Ensaio biomecânico para determinação do diâmetro de barra conectora de polimetilmetacrilato em fixador esquelético externo tipo Ia no úmero de suínos / Biomechanical test to determination the diameter of the polymethylmethacrylate bar in external skeletal fixator type Ia in swine humerusi

Fraturas ósseas podem ser corrigidas com a utilização de fixadores esqueléticos externos (FEE), método de estabilização bastante comum. Para tanto, têm-se utilizado barras conectoras de polimetilmetacrilato (PMMA) sem critério de diâmetro, as quais podem quebrar, se ficarem muito delgadas, ou ocasionar incômodo, quando muito pesadas e volumosas. O objetivo deste trabalho foi testar, por meio de ensaio biomecânico de compressão axial e flexão, qual é o diâmetro ideal da barra conectora de PMMA, correlacionado com o diâmetro ósseo para utilização em FEE tipo Ia. Utilizaram-se 24 úmeros para se realizarem medidas de comprimento, diâmetro, circunferência e ensaios biomecânicos. Após, foram confeccionadas barras de 1,5 vezes a média do diâmetro ósseo (grupo I), do mesmo diâmetro ósseo (grupo II) e de 0,5 vezes o diâmetro (grupo III). Com os resultados obtidos ao se compararem os valores dos ossos com os dos grupos II e III, verificou-se que as barras conectoras do grupo II mostraram-se mais resistentes do que o tecido ósseo no ensaio de compressão. No ensaio de flexão, os ossos resistiram mais quando comparados aos grupos II e III, sendo 4,3 vezes mais resistentes do que o grupo III nesse mesmo ensaio mecânico. Os resultados permitem um direcionamento para confecção de barras considerando-se o diâmetro ósseo como referência.(AU)

Bone fractures can be corrected from external skeletal fixators (ESF) in a fairly common internal stabilization method, in which connector bars polymethylmethacrylate (PMMA) is used. PMMA is used without criterion of diameter, and it can break if it is too thin or too heavy. It can be uncomfortable when bulky. The aim of this study was to test, through biomechanical axial compression and bending which is the ideal connector bar diameter PMMA, correlated to bone diameter for use in type Ia ESF. Twenty-four humerus were used to make measurements of length, diameter, circumference, and biomechanical testing. After the bars confected with 1.5 times the average diameter of the bone (group I), the same diameter (group II) and 0.5 times the diameter of the bone (group III). With the obtained results, using GII and GIII results, it was observed that the connector bars in group II were more resistant than the bones in the compression test. In the bending test, the bones resisted flexion strength when compared to group III and the group II was 4.3 times more resistant than group III in the same mechanical test. The results allow a direction for making bars considering bone diameter as a reference.(AU)

Betalains increase vitexin-2-O-xyloside cytotoxicity in CaCo-2 cancer cells.

Vitexin-2-O-xyloside (XVX) from Beta vulgaris var. cicla L. (BVc) seeds, betaxanthin (R1) and betacyanin (R2) fractions from Beta vulgaris var. rubra L. (BVr) roots were combined and tested for cytotoxicity in CaCo-2 colon cancer cells. XVX was the most cytotoxic molecule, but the combination of XVX with R1 and R2 significantly prolonged its cytotoxicity. Cytotoxicity was mediated by the intrinsic apoptotic pathway, as shown by an increase in Bcl2-like protein 4, cleaved Poly ADP-Ribosyl Polymerase 1 and cleaved Caspase 3 levels with a parallel decrease in anti-apoptotic protein B-cell leukemia/lymphoma 2 levels. R1 and R2, used alone or in combination, reduced oxidative stress triggered by H2O2 in CaCo-2 cells. Betalains dampened cyclooxygenase-2 and interleukin-8 mRNA expression after lipopolysaccharide induction in CaCo-2, showing an anti-inflammatory action. Our results support the use of a cocktail of R1, R2 and XVX as a chemopreventive tool against colon cancer.

