Prospective Study to Evaluate the Role of Dual Point Contrast-enhanced Magnetic Resonance Imaging in Differentiation of Brain Tumoral from Nontumoral Tissue: A Magnetic Resonance/PET Study.

Background and Purpose: Follow-up imaging of gliomas is crucial to look for residual or recurrence and to differentiate them from nontumoral tissue. Positron emission tomography (PET)-magnetic resonance imaging (MRI) is the problem-solving tool in such cases. We investigated the role of dual point contrast (DPC)-enhanced MRI to discriminate tumoral from the nontumoral tissue compared to PET-MRI taken as the gold standard. Materials and Methods: The institutional ethics committee approved the study, and consent was obtained from all the patients included in the study. We prospectively did immediate and 75-min delayed contrast MRI in glioma cases who came for follow-up as a part of PET-MRI study in our institute. Subtracted images were obtained using immediate and 75-min delayed contrast images. Color-coded subtracted images were compared with PET-MRI images. 75-min delayed contrast MRI and diffusion-weighted imaging (DWI) images with Gray Scale inversion were compared with PET attenuation-corrected images. Results: We included 23 PET MRI cases done with different radiotracers in our study. Overall, we found PET-DPC correlation in (20/20 ~ 100%) cases of enhancing tumors. In two cases (DOPA and fluorodeoxyglucose), since they were nonenhancing low-grade gliomas and the other one was melanoma with intrinsic T1 hyperintensity and the DPC technique could not be used. DWI-PET correlated in 17/19 (~89.4%) cases, and perfusion-weighted imaging (PWI)-PET dynamic susceptibility contrast (DSC)/ASL correlated in 14/18 (~77.7%) cases after cases with hemorrhage were excluded. Conclusion: DPC MRI showed a good correlation with PET MRI in discriminating tumoral from the nontumoral tissue. DPC MRI can act as a potential alternative to PET MRI in peripheral hospitals where PET is not available. However, the DPC technique is limited in low-grade nonenhancing gliomas.

Molecular Delineation of Partial Trisomy 14q and Partial Trisomy 12p in a Patient with Dysmorphic Features, Heart Defect and Developmental Delay.

This study describes a molecular analysis of partial trisomy 14q and partial trisomy 12p in a 5-year-old male child presenting with dysmorphic features, congenital heart disease and global developmental delay. Chromosomal analysis of the patient with GTG bands revealed a 47,XY,+der(14)t(12;14)(p13;q22)mat karyotype; the mother's karyotype was 46,XX,t(12;14)(p13;q22). Further, oligonucleotide array- CGH studies revealed an amplification of 32.3 Mb in the 14q11.1q22.1 region, substantiating partial trisomy 14q and additionally displaying an amplification of ∼1 Mb in the 12p13.3pter region for partial trisomy 12p. This is the first study to demonstrate a novel association of partial trisomies of 14q and 12p due to a 3:1 segregation of a maternal balanced translocation involving chromosomes 12 and 14. Gene ontology studies indicated 5 potential candidate genes in the amplified regions for the observed congenital anomalies.

Episodic transdermal delivery of testosterone.

Film-forming lotions, precast films and adhesive patches containing testosterone (T) were prepared by compounding vinylic, acrylic and cellulosic polymers with a variety of excipients in order to achieve distribution of T in domains of heterogeneity within multicomponent matrices. The feasibility of this approach in achieving episodic transdermal delivery of testosterone (T) was investigated. Composition-dependent differences in extent of in vitro drug release and periodicity were observed. Representative formulations showing the most pronounced episodic T release in vitro were tested in female rats. Whereas intravenously administered T decayed exponentially, three maxima of T in serum were observed upon application of selected formulations. Thus, peak serum concentrations of 240, 36, and 29 ng/dL were observed at 0.2, 5, and 16.8 h after application of the preferred lotion formulation, and 89, 65, and 64 ng/dL at 1, 16.4, and 48.8 h after patches. Deconvolution, noncompartment pharmacokinetic analysis and multiple peak fitting also indicated episodicity. These results suggest the feasibility of using transdermal systems for pulsatile T delivery in a variety of clinical applications, including hormone supplementation and male contraception.

