Aggressiveness of inflammation in histological prostatitis--correlation with total and free prostate specific antigen levels in men with biochemical criteria for prostate biopsy.

BACKGROUND AND AIMS: Although prostatitis can contribute to the lack of prostate specific antigen (tPSA) specificity, there is disagreement concerning the effect of histological inflammation on free PSA (fPSA). We investigated the correlation between aggressiveness of histological inflammation and tPSA, fPSA and f/tPSA in patients without detectable prostate cancer (PC). METHODS: The study included 106 patients with tPSA <10 ng/mL, without clinical prostatitis and with biopsy negative for PC. The inflammation in prostate biopsies was scored for aggressiveness using the four-point scale reported by Irani. The patients were divided into two groups of less aggressive and more aggressive inflammation and compared by use of regression analysis. RESULTS: The median tPSA, fPSA and f/tPSA levels were 6.39 ng/mL, 1.1 ng/mL and 16% in the less aggressive inflammation group and 7.3 ng/mL, 0.79 ng/mL and 10.7% in the more aggressive inflammation group, respectively. There was no significant between-group difference in tPSA levels (P=0.16), however, statistically significant between-group differences were recorded in fPSA and f/tPSA levels (P<0.001 both). Spearman's analysis yielded a significant negative correlation of inflammation aggressiveness with fPSA (r=-0.34; P<0.001) and f/tPSA (r=-0.45; P<0.001). Free PSA and f/tPSA were lower in the group with more aggressive inflammation. CONCLUSIONS: Histological inflammation has a high prevalence in cancer-free prostate biopsy specimens and exerts similar effects on fPSA and f/tPSA levels as PC. Our study suggests histological prostatitis to be an important cause of decreased fPSA and f/tPSA values; therefore, when it is identified, antibiotic or anti-inflammatory therapy should be introduced to reduce the percentage of men with a continuing indication for prostate biopsy.

Comparison of postmortem magnetic resonance imaging and neuropathologic findings in the cerebral white matter.

Two types of high-signal intensity abnormalities are frequently found bilaterally in the cerebral white matter of brains of elderly patients on T2-weighted magnetic resonance imaging (MRI) scans. One is located in the immediate periventricular region; the other, in the deep subcortical white matter (centrum semiovale). The diagnostic implications of this second type continue to be uncertain. To determine the neuropathologic correlates of these lesions, the brains from seven elderly patients were fixed in buffered formaldehyde solution, subjected to MRI scanning, and examined neuropathologically. Variable degrees of bilateral periventricular (subependymal) sharply defined areas of high-signal intensity were found in all the brains, and the larger of these showed corresponding areas of myelin pallor with gliosis and dilated perivascular spaces. Discrete bilateral patches of high-signal intensity were found in the centrum semiovale in five patients. Myelin and axon stains showed varying degrees of diffuse white matter pallor in many areas examined, both with and without these areas of high-signal intensity on MRI scans. Neither the myelin nor the axon stains showed discrete white matter abnormalities that corresponded to the MRI findings. We believe that these changes, so commonly found on MRI scans in the elderly, reflect actual changes in the white matter but that their nature and clinical significance need to be elucidated.

Poor prediction of positive computed tomographic scans by clinical criteria in symptomatic pediatric head trauma.

A retrospective study of 98 children who received CT scanning for head trauma was conducted to determine whether clinical signs would accurately identify patients needing CT scans. The clinical findings of Glasgow Coma Scale score of 12 or less, altered consciousness on admission, and focal abnormalities on neurologic examination were each significantly associated with abnormal findings on CT scans (P less than .01). However, 31% of the 51 patients with Glasgow Coma Scale scores greater than 12 had abnormal CT scan findings. No clinical findings, alone or in combination, accurately identified all patients with abnormal findings on CT scans.

CT and MR of angiomatous malformations of the choroid plexus in patients with Sturge-Weber disease.

Eight patients with Sturge-Weber disease were evaluated by CT (six patients), MR (one patient), or both (one patient). CT scans of five of seven patients showed enlargement and increased enhancement of the choroid plexus on the same side as the facial and intracranial lesions. MRI showed similar findings in both patients examined. This enlargement, seen in six of eight cases of Sturge-Weber disease, is compatible with the presence of angiomatous malformations of the choroid plexus. It appears to be a common finding in this disease.

CT diagnosis of toxic brain injury in cyanide poisoning: considerations for forensic medicine.

Two deaths occurred after ingestion of cyanide-containing Extra-Strength Excedrin capsules. Cranial CT scans obtained within 3 hr of each patient's collapse showed diffuse cerebral swelling and loss of gray-white differentiation. Most diffuse cerebral insults (hypoxia, ischemia) do not show such changes so soon after injury. The early onset of diffuse cerebral edema with loss of gray-white differentiation may be a clue to the diagnosis of acute cyanide poisoning.

