MR-Eye: High-Resolution Microscopy Coil MRI for the Assessment of the Orbit and Periorbital Structures, Part 2: Clinical Applications.

In the first part of this 2-part series, we described how to implement microscopy coil MR imaging of the orbits. Beyond being a useful anatomic educational tool, microscopy coil MR imaging has valuable applications in clinical practice. By depicting deep tissue tumor extension, which cannot be evaluated clinically, ophthalmic surgeons can minimize the surgical field, preserve normal anatomy when possible, and maximize the accuracy of resection margins. Here we demonstrate common and uncommon pathologies that may be encountered in orbital microscopy coil MR imaging practice and discuss the imaging appearance, the underlying pathologic processes, and the clinical relevance of the microscopy coil MR imaging findings.

MR-Eye: High-Resolution Microscopy Coil MRI for the Assessment of the Orbit and Periorbital Structures, Part 1: Technique and Anatomy.

Microscopy coil MR imaging of the orbits has been described previously as a technique for anatomic depiction. In the first part of this 2-part series, the improvement in spatial resolution that the technique offers compared with conventional MR imaging of the orbits is demonstrated. We provide a guide to implementing the technique, sharing pearls and pitfalls gleaned from our own practice to make implementation of microscopy coil MR imaging at your own center easy. As a quick reference guide to the small-scale structures encountered when reading the studies, a short anatomy section is included, which doubles as a showcase for the high-quality imaging that can be obtained. In the second part, our experience of microscopy coil MR imaging in day-to-day clinical practice takes it far beyond being a useful anatomic educational tool. Through a series of interesting cases, we highlight the added benefit of microscopy coil MR imaging compared with standard orbital MR imaging.

Establishment of a clinically relevant large animal model to assess the healing of metaphyseal bone.

Despite the high incidence of metaphyseal bone fractures in patients, the mechanisms underlying the healing processes are poorly understood due to the lack of suitable experimental animal models. Hence, the present study was conducted to establish and characterise a clinically relevant large-animal model for metaphyseal bone healing. Six female adult Merino sheep underwent full wedge-shaped osteotomy at the distal left femur metaphysis. The osteotomy was stabilised internally with a customised anatomical locking titanium plate that allowed immediate post-operative full-weight bearing. Bone healing was evaluated at 12 weeks post-fracture relative to the untouched right femur. Histological and quantitative micro-computed tomography results revealed an increased mineralised bone mass with a rich bone microarchitecture. New trabeculae healed by direct intramembranous ossification, without callus and cartilaginous tissue formation. Stiffness at the cortical and trabecular regions was comparable in both groups. Functional morphological analysis of the osteocyte lacunae revealed regularly arranged spherically shaped lacunae along with the canalicular network. Bone surface biochemical analysis using time-of-flight secondary-ion mass spectrometry showed high and homogeneously distributed levels of calcium and collagenous components. Ultrastructure imaging of the new trabeculae revealed a characteristic parallel arrangement of the collagen fibrils, evenly mineralised by the dense mineral substance. The specialised bone cells were also characterised by their unique structural features. Bone remodelling in the fractured femur was evident in the higher expression levels of prominent bone formation and resorption genes. In conclusion, the novel metaphyseal fracture model is beneficial for studying healing and treatment options for the enhancement of metaphyseal bone defects.

The -31 G/C promoter gene polymorphism of surviving in Turkish colorectal cancers patients

Introduction: Survivin (also known as birc5) is the first protein discovered among the apoptosis-regulating gene family referred to as inhibitor of apoptosis proteins (IAPs). It is expressed and controlled during cellular differentiation and development in human beings. Survivin expression has been shown in a number of cancers and has been associated with cancer development. Objective: In our study, we compared with blood samples as our control and normal- tumoural tissue samples, which obtained from the same tissue of 100 cases diagnosed with colorectal cancer, at Department of Pathology, Istanbul University. Methods: The present study employed PCR-RFLP to identify the -31 G/C polymorphism in the promoter region of the survivin gene. Distribution of the survivin polymorphism was compared between control and tumoural tissue samples using the chi-square test. Results: Comparison of all samples revealed that there was significant difference in distribution of survivin promoter -31G/C between control group and tumour and normal tissue of the patient group (p<0.05). When genotypes of the control and tumour tissues were compared according to gender, there was no statistically significant difference in the distribution of survivin promoter -31G/C in females p=0.420 or males p=0.309. Conclusion: A significant difference was seen in distribution of C allele in tumour tissue compared to normal tissue.

