had the same strength (standardized ß of -0.41 and -0.41, respectively). CONCLUSIONS: Central obesity indices are not correlated with estimated liver iron content by MRI. Hepatic steatosis and serum ferritin seem to be the best predictors of hepatic T2* value. Since central obesity indices were not direct predictors of hepatic T2* value after the adjustment for confounding factors, it is possible that lipid accumulation in the liver locally, but not systematically, influences hepatic iron metabolism.

Riluzole in augmentation of fluvoxamine for moderate to severe obsessive-compulsive disorder: Randomized, double-blind, placebo-controlled study.

AIM: The aim of the present randomized, double-blind, placebo-controlled, 8-week trial was to assess the efficacy and tolerability of riluzole augmentation of fluvoxamine in treatment of patients with moderate to severe obsessive-compulsive disorder. METHODS: Patients were randomized into two parallel groups to receive fluvoxamine plus placebo or fluvoxamine plus riluzole (50 mg twice daily). All patients, regardless of their treatment group, received fluvoxamine at 100 mg/day for the initial 4 weeks of the study followed by 200 mg/day of fluvoxamine for the rest of the trial course. A total of 50 patients (25 in each group) were evaluated for response to treatment using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) at baseline and at weeks 4, 8 and 10. Side-effects were recorded using predesigned checklists in each visit. Repeated-measure analysis of variance showed a significant effect for time × treatment interaction in the Y-BOCS total score and a significant effect for time × treatment interaction in the Y-BOCS Compulsive subscale score between the two groups. RESULTS: Repeated-measure analysis of variance showed a significant effect for time × treatment interaction (Greenhouse-Geisser corrected: F = 4.07, d.f. = 1.22, P = 0.04) in the Y-BOCS total score and a significant effect for time × treatment interaction (Greenhouse-Geisser corrected: F = 4.45, d.f. = 1.33, P = 0.028) in the Y-BOCS Compulsive subscale score between the two groups. Riluzole augmentation therapy demonstrated higher, partial or complete treatment response according to the Y-BOCS total scores. CONCLUSION: Riluzole may be of clinical use as an adjuvant agent to fluvoxamine in treatment of moderate to severe obsessive-compulsive disorder.

Internal jugular vein/common carotid artery cross-sectional area ratio and central venous pressure.

PURPOSE: To investigate the accuracy of the sonographic assessment of internal jugular vein/common carotid artery (IJV/CCA) cross-sectional area ratio in predicting central venous pressure (CVP) in critically ill patients. METHODS: In adult patients who underwent central venous catheterization for monitoring of hemodynamic status, we used bedside sonography for diameter and cross-sectional area measurement of IJV and CCA. The IJV/CCA ratio was then calculated, and its correlation with CVP as well as its sensitivity, specificity, and positive and negative predictive values were analyzed. RESULTS: We enrolled 52 patients with a mean age of 58.8 ± 10.7 years. The mean IJV/CCA ratio was 1.89 ± 0.83 and 1.90 ± 0.83, respectively, at inspiration and expiration. A significant correlation was observed between IJV/CCA ratio and CVP (r = 0.728, p < 0.0001 at inspiration, and r = 0.736, p < 0.0001 at expiration). Sensitivity was 90%, specificity 86.36%, positive predictive values 90%, and negative predictive values 86.36% for the prediction of CVP <10 cm H2 O. CONCLUSIONS: Assessing the IJV/CCA ratio with a portable sonographic device could be a noninvasive alternative for central venous catheterization in order to evaluate the hemodynamic status of critically ill patients. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:312-318, 2016.

Value of CT scan-assessed tibial tuberosity-trochlear groove distance in identification of patellar instability.