CT of acquired hyperopia with choroidal folds.

Seven patients with an ophthalmologic diagnosis of acquired hyperopia with choroidal folds were evaluated by high-resolution axial CT of the orbits. Coronal, oblique coronal, and parasagittal reformations were obtained and the thickness of the optic nerve and morphologic appearance of the globes were assessed by measurement and subjective appearance. Flattening of the globe, which caused the globe to assume an ellipsoid shape, was seen in all 11 affected eyes. Mild to moderate optic nerve enlargement was also demonstrated in most patients. In six of 11 affected eyes a visible space was noted between the optic nerve and its sheath, implying expansion of the subarachnoid perineural compartment. These findings were not demonstrated in a control group of five patients scanned in a similar manner. Scans of a phantom revealed no evidence of CT-generated distortion. These findings may help to identify hyperopia with choroidal folds as a benign disease and eventually help to establish its cause.

Multicenter study of gadopentetate dimeglumine as an MR contrast agent: evaluation in patients with spinal tumors.

In an open-label, multicenter study, the efficacy and safety of gadopentetate dimeglumine (0.1 mmol/kg) administered IV as an MR imaging contrast agent were evaluated in 113 patients with symptoms of spinal tumors. The examinations were performed with a variety of imagers at different field strengths. Scans with short and long TRs were obtained in all patients before and after IV administration of the contrast medium. Contrast enhancement was seen in 77% of patients. No enhancement was seen in 23%, but this absence was useful diagnostic information in all cases. In 66% of the cases, additional information regarding location, size, configuration, and/or characterization of the lesion was obtained from postcontrast scans. The investigators made a change from referral diagnosis to postinjection diagnosis in 30% of the cases. Postinjection images provided additional information in 96% (43/45) of intradural extramedullary and intramedullary tumors; it also provided additional information in 20 (53%) of 38 cases of extradural tumor. Gadopentetate dimeglumine demonstrated a high level of safety and tolerance, as evidenced by the lack of clinically significant trends toward abnormal changes from baseline evaluations for physical and neurologic examinations, vital signs, and hematologic and blood chemistry parameters and by the low prevalence and mild nature of adverse reactions. Gadopentetate dimeglumine was found to be efficacious in the evaluation of suspected spinal tumors. High levels of safety and tolerance were demonstrated.

Blinded comparison of cranial CT and MR in closed head injury evaluation.

PURPOSE: To compare CT and MR in the evaluation of acute head injury. METHODS: One hundred seven consecutive patients who were referred to the emergency department and underwent both MR and CT cranial examinations within 48 hours were retrospectively reviewed. The films were interpreted by two neuroradiologists blinded to all patient information. RESULTS: The sensitivity of MR was significantly higher than that of CT for the detection of contusion, shearing injury, subdural and epidural hematoma, and sinus involvement. The sensitivity of CT was significantly higher than that of MR for the evaluation of fracture. The sensitivities of MR and CT were statistically equivalent for the detection of superficial soft-tissue injury. The overall sensitivity of MR for the detection of abnormalities in acute head trauma was 96.4%, and for CT was 63.4%. CONCLUSIONS: CT and MR are complementary studies in the evaluation of acute head trauma. MR is necessary to define or exclude contusions, deep shearing injury, and extraaxial fluid collections in acute head trauma.

CT infusion scanning for the detection of cerebral aneurysms.

Computerized tomography (CT) infusion scanning can confirm the presence or absence of an aneurysm as a cause of spontaneous intracerebral hemorrhage. Eight patients who presented with spontaneous hemorrhage were examined using this technique. In five patients the CT scan showed an aneurysm which was later confirmed by angiography or surgery; angiography confirmed the absence of an aneurysm in the remaining three patients. This method is an easy effective way to detect whether an aneurysm is the cause of spontaneous intracerebral hemorrhage.

Adult "congenital" bilateral occlusion of the foramina of Monro.

Bilateral occlusion of the foramina of Monro was detected and treated in a hydrocephalic adult who developed rapid striking recent memory loss. She was treated by midline windowing of the third ventricle into the dilated lateral ventricles at a location 2 cm posterior to the occluded foramina of Monro. No inflammation was present. A biopsy specimen showed no evidence of malignancy. A reservoir was placed for long-term measurement of intraventricular pressure. Ten-year follow-up with pressure measurements, serial computed tomography scans, and magnetic resonance imaging showed no evidence of tumor.

Holistic approach to analysis of medical data: cancer of the corpus uteri.