Evidence-based anatomical review areas derived from systematic analysis of cases from a radiological departmental discrepancy meeting.

AIM: To produce short checklists of specific anatomical review sites for different regions of the body based on the frequency of radiological errors reviewed at radiology discrepancy meetings, thereby creating "evidence-based" review areas for radiology reporting. MATERIALS AND METHODS: A single centre discrepancy database was retrospectively reviewed from a 5-year period. All errors were classified by type, modality, body system, and specific anatomical location. Errors were assigned to one of four body regions: chest, abdominopelvic, central nervous system (CNS), and musculoskeletal (MSK). Frequencies of errors in anatomical locations were then analysed. RESULTS: There were 561 errors in 477 examinations; 290 (46%) errors occurred in the abdomen/pelvis, 99 (15.7%) in the chest, 117 (18.5%) in the CNS, and 125 (19.9%) in the MSK system. In each body system, the five most common location were chest: lung bases on computed tomography (CT), apices on radiography, pulmonary vasculature, bones, and mediastinum; abdominopelvic: vasculature, colon, kidneys, liver, and pancreas; CNS: intracranial vasculature, peripheral cerebral grey matter, bone, parafalcine, and the frontotemporal lobes surrounding the Sylvian fissure; and MSK: calvarium, sacrum, pelvis, chest, and spine. CONCLUSION: The five listed locations accounted for >50% of all perceptual errors suggesting an avenue for focused review at the end of reporting.

Un-methylation of the survivin gene has no effect on immunohistochemical expression of survivin protein in lung cancer patients with squamous cell carcinoma.

Survivin is a member of the inhibitor of apoptosis (IAP) family. The function of the survivin protein is to inhibit caspase activation, thereby leading to negative regulation of apoptosis or programmed cell death. This has been shown by the disruption of survivin induction pathways leading to an increased apoptosis and decreased tumour growth. These data suggest that survivin may provide a new target for cancer treatment, which would distinguish transformed cells from normal cells. In the present study, we aimed to investigate exon 1 of the survivin gene by means of methylation-specific PCR and evaluate its impact on survivin protein expression following DNA isolation and bisulphite modification in paraffin-embedded normal and tumour tissues of lung cancer patients with squamous cell carcinoma. We used 41 squamous cancer tissues with methylation in exon 1 of the survivin gene and non-methylation in corresponding tumours. However, the immunohistochemistry staining of these samples demonstrated an increased survivin protein compared to normal tissue. While there is almost no other study to date on this subject matter, we believe that the absence of methylation in exon 1 of the survivin gene may not affect disease prognosis as it has no effect on expression, and possible promoter methylation or transcription factors (Tab. 1, Fig. 4, Ref. 15).

Acute pancreatitis: a comparison of intervention rates precipitated by early vs guideline CT scan timing.

AIM: To assess whether computed tomography (CT) examination earlier in acute pancreatitis (AP) precipitates any surgical or radiological intervention. MATERIALS AND METHODS: A single-centre retrospective cohort study comparing intervention rates in AP precipitated by early (<6 day of admission, n=100) and UK guideline (≥6 day of admission, n=103) CT examinations. RESULTS: No intervention was precipitated by performing CT before the sixth day of admission in AP. A statistically significant larger number of interventions were precipitated when CT was performed on the sixth day or later (p<0.05). Of note, this study was conducted using day of admission, rather than day of symptom onset. Six patients underwent repeat CT examination in the same admission after an early CT examination. CONCLUSION: Performing CT before the sixth day of admission does not lead to earlier intervention. Such early examinations waste resources and may offer false reassurance to clinicians.

Mutation detection in the promoter region of survivin gene on N-methyl-N-nitrosourea induced colon tumor model in experiment.

