The role of diffusion-weighted MRI in the classification of liver hydatid cysts and differentiation of simple cysts and abscesses from hydatid cysts.

PURPOSE: The purpose of this study is to identify the role of diffusion-weighted magnetic resonance imaging (DW-MRI) in the classification of liver hydatid cysts (HCs) and their differentiation from simple cysts and liver abscesses. MATERIALS AND METHODS: Twenty-two patients that were sent to our department with preliminary diagnoses of HCs or abscess were included in the study. Thirty lesions were evaluated. MRI included T1-weighted fast gradient echo, T2-weighted half-Fourier acquisition single-shot turbo spin echo, and DW single-shot echo planar pulse sequencing (b, 0, 50, and 1000 s/mm²). The apparent diffusion coefficient (ADC) values (mm²/s) of the HCs, abscesses, and simple cysts were calculated. RESULTS: No statistically significant difference was found between the ADC values of type 1 and 3 (P > 0.05) HCs and of simple cysts and type 1 HCs (P > 0.05). The ADC values of abscesses were significantly lower than those of type 1 and type 3 HCs, and simple cysts. No statistically significant difference was found between the ADC values of abscesses and type 4 HCs (P > 0.05). Type 4 lesions exhibited significantly lower ADC values in comparison to type 1 and 3 HCs. CONCLUSION: DW-MRI helps differentiate type 4 lesions from other cysts and can distinguish abscesses from hydatid cysts other than type 4 as well as from simple cysts. Type 1 HCs cannot be differentiated from simple cysts using ADC values alone, and type 4 lesions are indistinguishable from abscesses.

The effect of blood albumin and total lymphocyte count on short-term results in elderly patients with hip fractures.

BACKGROUND: A study was performed to determine the effects of blood albumin and total lymphocyte count on the postoperative one-year period in 74 elderly hip fracture patients. METHODS: In 2006, 74 patients (52 female, 22 male) with hip fracture who were 65 years of age or older were included in the study. Admission albumin levels and total lymphocyte counts were recorded. The outcomes examined were mortality, length of hospital stay and ambulatory ability. Ambulatory ability was assessed according to Parkland and Palmer criteria. RESULTS: There were 61 patients aged 65-84 years, and 13 patients aged 85-105 years. Forty-one patients (55.4%) had hypoalbuminemia and 23 patients (31.1%) had low total lymphocyte count. Low albumin and total lymphocyte counts were associated with higher mortality (p = 0.011). Patients with low albumin levels had longer length of hospital stay (p = 0.002). Patients with normal albumin and total lymphocyte counts had higher mobility score meaning better function (p = 0.012). Multivariate analysis yielded that low total lymphocyte count, American Society of Anesthesiologists (ASA) 3-4 and female gender remained significant independent predictors of one-year mortality. No single blood parameter was found to be effective on ambulatory status. CONCLUSION: Risk of mortality in elderly hip fracture patients increases with female gender, ASA 3-4 and low total lymphocyte counts. Hypoalbuminemia is associated with longer hospitalization. Identification of these risk factors can help in the case management for a more favorable outcome.

The effects of phytoestrogens on fracture healing: experimental research in New Zealand white rabbits.

BACKGROUND: Phytoestrogens are plant-derived natural molecules having some bone forming and bone substituting effects. In the present study, the role of phytoestrogens on bone healing was investigated in a rabbit fracture model. METHODS: Twenty-two New Zealand white rabbits with right tibia fracture were divided into two groups randomly. The plant derived extract of Vitex agnus-castus L. (Verbenaceae) prepared before the study was administered intramuscularly in group 1 and group 2 was chosen as control. Fracture healing was monitored in weekly basis with blood alkaline phosphatase level, radiographs of extremities and 99m-Tc MDP bone scintigraphy. The study was finished at the end of the 3rd week. The extremities including tibial fractures were collected for histological examination. RESULTS: Radiographic evidence of fracture healing obtained on postoperative day seven was superior in group 1 than control group (p<0.01). The 99m-Tc MDP bone scintigraphy uptake ratios on postoperative seventh day showed higher uptake in group 1 than in group 2 (p<0.05). The differences of scintigraphic uptakes in fractured tibias calculated on postoperative seventh day and postoperative 14th in group 1 were higher than group 2 (p=0.04). The histopathologic evaluation performed after sacrification of all rabbits on postoperative 25th day showed no significant difference between both groups. No statistical difference was determined related to the other variables. CONCLUSION: Flavonoids affected positively the early periods of fracture healing mechanism in New Zealand white rabbits. We suggest further studies with phytoestrogens to determine the effects of various dosages and administration ways.

