Implementation of a 7T Epilepsy Task Force consensus imaging protocol for routine presurgical epilepsy work-up: effect on diagnostic yield and lesion delineation.

OBJECTIVE: Recently, the 7 Tesla (7 T) Epilepsy Task Force published recommendations for 7 T magnetic resonance imaging (MRI) in patients with pharmaco-resistant focal epilepsy in pre-surgical evaluation. The objective of this study was to implement and evaluate this consensus protocol with respect to both its practicability and its diagnostic value/potential lesion delineation surplus effect over 3 T MRI in the pre-surgical work-up of patients with pharmaco-resistant focal onset epilepsy. METHODS: The 7 T MRI protocol consisted of T1-weighted, T2-weighted, high-resolution-coronal T2-weighted, fluid-suppressed, fluid-and-white-matter-suppressed, and susceptibility-weighted imaging, with an overall duration of 50 min. Two neuroradiologists independently evaluated the ability of lesion identification, the detection confidence for these identified lesions, and the lesion border delineation at 7 T compared to 3 T MRI. RESULTS: Of 41 recruited patients > 12 years of age, 38 were successfully measured and analyzed. Mean detection confidence scores were non-significantly higher at 7 T (1.95 ± 0.84 out of 3 versus 1.64 ± 1.19 out of 3 at 3 T, p = 0.050). In 50% of epilepsy patients measured at 7 T, additional findings compared to 3 T MRI were observed. Furthermore, we found improved border delineation at 7 T in 88% of patients with 3 T-visible lesions. In 19% of 3 T MR-negative cases a new potential epileptogenic lesion was detected at 7 T. CONCLUSIONS: The diagnostic yield was beneficial, but with 19% new 7 T over 3 T findings, not major. Our evaluation revealed epilepsy outcomes worse than ILAE Class 1 in two out of the four operated cases with new 7 T findings.

Thymolipoma. A report of nine cases, with emphasis on its association with myasthenia gravis.

PURPOSE: Thymolipomas are rare tumors of the anterior mediastinum accounting for up to 9% of all thymic tumors. These tumors are associated with autoimmune diseases in up to 50% of the patients, including myasthenia gravis, aplastic anemia, hypogammaglobulinemia, lichen planus, and Graves' disease. These tumors with a fatty appearance also can arise in older patients with autoimmune disease. METHODS: This retrospective study evaluated the thymolipomas from nine patients at a single institution, which were resected between 2002 and 2007. The clinical data as well as radiologic findings were evaluated, together with the follow-up. RESULTS: Seven patients initially presented with myasthenia gravis, and therefore they underwent a resection of the thymus, even though imaging techniques did not reveal a tumor in any of the cases. Another patient showed no symptoms of autoimmune disease for 20 years, and though cardiomegaly was suspected, further investigation revealed a thymolipoma. The symptoms of myasthenia gravis improved following the surgery in one patient. During follow-up, one patient died due to esophageal cancer, and the remaining patients are alive without recurrence. CONCLUSIONS: Thymolipomas are benign tumors that show an excellent outcome. Patients with autoimmune disease symptoms occasionally show an improvement of the symptoms after a resection of the tumors.

Are Women Really Less Competitive Than Men? Career Duration in Nordic and Alpine Skiing.

Do women shy away from competition while men compete too much? The available, mostly experimental evidence generally supports these assumptions. However, in contrast to laboratory settings, labor markets do not have random assignment of workers. Instead, individuals-professional athletes and corporate executives-self-select into specific occupations. Using data from Alpine and Nordic skiing over 52 and 37 years respectively, we show that career length of men and women is virtually identical. Thus, when adequately controlling for self-selection into a highly competitive environment, differences between men and women with respect to competitiveness completely disappear.

[Etiology, therapy and prophylaxis of bovine parturient paresis (hypocalcaemia)]. / Wesen, Ursachen, Therapie und Prophylaxe der hypokalzämischen Gebärparese beim Rind.