Surgical time and complications of total transvaginal (total-NOTES), single-port laparoscopic-assisted and conventional ovariohysterectomy in bitches / Tempo cirúrgico e das complicações entre as técnicas de ovário-histerectomia totalmente transvaginal (total-NOTES), videoassistida com único portal e convencional em cadelas

The recently developed minimally invasive techniques of ovariohysterectomy (OVH) have been studied in dogs in order to optimize their benefits and decrease risks to the patients. The purpose of this study was to compare surgical time, complications and technical difficulties of transvaginal total-NOTES, single-port laparoscopic-assisted and conventional OVH in bitches. Twelve bitches were submitted to total-NOTES (NOTES group), while 13 underwent single-port laparoscopic-assisted (SPLA group) and 15 were submitted to conventional OVH (OPEN group). Intra-operative period was divided into 7 stages: (1) access to abdominal cavity; (2) pneumoperitoneum; approach to the right (3) and left (4) ovarian pedicle and uterine body (5); (6) abdominal or vaginal synthesis, performed in 6 out of 12 patients of NOTES; (7) inoperative time. Overall and stages operative times, intra and postoperative complications and technical difficulties were compared among groups. Mean overall surgical time in NOTES (25.7±6.8 minutes) and SPLA (23.1±4.0 minutes) groups were shorter than in the OPEN group (34.0±6.4 minutes) (P<0.05). The intraoperative stage that required the longest time was the approach to the uterine body in the NOTES group and abdominal and cutaneous sutures in the OPEN group. There was no difference regarding the rates of complications. Major complications included postoperative bleeding requiring reoperation in a bitch in the OPEN group, while minor complications included mild vaginal discharge in four patients in the NOTES group and seroma in three bitches in the SPLA group. In conclusion, total-NOTES and SPLA OVH were less time-consuming then conventional OVH in bitches. All techniques presented complications, which were properly managed.

O emprego de novas técnicas minimamente invasivas de ovário-histerectomia (OHE) vem sendo estudado em cães com o intuito de otimizar seus benefícios e reduzir os riscos aos pacientes. O presente estudo objetivou comparar o tempo cirúrgico, as complicações e dificuldades técnicas entre as abordagens por total-NOTES transvaginal, videoassistida com único portal e por celiotomia para ovário-histerectomia (OVH) em cadelas. Foram operados 12 animais por total-NOTES (grupo NOTES), 13 pela técnica videoassistida (grupo SPLA) e 15 pela técnica convencional (grupo OPEN). O período intraoperatório foi dividido em sete etapas: (1) acesso à cavidade abdominal; (2) criação do pneumoperitônio; abordagem ao pedículo ovariano direito (3), esquerdo (4) e ao corpo uterino (5); (6) síntese abdominal ou vaginal, realizado em seis de 12 pacientes do grupo NOTES; (7) tempo inoperante. Os parâmetros avaliados foram o tempo cirúrgico total e de cada etapa intraoperatória, a frequência de complicações intra e pós-operatórias e dificuldades técnicas. O tempo cirúrgico total médio dos grupos NOTES (25,7±6,8 minutos) e SPVA (23,1±4,0 minutos) foram menores que o do grupo OPEN (34,0±6,4 minutos) (P<0.05). A etapa intraoperatória que demandou maior tempo de execução foi a abordagem ao corpo uterino para o grupo NOTES, e síntese abdominal e cutânea para o grupo OPEN. Uma cadela do grupo OPEN necessitou de reintervenção para controle de hemorragia como complicação maior, e três cadelas do grupo SPVA apresentaram seroma de ferida cirúrgica como complicações menores. Concluiu-se que as técnicas de total-NOTES e SPLA apresentaram menor tempo cirúrgico que a abordagem convencional de OVH em cadelas. Todas as técnicas apresentaram complicações que foram adequadamente manejadas.

Células-tronco mononucleares associadas ao plasma rico em plaquetas na consolidação de falha óssea no cão. Estudo piloto / Mononuclear stem cells associated with platelet-rich plasma in the consolidation of bone defects in dogs. A pilot study