Eosinophilic cystitis: a rare cause of hematuria in children.

A 7-year-old boy presented with a history of acute onset of hematuria, dysuria, and suprapubic pain. Urine routine and microscopy showed 40-45 red cells/high power field. Urine culture was sterile. Radiological investigations showed a focal mucosal lesion with bladder wall thickening. Biopsy of the lesion revealed an edematous mucosa with florid infiltration by eosinophils into the muscularis propria with focal areas of myonecrosis. He was diagnosed as a case of eosinophilic cystitis. The patient received 6 weeks of tapered prednisone therapy. He was asymptomatic on followup.

Nanoscaffold matrices for size-controlled, pulsatile transdermal testosterone delivery: nanosize effects on the time dimension.

Pulsatile transdermal testosterone (T) has applications in hormone supplementation and male contraception. Pulsatile T delivery was achieved by assembling crystalline and nanoparticulate T in nucleation-inhibiting polymer matrices of controlled porosity. Different interference patterns observed from various polymeric films containing T were due to the various particle sizes of T present in the polymer matrices. Scanning electron microscopy was used to determine the size and shape of T crystals. Skin-adherent films containing T nanoparticles of any size between 10-500 nm could be prepared using pharmaceutically acceptable vinylic polymers. Drug release and skin permeation profiles were studied. The dissolution-diffusion behavior of nanoparticles differed from crystalline and molecular states. Nanosize may thus be used to engineer chronopharmacologically relevant drug delivery.

The 53-kDa proteolytic product of precursor starch-hydrolyzing enzyme of Aspergillus niger has Taka-amylase-like activity.

The 53-kDa amylase secreted by Aspergillus niger due to proteolytic processing of the precursor starch-hydrolyzing enzyme was resistant to acarbose, a potent alpha-glucosidase inhibitor. The enzyme production was induced when A. niger was grown in starch medium containing the inhibitor. Antibodies against the precursor enzyme cross-reacted with the 54-kDa Taka-amylase protein of A. oryzae. It resembled Taka-amylase in most of its properties and also hydrolyzed starch to maltose of alpha-anomeric configuration. However, it did not degrade maltotriose formed during the reaction and was not inhibited by zinc ions.

Evidence that cleavage of the precursor enzyme by autocatalysis caused secretion of multiple amylases by Aspergillus niger.

The observation that a mutant strain of Aspergillus niger isolated for protease overproduction accumulated Taka-amylase supported an earlier report that processing of the precursor amylase by protease resulted in the secretion of multiple amylases. Studies using a mutant strain revealed that such processing was not due to aspergillopepsin but to autocatalysis by an inherent protease activity of the precursor and glucoamylase. Alignment of protease sequences with glucoamylase showed regions of consensus with serine carboxypeptidase of A. niger. Thus point mutations in this region due to ultraviolet radiation apparently caused the mutant to evolve with enhanced protease activity that degraded the precursor and accumulated Taka-amylase.

An unusual case of squamous cell carcinoma arising at the stomal site: case report and review of the literature.

An unusual case of squamous cell carcinoma arising at the ileocutaneous stomal site is reported. The presenting symptoms were peristomal ulceration and bleeding. The patient was treated with wide local excision of the stoma and the peristomal skin, and relocation of the ileostomy. A search of the literature for other similar cases subsequently identified two additional cases that were reported in the literature in 1987 and 2000.

Endoscopic therapy for radiation proctitis-induced hemorrhage in patients with prostatic carcinoma using argon plasma coagulator application.

BACKGROUND: Recurrent hemorrhage in patients with severe radiation proctitis is very common. It is often refractory to medical therapy. Endoscopic and surgical treatment may be required when conservative medical therapy fails. The aim of this study was to assess the therapeutic results of the Argon Plasma Coagulator (APC) (ERBE USA, Inc., Marietta, GA, USA) application in patients with radiation proctitis-induced hemorrhage. METHODS: Forty patients with radiation-induced proctitis causing severe bleeding, who had failed conservative medical management were treated endoscopically. Twenty-one patients in this group required blood transfusions. RESULTS: APC application was used in 40 patients with only one failure. The failed patient underwent formalin application using 4% formalin solution with resolution of the bleeding. CONCLUSION: Argon plasma coagulation application is a safe, well-tolerated treatment option and, historically, has been superior to Nd:YAG laser ablation.

