Metabolite findings in tumefactive demyelinating lesions utilizing short echo time proton magnetic resonance spectroscopy.

BACKGROUND AND PURPOSE: To use MR spectroscopy to aid in the diagnosis of demyelinating disease and to help differentiate tumefactive demyelinating lesions from neoplastic processes. MATERIALS AND METHODS: MR imaging of the brain was obtained in 4 patients who presented clinically with focal neurologic deficits. MR imaging initially revealed parenchymal mass lesions. Single-voxel MR spectroscopy was then performed utilizing a point-resolved spectroscopy sequence protocol with a short echo time (30 msec). RESULTS: MR imaging revealed a focal ring-enhancing mass in one patient, multiple ring-enhancing lesions in the second patient, a large area of edema and mass effect without associated enhancement in the third patient, and multiple solid and peripherally enhancing lesions in the fourth patient. MR spectroscopic results in all 4 patients demonstrated marked elevation of the glutamate and glutamine peaks (2.1-2.5 ppm). Other nonspecific (and in a sense confounding) findings included elevation of the choline peak (3.2 ppm), elevation of the lactate peak (1.3 ppm), elevation of the lipid peak (0.5-1.5 ppm), and decrease in the N-acetylaspartate peak (2.0 ppm). All 4 patients were eventually given the diagnosis of multiple sclerosis based on CSF analysis, brain biopsy, and/or clinical follow-up. CONCLUSION: MR spectroscopic metabolite information may be useful in the diagnosis of demyelinating disease by demonstrating elevation of the glutamate/glutamine peaks because elevation of these peaks is typically not seen in aggressive intra-axial neoplastic processes. This is particularly beneficial in the rarer cases of tumefactive demyelinating lesions, which are very difficult to differentiate from neoplasms by imaging findings alone.

Intestinal de-epithelialization and augmentation cystoplasty: an animal model.

OBJECTIVES: An animal model of augmentation cystoplasty was developed in New Zealand rabbits to study the effects of intestinal de-epithelialization on subsequent re-epithelialization by bladder urothelium. METHODS: Twenty-four rabbits underwent augmentation cystoplasty using intestinal segments that were either treated with protamine sulfate and urea solution or else anastomosed with an intact epithelium. Half of the rabbits receiving the de-epithelialized intestinal segments were subjected to glycosaminoglycan replacement therapy by administration of intravesical heparin. Experimental and control rabbits were sacrificed at 1-, 2-, and 3-month intervals. RESULTS: Histologic examination of the augmented sections showed small areas of urothelium growing over the intestinal epithelium (approximately 15%). The heparin-treated group demonstrated the greatest amount of re-epithelialization. There was no obvious histologic difference in the amount of collagen present in the augmented tissues in any of the experimental groups. CONCLUSIONS: In a preliminary study, New Zealand rabbits appear to be satisfactory as an experimental animal for studying the augmentation cystoplasty procedure and for the development of therapeutic interventions for enhancing epithelial growth. Protamine and urea will de-epithelialize the bowel and heparin may promote epithelialization of augmented intestinal segment by transitional epithelium.

MRI of pelvic neurofibromatosis.

Pelvic neurofibromatosis is a rare disease and rarely involves the prostate. A 19-year-old male presented with irritative and obstructive voiding symptoms. Magnetic resonance imaging showed a large mass extending from the sacral promontory to the perirectal and perivesical spaces and to the proximal root of the penis. The mass also involved the prostate. The characteristics of the mass were highly suggestive for neurofibroma. Prostate biopsy showed neurofibroma, and the immunohistochemistry stain for S-100 protein was positive.

Neonatal circumcision.

Circumcision remains the most common operation performed in males in the United States. When performed by an experienced operator, circumcision is usually a safe and simple operation. The medical benefits of circumcision appear to exceed the risks of the procedure. The history, embryology, indications, techniques, and complications of neonatal circumcision are discussed.

Fibrous hamartoma of infancy: a report of two cases in the genital region.

OBJECTIVES: Fibrous hamartoma of infancy (FHI) is an uncommon subcutaneous proliferative lesion usually found in the upper portions of the body, particularly in males during the first 2 years of life. We report 2 cases of FHI in the genital region. METHODS: We retrospectively reviewed the charts of children treated at Children's Hospital and Health Center, with FHI located in the genital region. RESULTS: We report 2 cases of FHI in the genital region, 1 involving the scrotum and 1 the labium majus. CONCLUSIONS: FHI should be considered in the differential diagnosis of genital masses in children. The histologic features are characteristic, local excision of the tumor is curative, and the local recurrence rate is low.