A padronização de técnicas e o teste da associação do Plasma Rico em Plaquetas (PRP) e das Células-Tronco Mononucleares (CTMs) na consolidação de falhas ósseas corticais, por meio de avaliação clínica, biomecânica, radiológica e histológica, é avaliada em um estudo piloto. Foram utilizados seis cães adultos, fêmeas, sem raça definida, pesando entre 5 e 10kg, separados por sorteio aleatório em seis tratamentos. Foi confeccionada uma falha elíptica de 1,0x0,4cm na cortical medial diafisária da tíbia direita de cada animal, sendo preenchida de acordo com o tratamento proposto. No cão I, a falha foi preenchida com solução fisiológica (SF); no II, com o PRP; no III, com a fração total das células mononucleares (FTCM); no IV, com a fração vascular estromal (FVE); no V, com o PRP associado à FTCM; no VI, com a associação PRP e FVE. Foram realizadas avaliações: clínicas, diariamente; dos graus de claudicação, semanalmente; radiológica e perimetria da coxa, antes, no pós-operatório imediato, aos 7, 14, 21 e 30 dias; biomecânica, antes do procedimento, aos 10, 20 e 30 dias; e biópsias, aos 15 e 30 dias. A FTCM obteve uma contagem e viabilidade média de 2,0x108cél. e 90%, respectivamente, enquanto a FVE obteve 3x106cél. e 50%. O PRP concentrou, em média, sete vezes o número inicial de plaquetas do sangue total, de 250.000 µl-1 plaquetas no sangue total para 1.750.000 µl-1 plaquetas no PRP. Obteve-se padronização adequada de técnicas, possibilitando o teste da associação entre as células-tronco mononucleares (CTMs) e o plasma rico em plaquetas (PRP), assim como seu uso isolado, no reparo de falhas ósseas corticais, indicando a possibilidade de a associação FTCM e PRP ser o melhor tratamento...

The standardization of techniques and tests of the association of Platelet Rich Plasma (PRP) and Mononuclear Stem Cells (MSCs) in the consolidation of cortical bone defects by clinical, biomechanical, radiological, and histological analysis is evaluated in a pilot study. Six adult female dogs of mixed breed, weighing between 5 and 10kg, separated by random draw in six treatments were used. An elliptical failure of 1.0 x0.4cm was done in the medial diaphyseal cortical of the right tibia of each animal, that was filled according with the proposed treatment. In dog I, the failure was filled with saline (S), in dog II with PRP, in dog III with total mononuclear cell fraction (TMCF), in dog IV with stromal vascular fraction (SVF), in dog V with association of PRP and TMCF, and in dog VI with an association of PRP and SVF. Daily clinical evaluation, weekly degrees of lameness, radiological and girth before, immediate postoperative, 7, 14, 21 and 30 days, biomechanics before the procedure, at 10, 20 and 30 days, and biopsies at 15 and 30 days were performed. The TMCF got a count and viability of 2,0x108cells and 90% respectively, while for SVF it was 3x106cells and 50%, respectively. The PRP concentrated on average seven times the original number of platelets from whole blood, platelets from whole blood 250.000 μl-1 to 1.750.000 μl-1 platelets in PRP. This afforded adequate standardization of techniques, enabling the test of association between mononuclear stem cells (MSCs) and platelet-rich plasma(PRP), as well as their separate use to repair cortical bone defects, indicating the possibility of the association between FTCM and PRP to be the best treatment...

Ovariossalpingo-histerectomia em cadelas: comparação da dor e análises cardiorrespiratória, pressórica e hemogasométrica nas abordagens convencional, por NOTES híbrida e NOTES total / Ovariosalpingohisterectomy in bitches: comparison of pain, cardiopulmonary, pressure and arterial blood gas analysis of the conventional approaches, by NOTES hybrid and NOTES pure

A cirurgia endoscópica por orifícios naturais (NOTES) é um novo conceito de abordagem videocirúrgica, que surge como alternativa à cirurgia convencional, eliminando incisões abdominais e as possíveis complicações relacionadas a ela. A proposta deste artigo foi comparar técnicas de ovariossalpingo-histerectomia (OSH) em cadelas, buscando determinar o procedimento que oferece menores alterações hemodinâmicas e menos estímulos dolorosos trans e pós-operatório. Para tanto, foram utilizadas 21 cadelas alocadas em três grupos. No primeiro, os pacientes foram submetidos à OSH por celiotomia (GC), no segundo por meio da técnica de NOTES híbrida (GNH) e no terceiro (GNT), utilizando-se a técnica de NOTES total. O tempo cirúrgico do GNH foi significativamente maior que nos demais grupos. Em ambos os grupos de cirurgia NOTES, verificou-se diminuição das pressões arteriais médias e diastólicas no transoperatório. Apenas o grupo GNH desenvolveu acidose severa no transoperatório. Levando-se em consideração as avaliações da dor, apenas o grupo convencional necessitou de analgesia resgate transcirúrgica. No pós-operatório, observou-se que os cães do GC apresentaram índices mais elevados na escala visual analógica e na escala de Melbourne que os animais dos demais grupos, sendo necessária analgesia resgate em 100% deles. Em contraste, no GNT nenhum dos cães requereram complementação analgésica pós-operatória. Conclui-se que a técnica de OSH por NOTES total apresenta parâmetros cardiorrespiratórios e hemogasométricos semelhantes à técnica convencional e mais estáveis que a técnica de NOTES híbrida, bem como resulta em menor dor trans e pós-operatória que a técnica convencional...

