Improving practice in radiology: a quality-improvement project examining CT colonography patient dose and scanning technique.

AIM: To audit scanning technique and patient doses for computed tomography (CT) colonography (CTC) examinations in a large UK region and to identify opportunities for quality improvement. MATERIALS AND METHODS: Scanning technique and patient dose data were gathered for both contrast-enhanced and unenhanced CTC examinations from 33 imaging protocols across 27 scanners. Measurements of patient weight and effective diameter were also obtained. Imaging protocols were compared to identify technique differences between similar scanners. Scanner average doses were calculated and combined to generate regional diagnostic reference limits (DRLs) for both examinations. RESULTS: The regional DRLs for contrast-enhanced examinations were volume CT dose index (CTDIvol) of 11 and 5 mGy for the two scan phases (contrast-enhanced and either delayed phase or non-contrast enhanced respectively), and dose-length product (DLP) of 740 mGy·cm. For unenhanced examinations, these were 5 mGy and 450 mGy·cm. These are notably lower than the national DRLs of 11 mGy and 950 mGy·cm. Substantial differences in scan technique and doses on similar scanners were identified as areas for quality-improvement action. CONCLUSION: A regional CTC dose audit has demonstrated compliance with national DRLs but marked variation in practice between sites for the dose delivered to patients, notably when scanners of the same type were compared for the same indication. This study demonstrates that the national DRL is too high for current scanner technology and should be revised.

Incidental focal colonic lesions found on (18)Fluorodeoxyglucose positron emission tomography/computed tomography scan: further support for a national guideline on definitive management.

AIM: (18)Fluorodeoxyglucose ((18)FDG) positron emission tomography/computed tomography (PET/CT) is an established part of staging in a wide variety of malignancies. Incidental abnormal uptake of (18)FDG of unknown significance is frequently encountered. Therefore, we investigated patients with abnormal colonic uptake of (18)FDG, determined by PET/CT images, using colonoscopy. METHOD: The radiology reports of all patients referred to a tertiary referral centre for a PET/CT scan were reviewed retrospectively. Patients with abnormal colonic uptake of (18)FDG were identified and the PET/CT findings were correlated with colonoscopic findings. RESULTS: Of 555 consecutive patients identified over a 26-month period, 53 had abnormal colonic uptake of (18)FDG, as determined by PET/CT images. Twenty-nine were not investigated following discussion in a specialist multidisciplinary (MDT) meeting, according to local protocol. Twenty out of 24 patients investigated by endoscopy had a colonic lesion correlating to the site identified on the PET/CT image: 16 patients had tubulovillous adenomas (nine of which were > 10 mm), two had invasive adenocarcinomas, two had diverticular disease and one had collagenous colitis; no colonic lesion was detected in three. These findings were incidental and not related to the primary diagnosis for which the scan was being performed. Accordingly, a positive predictive value of 83% is associated with the finding of abnormal uptake of (18)FDG on PET/CT images. CONCLUSION: Incidental abnormal colonic uptake of (18)FDG, determined by a PET/CT scan requires definitive colonic investigation in patients suitable for further treatment because significant colonic pathology is frequently identified. The benefit of this approach should be discussed in specialist MDT meetings and tailored to each patient; however, national guidelines for management are required.

Neo-XY body: an analysis of XY1Y2 meiotic behavior in Carollia (Chiroptera, Phyllostomidae) by chromosome painting.

Classical and molecular cytogenetic analyses of mitotic and meiotic cells were performed on two species of Carollia from the family Phyllostomidae (Chiroptera), which have an XX/XY(1)Y(2) sex determination system. Our results show that the species Carollia perspicillata and Carollia brevicauda have the same Xq-autosome translocation (neo-X). Using multicolor FISH we observed different levels of condensation of the original X and Y chromosomes when compared to the translocated autosomal segment, a likely consequence of the nucleolar organizer region blocking spreading of inactivation to the autosomal region of the neo-X. The use of chromosome painting showed the behavior of the sex chromosome trivalent--here called the 'neo-XY body'--in meiosis. We compared the variation between the condensation of the original X and Y and the autosome-sex chromosome axis and described the pairing between the original X-Y segments (pseudoautosomal region) and the XY(2) homologous segments, suggesting genetic activity of the latter during meiosis.