Besides the information regarding his/her disease, each hospitalized cancer patient also provides the variety of data regarding his/her psychological, cultural, social, economical, genetic, constitutional and medical background. The aim of this study was to introduce a holistic approach to analysis of medical data, in this case clinical data regarding cancer of the corpus uteri. Such approach requires the collection of data regarding different aspects of the cancer patient, and after the satisfactory sample size is obtained (which should be at least five times greater than the number of examined patient characteristics), the performance of factor analysis. In this study, the authors have processed the data regarding 25 characteristics of 928 corpus uteri cancer patients treated between 1980 and 1990 at the Department for Gynecological Oncology of the University Hospital for Gynecology and Obstetrics, Zagreb, Croatia. In factor analysis, the principal components were rotated after the initial extraction (the authors recommended the use of oblimin rotation) in order to obtain better ground for interpretation of the obtained results. The next step in this approach was the stepwise exclusion of characteristics with smallest communalities according to Kaiser-Meyer-Olkin criteria, and retaining the characteristics and components with the most significant impact on the explained system variance. When the number of principal components and initial analyzed characteristics was reduced to 3-4 and 7-10, respectively, the ultimate interpretations and conclusions were made. This approach outlined some clusters of correlations between medical data which are difficult to identify using other statistical procedures, primarily the impacts of various socioeconomic and hereditary-constitutional variables on overall survival.

Prognostic value of connexin43 expression in patients with clinically localized prostate cancer.

Connexins (Cxs) are a family of transmembrane proteins that build cell-to-cell channels in gap junctions. Gap junctions composed of Cxs have an essential role in intercellular communication, adhesion and cell differentiation. Several studies investigated the role of connexin43 (Cx43) in different carcinomas; however, none investigated its prognostic role in prostate cancer. Cx43 expression and relationship with established prognostic features were assessed in a cohort of 102 patients treated with radical prostatectomy for clinically localized prostate adenocarcinoma. Cx43 expression in prostate cancer was significantly associated with established features indicative of worse prognosis, such as follow-up time (P < 0.001) and preoperative PSA (P < 0.007). Patients with lower Cx43 expressions in tumours have shorter follow-up time, which indicated shorter disease-free survival and higher preoperative PSA values. Furthermore, tumours with positive surgical margins (P < 0.001) showed significantly lower Cx43 expression compared with tumours without this feature. In univariate (P < 0.001) and multivariate (P = 0.014) analyses, decreased Cx43 expression was found to be a significant predictor of biochemical recurrence free-survival. Study results show the association of decreased Cx43 expression with prostate cancer progression. Moreover, Cx43 could serve as an additional prognostic marker and used together with traditional prognostic markers might help in further stratifying the risk of disease progression in patients with prostate cancer.

Expression and prognostic role of syndecan-2 in prostate cancer.

Syndecans are a four-member family of transmembrane heparan sulphate proteoglycans that have different functions in cell signalling, adhesion, cytoskeleton organization, migration, proliferation, and angiogenesis. Several studies investigated the role of syndecan-2 (SDC2) in different carcinomas; however, only one being focused on SDC2 in prostate cancer. SDC2 expression and relationship with established prognostic features were assessed in a cohort of 86 patients treated with radical prostatectomy for clinically localized prostate adenocarcinoma. SDC2 expression was present in the majority of prostate cancers and absent in only 11.6% of cases. SDC2 expression was also recorded in cells of prostatic intraepithelial neoplasia, whereas normal prostatic epithelial tissue and stroma did not express SDC2. SDC2 overexpression in prostate cancer was significantly associated with established features indicative of worse prognosis such as higher preoperative PSA (P=0.011), higher Gleason score (P<0.001), positive surgical margins (P<0.003), and extraprostatic extension of disease (P<0.003). Moreover, expression of SDC2 was also associated with biochemical disease progression on univariate analysis (P<0.001). Study results supported the potential role of SDC2 in prostatic carcinogenesis and cancer progression. Moreover, SDC2 could serve as an additional prognostic marker that might help in further stratifying the risk of disease progression in patients with prostate cancer.

Jugular vein obstruction caused by turning of the head.

In vivo and cadaver studies demonstrated that turning the head to one side results in torsion and compression of the ipsilateral internal jugular vein. This can obstruct venous drainage from the head and cause increased intracranial pressure in patients who have had ligation or resection of the contralateral jugular vein or who have maldevelopment of the contralateral dural sinuses.

Nuclear magnetic resonance imaging. Applications in the diagnosis of cerebrospinal diseases.

