Magnetic resonance imaging for intratesticular and extratesticular scrotal lesions.

INTRODUCTION: To evaluate magnetic resonance imaging (MRI) utility in intratesticular and extratesticular scrotal diseases. MATERIALS AND METHODS: Two radiologists retrospectively reviewed images of patients who underwent ultrasound followed by MRI, categorizing them as intratesticular or extratesticular and malignant, benign, indeterminate, or inadequate study. For patients who underwent surgical excision, pathologic results were also correlated to the presurgical ultrasound and MRI diagnoses. RESULTS: Of 69 cases, 38 were intratesticular lesions and 31 were extratesticular lesions. MRI and ultrasound diagnoses were discordant in 21 (55.32%) intratesticular and 19 (61.3%) extratesticular lesions. MRI diagnosis was malignant after an indeterminate ultrasound in 0 and 4 (12.9%) intratesticular and extratesticular lesions, respectively. MRI diagnosis was benign after an indeterminate ultrasound in 18 (47.43%) and 14 (45.2%) intratesticular and extratesticular lesions, respectively. A malignant ultrasound diagnosis was reversed to benign MRI diagnosis in one (2.6%) intratesticular and one (3.2%) extratesticular lesion. In no case was a benign lesion on ultrasound read as malignant on MRI in either group. The cohort of patients with intratesticular lesions received a mean clinical and radiographic follow up of 2.49 ± 1.97 and 1.85 ± 1.46 years, respectively. The patients with extratesticular lesions received a mean clinical and radiographic follow up of 1.30 ± 1.08 and 2.00 ± 1.28 years, respectively. In no case did repeat imaging change the diagnosis after initial MRI and ultrasound evaluation. CONCLUSIONS: MRI was effective at characterizing both intratesticular and extratesticular lesions in the majority of cases.

Communication of pain intensity and unpleasantness through magnitude ratings: Influence of scale type, but not gender of the participant.

BACKGROUND: A critical aspect for most human pain research is the ability of participants to communicate their first-person, experiential perspective to a third-person observer. This communication is frequently accomplished via pain ratings. The scale type can influence the communication of pain experiences and can contribute to gender differences in pain. This study examined the role of gender on pain ratings using noxious and innocuous stimuli across two types of rating scales. METHODS: Healthy participants (n = 46) underwent noxious heat, auditory and visual stimulation paradigms. Pain intensity and unpleasantness ratings were collected using the visual analogue scale (VAS) and numerical rating scale (NRS). To determine if one rating scale allows a better report of small differences between different stimulus intensities, the sensitivity to small differences was calculated. RESULTS: Significant effects for rating scale were found for all stimulus modalities (noxious heat, auditory and visual, p < 0.001) with higher intensity and unpleasantness ratings for the NRS compared to the VAS. Overall, no effects of gender or interactions with gender were found. No differences in rating scale and gender were detected for sensitivity to small differences between stimuli. CONCLUSIONS: These findings confirm differences in rating scale usage; however, the different usage might not contribute significantly to gender differences in pain. SIGNIFICANCE: There are differences in the usage of rating scales in which ratings for auditory, visual and noxious somatosensory stimuli are higher with NRS compared to VAS. Choosing a rating scale for research or clinical use should take this different item functioning into account.

Weak Relationships Between Psychological Factors and Experimental Pain Outcomes in Pain-Free Individuals: An Aggregate Analysis of 8 Studies.