The significance of hemosiderin deposition in the lungs and organs of the mononucleated macrophage resorption system in infants and children.

Hemosiderin deposition is not often recognized on routine examination with hematoxylin and eosin staining; however, iron stains may be helpful in the evaluation of hemosiderin deposition in infant autopsies. This report describes the data obtained from autopsy of 86 infants and children whose deaths were investigated at the Forensic Medicine Council Bursa Morgue Department from January 2000 to January 2003. A histochemical technique was used to identify hemosiderin in lung, liver and spleen specimens, which was correlated with other descriptive variables such as the reported cause of death, postmortem interval, trauma history, gender, and age. There was a weakly positive but significant correlation between lung and liver hemosiderin scores (Spearman's rank correlation coefficient, rho=0.348, p=0.001); i.e., given an increase in lung hemosiderin scores, an increase in liver hemosiderin scores was also observed. Similarly, a marked positive correlation between spleen and liver hemosiderin scores (Spearman's rank correlation coefficient, rho=0.335, p=0.002) was observed. The probability of spleen hemosiderin-positive cases belonging to the age group under 6 months was found to be 4.3 times greater than those who were hemosiderin-negative (95% confidence interval, 1.6-11.8). After the major differential diagnoses were ruled out, this study demonstrated, that depending on the statistically assessed morphometric grounds, the presence of hemosiderin deposits in the liver and spleen were significantly higher in the age group under 6 months.

The levels of caspase-cleaved cytokeratin 18 are elevated in serum from patients with lung cancer and helpful to predict the survival.

Caspase-cleaved cytokeratin 18 fragments (M30 antigen) can be detected in the circulation of patients with carcinoma and are believed to reflect cell death of tumors of epithelial origin. M30 antigens cleaved at Asp396 are detected using an epitope-specific antibody (M30 antibody). We here measured the levels of such fragments in patients with lung cancer (n=60), patients with benign lung disease (n=22) and healthy control subjects (n=32). A statistically significant difference was observed between these groups (p<0.001; Kruskal-Wallis). Basal M30 antigen levels were evaluated with regard to their predictive power of survival. The best cut-off value for M30 antigen level for the prediction of death was 43.8 U/L. Patients with basal M30 antigen levels higher than 43.8 U/L had significantly shorter median survival than those with lower basal M30 antigen levels (p=0.013; hazard ratio: 3.9) (95% CI=1.3-11.4). To determine whether cytotoxic therapy increases serum M30 antigen in lung cancer patients, we monitored the levels of M30 antigen in 18 lung cancer patients before chemotherapy and after 24 and 48 h. An approximately four-fold increase in M30 antigen levels was observed at 48 h (p<0.001). These results suggest as a first time that serum M30 antigen might be used as a novel biomarker for prediction of survival as well as for monitoring the efficiency of chemotherapy in lung cancer patients.

Value of chemical shift subtraction MRI in characterization of adrenal masses.

OBJECTIVE: The purpose of this study was to assess the advantages of the image subtraction technique in chemical shift MRI for the differentiation of adrenal adenomas from nonadenomas. SUBJECTS AND METHODS: Thirty-five patients with 42 adrenal masses (eight metastases and 34 nonfunctioning adenomas) underwent chemical shift MRI using a double-echo fast low-angle shot sequence. Subsequently, opposed-phase chemical shift MR images were subtracted from in-phase images. The subtraction images were assessed quantitatively and qualitatively. For quantitative assessment, the signal intensity values of the adrenal masses were measured by one investigator with manually defined regions of interest. Qualitative assessment of the subtraction images was performed independently by two investigators, who reported their confidence in diagnosing adenomas versus nonadenomas based on signal intensity of the adrenal masses on subtraction images. RESULTS: The mean signal intensities were significantly different between adenomas and metastases on subtraction images (213 vs 18; p < 0.0001). There was no overlap in signal intensities between adenomas and metastatic tumors. The accuracy in distinguishing adenomas from metastatic tumors was 100% if the cutoff value of the signal intensity selected was 36-106. Quantitative results corresponding to 100% specificity were also observed, with similar sensitivity. No difference in interpretation between the two investigators occurred. CONCLUSION: Chemical shift subtraction MRI provides a high confidence level in distinguishing adrenal adenomas from adrenal metastases. The image subtraction technique also facilitates quantitative and qualitative evaluation of adrenal masses in chemical shift MRI.