Due to the sudden increase of calcium demand at the onset of lactation many high yielding dairy cows experience a certain level of hypocalcaemia following parturition. The incidence of hypocalcaemia (parturient paresis) increases with age but also depends on many other factors such as the acid-base status and the availability of calcium as well as other minerals and trace elements. Hypocalcaemia can easily be treated by supplementation of calcium parenterally or orally, nonetheless, prophylaxis of the condition should be the main focus in modern dairy farming, in order to avoid its negative effects. Oral administration of calcium around parturition is the simplest way of prophylaxis, but results in a high work load and requires exact knowledge of the date of parturition. The latter also applies for the parenteral administration of vitamin D3, which should be injected 1 week before parturition. Additionally, repeated treatment with vitamin D increases the risk for calcinosis. Reducing the calcium concentration of the ration fed during the late dry period also decreases the risk for hypocalcaemia by activating the mechanisms for calcium homeostasis within the body. The induction of a mild (compensated) metabolic acidosis to increase the sensitivity of parathormone receptors and enhance intestinal calcium uptake may also be employed to prevent milk fever. For this purpose, a DCAD (dietary cation anion difference) diet is fed during the late dry period, in which the concentrations of strong cations (potassium and sodium) as well as strong anions (sulfate and chloride) are altered. This may either be achieved by reducing the potassium concentration (partial-DCAD) or by adding anionic salts (full-DCAD). This method, especially the full-DCAD variant, requires a substantial level of surveillance and monitoring. Suitable prophylactic measures for the prevention of hypocalcaemia must be chosen individually for each farm, depending on the incidence of hypocalcaemia as well as personnel and structural resources.

[Evaluation of sonographic parameters as prognostic risk factors in cats with pancreatitis - A retrospective study in 42 cats]. / Prognostische Bedeutung sonographischer Parameter der Pankreatitis der Katze.

OBJECTIVE: Pancreatitis in cats can have different clinical courses. A range from asymptomatic or mild, unspecific clinical signs to severe disease with multi-organ dysfunction or even death has been described. It is sometimes difficult to evaluate the prognosis of the cat based on clinical findings, laboratory diagnostics and diagnostic imaging. There are only a few studies that have examined the outcome and prognostic factors for cats with pancreatitis. In cats presenting with signs of pancreatitis, the feline pancreatic lipase immunoreactivity (fPLI) and sonography are frequently used for establishing a diagnosis. Different sonographic parameters have been described to be asso ciated with pancreatitis. The aim of this retrospective study was to determine whether certain sonographic parameters correlate with the severity and the outcome of pancreatitis in the cat. MATERIAL AND METHODS: In 42 cats, presented with at least two clinical signs consistent with pancreatitis and increased fPLI-values (> 5.3 µg/l), the following sonographic parameters were examined: thickness, surface and echogenicity of the pancreas, echogenicity of the peripancreatic fat tissue and the presence of ascites. Cats surviving the first 30 days were classified as survivors and those dying within 30 days as nonsurvivors. RESULTS: Sonographic changes were found in 33/42 cats (79 %). The most frequent sonographic abnormalities were hyper-echoic peripancreatic fat (55 %), hypoechoic pancreatic tissue (45 %) and a thickened pancreas (36 %). There was no significant correlation between sonographic changes and the outcome of the cats. No significant differences in the fPLI concentration were found between the two groups. The fPLI concentration correlated significantly with the prognosis. CONCLUSION: Neither the presence nor the intensity of the sonographic changes correlate with the outcome of cats with pancreatitis. Contrary to this, the fPLI value is a negative prognostic factor, as has been described previously.

Correlation of clinical, diagnostic and histopathological parameters in dogs with chronic lymphocytic-plasmacytic enteropathy.

OBJECTIVE: The objective of this study was to correlate clinical signs and diagnostic parameters with duodenal inflammatory and architectural changes in dogs with lymphocytic-plasmacytic enteropathy. MATERIAL AND METHODS: In a retrospective study dogs presented between 2003 and 2014 with chronic gastrointestinal signs (duration > 3 weeks) and histologic evidence of intestinal lymphocytic-plasmacytic inflammation were evaluated. Clinical signs, serum albumin, cobalamin and folic acid concentrations were recorded and a sonographic, endoscopic, histologic and cytological inflammatory score was determined. Furthermore, the presence of lacteal dilation, villus stunting, crypt lesions, epithelial integrity and increased intraepithelial lympho cytes was evaluated. RESULTS: A total of 270 dogs were retrospectively evaluated. No significant correlation was found between clinical signs and sonographic, endoscopic or duodenal inflammatory score. Dogs with histological signs of lacteal dilation (p = 0.001) and increased intraepithelial lymphocytes (p = 0.005) had significantly higher clinical scores compared to dogs without these changes. No correlation was found between clinical score and villous stunting or crypt lesions. Hypoalbuminemia and hypocobalaminemia correlated significantly with lacteal dilation (p = 0.001, p = 0.009) and increased intraepithelial lymphocytes (p = 0.036, p = 0.018). CLINICAL SIGNIFICANCE: Some clinical and diagnostic parameter correlate with histopathologic features whereas others do not. Morphological features seem to be more important than the intensity of the duodenal inflammation in the assessment of the disease.