Although psychological factors such as anxiety, depression, and pain catastrophizing are known to influence pain outcomes in chronic pain populations, there are mixed results regarding whether they influence experimental pain outcomes in pain-free individuals. The objectives of this study were to determine the associations between psychological factors and experimental pain outcomes in pain-free adolescents and adults. Relationships between anxiety, depression, and pain catastrophizing and experimental pain outcomes across 8 different studies (total N = 595) were examined in different populations of pain-free adult and adolescent participants. Analyses were conducted with and without controlling for sex, age, and race. Studies were analyzed separately and as part of an aggregate analysis. Individual study analyses resulted in 136 regression models. Of these, only 8 models revealed a significant association between psychological factors and pain outcomes. The significant results were small and likely due to Type 1 error. Controlling for demographic factors had minimal effect on the results. The aggregate analyses revealed weak relationships between anxiety and pressure pain threshold (Fisher's z = -.10 [-.19, -.01]), anxiety and cold pain intensity ratings (Fisher's z = .18 [.04, .32]), and pain catastrophizing and pressure pain threshold (Fisher's z = -.14 [-.26, -.02]). Sample size calculations based on the aggregate analyses indicated that several hundred participants would be required to detect true relationships between these psychological factors and pain measures. The overall negative findings suggest that in pain-free individuals, anxiety, depression, and pain catastrophizing are not meaningfully related to experimental pain outcomes. PERSPECTIVE: Psychological variables have been shown to predict pain outcomes in chronic pain populations but these relationships may not generalize to pain-free populations. An analysis of 595 pain-free individuals across 8 studies in our lab revealed that anxiety, depression, and pain catastrophizing were not meaningfully related to experimental pain outcomes.

Ureteral intussusception: a case report and literature review.

We present the case of a 64-year-old man with intussusception of the right ureter as a complication of an underlying transitional cell carcinoma. To our knowledge, this is the first case report that illustrates ureteral intussusception by both multidetector computerized tomography and magnetic resonance imaging. Although ureteral intussusceptions are thought to be associated with benign masses, our comprehensive review of the literature demonstrates that almost half of the cases are associated with underlying malignancy.

The Effect of Lacrosse Protective Equipment on Cardiopulmonary Resuscitation and Automated External Defibrillator Shock.

CONTEXT: In the event of an acute cardiac event, on-field equipment removal is suggested, although it remains unknown how lacrosse equipment removal may alter time to first chest compression and time to first AED shock. OBJECTIVE: To determine time to first chest compression and first AED shock in 2 chest exposure procedures with 2 different pad types. DESIGN: Crossover study Setting: Simulation laboratory Participants: Thirty-six athletic trainers (21 females, 15 males; age=30.58±7.81) Main Outcome Measures: Participants worked in pairs to provide 2 rescuer CPR intervention on a simulation manikin (QCPR manikin, Laerdal Medical, Wappingers Falls, NY) outfitted with lacrosse pads and helmet. Participants completed a total of 8 trials per pair (2 chest exposure procedures X 2 pad types X 2 participant roles). The dependent variables were time to first compression (s) and time to first AED shock (s). The independent variables were chest exposure procedure with 2 levels (procedure 1: removal of helmet while initiating CPR over the pads followed by pad retraction and AED application; procedure 2: removal of helmet and removal of pads followed by CPR and AED application) and pad type (Warrior Burn Hitman shoulder pads; Warrior Nemesis chest protector). RESULTS: We found a statistically significant interaction between chest exposure procedure and pad type for time to first compression (F1,35=4.66, P=0.04, ω2p=0.10) with significantly faster times during procedure 1 for both the Nemesis pads (16.1±3.4 s) and the Hitman pads (16.1±4.5 s) compared to procedure 2 (Nemesis pads: 49.6±12.9 s, P<0.0001; Hitman pads: 53.8±14.5 s, P<0.0001). CONCLUSIONS: Completing the initial cycle of chest compressions over either shoulder pads or a chest protector hastens time to first chest compression without diminishing CPR quality which may improve patient outcomes. Time to first AED shock was not different between equipment procedure or pad type.

Transient homogeneously enhancing hepatic masses: can size predict benignity?

