Diagnostic accuracy of preoperative computed tomography used alone to detect lymph-node involvement at radical nephrectomy.

OBJECTIVE: The aim of this study was to compare preoperative computed tomography (CT) with pathological findings in patients undergoing lymphadenectomy at the time of nephrectomy for renal cancer-associated lymphadenopathy. MATERIALS AND METHODS: Data from 515 consecutive nephrectomy surgeries (2004-2012) in a single university-affiliated centre were analysed to identify patients who had undergone lymph-node dissection concomitant with nephrectomy. Preoperative CT imaging was subjected to multiple repeated independent blinded reviews (two radiologists and one surgeon, each individually and on two separate occasions). Retroperitoneal lymph-node status was subjectively categorized (in a manner not based purely on size criteria) at each review as: 1 = unequivocally positive, 2 = equivocally positive, 3 = equivocally negative, or 4 = unequivocally negative. These findings were compared with pathological analysis, and interobserver and intraobserver agreement was assessed using non-weighted kappa () statistics. RESULTS: In total, 71 patients were stratified as category 1 (n = 18), 2 (n = 14), 3 (n = 31) and 4 (n = 8); pathological lymph-node metastasis was present in 14 (78%), four (28%), four (13%) and zero patients, respectively. Sensitivity, specificity, positive and negative predictive values for preoperative CT were 82%, 71%, 56% and 90%, respectively. Intraobserver agreement was greater for the radiologists (values 0.490, 0.540) than for the surgeon (value 0.393). Interobserver agreement was strongest for radiological category 1 (unequivocally positive; value 0.75). Receiver operating characteristics curves did not reveal significant differences in any observer accuracy. CONCLUSION: Contrary to concerns about a high false-positive rate, metastasis within regional lymph nodes can be predicted with reasonable accuracy by preoperative CT imaging alone.

A Pictorial Review of the MRI Appearances of Focal Liver Lesions.

The role of magnetic resonance imaging (MRI) in evaluating benign and malignant liver lesions has undergone significant expansion in recent years with the evolution and optimization of imaging sequences and contrast enhanced techniques. The aim of this article is first to summarize the various imaging sequences employed in the evaluation of liver pathology, with reference to the recent literature on the subject and second, to illustrate through pictorial review, the MRI characteristics of a number of benign and malignant lesions both in the normal liver and in those with chronic liver disease. We highlight the importance of availability of adequate clinical history in the interpretation of focal liver lesions on MRI, including the presence or absence of chronic liver disease, known history of primary malignancy and if applicable, serum alpha fetoprotein levels. In conclusion, MRI is the optimum imaging modality in the evaluation of focal liver lesions. Pattern recognition and knowledge of patient history enables characterization of the majority of liver lesions without the use of ionizing radiation.

Genital self-mutilation.

A 53-year-old man was brought to the emergency department having removed both testicles and amputated his penis using a bread knife. Examination of the amputated penis showed it to be unsuitable for an attempted replant procedure. The patient was taken to theatre where the perineal wound was debrided and the remaining urethra brought down as a perineal urethrostomy, with a local cutaneous flap rotated to provide coverage for the urethra. Discussed herein are the incidence, predisposing factors, management and complications of genital self-mutilation in the adult male, and the existing literature is reviewed on the subject.

Caspase 3 in breast cancer.

PURPOSE: An inability to undergo apoptosis is widely thought to contribute to both tumorigenesis and tumor progression. One of the key mediators of apoptosis is the thiol protease caspase 3. In this investigation, caspase 3 mRNA and protein expression in breast cancer was examined. EXPERIMENTAL DESIGN: Caspase 3 was measured at the mRNA level using reverse transcription-PCR and at the protein level using both Western blotting and activity assays. Levels of apoptosis were determined using an ELISA, which detects nucleosomes released during DNA fragmentation. RESULTS: Relative levels of caspase 3 mRNA were similar in breast carcinomas (n = 103), fibroadenomas (n = 25), and normal breast tissues (n = 6). However, levels of both the precursor and active forms of caspase 3 were significantly higher in carcinomas compared with both fibroadenomas (P = 0.0188) and normal breast tissues (P = 0.0002). Levels of apoptosis were also highest in the carcinomas and correlated significantly with active caspase 3 levels (r = 0.481; P = 0.0003). In the carcinomas, expression of caspase 3 showed no significant relationship with either tumor size, tumor grade, nodal status, or steroid receptor status but was significantly higher in ductal carcinomas than in lobular carcinomas (P = 0.0188). CONCLUSIONS: We conclude that rates of apoptosis as measured by both caspase 3 activation and nucleosome release are higher in breast cancer than in nonmalignant breast tissue. This finding would appear to conflict with the widely held belief that apoptosis is reduced in malignancy. The proliferation:apoptosis ratio, however, may be higher in carcinomas than in the corresponding normal tissue.