MR enterocolonography in patients with Crohn's disease and healthy volunteers - Do we achieve diagnostic bowel distension?

PURPOSE: The aim of our prospective randomized study was to assess diagnostic quality and stability of bowel distension in patients with Crohn's disease (CD) and healthy volunteers subjected to synchronous magnetic resonance enterography and colonography (MREC), as well as to test the role of water enema and intravenous spasmolytics. The influence of gastric content, age, gender, and body mass on bowel distension was also evaluated. METHOD: Study groups included 164 CD patients and 53 healthy volunteers. After bowel preparation, randomized subgroups started ingestion ≥1000 mL of hyperosmolar solution within 30, 45, 60, 75, and 90 min before admission to MRI, respectively. Patients were examined in prone position and water enema was applied. Spasmolytics were administered prior to I.V. gadolinium. Distension of five bowel segments was independently assessed by two experienced radiologists. RESULTS: MREC yields diagnostic distension of the jejunum in 81.1 % and 79.2 % patients in the CD group and controls, respectively. For the terminal ileum it was >94 % in both groups. Good and excellent distension was achieved in other bowel segments. Distension was maintained up to 75 min from the start of oral ingestion. Water enema and spasmolytics significantly and independently improved distension of the small bowel. Distension of the cecum after spasmolytics was decreased. Gastric content, age, gender and body mass had no significant influence of bowel distension. CONCLUSIONS: MREC enables diagnostic distension of the colon and ileum (including terminal segment) in CD patients and healthy volunteers and diagnostically acceptable distension of the jejunum.

Possible role of standardized echography complementing ultrasound biomicroscopy in tumors of the anterior eye segment: a study in a series of 13 patients.

PURPOSE: To evaluate the efficacy of standardized A-scan echography (ASE) complementing ultrasound biomicroscopy (UBM) to propose the most efficient method as grounds for the diagnosis, treatment, and follow-up of anterior eye-segment tumors. METHODS: The inclusion criteria were tumors of the ciliary body and peripheral choroidal tumors, whose anterior border could not be visualized with a 10 MHz ultrasound probe. The largest basal dimension and the highest prominence of the tumor were measured with a UBM Lin 50 probe. A standardized A-scan examination determined the tumor's thickness and internal reflectivity. Thus, tissue differentiation led to a standardized echography-based diagnosis (SED). RESULTS: The study included 13 patients. SED was achieved in all examined tumors. The smallest thickness of the tumor of the ciliary body enabling SED was only 1.78 mm. The highest prominence of the tumor (3.66 ± 1.39 mm) was generally larger than its thickness (3.30 ± 1.71 mm). CONCLUSION: When approaching ciliary body tumors, both ASE and UBM should be performed, the former to accurately differentiate the tumor and measure its height, and the latter to delineate anterior tumor margins and iris involvement. Standardized echography-based diagnosis was grounds for further evaluation and/or treatment in this case series. The highest prominence of the ciliary body tumor perpendicular to the sclera as evidenced by UBM was generally higher than the thickness obtained with standardized echography. Hence, we propose ASE thickness to be the grounds for staging the severity of ciliary body tumors in the algorithm for their management.

Scleral Thinning Documented by Ultrasound Biomicroscopy after Plaque Therapy for Anterior Ciliary Melanoma.

PURPOSE: To evaluate, by ultrasound biomicroscopy (UBM), changes in scleral thickness after ruthenium-106 CCB and CCC plaque (Eckert & Ziegler BE-BIG GmbH, Berlin, Germany) therapy for anterior ciliary melanoma. METHODS: Eleven patients with anterior ciliary melanoma underwent ruthenium-106 CCB and CCC plaque radiation with a radiation dose at the tumor apex of 80-100 Gy. UBM measurements performed prior to and after treatment were as follows: the largest prominence of the tumor perpendicular to the sclera and scleral thickness at scleral spur, 1.0 mm, and 2.0 mm posteriorly. RESULTS: The article presents one year follow-up results for each of the 11 patients. The mean regression of the tumor of 24.3±9.31% was observed. The thinning of the sclera was statistically significant at the scleral spur (t=1.80, p ≤ 0.05) and at maximal tumor thickness (t=1.35, P=0.05). CONCLUSION: UBM documented significant thinning of the sclera at the scleral spur and overlying the maximal tumor thickness after Ru-106 CCB and CCC plaque radiation. Taking into consideration the shortcomings of the study-small sample size, insufficient probe resolution, and subjectively determined anatomic landmarks-observed minimal thickness change of the sclera does not necessarily mean its necrosis. However, thinning of the sclera documented at one year follow-up associated with very slow regression of the tumor indicates the need for the introduction of the CIA plaque treatment in our patients with anterior ciliary melanoma.