Survivin (also known as BIRC5) is one of the first reported inhibitors of apoptosis proteins (IAPs), which is an important family of proteins that regulate apoptosis. It is developmentally regulated and expressed during cell differentiation in humans, mice and rat. Survivin is expressed in a series of human cancers and it has been widely accepted that survivin is strongly related to the onset and development of cancer. In the present study, we tried to determine differences in the promoter region of survivin gene in colon tissue samples from N-methyl-N-nitrosourea (MNU) induced rat colon tumor model and control group. Polymerase chain reaction (PCR) - single strand conformation polymorphism (SSCP) analysis was used for this aim. No significant differences were found in the promoter region of survivin gene between the normal and tumor tissues (Tab. 2, Fig. 1, Ref. 16).

Contrast-enhanced magnetic resonance lymphography in the assessment of lower limb lymphoedema.

Chronic lower limb lymphoedema is a debilitating condition that may occur as a primary disorder or secondary to other conditions. Satisfactory visualization of the lymphatic vessels to aid diagnosis and surgical planning has been problematic. Historically, direct lymphography was used to visualize lymphatic vessels, although the significant surgical risks involved led to this being largely abandoned as a technique. Technetium-99m lymphoscintigraphy has been the mainstay of diagnosis for over two decades, but is hampered by inherently poor temporal and spatial resolution and limited anatomical detail. Contrast-enhanced magnetic resonance lymphography (MRL) is a relatively new technique that shows early promise in the evaluation of chronic lymphoedema. This article provides the procedural technique for lower limb MRL at both 1.5 and 3 T, discusses pathophysiology and classifications of lymphoedema, provides an overview of relevant lower limb lymphatic anatomy using MRL imaging, compares the various techniques used in the diagnosis of lower limb lymphoedema, shows common pathological MRL imaging findings, and describes alternative uses of MRL. Utilization of this technique will allow more accurate diagnosis and classification of patients suffering from lymphoedema.

A whiff of trouble: tumours of the nasal cavity and their mimics.

A range of disease entities can affect the nasal cavity, often presenting with variable and non-specific symptoms. There is considerable overlap between the clinical and radiological features of neoplastic and non-neoplastic entities. The nasal cavity is often included in routine imaging of the brain, middle ear, skull base, and paranasal sinuses and should be included as a critical review area. The definitive diagnosis is in most cases confirmed by histopathological analysis. However, this review highlights the role of imaging in identifying nasal cavity disease, eliciting features of aggressive or indolent behaviour, and helping to narrow the differential diagnosis, thus facilitating a systematic approach when reviewing the nasal cavity.

Endothelial nitric oxide synthase intron 4a/b polymorphism in coronary artery disease in Thrace region of Turkey.

Coronary artery disease (CAD) is one of the frequent cardiovascular mortality causes in the world. Common risk factors explain only about half the risk of CAD. The healthy familial predisposition to CAD, combined with advances in genetic analysis, has led to a number of studies in recent years making an effort to identify the genetic factors that influence the risk. The approach taken by most studies was to examine the association of naturally occurring genetic polymorphisms in candidate genes with risk of or severity of CAD. Endothelial nitric oxide synthase (eNOS) is important for vascular and tissue protection and is found in endothelial cells that encompass the entire vasculature, including the vessels in the heart. Nitric oxide (NO) is produced in a catabolic reaction in the endothelial cells, neurons, glia and macrophages by nitric oxide synthase (NOS) isoenzymes. eNOS is a subgroup of this family of enzymes that catalyses the production of nitric oxide (NO) from L-arginine and oxygen, which leads to vascular relaxation by activating the guanylate cyclase. This finally induces smooth muscle relaxation. The aim of this study was to investigate the allelic frequency and the genotypic distribution of the variable number of tandem repeat 27 (27 VNTR) gene polymorphism in intron 4 of the eNOS (eNOS 4a/b) gene in Thrace region, to compare CAD patients with appropriate healthy controls and to correlate the genetic findings with CAD subtypes. The study group included 281 (153 subjects with CAD and 128 controls) patients. The eNOS polymorphism was identified with a polymerase chain reaction. Genotypes were defined as aa, ab and bb according to the presence of a and b alleles. In this case-control study, we found that there was sensible correlation between eNOS gene intron 4a/b VNTR polymorphism and the risk of CAD in Thrace region of Turkey. However, there was no major difference for the genotype distribution and the allelic frequency among the CAD subtypes. Further studies on the interaction of such genes are needed to clarify the association between eNOS 4a/b polymorphism and CAD patients.

