Spectroscopic evaluation of glioma grading at 3T: the combined role of short and long TE.

PURPOSE: To evaluate the diagnostic value of 3T (1)H-MRS in grading cerebral gliomas using short and long echo times. METHODS: 1H-MRS was performed on 71 patients with untreated cerebral gliomas. Metabolite ratios of NAA/Cr, Cho/Cr, Cho/NAA, and mI/Cr were calculated for short and long TE and compared between low and high grade gliomas. Lipids were qualitatively evaluated. ROC analysis was performed to obtain the cut-off values for the metabolic ratios presenting statistical difference between the two glioma grades. RESULTS: Intratumoral Cho/Cr at both TEs and long TE Cho/NAA were significantly different between low and high grade gliomas. Peritumoral NAA/Cr of both TEs, as well as long TE Cho/Cr and Cho/NAA ratios, significantly differentiated the two tumor grades. Diagnostic sensitivity of peritumoral short TE NAA/Cr proved to be superior over the other metabolic ratios, whereas intratumoral short TE Cho/Cr reached the highest levels of specificity and accuracy. Overall, short TE 1H-MRS reached higher total sensitivity in predicting glioma grade, over long TE. CONCLUSION: An advantage was found in using short TE over long TE 1H-MRS in the discrimination of low versus high grade gliomas. Moreover, the results suggested that the peritumoral area of gliomas may be more valuable in predicting glioma grade than using only the intratumoral area.

The CEAP-L classification for lymphedemas of the limbs: the Italian experience.

AIM: A method to classificate lymphedema has been needed to gather all the important information on the clinical evolution of the disease using a common language and an easy clinical applicability. METHODS: The proposal for a new classification of the limb lymphedema was inspired by the C.E.A.P. classification for chronic venous insufficiency of the lower limb. The classification adopts the acronym C.E.A.P. by adding the letter L to underline the aspect ''lymphedema'' and is based on clinical data such as extension of lymphedema, presence of lymphangitis, leg ulcers and loss of functionality of the limb and instrumental criteria that permit to confirm and precise diagnosis. The Clinical classification is based on the most objective sign in these patients, the edema which is subdivided into 5 classes depending on the clinical manifestations. The etiological aspect considers 2 types of alterations of the lymphatic system: congenital and acquired. The anatomic is aimed to locate the anatomical structures involved. Pathophysiological conditions are gathered into 5 groups: agenesia or hypoplasia, hyperplasia, reflux, overload, obstruction. RESULTS: The classification has already been appraised after 4 years of activity at the unit of Vascular and Endovascular Surgery of Ferrara, at the S. Giovanni Battista Hospital in Rome, at the Umberto I Ancona Hospital and at the S. Giovanni-Addolorata Hospital in Rome. CONCLUSIONS: The proposal for a new classification of lymphedema C.E.A.P. L was developed in order to categorize patients with definite and objective marks, creating clinical reports with a common vocabulary, clear to all clinicians, permitting to stage the disease, evaluate treatment and finally obtain epidemiological and statistical data.

Primary intravascular synovial sarcoma of the femoral vein in a male patient, case report.

Synovial Sarcoma (SS) is an aggressive neoplasm commonly affecting deep soft tissues of the extremities. In rare instances SS can arise in large veins of the lower extremities or trunk. We report the first case of intravascular synovial sarcoma (IVSS) occurring in a male patient. A biphasic tumor was diagnosed by histology and immunohistochemistry. Molecular analysis at RNA level confirmed the diagnosis demonstrating the chromosomal translocation t(X;18) (p11.2;q11.2) in the tumor. Although extremely rare, IVSS should be considered in the differential diagnosis of primary intravascular neoplasms and as a potential cause of deep vein thrombosis and thromboembolism.

Double right bronchial artery aneurysm treated with combined procedures.

PURPOSE: Bronchial artery aneurysms occur rarely. We present an unusual case. CASE REPORT: We present a patient with double right bronchial artery aneurysms that were treated with a combination of endovascular and surgical procedures. CONCLUSION: This case report illustrates the treatment options for this unusual problem.

Selected heterocyclic compounds as antioxidants. Synthesis and biological evaluation.

Reactive oxygen species, oxidative stress, and oxidative damage are increasingly assigned important roles as harmful factors in pathological conditions and ageing. ROS are potentially reactive molecules derived from the reduction of molecular oxygen in the course of aerobic metabolism. ROS can also be produced through a variety of enzymes. Under normal circumstances, ROS concentrations are tightly controlled by physiological antioxidants. When excessively produced, or when antioxidants are depleted, ROS can impose oxidative damage to lipids, proteins, sugars and DNA. This reduction-oxidation imbalance, called oxidative stress, can subsequently contribute to the development and progression of tissue damage and play a role in the pathology of various diseases. An antioxidant is defined as "any substance that, when present at low concentrations compared with those of a substrate, significantly delays, prevents or removes oxidative damage to this target molecule". Despite evidence that oxidative damage contributes to a wide range of clinically important conditions, few antioxidants act as effective drugs in vivo. Inter alia, the difficulty of measuring antioxidant efficacy in vivo makes the interpretation of results from clinical trials difficult. A large number of synthetic compounds have been reported to possess antioxidant activity. Several of them derive from natural antioxidants, others have various structures. In this review, some of the most often reported classes of heterocyclic antioxidant compounds, as well as methods for evaluation of their antioxidant activity are discussed.

Strengths and weaknesses of 1.5T and 3T MRS data in brain glioma classification.

Although magnetic resonance spectroscopy (MRS) methods of 1.5Tesla (T) and 3T have been widely applied during the last decade for noninvasive diagnostic purposes, only a few studies have been reported on the value of the information extracted in brain cancer discrimination. The purpose of this study is threefold. First, to show that the diagnostic value of the information extracted from two different MRS scanners of 1.5T and 3T is significantly influenced in terms of brain gliomas discrimination. Second, to statistically evaluate the discriminative potential of publicly known metabolic ratio markers, obtained from these two types of scanners in classifying low-, intermediate-, and high-grade gliomas. Finally, to examine the diagnostic value of new metabolic ratios in the discrimination of complex glioma cases where the diagnosis is both challenging and critical. Our analysis has shown that although the information extracted from 3T MRS scanner is expected to provide better brain gliomas discrimination; some factors like the features selected, the pulse-sequence parameters, and the spectroscopic data acquisition methods can influence the discrimination efficiency. Finally, it is shown that apart from the bibliographical known, new metabolic ratio features such as N-acetyl aspartate/ S, Choline/ S, Creatine/ S , and myo-Inositol/ S play significant role in gliomas grade discrimination.