Metrological characterization of custom-designed 894.6 nm VCSELs for miniature atomic clocks.

We report on the characterization and validation of custom-designed 894.6 nm vertical-cavity surface-emitting lasers (VCSELs), for use in miniature Cs atomic clocks based on coherent population trapping (CPT). The laser relative intensity noise (RIN) is measured to be 1 × 10(-11) Hz(-1) at 10 Hz Fourier frequency, for a laser power of 700 µW. The VCSEL frequency noise is 10(13) · f(-1) Hz(2)/Hz in the 10 Hz < f < 10(5) Hz range, which is in good agreement with the VCSEL's measured fractional frequency instability (Allan deviation) of ≈ 1 × 10(-8) at 1 s, and also is consistent with the VCSEL's typical optical linewidth of 20-25 MHz. The VCSEL bias current can be directly modulated at 4.596 GHz with a microwave power of -6 to +6 dBm to generate optical sidebands for CPT excitation. With such a VCSEL, a 1.04 kHz linewidth CPT clock resonance signal is detected in a microfabricated Cs cell filled with Ne buffer gas. These results are compatible with state-of-the-art CPT-based miniature atomic clocks exhibiting a short-term frequency instability of 2-3 × 10(-11) at τ = 1 s and few 10(-12) at τ = 10(4) s integration time..

Unusual consecutive sacral stress fractures in a female distant runner: a case report.

Sacral stress fractures are rare overuse injuries predominantly perceived in female long-distance runners. Our case report describes left-sided sacral wing stress fracture followed by contralateral sacral wing fracture after return to running. A 21-year-old female amateur long-distance runner presented with nonspecific low back and left buttock pain. Plain radiograph at presentation was unremarkable. Magnetic resonance imaging (MRI) revealed extensive bone marrow oedema in the cranial part of the left sacral wing and oblique fracture line. After six weeks of moderate training and two months of tailored running program she felt sharp pain in her right buttock during landing on her right leg. MRI confirmed contralateral sacral wing stress fracture. Additional two-month program to correct lumbar hyperlordotic posture with relaxation techniques and stretching of quadratus lumborum, psoas, multifidus and rectus femoris muscles was carried out. Strengthening of the abovementioned muscles was also done together with abdominal wall muscles and gluteals to stabilize the lumbar spine. She regained full level of training six months after the second fracture. Two years after the second stress fracture of the sacral wing she is free of pain, running about 60 to 70 km per week. Despite rapid rehabilitation program after first sacral stress fracture, contralateral stress fracture occurred. After a few months of additional conditional training and strengthening of lumbar, abdominal and pelvic muscles she regains her long-distance running including four marathons without obstacles. From this case we can assume that following proper rehabilitation program with correction of hyperlordotic posture sacral stress fractures can be avoided.

Dynamic changes in the common bile duct after laparoscopic cholecystectomy: a prospective longitudinal sonographic study.

PURPOSE: The aim of this prospective study was to assess the dynamics of potential common bile duct (CBD) dilatation and to find the best predictors in patients after laparoscopic cholecystectomy due to gallstones. MATERIALS AND METHODS: Fifty patients (36 women, 14 men) with gallstones scheduled for laparoscopic cholecystectomy underwent preoperative sonography one day prior to surgery and again within 24 hours of cholecystectomy. In all patients, the diameter of the CBD was measured again on the 7 (th), 90 (th) and 180 (th) day after cholecystectomy. The luminal diameter was measured just below the bifurcation of hepatic ducts, at the level of intersection with the hepatic artery and at the level of the pancreatic head. The control group consisted of 50 healthy individuals (35 women and 15 men) with normal biochemistry and sonography, and without a history of hepatobiliary disease, clinical symptoms or surgery. RESULTS: The mean preoperative CBD diameter at three locations was 2.27 ± 0.18, 3.49 ± 0.23 and 4.31 ± 0.30, respectively. The mean diameter of the common bile duct measured within 24 hours of surgery and on the seventh postoperative day did not significantly change with respect to the preoperative measurement. Three months after cholecystectomy, the CBD was statistically wider at all three locations (p < 0.05). Six months after cholecystectomy, the CBD remained significantly wider at the proximal and distal part when compared to the preoperative measurements. CONCLUSION: The CBD showed an overall trend towards a slight, but significant, dilatation after cholecystectomy. The common bile duct dilates significantly 3 months after cholecystectomy. Familiarity with these patterns prevents ultrasound misdiagnosis when examining patients within 6 months of cholecystectomy.