New insights of karyoevolution in the Amazonian turtles Podocnemis expansa and Podocnemis unifilis (Testudines, Podocnemidae).

BACKGROUND: Cytogenetic studies were conducted in the Brazilian Amazon turtles, Podocnemis expansa Schweigger, 1912 (PEX) and Podocnemis unifilis Troschel, 1848 (PUN) to understand their karyoevolution. Their chromosomal complements were compared using banding techniques (C, G-, Ag-NOR and Chromomycin A3) and fluorescence in situ hybridization (FISH), and efforts were made to establish evolutionary chromosomal relationships within the Podocnemidae family. RESULTS: Our results revealed that both species have a chromosome complement of 2n = 28. For PEX and PUN, the fundamental numbers (FNs) were 54 and 52, respectively and the karyotypic formulas (KFs) were 24 m/sm + 2st + 2a and 22 m/sm + 2st + 4a, respectively. G-banding evidenced homologies between the two species and allowed identify a heteromorphic pair (chromosome pair 10) in PUN. In PEX, constitutive heterochromatin (CH) was found in the centromeric regions of pairs 1, 2, 4, 6 and 11 and on 9p. In PUN, CH was observed in the centromeric regions of all chromosomes, and in small proximal bands on 1p, 2p, 3q, 4q, 5q, 9q, 10q and 11q. Moreover, CH amplification was seen in one of the homologs of pair 10 (the heteromorphic pair). The CMA3 staining results were consistent with the CH findings. Ag-NOR staining showed that nucleolar organizing regions (NORs) were localized in the pericentromeric region of pair 1 in both species, and this result was confirmed by the 18S rDNA FISH probe. FISH with telomeric probes identified telomeric sequences in the distal regions of all chromosomes. In addition, interstitial telomeric sequences (ITSs) were present in seven chromosome pairs of PUN, perhaps reflecting the amplification of telomere-like sequences. FISH with a probe against the transposable element (TE), Rex 6, revealed that it is dispersed in euchromatic regions of the first chromosome pairs of both species. This is the first report describing the FISH-based analysis of PEX and PUN for the 18S rDNA, Rex 6 and human telomeric sequences. CONCLUSIONS: Our results contribute to clarifying the chromosomal homologies and rearrangement mechanisms that occurred during the evolution of these species, and may help researchers uncover new markers that will improve our understanding of the taxonomy and systematic classification of Podocnemidae. TRIAL REGISTRATION: ISRCTN ISRCTN73824458. Registered 28 September 2014. Retrospectively registered.

Hepatic angiosarcoma in childhood. A case report and review of the literature.

We describe the clinical and pathologic features of an hepatic angiosarcoma in a 5-year-old child. The neoplasm manifested as a multicentric vascular tumor and was initially treated by lobectomy. Histopathologically, the lesion showed the features of infantile hemangioendothelioma, in which foci of cytologic atypia ("type 2") were present. A recurrence with rapid growth appeared that suggested a malignant tumor, but no metastases developed. A literature review confirmed the rarity of angiosarcomas in children and underscored the difficulties of formulating a prognostic estimate about infantile hemangioendotheliomas based on histology alone. Mitotic activity and cytologic atypism are regular features of angiosarcoma in children and cannot be ignored. This report also contrasts certain features of the biology of malignant vascular tumors of the liver in childhood with the counterpart in adults.

Unusually high susceptibility of NZR/Gd rats to bladder cancer induction by low doses of nitrosomethylurea.

Inbred female rats of the NZR/Gd strain were exceptionally susceptible to nitrosomethylurea (NMU) toxicity after intravesical instillations. After only 1.0 mg NMU total given in 10 fractions, 100% of NZR rats developed malignant bladder tumours. Transitional cell carcinomas predominated (56%) when the NMU dose interval was 2 weeks, and most tumours were squamous carcinomas (57%) with a 1-week interval.