There's a hole in my symphysis -- a review of disorders causing widening, erosion, and destruction of the symphysis pubis.

The symphysis pubis is demonstrated on many conventional radiographic and cross-sectional examinations and abnormality of the symphysis pubis is a common imaging finding with numerous possible causes. Many significant disorders that affect the symphysis pubis cause it to appear widened, eroded, or destroyed on imaging studies. It is useful for radiologists to have a working differential diagnosis for these appearances, to use when reporting such studies. This review briefly describes the anatomy of the symphysis pubis and presents examples of the various developmental, inflammatory, infectious, neoplastic, traumatic, and metabolic disorders that may cause it to become widened, eroded, or destroyed. Some disorders have pathognomonic imaging features. Others give rise to similar findings that depend more on overall disease activity, rather than the specific diagnosis itself. In such cases, correlation with clinical and laboratory findings will help narrow the differential diagnosis.

Sulfotransferase 1A1 (SULT1A1) polymorphism and susceptibility to primary brain tumors.

PURPOSE: Sulfotransferase 1A1 is a member of sulfotransferase family that plays an important role in the biotransformation of numerous carcinogenic and mutagenic compounds through sulfation. The present study has investigated the association between SULT1A1 polymorphism and primary brain tumor incidence. METHODS: SULT1A1 genotypes were successfully detected using the PCR-RFLP assay in 60 primary brain tumor patients and 156 hospital-based healthy control individuals with no history of cancer or precancerous disorder. RESULTS: There was a significant difference in genotypes distribution (GG vs. GA + AA) between brain tumor patients (GG genotype frequency = 48.3%) and control population (GG genotype frequency = 65.4%; OR = 2.019, 95% CI = 1.103-3.695; P = 0.022). In order to determine the association between SULT1A1 polymorphism and specific types of brain tumors, the patients were classified according to the type of brain tumors they suffer from: glial and non-glial. Results of the statistical analyses of each group of patients in comparison with the control individuals showed a significant difference only between SULT1A1 polymorphism and non-glial brain tumors (OR = 2.615; 95% CI = 1.192-5.739; P = 0.014) but glial tumors (OR = 1.535; 95% CI = 0.688-3.425; P = 0.293). When non-glial tumors were classified as meningiomal and others (pituitary adenoma, craniopharyngioma, acoustic neuroma and hemangioblastoma), statistical analysis showed that this significance is only due to the meningiomal tumors (OR = 3.238; CI = 1.205-8.704; P = 0.015). We also estimated a reduced risk of brain tumor in non-smokers (OR = 1.700; CI = 0.800-3.615) in comparison to smokers (OR = 2.773; CI = 0.993-7.749), but this was not statistically significant. CONCLUSION: Our findings have suggested that there was a significant association between brain tumor and SULT1A1*2 allele (A allele that is also known as His allele) and this allele is an important risk factor in the development of meningiomal brain tumors.

P53 codon 72 genotypes in colon cancer. Association with human papillomavirus infection.

It has been reported that the p53Arg homozygous genotype could be a potential genetic risk factor for cancer. In this study we investigated the proportion of p53 codon 72 genotypes in patients with colon cancer and compared to a control population. A region of the p53 gene containing the polymorphic site was amplified by PCR and the genotypes were determined by restriction enzyme digestion. No significant difference was found between genotype frequencies in the study groups. Infection with human papilloma virus was also investigated in the tumor samples. HPV 18 and HPV 33 infection was observed in a considerable number of the tumor samples. Incidence of HPV infection did not show a correlation with the genotypes. Thus the p53 genotypes do not seem to be associated with risk of colon cancer or HPV infection.

Randomized study of transurethral resection of the prostate and combined transurethral resection and vaporization of the prostate as a therapeutic alternative in men with benign prostatic hyperplasia.