PURPOSE: Tibial tuberosity-trochlear groove (TTTG) distance is currently considered as one of the main factors in decision-making for surgical intervention in patients with patellar instability. The current study aimed to provide a valid comparison of TTTG distance in the healthy knees with those with patellar instability. MATERIALS AND METHODS: Patients with a history of two or more episodes of patellar dislocation in the same knee who were referred to our department for the assessment of TTTG distance were included. Asymptomatic knees of patients as well as both knees of 21 healthy individuals were used as controls. RESULTS: A total number of 42 patients, including 14 (33.3 %) male and 28 (66.7 %) female, with a mean age of 28.6 ± 12.3 years were included. Twenty-one controls with no significant difference of personal characteristics with patients were also enrolled. The mean TTTG distance in symptomatic and asymptomatic knees of patients were 18.71 ± 3.96 mm and 17.35 ± 4.39 mm with no significant difference (P = 0.298). The mean TTTG distances of both symptomatic and asymptomatic knees of patients were significantly higher than in knees of controls (P < 0.001). CONCLUSION: The findings of the current study are not in favor of considering TTTG distance independently in decision-making for surgical interventions. However, greater TTTG in both asymptomatic and symptomatic knees of patients compared to controls indicates that this measure could still be considered as an indicator of knee instability and even the need for surgery if considered in addition to other factors.

Primary ciliary dyskinesia in six patients with bronchiectasis.

INTRODUCTION: Primary ciliary dyskinesia [PCD] is generally considered as a rare autosomal recessive disorder. Previous studies reported various prevalence of PCD among patients with bronchiectasis. MATERIAL AND METHODS: Six PCD patients who were diagnosed during the investigation of 40 patients with bronchiectasis were enrolled in this study. Ultra structural studies for both epithelium and cilia were performed, and the deformities in detailed electron microscopic images confirmed the diagnosis of PCD. RESULTS: Four patients experienced the first symptoms shortly after the birth, 1 by the age of 1 and 1 by the age of 4 years. Except of 1 case that was diagnosed 2 months after the onset of disease, diagnosis delay was longer than 5 years in all patients. Consanguineous marriage was observed in the parents of all patients. Upper respiratory tract infections were documented for all patients. CONCLUSIONS: PCD should be considered as a probable underlying disorder in patients with bronchiectasis. Past medical history of otitis media and history of similar clinical findings in family members should raise suspicion toward PCD.

Celecoxib adjunctive therapy for acute bipolar mania: a randomized, double-blind, placebo-controlled trial.

OBJECTIVES: Recent research has focused on the inflammatory cascade as a key culprit in the etiology of bipolar disorder. We hypothesized that celecoxib, via its anti-inflammatory properties, may have a therapeutic role in mood disorder. METHODS: Forty-six inpatients with the diagnosis of acute bipolar mania without psychotic features participated in a parallel, randomized, double-blind, placebo-controlled trial, and underwent six weeks of treatment with either celecoxib (400 mg daily) or placebo as an adjunctive treatment to sodium valproate. Patients were evaluated using the Young Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale (HDRS). The primary outcome measure with respect to efficacy was the mean decrease in YMRS score from baseline to the study endpoint, which was compared between the two groups. RESULTS: A significant difference was observed in the change in YMRS scores on Day 42 compared to baseline in the two groups (p < 0.001). The changes at the endpoint compared to baseline were -29.78 ± 21.78 (mean ± standard deviation) and -21.78 ± 7.16 for the celecoxib and placebo groups, respectively. A significantly higher remission rate was observed in the celecoxib group (87.0%) than the placebo group (43.5%) at Week 6 (p = 0.005). General linear model repeated measures demonstrated a significant effect for the time × treatment interaction on the YMRS scores [F(2.27,99.98) = 6.67, p = 0.001]. CONCLUSIONS: Celecoxib is an effective adjuvant therapy in the treatment of manic episodes (without psychotic features) of bipolar mood disorder. The mood-stabilizing role of the drug might be mediated via its action on the inflammatory cascade.

The Epidemiology of Exertional Headache in the General Population of Tehran, Iran.