Correlation between the FCEAI and diagnostic parameters in chronic enteropathies in 147 cats (2006-2012).

OBJECTIVE: The Feline Chronic Enteropathy Activity Index (FCEAI) has been established as a quantitative index for disease activity in chronic enteropathies in cats. A definite diagnosis is aimed at histology with initial exclusion of extraintestinal causes by laboratory examinations, diagnostic imaging and endoscopy. The study aimed to examine diagnostic parameters and FCEAI in chronic gastroenteropathies. MATERIALS AND METHODS: A retrospective case review of 147 cats with chronic enteropathies was performed. In all patients, the FCEAI was established and endoscopy performed including biopsies and duodenal cytology. Histopathologic reports were reviewed for the diagnosis of lymphoma and architectural changes (epithelial integrity, villi/gland atrophy, intestinal crypt atrophy, lymphangiectasia, epitheliotropism/infiltration of intraepithelial lymphocytes). A cytopathologic score (CS) and histopathologic score (HS) regarding lymphocytic intestinal infiltration were assigned. Statistical dependency analysis was used to determine correlations between the FCEAI, lymphoma, architectural changes, CS, HS, serum concentrations of cobalamin, folate and albumin. RESULTS: The 147 cats consisted of predominately European Shorthair cats (n = 126), were mostly castrated (n = 127) and had a mean age of 9.8 (1-17) years. For the proven lymphoma group (12.2%; n = 18) and the non-lymphoma group a mean FCEAI of 7.3 (4-17) and 6.6 (2-13), respectively, was established. The FCEAI showed a low correlation with the CS (p = 0.010; R = 0.22) and intestinal villous atrophy (n = 121; p = 0.035; R = 0.19). Cats with a CS of 0 had a significant lower FCEAI score (p = 0.015) than cats with all other CSs. The histo- and cytopathologic scores were highly related (p < 0.001; R = 0.43). The gastric intraepithelial lymphocytic infiltration (n = 131) was significantly correlated to serum folate (p = 0.014; R = -0.56) and albumin (p = 0,048; R = -0.20). CONCLUSION: The FCEAI showed only a few correlations. Not only the grade of inflammation, but also the histologic architectural changes are of importance.

A typical thymic carcinoid tumour within a thymolipoma: report of a case and review of combined tumours of the thymus.

Thymolipomas are rare tumours located in the anterior mediastinum. Sometimes these tumours may be combined with thymomas or lymphomas. We present a unique case of a thymic carcinoid arising within a thymolipoma. A 68-year-old patient presented with chronic chest and neck pain, which was initially thought to be caused by coronary artery disease. A chest x-ray, exercise tolerance test and coronary angiography were unremarkable. The following CT scan of the neck and chest showed a small tumour in the anterior mediastinum. A robotic-assisted thymectomy was performed and histological examination revealed a neuroendocrine tumour of the thymus within a thymolipoma. The patient was discharged 3 days after surgery in good general condition.

Association between atherosclerosis and urothelial tumors of the renal pelvis.

OBJECTIVES: An association between the prevalence of general and local atherosclerosis and various types of cancer has previously been reported. The present study therefore aimed to morphometrically compare atherosclerotic changes in kidneys with urothelial carcinomas of the renal pelvis and tumor-negative renal tissue. MATERIALS AND METHODS: The intima-to-media ratio (IMR), which is the most sensitive marker for the degree of atherosclerosis, was evaluated in arteries (n = 492) of non-invasive papillary urothelial carcinoma (n = 128), invasive urothelial carcinoma (n = 168) and tumor-negative renal specimens (n = 196). RESULTS: IMR was significantly higher and more often exceeded 1 in invasive and non-invasive urothelial carcinomas than in tumor-negative specimens. Furthermore, in invasive urothelial carcinomas IMR was significantly higher in immediately peritumorous arteries than in more distant arteries. Moreover, IMR correlated weakly with age and renal parenchymal inflammation but not with peritumorous inflammation, coronary heart disease (CHD) or gender. CONCLUSION: Local atherosclerosis was more pronounced in tumor-positive than in tumor-negative renal specimens. IMR > 1 was significantly associated with urothelial tumors and the overall odds of having a urothelial tumor were significantly greater for patients with an IMR > 1 than for patients with an IMR < or = 1, supporting the view that patients with local atherosclerotic lesions are at elevated risk for urothelial carcinoma of the renal pelvis.