First-order cancellation of the Cs clock frequency temperature-dependence in Ne-Ar buffer gas mixture.

Through the detection of Coherent Population Trapping (CPT) resonances, we demonstrate the temperature-dependence cancellation of the Cs clock frequency in microfabricated vapor cells filled with a mixture of Ne and Ar. The inversion temperature at which the Cs clock frequency temperature sensitivity is greatly reduced only depends on the partial pressure of buffer gases and is measured to be lower than 80°C as expected with simple theoretical calculations. These results are important for the development of state-of-the-art Cs vapor cell clocks with improved long-term frequency stability.

Leiomyoma of the left renal vein. A report of a case.

Only a few cases of leiomyoma of the vena cava or iliac vein and, according to our knowledge, only one case of renal vein leiomyoma have been reported. We report a patient with leiomyoma of the left renal vein. Tumour resection was performed by resecting a part of the vein along with the tumour and by ligation of the vein. Left kidney drainage was established through the preserved ovarian vein. In order to establish a diagnosis, careful pathologic examination of multiple sections has to be done and because of the potentially malignant behaviour, long-term follow-up after total resection is necessary.

Gender-related differences in MS: a study of conventional and nonconventional MRI measures.

BACKGROUND: Studies showed gender-associated differences in multiple sclerosis (MS) disease evolution and in the evolution of conventional magnetic resonance imaging (MRI) findings. OBJECTIVE: The aim of this study was to investigate gender differences according to a number of conventional and nonconventional MRI measures in patients with MS. METHODS: We examined 763 consecutive patients with MS [499 (19.2% men) relapsing-remitting (RR), 230 (24.8% men) secondary-progressive, and 34 (44.1% men) primary-progressive], 32 (21.9% men) patients with clinically isolated syndrome (CIS), and 101 (30.7% men) normal controls (NC). Patients were assessed using conventional and nonconventional MRI measures. Gender-related MRI differences were investigated using general linear model analysis, corrected for MS disease type. RESULTS: In the total MS group, male patients showed lower normalized peripheral gray matter (GM) (P<0.001) and normalized GM (P=0.011) volumes than female patients. Female patients presented lower normalized white matter (WM) volumes (P=0.011). These gender effects were not observed in NC. Male patients also showed more advanced central atrophy (P=0.022). In RRMS male patients, there was also a higher lateral ventricle volume (P=0.001). The GM-WM normalized ratio was lower for male patients with MS compared with male NC (0.97 vs. 1.09, P<0.001) but not in patients with CIS compared with NC. CONCLUSIONS: There were no significant gender-related differences regarding nonconventional MRI measures. GM and central atrophy are more advanced in male patients, whereas WM atrophy is more advanced in female patients. These gender-related MRI differences may be explained by the effect of sex hormones on brain damage and repair mechanisms.

Giant anterior sacral meningocele presenting as bacterial meningitis in a previously healthy adult.

Meningocele may be asymptomatic and incidentally discovered. Presenting as a retrorectal mass, sacral meningocele may produce urinary, rectal, and menstrual pain. Anterior sacral meningocele may be the cause of tethered cord syndrome. This article presents a case of a previously healthy 39-year-old man with large meningeal herniation that occupied the entire pelvis who developed symptoms of bacterial meningitis. A 39-year-old man was admitted with fever, chills, headache and photophobia. Escherichia coli was isolated from cerebrospinal fluid culture. Moderate improvement regarding meningeal symptoms was noted due to intravenous antibiotic therapy, but intense pain in the lower back associated with constipation, fecal and urinary incontinence, and saddle anesthesia developed. Abdominal ultrasound was negative. Plain radiographs and computed tomography demonstrated sacral bone defect and retrorectal expansive mass. MRI confirmed anterior sacral meningocele with cord tethering. After posterior laminectomy and dural opening, communication between meningocele and intrathecal compartment was obliterated. Computed tomography-guided percutaneous drainage through the ischiorectal fossa was performed to treat residual presacral cyst. Delayed diagnosis in our patient was related to misleading signs of bacterial meningitis without symptoms of intrapelvic expansion until the second week of illness. In our patient, surgical treatment was unavoidable due to resistive meningitis, acute back pain, and symptoms of space-occupying pelvic lesion. Neurosurgical approach was successful in treatment of meningitis and neurological disorders. Computed tomography-guided evacuation of the residual retrorectal cyst was less invasive than laparotomy, resulting in normalization of defecation and miction despite incomplete evacuation. Further follow-up studies may provide insight into the most effective treatment of such conditions.