OBJECTIVE: The purpose of our study was to test the hypothesis that, in noncirrhotic livers, large size predicts benignity of masses that homogeneously hyperenhance on arterial phase CT and then fade to isoattenuation. MATERIALS AND METHODS: All multiphasic CT scans obtained at a cancer center over a 2-year period were reviewed. In consensus, three authors retrospectively identified 227 hepatic masses (> or = 5 mm) in 55 noncirrhotic patients that homogeneously hyperenhanced on arterial phase and then faded to isoattenuation: 107 masses were malignant and 120 were benign; 37 patients had benign and 18 patients had malignant masses. Two analytic approaches were pursued: per lesion and per patient. For the per-lesion analysis, the mean cross-sectional diameter of each mass was calculated and receiver operator characteristics (ROC) were assessed. For the per-patient analysis, the maximum lesion diameter was determined for each subject and logistic regression models were used to predict lesion classification (benign vs malignant) based on per-patient maximum lesion size and additional information. RESULTS: Masses ranged from 5 to 84.5 mm. All 29 masses > or = 22 mm were benign. Size was a statistically significant classifier of benign versus malignant lesions in the per-lesion analysis (p = 0.024, ROC area under the curve) and a significant or trend-level predictor of tumor type in the per-patient analysis (logistic regression p values of the diameter coefficients: 0.01-0.07). CONCLUSION: In noncirrhotic livers, relatively large size is a significant or trend-level predictor for benign tumors. Homogeneously hyperenhancing masses > or = 22 mm that fade to isoattenuation are benign; smaller masses may be malignant.

Plugoma: CT findings after prosthetic plug inguinal hernia repairs.

BACKGROUND: Unrecognized CT findings of a prosthetic plug used in inguinal hernia repair can lead to incorrect diagnosis or unnecessary workup of a patient. The objective of this study is to review the expected CT findings present in patients with a history of plug repair. STUDY DESIGN: Retrospective cohort study retrieving clinical and image data from a single-institution database. Patients who underwent prosthetic plug hernia repair during a 5-year period at our institution had their records queried for subsequent abdominal CT scans. These CT scans were reviewed by 2 radiologists for findings referable to the hernia repair. RESULTS: Five-hundred and sixty-four consecutive patients underwent prosthetic plug hernia repair during a 5-year period. Fifty-one patients who had had 55 surgical procedures had subsequent CT scans, none in the early postoperative period. Readers identified 100% of the plugs, 68% of which were described as round or oval in shape. All the plugs were in close proximity to the inferior epigastric artery and were of low density on CT images. Surgical scar was identifiable in 87% of patients. Thirty-two patients (63%) had a second CT scan, demonstrating no change in size and location of the plugoma. CONCLUSIONS: A prosthetic mesh plug is easily seen on CT images, typically appearing as a smooth round or oval hypodense mass close to the inferior epigastric artery, deep to a surgical scar, and stable over time. It can usually be distinguished from pathologic findings. It is important that the radiologist be familiar with the patient's surgical history when interpreting these images.

Superparamagnetic iron oxides and low molecular weight gadolinium chelates are synergistic for direct visualization of advanced liver fibrosis.

PURPOSE: To compare the contrast-to-noise ratio (CNR) of advanced liver fibrosis on nonenhanced (NE), gadolinium enhanced (Gd), superparamagnetic iron oxides enhanced (SPIO), and combined contrast-enhanced (CCE) spoiled gradient echoes (SGEs). MATERIALS AND METHODS: This retrospective study assessed 83 consecutive patients with cirrhosis and 10 consecutive patients without fibrosis. All patients had NE, Gd, SPIO, and CCE images at 1.5 T. A total of six breathhold SGE sequences with varying imaging parameters were assessed. MR images were evaluated qualitatively and, in 15 cirrhotics who underwent liver transplantation, compared to gross pathology. CNR of fibrosis to background liver was compared across sequences and contrast enhancement types. RESULTS: In cirrhotic patients, CCE images on all sequences showed fibrosis as a meshwork of high-signal 1-mm to 3-mm thick reticulations surrounding 2-mm to 5-mm low-signal regenerative nodules. Fibrosis was less visible on Gd and SPIO images and was barely visible on NE images. CNR was significantly higher for CCE than for NE, Gd, or SPIO images in eight of nine comparisons (P < 0.0001-0.05). The liver had a homogeneous appearance in subjects without fibrosis. CONCLUSION: CCE imaging depicts advanced liver fibrosis with higher CNR than NE, Gd, or SPIO SGEs.