OBJECTIVE: In this cross-sectional study, we investigated the prevalence and characteristics of primary exertional headache (EH) among the Iranian general population living in Tehran, the capital city of the country. BACKGROUND: Headache is the most common complaint and is listed in the top 10 most disabling conditions. Epidemiological researches on headache can demonstrate its actual burden. There are still limited data on EH, especially in Iran and the Middle East. METHODS: A Persian questionnaire was designed based on the International Headache Society (IHS) criteria of headache disorders (ICHD-II). Face-to-face interviews were performed by 5 trained medical interns on a sample size of 2300 people. RESULTS: Data for a total number of 2076 subjects were enrolled for final analysis. The mean age of the subjects at the time of the study was 36.3 ± 14.6 years. The 1-year prevalence of EH was 7.3% (95% confidence interval [CI]: 6.2-8.4%). The prevalence of EH was significantly higher in females compared to males (10.0% vs 5.4%, P < .001). The mean age of the subjects with EH was 32 ± 12.1 years. None of our EH patients received medical consult prior to the study. CONCLUSION: EH seems to be less prevalent among the Iranian population compared to previous studies.

Celecoxib Versus Diclofenac in Mild to Moderate Depression Management Among Breast Cancer Patients: A Double-Blind, Placebo-Controlled, Randomized Trial.

BACKGROUND: Depression is a well-known complication of breast cancer, which is known to adversely affect quality of life, prognosis, and survival in breast cancer patients. Celecoxib, a nonsteroidal anti-inflammatory drug, which acts via the selective inhibition of cyclo-oxygenase (COX)-2, has been shown to have antidepressive effects. OBJECTIVES: Here, we aimed to compare the efficacy and safety of celecoxib, a selective inhibitor of COX-2, with diclofenac, a nonselective inhibitor of both COX-1 and COX-2 in reducing depressive symptoms and pain in breast cancer patients. METHODS: A total of 52 outpatients with breast cancer with mild to moderate depression, who suffered from pain and needed analgesics, participated in the trial and underwent 6 weeks of treatment with either celecoxib (200 mg twice daily) or diclofenac (50 mg twice daily). Participants were investigated using the Hamilton Depression Rating Scale (HDRS). The primary outcome measure was to compare the antidepressant effects of celecoxib and diclofenac. RESULTS: Repeated-measures analysis demonstrated significant effect for Time × Treatment interaction on the HDRS scores: F(1.76, 87.85) = 9.66; P < 0.001. By study conclusion, greater improvement was observed in the HDRS score of the celecoxib group compared with the diclofenac group (P = 0.002). No one experienced remission (HDRS ≤ 7) in either group. Frequencies of adverse events were not significantly different between groups. CONCLUSION: Celecoxib seems to possess superior antidepressive effects compared with diclofenac in breast cancer patients with mild to moderate depression.

Class switch recombination process in ataxia telangiectasia patients with elevated serum levels of IgM.

Ataxia telangiectasia (AT) is a rare primary immunodeficiency disorder with various clinical manifestations. Increased serum levels of IgM and recurrent infections, mainly sinopulmonary infections, can be the presenting feature in a number of AT patients and may be initially misdiagnosed as hyper-IgM (HIgM) syndrome. This study was designed to investigate class switch recombination (CSR) as a critical mechanism in B lymphocytes' maturation to produce different isotypes of antibody in response to antigen stimulation in AT cases with HIgM presentation. Quantitative IgE production after stimulation by IL-4 and CD40L was considered as an indicator for CSR function. We also compared their results with sex and age matched AT patients without HIgM presentation. We report four AT patients with recurrent infections during infancy and high serum levels of IgM. Laboratory evaluations revealed defective CSR while none of the three AT patients without HIgM presentation had a defect in the CSR process. The characterized defect in AT is a mutation in the ataxia telangiectasia mutated (ATM) gene. This gene may result in CSR defects due to impaired DNA break repair. A special association between AT and HIgM may indicate a new subgroup of AT patients according to their clinical phenotype and CSR condition.

Primary immunodeficiency disorders in Iran: update and new insights from the third report of the national registry.