Fibrin glue application in the treatment of recurrent anorectal fistulas.

PURPOSE: This prospective study was done to analyze the efficacy of autologous fibrin glue application in the healing or closure of recurrent anorectal fistulas. Autologous cryoprecipitate was used as fibrin glue in all patients. This group included complex anorectal fistulas, rectovaginal fistulas, and urethrovesicorectal fistulas. METHODS: Patients were given bowel preparation and intravenous antibiotics before the procedure. Fistulas were curetted before injection of fibrin glue. RESULTS: Overall success rate was 60 percent. Patients with fistulas associated with acquired immunodeficiency syndrome and the urinary tract failed to respond. No major complications were encountered. CONCLUSION: The results of fibrin glue use in this small series of recurrent fistulas is appealing. This use of fibrin glue can be done as an outpatient procedure as a minimally invasive technique, without any significant complications. It can be offered as an alternative to conventional surgery in recurrent fistulas.

Surgical treatment of traumatic cloaca.

PURPOSE: This study was designed to evaluate the repair of traumatic cloaca and determine the satisfactory outcome as determined by improvement in the continence mechanism of patients. METHODS: Forty-four patients were entered in this study during a 14-year period. The majority of traumatic cloaca occurred secondary to obstetric injury, most frequently during the first childbirth. No definite medical illnesses precipitated the occurrence of traumatic cloaca. Only two patients had diabetes mellitus, and one patient had prior radiation. All patients underwent surgical repair using puborectalis interposition and sphincteroplasty and perineal body repair, approximating the internal and external sphincter fused bundles and transversus perinei muscles in a vest-over-pants manner. Average stay in the hospital was less than three days, and postoperative morbidity was minimal. One patient had minor postoperative bleeding, which was corrected with cauterization. One patient had a superficial subcutaneous infection, which was drained on the 15th postoperative day. RESULTS: Majority of patients regained excellent control of continence to both flatus and feces. Four patients had unsatisfactory control to passage of flatus. One patient had unsatisfactory control to passage of liquid stool in addition to flatus. All five patients improved, with very satisfactory results, following an exercise program and biofeedback therapy. Six of 12 patients who had perineal discomfort before the surgical procedure, with associated dyspareunia, were the most dissatisfied subgroup in the series. Exact mechanism for perineal discomfort is unclear at this point.

Study of human papillomavirus infection in patients with anal squamous carcinoma.

PURPOSE: The purpose of this study was to determine the incidence of human papillomavirus deoxyribonucleic acid (HPV DNA) in anal squamous carcinoma. METHODS: HPV DNA in situ hybridization for HPV Types 6, 11, 16, 18, 31, 33, and 35 was performed on the formalin-fixed, paraffin-embedded tissue from 53 perianal and anal squamous carcinomas and 10 controls. RESULTS: HPV DNA sequences were identified in 18 of 53 anal squamous carcinomas (34 percent). All 10 controls were negative for HPV DNA. Of the 18 positive patients, 10 were perianal squamous carcinomas, and 8 were anal canal squamous carcinomas. Six of the perianal carcinomas were positive for HPV Types 6 and 11. The remaining four perianal carcinomas and all eight of the anal canal carcinomas were positive for HPV Types 16 and 18. CONCLUSION: HPV DNA sequences can be identified in anal squamous carcinomas. Anal squamous epithelium is another site where HPV infection may carry a risk for malignant transformation. One-third of anal squamous carcinomas may be associated with prior HPV infection. Patients with anogenital HPV infection should be routinely screened for anal squamous lesions.

Hemangioma of the small intestine: case report and literature review.

One case of small bowel polypoid hemangioma of the jejunum presenting as recurrent gastrointestinal blood loss is reported. The presenting symptoms and diagnostic methods are discussed. The importance of intraoperative enteroscopy in diagnosing and treating this condition is emphasized.