The aim of the present study was to perform bacteriological and molecular methods for identification of Mycobacterium bovis in lesions derived from bovine carcasses detected during routine post-mortem examination in officially inspected slaughterhouses. We checked the slaughter and inspection of 825,394 bovines, health upon ante-mortem examination, by the official service in 10 slaughterhouses of Bahia state from April, 2009 to April 2012. Lesions suggestive of tuberculosis were collected from 180 bovines and further evaluated by bacteriology and multiplex PCR. The majority of lesions were located in the respiratory tract lymph nodes and 71% were from male bovines up to 32 months old. 13.9% of samples presented small, granular and creamy-yellowish colonies after being cultured in Stonebrink-Leslie with an average growth time of 34 days. All smears from the isolated samples were Acid Fast Bacilli (AFB) and among them 56% were identified by mPCR as M. bovis. Thus, the association between post-mortem examination, culture and multiplex PCR allowed the bacillus identification in a reduced time and in regions of low prevalence, pointing out its importance for bovine tuberculosis detection and as a supportive tool for the tuberculosis control and eradication program...

The use of CEUS in the diagnosis of retinal/choroidal detachment and associated intraocular masses - preliminary investigation in patients with equivocal findings at conventional ultrasound.

PURPOSE: To investigate whether contrast-enhanced ultrasound (CEUS) may help to diagnose retinal/choroidal detachment and may help to differentiate intraocular lumps in cases with equivocal features on conventional grayscale and Doppler modes. MATERIALS AND METHODS: The institutional review board approved this retrospective study. The need for informed consent was waived. A computerized data search was performed in the database of our institution for patients with vitreous hemorrhage who underwent CEUS of the eye to assess retinal/choroidal detachment and/or associated masses. This process yielded a total of 31 patients (18 men, 13 women, age range: 39 - 88 years) in whom CEUS was performed because the findings on conventional grayscale and Doppler modes were equivocal. CEUS was performed using low acoustic power contrast-specific modes. A 2.4 - 4.8  mL bolus of SonoVue was injected, followed by a saline flush. All examinations were digitally recorded for retrospective analysis. Confirmation of CEUS findings was obtained at surgery (n = 20) or with binocular indirect fundoscopy performed after clearance of the ocular media (n = 11). Two readers with different levels of ultrasound experience independently reviewed the imaging features. A five-degree scale ranging from definitely absent (score 1) to definitely present (score 5) was used to assess the presence or absence of retinal/choroidal detachment on conventional ultrasound modes alone and with the addition of CEUS. ROC curve analysis was performed to assess the diagnostic accuracy of both methods. The inter-reader agreement was also evaluated. In patients with associated intraocular lumps, conventional Doppler modes and CEUS were used to differentiate non-tumor masses from tumor masses. RESULTS: According to the reference standard, 13 patients had retinal detachment, 4 had choroidal detachment, and 3 had both retinal and choroidal detachment. There were 8 associated intraocular lumps (4 subretinal hemorrhages, 3 malignant melanomas, 1 metastasis). The inter-reader agreement was good (K = 0.644) and very good (K = 0.833) for conventional modes and CEUS, respectively. The diagnostic performance of CEUS was high for both readers (area ± standard error under the ROC curve: 0.966 ±â€Š0.031 and 0.900 ±â€Š0.055 for readers 1 and 2, respectively). There were 2 false-positive results and 1 false-negative result in patients with proliferative diabetic retinopathy. CEUS was effective in differentiating subretinal hemorrhage from hypovascular tumors. CONCLUSION: CEUS can be used as a problem-solving technique when conventional ultrasound modes are not diagnostic for retinal/choroidal detachment and when intraocular lumps cannot be characterized as tumor or non-tumor masses on conventional modes. The evaluation of patients with proliferative diabetic retinopathy, however, may be problematic.

Preoperative evaluation in infants and children: recommendations of the Italian Society of Pediatric and Neonatal Anesthesia and Intensive Care (SARNePI).