Primary leiomyosarcoma of the tibia: five years without recidivism

Primary leiomyosarcoma of the bone is a rare malignancy. Clinical follow-up suggests that primary osseous leiomyosarcoma has an aggressive biologic behaviour with poor survival time. We report a case of primary leiomyosarcoma arising from the proximal metaphysis of the right tibia of a 55-year old woman with a long follow-up period, without recidivism. Primary leiomyosarcoma has to be considered as a differential diagnostic possibility in the case of bone tumours seen on routine initial plain radiographs as lytic lesions. If the tumour has been adequately excised at the time of diagnosis, as in the present case, with adjuvant therapy protocol, the long-term prognosis of such an aggressive tumour can be exceptionally good.

El leiomiosarcoma primario del hueso es un tumor maligno raro. El seguimiento clínico sugiera que el leiomiosarcoma óseo primario tiene un comportamiento biológico agresivo con escaso tiempo desobrevivencia. Reportamos un caso de leiomiosarcoma primario proveniente de la metáfisis proximal de la tibia derecha de una mujer de 55 años de edad con un largo período de seguimiento, sin recidivas. El leiomiosarcoma tiene que ser considerado una posibilidad de diagnóstico diferencial en el caso detumores óseos observados en radiografías simples iniciales de rutina como lesiones líticas. Si el tumorha sido debidamente extirpado en el momento del diagnóstico – como en el caso presente – con un protocolo de terapia adyuvante, la prognosis a largo plazo de un tumor tan agresivo puede ser excepcionalmente buena.

Mediastinal necrosis in acute pancreatitis - case report.

Ascites, pseudocyst, necrosis of the retroperitoneal fat tissue and pancreatopleural fistula with left sided pleural effusion may complicate pancreatitis. However, steatonecrosis of the mediastinum and right side pleural effusion are rather rare complications of pancreatitis. We present a case of a patient with alcohol induced pancreatitis. Chest x-ray showed right sided pleural effusion. Although high levels of amylase in pleural fluid made the diagnosis of pancreatopleural fistula most likely, necrosis of the mediastinal fat tissue with right side pleural effusion was found postmortem.

Primary leiomyosarcoma of the tibia--five years without recidivism.

Primary leiomyosarcoma of the bone is a rare malignancy. Clinical follow-up suggests that primary osseous leiomyosarcoma has an aggressive biologic behaviour with poor survival time. We report a case of primary leiomyosarcoma arising from the proximal metaphysis of the right tibia of a 55-year old woman with a long follow-up period, without recidivism. Primary leiomyosarcoma has to be considered as a differential diagnostic possibility in the case of bone tumours seen on routine initial plain radiographs as lytic lesions. If the tumour has been adequately excised at the time of diagnosis, as in the present case, with adjuvant therapy protocol, the long-term prognosis of such an aggressive tumour can be exceptionally good.

Rapid idiopathic osteolysis of the humeral head and clavicle / Osteólisis idiopática rápida de la cabeza del húmero y la clavícula

Idiopathic osteolysis is a very rare bone condition of unknown origin. The length of the illness usually lasts for several years. The purpose of this paper is to point out the possibility of severely rapid progression of idiopathic osteolysis and to contribute to a better understanding of the natural history of Gorham-Stout disease. We report the case of a 58-year old man whose right humeral head and lateral clavicle had disappeared as a result of massive osteolysis observed only six months after onset of the symptoms. Such rapid progression has not been reported previously. His physical examination was otherwise normal. Serum interleukin-6 (IL-6) was elevated and the other laboratory tests were normal. Radiography, computed tomography scan, bone scan, and magnetic resonance imaging (MRI) evaluation revealed extensive destruction of the right humeral head and lateral clavicle involving the acromioclavicular joint. Although the histologic features could not be confirmed because the patient refused a biopsy, it was felt that the patient satisfies the other diagnostic features of Gorham-Stout disease. Follow-up examinations revealed no further bone or soft-tissue involvement. Gorham-Stout disease should be considered in the differential diagnosis of such severely rapid progression of lytic bony lesions.

