Oral sodium thiosulfate as maintenance therapy for calcific uremic arteriolopathy: a case series.

BACKGROUND: Calcific uremic arteriolopathy (CUA) is a rare but serious disorder affecting 4% of dialysis patients. Intravenous sodium thiosulfate (IV STS) has been shown as an effective treatment. In Canada, the average cost of IV STS is about CAD 12,000 per month, while the cost of compounded oral STS is CAD 45 per month. METHODS: Prospective cohort where all patients diagnosed with CUA during the year 2011 were included. They were treated initially with IV STS. Afterwards, each patient had a baseline bone scan and was started on oral STS for a total of 6 months followed by a repeat bone scan. A single radiologist, blinded to the dates of both scans for a given patient, read all scans. RESULTS: Four patients were studied. The intravenous dose used was 25 g three times a week for an average duration of 131 days. After the maintenance therapy, 2 patients developed further regression of the lesions, 1 had stable lesions, and 1 got worse; however, nonadherence to the drug was confirmed. The oral medication was well tolerated with no reported side effects. CONCLUSION: Oral STS, after IV STS, seems to stabilize, or even improve CUA lesions, and therefore could be useful as maintenance therapy, especially since its cost is much more reasonable than IV STS and due to the ongoing shortage of the IV formulation.

Ethics in radiology: wait lists queue jumping.

Education in ethics is a requirement for all Royal College residency training programs as laid out in the General Standards of Accreditation for residency programs in Canada. The ethical challenges that face radiologists in clinical practice are often different from those that face other physicians, because the nature of the physician-patient interaction is unlike that of many other specialties. Ethics education for radiologists and radiology residents will benefit from the development of teaching materials and resources that focus on the issues that are specific to the specialty. This article is intended to serve as an educational resource for radiology training programs to facilitate teaching ethics to residents and also as a continuing medical education resource for practicing radiologists. In an environment of limited health care resources, radiologists are frequently asked to expedite imaging studies for patients and, in some respects, act as gatekeepers for specialty care. The issues of wait lists, queue jumping, and balancing the needs of individuals and society are explored from the perspective of a radiologist.

Atypical brown fat distribution in young males demonstrated on PET/CT.

The development of PET/CT has led to the recognition that metabolically active fat, referred to as "brown fat," can accumulate FDG and represents a possible source of false-positive scans in oncology patients. Numerous reports have described the typical appearance of brown fat, which most commonly presents as neck and paravertebral uptake in young female patients. Other described sites of uptake include the mediastinum and retroperitoneum. We present examples of 2 cases of atypical diffuse brown fat uptake seen in the subcutaneous fat of the thighs, abdomen, and pelvis. Both of these patients were young men and did not show uptake in the typical supraclavicular and neck fat. Although rare in our experience, knowledge of this condition may prevent misinterpretation of this finding as an infiltrative condition of the skin, such as lymphoma.

Neuroanatomy of coprolalia in Tourette syndrome using functional magnetic resonance imaging.

OBJECTIVE: To determine the neural substrates of phonic tics in Tourette syndrome (TS) using functional magnetic resonance imaging (fMRI) and compare with a proposed tic-generating network (TGN). PATIENTS: One with TS and one normal control. METHODS: fMRI scans were obtained on the TS patient during which numerous unsuppressed phonic tics occurred and, along with the scanner noise, were recorded on audiotape. The control underwent the same functional MRI sequence but mimicked the tics within predetermined, on-off time blocks. Fuzzy clustering (FC) methods were used to generate the activation maps. RESULTS: The TS patient and control showed fMRI activation in the left middle frontal gyrus and right precentral gyrus. The TS patient also had activity in the caudate nucleus, cingulate gyrus, cuneus, left angular gyrus, left inferior parietal gyrus, and occipital gyri. CONCLUSIONS: fMRI, using an FC analysis, is a viable technique for studying TS patients with phonic tics. These results give further support to the hypothesis of a tic-generating circuit model. Further studies are required to confirm our data.

Giant left atrial appendage aneurysm in a neonate.

Giant aneurysm of the left atrial appendage (LAA) is a rare condition typically presenting in adulthood. This case report describes the investigations and surgical management of a giant LAA aneurysm in a neonate, emphasizing the role of echocardiography and cardiovascular magnetic resonance imaging in preoperative evaluation as well as challenges in surgical repair of this defect.

Single-shot steady-state free precession can detect myocardial edema in patients: a feasibility study.

