Can the addition of clinical information improve the accuracy of PI-RADS version 2 for the diagnosis of clinically significant prostate cancer in positive MRI?

AIM: To report prostate cancer (PCa) prevalence in Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) categories and investigate the potential to avoid unnecessary, magnetic resonance imaging (MRI)-guided in-bore biopsies by adding clinical and biochemical patient characteristics. MATERIALS AND METHODS: The present institutional review board-approved, prospective study on 137 consecutive men with 178 suspicious lesions on 3 T MRI was performed. Routine data collected for each patient included patient characteristics (age, prostate volume), clinical background information (prostate-specific antigen [PSA] levels, PSA density), and PI-RADS v2 scores assigned in a double-reading approach. RESULTS: Histopathological evaluation revealed a total of 93/178 PCa (52.2%). The mean age was 66.3 years and PSA density was 0.24 ng/ml2 (range, 0.04-0.89 ng/ml). Clinically significant PCa (csPCa, Gleason score >6) was confirmed in 50/93 (53.8%) lesions and was significantly associated with higher PI-RADS v2 scores (p=0.0044). On logistic regression analyses, age, PSA density, and PI-RADS v2 scores contributed independently to the diagnosis of csPCa (p=7.9×10-7, p=0.097, and p=0.024, respectively). The resulting area under the receiver operating characteristic curve (AUC) to predict csPCa was 0.76 for PI-RADS v2, 0.59 for age, and 0.67 for PSA density. The combined regression model yielded an AUC of 0.84 for the diagnosis of csPCa and was significantly superior to each single parameter (p≤0.0009, respectively). Unnecessary biopsies could have been avoided in 50% (64/128) while only 4% (2/50) of csPCa lesions would have been missed. CONCLUSIONS: Adding age and PSA density to PI-RADS v2 scores improves the diagnostic accuracy for csPCa. A combination of these variables with PI-RADS v2 can help to avoid unnecessary in-bore biopsies while still detecting the majority of csPCa.

[Acute abdomen - a practical approach]. / Akutes Abdomen ­ ein praktischer Zugang.

CLINICAL PROBLEM: Acute abdomen describes a critical clinical condition which includes a heterogeneous group of clinical presentations. Several diseases require immediate surgical treatment. Therefore, fast radiological assessment is demanded. STANDARD RADIOLOGICAL METHODS: Stable patients presenting at the emergency department with acute abdominal pain require an abdominal x­ray, an ultrasound examination and/or a computed tomography (CT) scan, depending on the location and character of their pain. These standard radiological methods provide a quick differentiation between simple and complicated pathologies. Unstable patients should undergo immediate CT and, if positive, be sent directly to surgery. METHODICAL INNOVATIONS AND ASSESSMENT: The ongoing technical developments in the field of computed tomography allow a quick and detailed characterization of pathologic conditions of the abdominal organs. A structured approach, based on the analysis of typical radiological signs and patterns, combined with the evaluation of extra-abdominal findings helps to assign the observed imaging findings to specific diseases. RECOMMENDATION: A systematic 4­point approach for structured analysis of specific and nonspecific imaging features and common pitfalls aids to choose the correct radiological method and help to narrow the broad spectrum of potential differential diagnoses.

[Changes in the clinical picture of sudden hearing loss and its therapy over the last 20 years]. / Anderung des Krankheitsbildes Hörsturz und dessen Therapie in den letzten 20 Jahren.

The present study comprises the data of 464 patients referred to the First Otolaryngological Hospital of the University of Vienna between 1960 and 1982. They all suffered from a clearly established sudden hearing loss. The data made it possible to prove that the number of cases suffering from sudden hearing loss increased statistically significantly in the past 20 years. In addition, efforts were made to prove the usefulness of a polypragmatic therapy in cases of sudden hearing loss. For this purpose, two statistically comparable groups subjected to different therapies were juxtaposed: a. One group of patients (1960-1967) treated with various therapies, mainly monotherapies, which are considered to be insufficient according to our present knowledge. b. One group of patients (1977-1981) treated with an uniform polypragmatic therapy. This second group showed significantly better results than the first group. Hence this study proves the effectiveness of a therapeutical method in cases of sudden hearing loss.

[Late results of corrective surgery of prominent auricles]. / Spätergebnisse der Korrektur abstehender Ohrmuscheln.

In 87 persons who had to undergo plastic surgery of the auricle an evaluation was carried out of the motives for undergoing such surgery, on the one hand, and of the late results of the success of surgical intervention, on the other. The motives for undergoing surgery clearly suggest a significant psychological component, so that the intervention must most likely be regarded as a psycho-prophylactic measure. As concerns the results, it is striking that the evaluation given by the patients has been better (subjective evaluation) than that given by the doctors (objective evaluation), the subjective evaluation sometimes differing from the objective one.

[Ototoxicity of locally applied amino-glycosides (author's transl)]. / Uber due Ototoxizität von Aminoglykosiden bei lokaler Anwendung.

Medical literature contains numerous references to the ototoxic effects of amino-glycosides if locally applied. In the present study patients who had fallen ill with otitis externa with concomitant myringitis, whose eardrum however, was intact, were treated with Neomycin and Polymyxin B containing ear-drops (Otosporin) and supervised audiometrically. There were no references to any ototoxic damage to the inner ear as a consequence of the treatment. Theoretical considerations and reports in the literature on the subject give advice to caution in the case of eardrum perforations and surgical caverns.