BACKGROUND: The preoperative assessment involves the process of evaluating the patient's clinical condition, which is intended to define the physical status classification, eligibility for anesthesia and the risks associated with it, thus providing elements to select the most appropriate and individualized anesthetic plan. The aim of this recommendation was provide a framework reference for the preoperative evaluation assessment of pediatric patients undergoing elective surgery or diagnostic/therapeutic procedures. METHODS: We obtained evidence concerning pediatric preoperative evaluation from a systematic search of the electronic databases MEDLINE and Embase between January 1998 and February 2012. We used the format developed by the Italian Center for Evaluation of the Effectiveness of Health Care's scoring system for assessing the level of evidence and strength of recommendations. RESULTS: We produce a set of consensus guidelines on the preoperative assessment and on the request for preoperative tests. A review of the existing literature supporting these recommendations is provided. In reaching consensus, emphasis was placed on the level of evidence, clinical relevance and the risk/benefit ratio. CONCLUSION: Preoperative evaluation is mandatory before any diagnostic or therapeutic procedure that requires the use of anesthesia or sedation. The systematic prescription of complementary tests in children should be abandoned, and replaced by a selective and rational prescription, based on the patient history and clinical examination performed during the preoperative evaluation.

PET with radiolabeled aminoacid.

Since the clinical introduction of FDG, neuroimaging has been the first area of PET application in oncology. Later, while FDG-PET became progressively a key imaging modality in the management of the majority of malignancies outside the brain, its neuro-oncologic indications faced some limitations because of the unfavourable characteristics of FDG as brain tumor-seeking agent. PET applications in neuro-oncology have received new effectiveness by the advent of positron-emission labelled amino acids, so that it has been coined the term "Amino acid PET" to differentiate this imaging tool from FDG-PET. Radiolabeled amino acids are a very interesting class of PET tracers with great diagnostic potential in neuro-oncology because of their low uptake in normal brain and, conversely, high uptake in most brain tumors including low-grade gliomas. The present article surveys the results obtained using L-[methyl-11C]Methionine (MET), that has been the ancestor of PET amino acid tracers and is still the most popular amino acid imaging modality in oncology, and stresses the important role that this diagnostic modality can play in the evaluation of brain tumors. However, the use of MET is restricted to PET centers with an in-house cyclotron and radiochemistry facility, because of the short half-life (20 min) of 11C. The promising results of MET have stimulated the development of 18F-labelled aminoacid tracers, particularly O-(2-18F-fluoeoethyl1)-L-tyrosine (FET), that has the same properties of MET and, thanks to the longer half-life of 18F (about 110 min), allows a distribution strategy from a production tracer site to user satellite PET centers. Considering a more widespread use of Amino acid PET, together with the recent development of integrated PET-MRI imaging systems, and the oncoming clinical validation of other interesting PET tracers, i.e. FMISO or 18F-FAZA for hypoxia imaging and FLT for tumor proliferation imaging, it can be reasonably expected that metabolic imaging with PET is close to becoming a key diagnostic modality in the management of brain tumors, as has already been for Total Body FDG-PET/CT in extra-brain oncology.

Diagnostic value of contrast-enhanced ultrasonography in the characterization of ovarian tumors().

INTRODUCTION: Vascularity influences the characteristics of gynecologic tumors observed with direct imaging techniques that reveal the macrovascular component of these lesions (color and power Doppler) and with indirect imaging involving the administration of contrast agents to examine the microcirculation and interstitial perfusion (contrast-enhanced computed tomography [CT] and magnetic resonance [MR] imaging). The purpose of this study was to determine whether contrast-enhanced ultrasonography (CEUS) of ovarian lesions provides useful information that cannot be obtained with conventional US. MATERIALS AND METHODS: We used CEUS to assess 72 nonspecific adnexal lesions in 61 patients. CEUS was performed with a 4.8-ml bolus of a second-generation ultrasonographic contrast agent and dedicated imaging algorithms. For each lesion, B-mode morphology, CEUS morphology, and time/intensity curves were evaluated. RESULTS: In 8/61 cases (13.1%) CEUS offered no additional morphovascular information. In 38/61 cases (62.3%), it provided additional information that did not modify the management of the lesion, and in 15/61 cases (24.6%) it gave additional information that modified the management of the lesion. Malignant lesions were characterized by significantly shorter times to peak enhancement (11.9 ± 3.1 s vs 19.8 ± 4.0 s p < 0.01) and significantly higher peak intensity (24.7 ± 4.2 dB vs 17.8 ± 3.3 dB p < 0.01) compared with benign lesions. CONCLUSIONS: CEUS improves diagnostic confidence in the characterization of liquid-corpuscular lesions where conventional US is inconclusive. CEUS can be proposed as a valid alternative to CT and MR. However, information obtained by CEUS influences the therapy in a limited percentage of cases (24.6%).