PURPOSE: To demonstrate the ability of single-shot, T(2)/T(1) weighted steady-state free precession (SSFP) to detect myocardial edema in patients with an acute myocardial infarction. MATERIALS AND METHODS: This study was performed in a series of patients (n = 10) referred for the assessment of acute myocardial infarcts (AMI). Localizers were used to obtain true short axis views of the left ventricle (LV). These views were used to plan and obtain T(2)-weighted STIR (short TI inversion recovery) images of the LV. These slices were then acquired using single-shot dark blood-prepared SSFP with a large (31) number of dummy pulses. Lastly, Contrast agent was injected, and late enhancement (LE) images were acquired. Images were analyzed using a multi-segment model of the heart. SSFP images were compared with STIR images, with STIR images used as the standard of truth for the presence of edema. LE images were used to identify segments which were positive for microvascular obstruction. RESULTS: All techniques were successful in all patients. A total of 312 segments were analyzed. Excluding segments positive for microvascular obstruction, SSFP had a sensitivity/specificity of 80%/89%. Including segments positive for microvascular obstruction, sensitivity/specificity was 71%/88%. On a patient-based analysis, no AMI was missed using SSFP (sensitivity = 100%). CONCLUSION: Using single-shot SSFP to detect myocardial edema in patients with AMI is feasible with a moderate sensitivity and high specificity.

A child with chromosome 22q11.2 deletion syndrome and a bilobed gallbladder.

We present an 11-year-old girl with a chromosome 22q11.2 microdeletion, velocardiofacial syndrome (VCFS), and a bilobed gallbladder as an incidental finding on abdominal sonography. The finding was confirmed by magnetic resonance cholangiopancreatography (MRCP). This is the first report of a gallbladder anomaly associated with a chromosome 22q11.2 deletion and the second report of a biliary tract anomaly associated with a mutation in the chromosome 22q11 region. We suggest that close attention be paid to the anatomy of the biliary tree in patients with mutations in the chromosome 22q11 region. Further study is warranted to determine the range and prevalence of biliary tract anomalies in this population.

Enzymatic and Immunological Approaches for the Quantitation and Confirmation of Ochratoxin A in Swine Kidneys.

Several techniques for the quantitation and confirmation of ochratoxin A (OA) in swine kidneys were examined. Naturally and artificially contaminated swine kidneys were analyzed for OA by conventional high-performance liquid chromatography (HPLC) analysis. Samples were additionally tested by enzyme-linked immunosorbent assay (ELISA) or treated with carboxypeptidase A followed by HPLC analysis (enzymatic method). Correlations (r values) between the conventional HPLC procedure and the ELISA, using artificially contaminated samples, were 0.88 and 0.81 (P < 0.05) respectively, while the corresponding values between the conventional HPLC procedure and the enzymatic method were 0.89 and 0.98 (P < 0.05). The ELISA gave a more direct estimation of OA contamination than the enzymatic procedure. The enzymatic method also had a reproducible tendency to underestimate or overestimate the amounts of OA in kidney. This was found to be dependent on the source of contamination, as artificially and naturally contaminated kidney samples resulted in linear regression analysis slopes of 0.38 and 2.8, whereas the slopes for the ELISA method were 1.13 and 0.92, respectively. The results with the naturally contaminated kidneys suggest that other naturally occurring forms of OA also occurred in swine kidney. Regardless of this effect, the enzymatic method accurately confirms the presence of OA and related compounds in kidney. The techniques are simple and will complement conventional HPLC analysis for the detection, quantitation, and confirmation of OA in swine kidneys.

The Development of a Quantitative ELISA for Aflatoxin B1 in Ground Peanuts Using Antibodies Isolated From the Yolk of a Laying Hen.

Antibodies directed against Aflatoxin B1 (AFB1) were produced in laying hens, isolated from egg yolk and applied in an enzyme-linked immunosorbent assay (ELISA) for AFB1 in ground peanuts. The ELISA sensitivity was improved by reduction of the amount of the coating antigen absorbed onto the microplate well surfaces. The main aflatoxins B1, B2, G1, G2, M1, aflatoxicol, sterigmatocystin were found to cross-react in the competitive ELISA, 100, 25, 23, 4, 0, 0, 0%, respectively. Aflatoxin B1 could be reproducibly detected and quantified in spiked ground peanuts at levels greater than 5 ppb using a hexane and methanol solvent based peanut extraction protocol.