Endourethral prosthesis for treatment of detrusor sphincter dyssynergia: impact on quality of life for persons with spinal cord injury.

Neurogenic bladders with detrusor sphincter dyssynergia (DSD) are common in persons with spinal cord injury and with multiple sclerosis. Treatment options such as sphincterotomy, urethral foley and suprapubic catheters are not without complications or failure; however, they are recommended for patients who are unable to do intermittent catheterization. An endourethral prosthesis for DSD has been developed for experimental use in the United States. We report one year results of the clinical trials with endourethral prostheses implanted in ten patients. Initial subjective and objective results show an 80% success rate. At present, preliminary data show that an endourethral prosthesis, which is simple to insert and has few complications, appears to offer an alternative to conventional treatment. A key to success is to prepare for changes in life style that impact the patient's quality of life. Both patient and staff education are necessary pre-operatively to achieve successful outcomes post-operatively.

Urolume urethral wallstent in the treatment of detrusor sphincter dyssynergia.

Neuropathic voiding dysfunction with detrusor sphincter dyssynergia (DSD) is a common complication of spinal cord injury (SCI) and multiple sclerosis. Sphincterotomy has been recommended for treatment of DSD if the patient lacks the ability to do intermittent self catheterization. We report our preliminary results of the Urolume urethral wallstent for the treatment of DSD in 10 patients. The insertion technique proved simple, with a short hospital stay and low morbidity; however, its long term safety has not yet been established.

A new method for cytodestruction of bladder epithelium using protamine sulfate and urea.

Bladder epithelium relies primarily on the presence of a surface glycosaminoglycan (GAG) layer and the structural integrity of cell-cell contact to maintain impermeability to toxic urinary wastes. Previous clinical studies evaluating bladder permeability characteristics in interstitial cystitis patients had indicated that epithelial desquamation occurs after treatment with protamine sulfate (PS) followed by hypertonic urea. The following study was performed using rabbits to further investigate this finding. The urinary bladder was evaluated for optimal treatment conditions for epithelial removal. Protamine sulfate (1 to 10 mg./ml.) and urea (100 to 200 gm./ml.) were instilled into the bladder at volumes ranging from 5 to 60 ml. to that required for near maximum distention. After incubation at room temperature for 15 minutes, the bladders were fixed and evaluated histologically for epithelial removal. The maximum epithelial removal occurred when the bladders were distended, and when PS concentration was 5 to 10 mg./ml. and urea at 200 gm./l. There was greater epithelium removal after repeated treatments. Epithelial cells that were removed were not viable based on Trypan blue staining. There was no significant increase of C14 labeled urea in the plasma after 15 minutes. Rabbits that were followed for 6 weeks after treatment did not show any histological evidence of increased collagen deposition and/or fibrosis. This procedure may have important clinical value since it may remove sufficient bladder epithelium in patients with transitional cell carcinoma to have therapeutic benefit. This offers a realistic option for selective, nontoxic destruction of bladder epithelium.

Viscosity of the flexor muscles of the elbow joint under maximum contraction condition.

The maximum contractile moments developed by the elbow flexors of eleven normal subjects at different elbow angles were measured, both isometrically and at various shortening velocities. The results were used to predict the damping coefficient of the viscous element of the elbow flexor muscles and soft tissue under maximum contraction condition for various angles and shortening velocities.

Isolation of lymphocytes from clotted blood.

A problem often faced in clinical cell-mediated immunology research is to obtain peripheral blood lymphocytes (PBLs) in sufficient numbers to carry out cellular immune assays. Obtaining sufficient amounts of blood for serum is usually more practical than for PBLs. Blood is usually drawn easily for serum, but obtaining PBLs from clotted blood has not been very practical. In this report we describe a procedure whereby PBLs can be recovered from clotted blood and used in functional immune assays. Using the enzyme streptokinase (SK) blood clots were dissolved and viable PBLs recovered up to 24 h post clotting. Concentrations of SK from 250 to 500 SK U/ml gave maximum recovery of PBLs.

Toward quantification of athetotic movements by frequency spectrum analysis.

The frequency spectrum of the elbow movements of one normal subject and six handicapped subjects were obtained in order to investigate the possibility of using this technique in quantifying athetosis. The frequency spectrum technique appears to be useful but data from more subjects must be obtained and specific details regarding scaling need to be investigated.

Determination of the parameters for an athetotic arm model.

A model is developed to represent elbow motions of a cerebral palsied arm with athetotic movements. The parameters of the model are defined and determined. The resulting computer model can then be used to either generate athetotic motions or to regenerate prerecorded experimental data.