Comparison of double and single parameters in DNA analysis for staging and as a prognostic indicator in patients with colon and rectal carcinoma.

PURPOSE: This study was designed to determine the reliability of DNA analysis in predicting outcome of patients with colorectal carcinoma and compare the prognostic efficacy of DNA analysis using two parameters vs. a single parameter. METHODS: Two hundred forty-eight patients with colon and rectal carcinoma were entered in the study over a period of 84 months. Thirty-one percent of carcinomas were found in the rectum. A total of 23.6 percent of cancers were found in the sigmoid colon. Majority of the patients were 60 years or older. Male to female ratio was equal. The colon bearing carcinoma was sent in a fresh state after resection for flow cytometry and DNA analysis. In this study, analysis was made, comparing two parameters (aneuploidy and S-phase fraction over 20 percent) with single parameters (aneuploidy) for staging and as a prognostic indicator in patients with colon and rectal carcinoma. RESULTS: The combined presence of aneuploidy and S-phase fraction over 20 indicated a poorer prognosis in patients with colon and rectal carcinoma. The prediction of patient outcome was more accurate with DNA analysis using two parameters than using a single parameter alone (P value = 0.00003). CONCLUSION: In our analysis, the odds of survival are over 3.7 times greater for aneuploidy than aneuploidy plus S-phase fraction over 20 percent.

Perineal excision of rectal procidentia in elderly high-risk patients. A ten-year experience.

PURPOSE: This report presents a ten-year experience with perineal excision and posterior levator ani repair in elderly, high-risk patients with complete rectal procidentia. METHODS: Seventy-two patients with rectal prolapse were treated with perineal excision. Nine presented with acute incarcerated rectal prolapse. Mortality, morbidity, recurrence rates, and improvement of anal continence were assessed. RESULTS: Recurrence rate was 5.5 percent. Improvement in anal continence was seen in 66.7 percent of patients. Morbidity and mortality was low. CONCLUSIONS: Perineal excision of rectal prolapse is safe and has a low recurrence rate. Posterior levator ani repair seems to improve anal continence.

Triangulating stapling technique: an alternative approach to colorectal anastomosis.

The triangulating stapling technique was employed to perform colorectal anastomosis in 259 patients. In 220 patients, the anastomosis was performed between the colon and nonperitonealized rectum. This anastomotic technique is safe and reliable and is an effective alternative to a circular stapling device, with minimal morbidity. The incidence of leak rate is comparable to anastomoses created by a circular stapling device. The main advantage seems to be the very low incidence of anastomotic stenosis.

Management of acute incarcerated rectal prolapse.

Perineal excision was used to treat eight elderly patients with acute incarcerated prolapse: four showed signs of strangulation with areas of gangrene, six made an uneventful recovery without colostomy, and two developed anastomotic leak, needing diverting colostomy with a complete recovery. There were no mortalities. There were no recurrences of rectal prolapse.

Hydrostatic balloon dilatation of benign colonic anastomotic strictures.

From 1985 to 1990, 25 patients with benign colorectal anastomotic strictures were treated. The majority of the patients presented with decreasing stool caliber and abdominal cramps. Most of the strictures were secondary to anastomosis utilizing the EEA stapling device (United States Surgical Corp., Norwalk, CT) for malignant neoplasm. Under IV sedation, strictures were dilated endoscopically with the TTS balloon (Microvasive). No complications were encountered in this series. Hydrostatic balloon dilatation is a safe and effective modality for treatment of anastomotic strictures.

Anorectal complications of vaginal delivery.

The incidence of anorectal complications following vaginal delivery was studied in 20,500 women. One thousand forty (5 percent) of all normal vaginal deliveries resulted in episiotomy with third- and fourth-degree extension or a fourth-degree perineal tear. Of these fourth-degree lacerations, 101 patients (10 percent) experienced wound disruption after primary repair. Sixty-seven patients (66 percent) experienced wound disruption that required surgical correction. Anorectal complications were anal ulcer, anorectal abscess, sphincteric disruption, and rectovaginal fistula. Surgical correction of these complications resulted in satisfactory outcome.