High-resolution, three-dimensional, and contrast-enhanced ultrasonographic findings in diseases of the eye().

OBJECTIVES: To review the contrast-enhanced ultrasound (CEUS) and 3D ultrasound findings (3D-US) in various pathologies involving the eye and orbit and to compare them with high-resolution US (HRUS) findings. BACKGROUND: CEUS is a valid diagnostic tool for study several districts. There are numerous pathological conditions of the eye in which CEUS can be very helpful or detrimental. IMAGE FINDINGS: We review a wide range of ocular lesions, traumatic (retinal and choroidal detachments) and malignant (choroidal melanoma, tumors inside and outside the muscle cone) evaluated alternatively with CEUS and 3D and compare these findings with those obtained with HRUS. Dysthyroid orbitopathy is not included in this review. CONCLUSION: CEUS plays a central role in the differentiation of detached retina (vascular) and vitreous membranes (avascular). It is also helpful in the assessment of tumor of the eye, in planning treatment for choroidal melanoma, and in assessing orbital masses for neovascularization. HRUS is highly effective in the detection of traumatic and non-traumatic lesions of the eye, but it is less effective for the assessment of orbital lesions. The 3D module has increased the diagnostic value of CEUS. CEUS is cost-effective and can be used when CT and MR cannot be performed.

Expression and characterization of the periplasmic cobalamin-binding protein of Photobacterium damselae subsp. piscicida.

Abstract Cobalamin (vitamin B(12)) is an essential cofactor in a variety of enzymatic reactions and most prokaryotes contain transport systems to import vitamin B(12). A gene coding for a periplasmic cobalamin-binding protein of Photobacterium damselae subsp. piscicida was identified by in silico analysis of sequences from a genomic library. The open reading frame was composed of 834 bp encoding a protein of 277 amino acids. The protein showed 61% identity with the vitamin B(12)-binding protein precursor of P. profundum, 53% identity with the corresponding protein of Vibrio parahaemolyticus and 43% identity with the periplasmic binding protein BtuF of Escherichia coli. The expression of the native protein was investigated in P. damselae subsp. piscicida, but BtuF was weakly expressed under normal conditions. To characterize the BtuF of P. damselae subsp. piscicida, the recombinant protein was expressed with a C-terminal His(6)-tag and purified; the molecular weight was estimated to be approximately 30 kDa. The protein does not contain any free thiol group, consistent with the view that the two cysteine residues are involved in a disulphide bond. The purified BtuF binds cyanocobalamin with an affinity constant of 6 +/- 2 microm.

Synchronous urinary tract metastases from breast cancer.

Breast carcinoma has a metastatic potential to any organ system. However, breast carcinoma metastases to the urinary tract have very rarely been described. The authors present the case of a patient with a synchronous right ureteral and vesical metastasis of a breast cancer. This is the unique case reported in Literature of synchronous urinary metastatic localization from breast invasive lobular carcinoma.

Contrast-enhanced ultrasound (CEUS) assessment of superselective uterine fibroid embolization (SUFE): Preliminary experience().

PURPOSE: The use of superselective uterine fibroid embolization (SUFE) requires imaging techniques that can be used to verify the success of the procedure. The purpose of our study was to analyze the potential value of pre- and post-treatment contrast-enhanced ultrasonography (CEUS) for assessing the outcome of SUFE and for posttreatment follow-up. MATERIALS AND METHODS: We studied twelve women undergoing SUFE for uterine fibroids. In those with multiple fibroids, only the three largest were considered in this study. A total of 21 lesions (size range 3.5-9.0 cm, mean 5.2 cm) were examined. Each myoma was examined immediately before and after SUFE (while the patient was still in the angiography room) with transabdominal CEUS performed after intravenous administration of a single bolus of contrast agent. The follow-up protocol included CEUS evaluation one month after treatment and CEUS plus dynamic magnetic resonance (MR) studies six months after treatment. RESULTS: In 20/21 cases, postembolization CEUS revealed total fibroid devascularization. The remaining lesion (in a woman with multiple lesions) showed persistent vascularization after SUFE. These findings were all consistent with angiographic data. No recurrences were observed during the six-month follow-up. One patient reported the reappearance of symptoms 18 months after SUFE, and CEUS showed the persistence of intralesional vascularization. CONCLUSIONS: CEUS is effective for assessing the completeness of vascular occlusion following SUFE for uterine fibroids. CEUS findings correlate with clinical results observed one and six months after treatment. Compared with dynamic MR, CEUS is reliable and cost-effective.