The applications of the important new diagnostic modality, nuclear magnetic resonance (NMR) imaging (or MRI), to the diagnosis of diseases of the central nervous system (CNS) are discussed. Specific examples of NMR imaging of cerebral and spinal tumours, infarction, demyelination and subdural haematomas are illustrated and compared with corresponding CT scans. The greater sensitivity of NMR, together with its ability to image in axial, coronal and sagittal planes, suggests that NMR will replace CT for many diagnostic investigations of the CNS.

Gadolinium-DTPA-enhanced MR imaging of spinal neoplasms: preliminary investigation and comparison with unenhanced spin-echo and STIR sequences.

Unenhanced T1- and T2-weighted spin-echo, short inversion time inversion recovery (STIR), and gadolinium-DTPA (Gd-DTPA)-enhanced spin-echo and STIR imaging techniques were used in 20 patients as part of a multicenter study to assess the safety and efficacy of Gd-DTPA in spinal imaging. Five patients had normal MR scans. Of those with lesions, both Gd-DTPA-enhanced T1-weighted spin-echo and unenhanced STIR scans improved detection and evaluation of spinal tumors over conventional spin-echo methods, particularly T2-weighted spin echo, by providing higher tissue contrast in shorter imaging times. The Gd-DTPA-enhanced T1-weighted spin-echo scans were most helpful in evaluating intradural tumors, whereas STIR sequences were most effective for extradural tumors and bone metastases. In most cases, Gd-DTPA-enhanced T1-weighted spin-echo scans best delineated tumor margins, and the enhancement was helpful in suggesting a cellular or active nature of the lesions. In some cases, the enhancement resulted in a more homogeneous and thus less abnormal-appearing marrow in vertebrae involved by tumor; therefore, a precontrast T1-weighted spin-echo scan is necessary in all patients who are to be studied with Gd-DTPA. A combined approach that uses T1-weighted spin-echo, Gd-DTPA-enhanced T1-weighted spin-echo, and STIR images currently appears optimal for MR imaging of spinal neoplasms. T2-weighted spin-echo images add information only in occasional cases.

High-resolution CT scanning in the evaluation of cervical spine fractures: comparison with plain film examinations.

Forty-nine patients with cervical spine fractures were identified among 160 patients who underwent CT of the cervical spine for blunt trauma. Although there was a high index of suspicion on the plain film interpretation, as well as a large percentage of false positives, many fractures were found on CT that were not suggested, even in retrospect, on the plain radiographs. Of the 136 fractures ultimately identified in these patients, CT detected 135 (99%) while only 64 (47%) were seen or suspected on the initial screening radiographs. At first glance, this might appear to discredit the plain films as a screening device. However, most of these "occult" fractures occurred in vertebrae that had been identified as probably fractured in other parts, for example, pedicle fractures found in vertebrae initially suspected of harboring only a vertebral body fracture. Most of the remainder of the uncovered fractures were in vertebrae immediately adjacent to ones that were initially identified as fractured. Indeed, of the 49 patients with fractures, only one had an adequately exposed and positioned plain film that was completely normal. The ability of CT to determine quickly and confidently the presence or absence of cervical fractures and to define the position of fragments in relation to the spinal canal is of considerable value in the medical and nursing management of the seriously traumatized patient. For example, when a fracture is seen or suspected on conventional films, a limited CT examination of the area is recommended. Plain films should be used to guide the CT examination so that an intact vertebra above and below the lesion is included. If an adequately exposed and positioned plain film series of the cervical spine is normal, it is unlikely that CT will reveal a fracture. While conventional radiographs fail to detect a surprising number of fractures, they retain their value as a screening tool and as a guide to selective CT imaging.

Bile flow through drainage catheters: an in vitro study.

An in vitro model was developed to measure bile flow at varied pressures through several commonly used transhepatic drainage catheters. As expected, larger catheters conduct more bile flow at a given pressure. All catheters studied conduct adequate amounts of bile at normal physiologic pressure gradients. The clinical observation that large catheters (10-12 French) are necessary for adequate antegrade drainage in some patients must be explained by an abnormal bile viscosity, increased duodenal pressures, or reduced biliary secretory pressure.

The natural history and CT appearance of acquired hyperopia with choroidal folds.

Seven healthy adults with acquired hyperopic change in refractive error had choroidal folds in affected eyes. High resolution computerized tomographic scanning techniques used to obtain coronal, oblique coronal, and parasagittal reformations revealed flattening of the posterior globes and mild to moderate optic nerve enlargement. In 5 of 11 eyes, a space was noted between the optic nerve and its sheath, implying expansion of the sub-arachnoid perineural compartment. The clinical findings and natural history of this syndrome, based on an average follow-up of 4.5 years, are discussed.