Clinicopathological study of renal biopsies after liver transplantation.

OBJECTIVE: To perform a clinicopathological study of patients having renal biopsies after liver transplantation. DESIGN: Case series. SETTING; Queen Mary Hospital, Hong Kong. PATIENTS: All post-liver transplantation patients who had a renal biopsy in the period from January 2000 to December 2010. RESULTS: Eleven renal biopsies were retrieved for review from 10 patients with liver transplantation. The male-to-female ratio was 9:1 (age range, 47-63 years). The median liver transplant-to-renal biopsy interval was 1590 (range, 102-3699) days. The predominant histological changes were interstitial fibrosis and tubular atrophy. Diabetic nephropathy (n=6) and immunoglobulin A nephropathy (n=4) were the commonest glomerulopathies. Only one patient had chronic calcineurin inhibitor nephrotoxicity. With a mean follow-up of 53 months, three patients died 2 to 53 months post-renal biopsy. All surviving patients had chronic renal impairment. Five patients developed end-stage renal failure and four had significant persistent proteinuria. CONCLUSION: Renal pathology was variable after liver transplantation; most biopsies showed complex renal lesions, whilst calcineurin inhibitor nephrotoxicity was rare. The recognition of kidney histology attributable to metabolic derangements after liver transplantation is potentially important in the interpretation of renal biopsy specimens and patient management. The renal outlook of this group of patients is guarded.

Torsion of a nongravid myomatous uterus: radiological features and literature review.

Torsion of the nongravid uterus is a rare but potentially fatal acute abdominal condition. The non-specific clinical presentation of this condition makes preoperative diagnosis difficult. We describe a patient with uterine torsion in whom the diagnosis was made using contrast-enhanced computed tomography with multiplanar reconstruction. Features of uterine torsion and its complications can be demonstrated by computed tomography, which is an important means of making a preoperative diagnosis.

"Ears of the Lynx" MRI Sign Is Associated with SPG11 and SPG15 Hereditary Spastic Paraplegia.

BACKGROUND AND PURPOSE: The "ears of the lynx" MR imaging sign has been described in case reports of hereditary spastic paraplegia with a thin corpus callosum, mostly associated with mutations in the spatacsin vesicle trafficking associated gene, causing Spastic Paraplegia type 11 (SPG11). This sign corresponds to long T1 and T2 values in the forceps minor of the corpus callosum, which appears hyperintense on FLAIR and hypointense on T1-weighted images. Our purpose was to determine the sensitivity and specificity of the ears of the lynx MR imaging sign for genetic cases compared with common potential mimics. MATERIALS AND METHODS: Four independent raters, blinded to the diagnosis, determined whether the ears of the lynx sign was present in each of a set of 204 single anonymized FLAIR and T1-weighted MR images from 34 patients with causal mutations associated with SPG11 or Spastic Paraplegia type 15 (SPG15). 34 healthy controls, and 34 patients with multiple sclerosis. RESULTS: The interrater reliability for FLAIR images was substantial (Cohen κ, 0.66-0.77). For these images, the sensitivity of the ears of the lynx sign across raters ranged from 78.8 to 97.0 and the specificity ranged from 90.9 to 100. The accuracy of the sign, measured by area under the receiver operating characteristic curve, ranged from very good (87.1) to excellent (93.9). CONCLUSIONS: The ears of the lynx sign on FLAIR MR imaging is highly specific for the most common genetic subtypes of hereditary spastic paraplegia with a thin corpus callosum. When this sign is present, there is a high likelihood of a genetic mutation, particularly associated with SPG11 or SPG15, even in the absence of a family history.

In vivo microelectrode track reconstruction using magnetic resonance imaging.

To obtain more precise anatomical information about cortical sites of microelectrode recording and microstimulation experiments in alert animals, we have developed a non-invasive, magnetic resonance imaging (MRI) technique for reconstructing microelectrode tracks. We made microelectrode penetrations in the brains of anesthetized rats and marked sites along them by depositing metal, presumably iron, with anodic monophasic or biphasic current from the tip of a stainless steel microelectrode. The metal deposits were clearly visible in the living animal as approximately 200 microm wide hypointense punctate marks using gradient echo sequences in a 4.7T MRI scanner. We confirmed the MRI findings by comparing them directly to the postmortem histology in which the iron in the deposits could be rendered visible with a Prussian blue reaction. MRI-visible marks could be created using currents as low as 1 microA (anodic) for 5 s, and they remained stable in the brains of living rats for up to nine months. We were able to make marks using either direct current or biphasic current pulses. Biphasic pulses caused less tissue damage and were similar to those used by many laboratories for functional microstimulation studies in the brains of alert monkeys.

Evaluation of the Confusion Assessment Method (CAM) as a screening tool for delirium in the emergency room.

The objective of this study was to compare the results of the Confusion Assessment Method (CAM) obtained by a trained non-physician interviewer to those obtained by a geriatrician, among a sample of elderly patients seen in an emergency room. A group of 110 elderly patients (> or =66 years) were evaluated in the emergency room by a lay interviewer. The geriatrician conducted an interview in the presence of the lay interviewer. Subsequently, the geriatrician and the lay interviewer completed a CAM checklist independently. Kappa statistics, sensitivity, specificity, positivity predictive value (PPV), and negative predictive value (NPV) for the geriatrician's and lay interviewer's results with the CAM diagnostic algorithm were compared. The kappa coefficient was 0.91, the sensitivity 0.86, the specificity 1.00, the PPV 1.00, and the NPV 0.97. In conclusion, the CAM used by a trained lay interviewer in the emergency room is sensitive, specific, reliable and easy to use for the identification of patients with delirium. The under-recognition and under-treatment of delirium is a major health issue and has important clinical and financial implications. The implementation of systematic screening in populations at risk could increase the rate of early detection and lead to the appropriate management of delirious patients.

Location-weighted CTP analysis predicts early motor improvement in stroke: a preliminary study.

OBJECTIVE: To develop multivariate models for prediction of early motor deficit improvement in acute stroke patients with focal extremity paresis, using admission clinical and imaging data. METHODS: Eighty consecutive patients with motor deficit due to first-ever unilateral stroke underwent CT perfusion (CTP) within 9 hours of symptom onset. Limb paresis was prospectively assessed using admission and discharge NIH Stroke Scale (NIHSS) scoring. CTP scans were coregistered to the MNI-152 brain space and subsegmented to 146 pairs of cortical/subcortical regions based on preset atlases. Stepwise multivariate binary logistic regressions were performed to determine independent clinical and imaging predictors of paresis improvement. RESULTS: The rates of early motor deficit improvement were 18/49 (37%), 15/42 (36%), 8/25 (32%), and 7/23 (30%) for the right arm, right leg, left arm, and left leg, respectively. Admission NIHSS was the only independent clinical predictor of early limb motor deficit improvement. Relative CTP values of the inferior frontal lobe white matter, lower insular cortex, superior temporal gyrus, retrolenticular portion of internal capsule, postcentral gyrus, precuneus parietal gyri, putamen, and caudate nuclei were also independent predictors of motor improvement of different limbs. The multivariate predictive models of motor function improvement for each limb had 84%-92% accuracy, 79%-100% positive predictive value, 75%-94% negative predictive value, 83%-88% sensitivity, and 80%-100% specificity. CONCLUSIONS: We developed pilot multivariate models to predict early motor functional improvement in acute stroke patients using admission NIHSS and atlas-based location-weighted CTP data. These models serve as a "proof-of-concept" for prospective location-weighted imaging prediction of clinical outcome in acute stroke.