La osteólisis ideopática es una condición muy rara del hueso, de origen desconocido. Usualmente la enfermedad tiene una duración de varios años. El propósito de este trabajo es señalar la posibilidad de una progresión severamente rápida de la osteólisis idiopática, y contribuir a una mejor comprensión de la historia natural de la enfermedad de Gorham-Stout. Reportamos un caso de un hombre de 58 años cuya cabeza humeral derecha así como la clavícula lateral habían desaparecido como resultado de una osteólisis masiva observada sólo seis meses después de la presentación de los síntomas. Una progresión tan rápida no había sido nunca reportada previamente. Por lo demás, su examen físico fue normal. La interleukina-6 de suero (IL-6) fue alta, y las otras pruebas de laboratorio fueron normales. La radiografía, la tomografía computarizada (escáner CT), tomografía de hueso, y el examen de imágenes por resonancia magnética (MIR) revelaron una destrucción extensa de la cabeza humeral derecha y la clavícula lateral con involucración de la articulación acromioclavicular. Aunque los rasgos histológicos no pudieron ser confirmados porque el paciente rehusó una biopsia, se entendió que el paciente satisfacía suficientemente las otras características del diagnóstico de la enfermedad de Gorham-Stout.

Rapid idiopathic osteolysis of the humeral head and clavicle.

Idiopathic osteolysis is a very rare bone condition of unknown origin. The length of the illness usually lasts for several years. The purpose of this paper is to point out the possibility of severely rapid progression of idiopathic osteolysis and to contribute to a better understanding of the natural history of Gorham-Stout disease. We report the case of a 58-year old man whose right humeral head and lateral clavicle had disappeared as a result of massive osteolysis observed only six months after onset of the symptoms. Such rapid progression has not been reported previously. His physical examination was otherwise normal. Serum interleukin-6 (IL-6) was elevated and the other laboratory tests were normal. Radiography, computed tomography scan, bone scan, and magnetic resonance imaging (MRI) evaluation revealed extensive destruction of the right humeral head and lateral clavicle involving the acromioclavicular joint. Although the histologic features could not be confirmed because the patient refused a biopsy, it was felt that the patient satisfies the other diagnostic features of Gorham-Stout disease. Follow-up examinations revealed no further bone or soft-tissue involvement. Gorham-Stout disease should be considered in the differential diagnosis of such severely rapid progression of lytic bony lesions.

[Outcome of 268 patients with pancreatic carcinoma treated surgically]. / Ergebnisse der chirurgischen Therapie bei 268 Patienten mit einem Pankreaskarzinom.

From January 1st 1987 to December 31st 2001, 268 patients (pts) with the diagnosis of pancreatic adenocarcinoma had undergone surgery at Surgical Clinic of University Hospital Rijeka. Pts were of both sexes: 154 males (57%) and 114 females (43%). The mean age of pts at the time of operation was 66 +/- 11.4 years. 36 pts (13.4%) underwent curative resection, while 198 pts (73.9%) underwent palliative operation. At 34 pts (12.7%) explorative laparotomy and biopsy were preformed. Overall 30-days postoperative mortality was 12.3% (33 pts). 44 pts (16.4%) developed postoperative complications. Mean overall survival after surgery was 5.8 months. Pts who underwent curative resection survived significantly longer (median 24.2 months) than pts with palliative surgery (median 5.4 months). 8 pts (2.98%) survived more than two years after surgery. Lymph node involvement, distant metastases and postoperative complications were predictors of significantly worse survival.

Effect of 6-month athletic training on motor abilities in seven-year-old schoolgirls.

The effects of six-month athletic training on improving motor abilities in 7-year-old schoolgirls were assessed. Analysis of the results of 12 motor tests showed significant improvement in the study group (n = 38) in comparison with control group (n = 140) subjected to conventional physical education classes only. The improvement referred to the variables of aerobic endurance (3-min run), flexibility (forward bow), explosive strength (ball throwing and 20-m run), keeping balance (bench standing), static strength (bent arm hang), and repetitive strength (sit-ups). These are probably adaptive changes brought up by discriminant functions. The varimax factor and discriminative function correlations indicated that all four factors of changes contributed significantly to the explanation of discriminative function. An almost equally high correlation of varimax factors and discriminative function was obtained on the basis of differences in the third factor responsible for changes in the frequency of movements and in the explosive strength of the jump type; in the second factor responsible for changes in coordination with changes in the repetitive strength of the body; and in the fourth factor responsible for changes in the explosive strength of the throw and sprint types with changes and endurance.