Short report: seroprevalence of Taenia solium cysticercosis in pigs in Bahia State, northeastern Brazil.

To determine the prevalence and etiologic factors of Taenia solium cysticercosis in pigs in the state of Bahia, northeastern Brazil, we performed serological surveys in Salvador, the capital of the state, and in two local towns, Santo Amaro and Jequié. Residents raising free-roaming pigs in the study areas were randomly selected. Sera were obtained from the pigs and examined by the enzyme-linked immunoelectrotransfer blot assay (EITB). The prevalence of antibodies to T. solium was 4.4% (2 of 45) in Salvador, 3.2% (3 of 93) in Santo Amaro, and 23.5% (24 of 102) in Jequié. A significantly high seroprevalence in Jequié was associated with poor sanitary conditions, such as an open sewer system and no inspection process of pork before marketing.

Sex hormone receptors in localized and advanced transitional cell carcinoma of urinary tract in humans.

Sex hormone receptors were identified in patients with localized and advanced transitional cell carcinoma of the bladder and kidney. Dihydrotestosterone and testosterone receptors were found most consistently in the specimens analyzed. Estrogen receptors were found less frequently. Androgen receptors in transitional cell carcinoma may prove to be a useful biologic marker in this disease.

Delayed cutaneous hypersensitivity reaction: complication of lymphangiography.

An unusual delayed hypersensitivity skin reaction developed after lymphangiography to stage the patient's adenocarcinoma of the prostate.

Changing patterns in age distribution of renal carcinoma patients.

A review of 890 cases of renal carcinoma in patients admitted to M. D. Anderson Hospital and Tumor Institute from 1975 to 1976 has revealed a significant increase in the proportion of patients in the age group forty to forty-nine years.

Mutagenic activation of dialkylnitrosamines by intact urothelial cells.

Intact urothelial cells isolated from bladders of untreated inbred NZO/BIGd or NZC/BIGd mice and NZR/Gd rats activated dimethyl, diethyl, dipropyl, and dibutyl nitrosamines in a liquid culture mutagenesis fluctuation assay using Salmonella typhimurium TA100 as target organism. Rat and mouse urothelial cells were highly effective at 1.5 X 10(5) cells/ml, in O2 gas phase, and no cofactors were required. Relative mutagenic activities were estimated at equitoxic (LD50) concentrations of the 4 nitrosamines. Nitrosamines with odd-carbon chain substitutents were more active than the C-even compounds. Although dibutylnitrosamine is a powerful bladder carcinogen in both rats and mice while the other 3 compounds very rarely cause bladder tumours, the most active promutagens were dipropyl and dimethyl, followed by diethyl and dibutyl nitrosamines. None were active in absence of urothelial cells. Mouse bladder cells were more active than those from NZR rats. There were sex differences in the mice with NZC males and NZO females predominating, but in NZR rats urothelial cells from male and female animals were equally active. These dialkylnitrosamines are widely distributed in the environment, and our results indicate that direct mutagenic activation in the urothelium could be one factor contributing to the incidence of bladder cancer.

Solitary intestinal fibromatosis in the newborn. Rare cause of neonatal intestinal obstruction.

We describe a case of solitary fibromatosis of the ileum in an infant. Intestinal fibromatosis is a rare cause of intestinal obstruction in the newborn. The disease is poorly characterized and has been rarely reported under this name. The differential diagnosis is discussed with particular attention to inflammatory fibroid polyps, neurofibromatosis, and sarcoma. Reasons of a theoretical and practical nature are outlined that recommend the term "solitary intestinal fibromatosis" as the most appropriate name for this disease.

One year of Lamivudine therapy for portuguese patients with chronic hepatitis B.