BACKGROUND: Primary immunodeficiency disorders (PID) are a group of heterogeneous disorders mainly characterized by severe and recurrent infections and increased susceptibility to malignancies, lymphoproliferative and autoimmune conditions. National registries of PID disorders provide epidemiological data and increase the awareness of medical personnel as well as health care providers. METHODS: This study presents the demographic data and clinical manifestations of Iranian PID patients who were diagnosed from March 2006 till the March of 2013 and were registered in Iranian PID Registry (IPIDR) after its second report of 2006. RESULTS: A total number of 731 new PID patients (455 male and 276 female) from 14 medical centers were enrolled in the current study. Predominantly antibody deficiencies were the most common subcategory of PID (32.3 %) and were followed by combined immunodeficiencies (22.3 %), congenital defects of phagocyte number, function, or both (17.4 %), well-defined syndromes with immunodeficiency (17.2 %), autoinflammatory disorders (5.2 %), diseases of immune dysregulation (2.6 %), defects in innate immunity (1.6 %), and complement deficiencies (1.4 %). Severe combined immunodeficiency was the most common disorder (21.1 %). Other prevalent disorders were common variable immunodeficiency (14.9 %), hyper IgE syndrome (7.7 %), and selective IgA deficiency (7.5 %). CONCLUSIONS: Registration of Iranian PID patients increased the awareness of medical community of Iran and developed diagnostic and therapeutic techniques across more parts of the country. Further efforts must be taken by increasing the coverage of IPIDR via electronically registration and gradual referral system in order to provide better estimation of PID in Iran and reduce the number of undiagnosed cases.

Synchronous Endometrial Cancer Detected on 68 Ga-DOTATATE PET/CT.

ABSTRACT: A 50-year-old woman with history of metastatic neuroendocrine tumor underwent a follow-up PET/CT with 68 Ga-DOTATATE. An enlarged uterus with diffuse increased uptake warranted further investigation with an MRI that showed mass-like thickening of the endometrium, T2 hyperintensity, lobulated contour, and invasion of more than 50% of the myometrium. Biopsy revealed endometrial carcinoma with mucinous features. Mild to moderate uptake of the 68 Ga-DOTATATE by the uterus can be a normal physiological finding; however, it should prompt further investigation, particularly in a postmenopausal woman with concerning imaging or clinical findings.

Incidental endometrial cancer detected on FDG PET/CT imaging for melanoma.

This case report follows a 66-year-old female who originally presented with malignant melanoma in the left knee and recurrence in the left inguinal region. This prompted a whole body FDG PET/CT scan which showed incidental focal hypermetabolism in the uterus. The diagnosis of endometrial cancer was confirmed at biopsy, and the patient was treated with total abdominal hysterectomy. Melanoma patients are at increased risk of second primary malignancy, and endometrial cancer is a common second primary often diagnosed in cancer survivors. Incidental endometrial focal hypermetabolism should be investigated further for a synchronous malignancy, especially in a post-menopausal woman.

The timing of established detrusor hyperreflexia in a rat model of neuropathic bladder.

BACKGROUND: Proper timing of catheter insertion and the use of a suitable surgical method are essential parts of producing rat models to evaluate neuropathic bladder following spinal cord injury (SCI). METHODS: Thirty-two female Sprague-Dawley rats were randomly allocated into four groups. Group 1 underwent surgical laminectomy using the classic method. Group 2 underwent SCI 7 d following insertion of the catheter, and group 3 underwent sham operation. For bladder catheterization, a 4.5 Fr catheter was fixed into the bladder and tunneled beneath the skin to reach out at the nape of the neck. Group 4 underwent urodynamic study via bladder catheter prior to surgery and every 10 d following the operation to determine the exact time of establishing neuropathic bladder following spinal shock. The animals' survival rate and bladder wall's histopathologic changes were assessed 30 d following the operation. RESULTS: Simultaneous suprapubic catheter placement raised the mortality rate in group 1 in comparison with group 2. Repeated urodynamic study in group 4 showed hypertonic behavior in the bladder 10 d after SCI, with significantly increased leak point pressure and bladder capacity; however, the end filling pressure and constant neuropathic bladder on cystometric indices are attained from 20 d after the operation. CONCLUSIONS: Insertion of a bladder catheter 1 wk prior to SCI provides an applicable route for repeated cystometric studies in rats. The results demonstrate that sustained bladder overactivity is established in rats 20 d after SCI and animals are ready for further experiments on neuropathic bladder dysfunction following this period.