Primary and secondary malignancies of the penis: ultrasound features.

Cancer of the penis is a rare neoplasm in developed countries but worldwide represents a significant health problem. In this study, the ultrasonographic features of primary and secondary malignant lesions of the penis are described. Squamous cell carcinoma usually presents as a hypoechoic lesion with heterogeneous appearance. Invasions of the corpora cavernosa and the corpus spongiosum are appreciable. B-cell lymphoma presents as well-vascularized mass, a plaque, or ulcers in the penile skin. Penile metastases results from hematogenous or lymphatic spreading of distant tumors or, more frequently, as penile infiltration by tumors from adjacent organs. Diffuse corporeal or nodular involvement can result.

Radiofrequency ablation of liver tumours with transpleurodiaphragmatic access.

Radiofrequency thermoablation (RFA) is used to treat unresectable liver tumours. RFA is performed using an abdominal access (laparotomic, laparoscopic and percutaneous). A transpleurodiaphragmatic approach has recently been proposed, particularly for the treatment of tumours which are placed near to inferior vein cava and hepatic veins and which are difficult to reach for an abdominal access. A patient with a liver metastasis of the segment VIII underwent RFA with an associated wedge resection of the segment VII, both were performed with a transthoracic access. Peri- and postoperative complications did not occurred. The patient was discharged on fifth postoperative day, and she is disease free after a follow up of 6 months. A transpleurodiaphragmatic access can be considered a safe and efficacy procedure to perform an RFA of a liver tumour in selected cases.

Humoral immune response against hepatitis C virus.

Antibodies are in several instances a reliable marker indicating vigorous immune response against infectious agents and in several viral diseases presence in the blood of specific anti-viral antibodies indicates an effective protection. However, this is not always true. For example, in the case of hepatitis C virus (HCV) an important human pathogen considered the causative agent of the nonA- nonB hepatitis, in spite of an intense antibody response there is no protection against a new infection and in the majority of infected individuals the virus overcomes host defences establishing a persistent infection. Here we describe how the dissection of the humoral immune response against HCV glycoprotein E2 of infected patients was useful for a better comprehension of the virus-host interplay. Cross-reactive antibodies directed against E2 are produced by the HCV-infected patient, but not all of them are protective, and some could even result to be detrimental for the patient. The cross-reactive anti-HCV/E2 humoral antibody response is complex and not necessarily completely beneficial to the host.

Heterogeneity of the humoral anti-HCV/E2 response in persistently infected patients as demonstrated by divergent patterns of inhibition of the binding of anti-HCV/E2 human monoclonal antibodies.

A complete understanding of the molecular features of humoral immune response could be of pivotal importance in the management of persistent viruses as HCV. In this study, 24 HCV-positive samples, characterized by classical virological parameters, are evaluated using a new assay for the quantitation of antibody subpopulations directed against discrete epitopes on surface glycoprotein E2, a key viral protein. The results, besides confirming the usefulness of this new approach, highlight the extreme heterogeneity of anti-HCV/E2 response as far as single epitopes are concerned. The specific epitopes under study are also demonstrated to be widely shared among different genotypes.

Upper respiratory tract infections and pediatric anesthesia.

Anesthesia for the child with an upper respiratory infection (URI) presents a challenge for the pediatric anesthesiologist. Differences in study design have made interpretation and comparison very difficult. The general lack of evidence-based research has led to disparities in the manner in which children which URI have been traditionally managed. Many studies have described associations between URIs and adverse events and we must decide whether to proceed or postpone the procedure and how long to postpone it. More recent research, however, suggests that children with uncomplicated infections can undergo elective procedures without significant increase in adverse anesthetic outcomes. This presentation summarizes the evolving literature about cancellation of surgery for the child with an upper respiratory infection, perioperative outcomes and anesthetic management.