OBJECTIVE: To assess the efficacy of lamivudine treatment on hepatitis B e antigen (HBeAg) and/or hepatitis B surface antigen (HBsAg) seroconversion, on other virological and serological markers of response including hepatitis B virus (HBV) DNA and serum aminotransferases, and the safety of lamivudine treatment in hepatitis B patients. PATIENTS: This phase III open-label study evaluated the virological and biochemical response to lamivudine in 70 Portuguese patients with HBeAg positive chronic hepatitis B. Patients were treated with lamivudine 100mg once daily for 12 months. METHODS: Antiviral activity was assessed by measuring alanine aminotransferase (ALT)/aspartate aminotransferase (AST) levels at all protocol visits, and hepatitis B serology and HBV DNA were performed at baseline and at month 12 visits. Evaluation of safety and tolerance was based on clinical adverse events and laboratory analyses. RESULTS: The primary endpoint was virological response at month 12, defined as loss of detectable HBeAg from serum with a reduction of HBV DNA to undetectable levels, and this was observed in 19/69 (27.5%) of patients. Almost half of the patients were HBV DNA negative by this time. Mean ALT values decreased steadily during treatment and by 12 months 61% of patients had values within the normal range. HBeAg seroconversion (HBeAg negative, HBeAb positive) was achieved in 27.9% of patients by 12 months, although all patients remained HBsAg positive. CONCLUSION: Lamivudine was well tolerated and the incidence of adverse events was similar to those reported in previous studies. Lamivudine treatment resulted in virological and biochemical improvements in HBeAg positive chronic hepatitis B patients, with HBeAg seroconversion in one-third of patients.

[Contribution to nursing care for patients with mitral valve disease]. / Subsídios para a assistência de enfermagem a pacientes com valvopatia mitral.

The purpose of this study was to define: the profile of patients with mitral valve dysfunction (stenosis and/or insufficiency) who were assisted at the University Outpatients' Clinic, the knowledge that these patients had concerning their disorder and the main difficulties and limitations resulting from it. The necessary data were obtained by interviewing 29 patients from November 1997 to February 1998. An analysis was conducted through the Content Analysis Technique. The results obtained helped to understand the problem under the individual's and his family's viewpoint, which helped to elaborate a nursing care program with an educational focus.

[Ambulatory nursing care for patients with aortic valve disease]. / Levantamento de subsídios para assistência de enfermagem ambulatorial a pacientes portadores de valvopatia aórtica.

This study aimed at characterizing the profile of outpatients with aortic valve dysfunction, identifying their knowledge about the disease, their major limitations during everyday activities and their means of coping with their predicament. The data obtained by semi-structured interviews with 12 patients and analyzed by quantitative and qualitative methods enabled to identify how the patients perceive the illness and the treatment as well as the implications to their everyday activities, that is, they allowed to capture reality from the subject's perspective, which is the knowledge for the elaboration of an educational proposal.

Incidental findings on positron emission tomography/CT scans performed in the investigation of lung cancer.

OBJECTIVES: This study aimed to clarify the number and cause of incidental findings detected on positron emission tomography (PET)/CT in patients undergoing investigation for presumed lung cancer. METHODS: The scan reports from PET/CT studies performed for patients with lung cancer under National Institute for Clinical Evidence guidelines from January 2006 until March 2008 were retrospectively reviewed. Incidental findings were followed up by a combination of case note review, clinician feedback, colonoscopy database, histopathology and follow-up imaging. RESULTS: 818 patients were investigated for lung cancer in the study period. 197 incidental findings were found in 175 (21%) patients. The subsequent investigation of 108 lesions confirmed a pathological correlation in 71 (66%) cases. A second primary malignancy was found in 10 patients within the bowel (6), breast (2), tongue (1) and stomach (1). A pre-malignant lesion was confirmed in 25 cases (24 large bowel tubulovillous adenomas and a follicular thyroid lesion). A further 41 (5%) benign abnormalities were detected at multiple sites; the thyroid gland was the single most frequently affected site (14 abnormalities). There were 36 (4.4%) false-positive reported findings, including 17 in the region of the pharynx and larynx and 12 within the large bowel. CONCLUSIONS: Overall, 9.2% of patients with suspected or known lung cancer having PET/CT had a confirmed incidental finding. A malignant or pre-malignant lesion was found in 1.2% and 3.0%, respectively. These were mostly located within the gastrointestinal tract. The majority of false-positive incidental findings were located in the larynx and pharynx. Uptake in these regions is unlikely to be significant in the absence of a CT morphological correlation.