BACKGROUND AND PURPOSE: In recent years, various minimally invasive alternatives to transurethral resection have become available for treatment of benign prostatic hyperplasia (BPH). Transurethral electrovaporization has become popular, with reported improvements in subjective and objectives measures, but a high rate of postoperative irritative symptoms and lack of tissue for histologic examination are the two most commonly reported disadvantages of this procedure. To decrease the postoperative irritative symptoms while minimizing intraoperative and postoperative bleeding and also to obtain tissue samples, we have combined the techniques of vaporization, which was termed "vapor-cut." The aim of this randomized study was to compare the efficacy and safety of vapor-cut with those of the gold standard, transurethral resection. PATIENTS AND METHODS: A series of 100 consecutive men (mean age 63.5 +/- 3.4 years) with moderate to severe symptoms of prostatism were randomized to receive transurethral resection of the prostate (TURP) or vapor-cut since November 1997. Adverse events during the procedure, including serial changes in both serum hematocrit and sodium and postoperative irritative symptoms, were recorded after removal of the urethral catheter. Preoperative and postoperative symptom scores and maximum flow rates (Qmax) were obtained from all patients. The volume of the prostate was measured preoperatively and postoperatively using transrectal ultrasonography. The mean follow-up of the patients was 6.7 months (range 6-10 months). RESULTS: The mean operative times for the vapor-cut group and the TURP group were 48.2 minutes and 42.7 minutes, respectively (P > 0.05). In the TURP group and the vapor-cut group, the International Prostate Symptom Score (I-PSS) decreased from 21.6 to 5.0 (P < 0.01) and from 19.4 to 4.0 (P < 0.01), respectively, at 6 months. The Qmax increased from 9.2 +/- 2.6 mL/sec to 24.6 +/- 3.4 mL/sec (P < 0.01) in the TURP group and from 7.9 +/- 2.1 mL/sec to 26.7 +/- 3.7 mL/sec (P < 0.01) in the vapor-cut group. The mean reductions in the weight of the prostate were 49.8% in the TURP group (P < 0.05) and 53.6% in the vapor-cut group (P < 0.05). Both catheterization time and hospital stay were significantly shorter for the vapor-cut group (P < 0.05). The decreases in the mean serum sodium concentration were statistically insignificant in both groups. However, the decrease in the mean hematocrit was statistically significant in the TURP group but not in the vapor-cut group. No patient in either group had the transurethral resection syndrome or required blood transfusion. After removal of the urethral catheter, irritative voiding symptoms, usually associated with frequency, were greater in those patients treated with TURP than in those having vapor-cut. None of the patients demonstrated sphincteric incontinence, bladder neck contracture, or urethral stricture. CONCLUSION: From our preliminary experience, vapor-cut seems to give results comparable to those of TURP. Because there is almost no bleeding during vapor-cut, the procedure is performed under excellent visibility, which permits more rapid and effective resection.

Effects of epidermal growth factor in artificial tear on vitamin C levels of corneal wounded eye tissues.

PURPOSE: To investigate the effect of artificial tear (AT) solution and epidermal growth factor (EGF) treatment on the cornea and aqueous humour ascorbic acid (AA) levels of full-thickness corneal wounded eyes. METHODS: The effect of EGF on the AA levels of aqueous humour and corneal wound tissue was determined in full-thickness corneal wounded rabbit eyes on the seventh post-operative day. There were three groups: untreated controls, AT-treated controls and an EGF+AT-treated experimental group (n = 6 in each group). Corneal wounded eyes were topically treated with 5 microl AT or 5 microl EGF in AT (1 mg/l EGF in AT prepaaration which contained 3.0% carbopol 940) twice daily for 6 days after operation. The wound strengths were also measured on the seventh post-operative day as a measure of wound healing. Statistical analysis was carried out using the Mann-Whitney U-test by Statview program. RESULTS: The wound strengths of corneas, and AA levels of wound tissues and aqueous humour, increased significantly following AT and EGF treatment (p < 0.05). CONCLUSION: In the corneal wounded eye, aqueous humour serves as a source of vitamin C and there may be a relation between EGF treatment in AT and AA levels of corneal wounded eye tissues.

Outcome of augmentation sigmoidocystoplasty in children with neurogenic bladder.

PURPOSE: The role of augmentation cystoplasty in the neuropathic bladder has been well determined since clean intermittent self-catheterization (CISC) has been accepted as a treatment modality in voiding dysfunction. We present our clinical experience with sigmoid augmentation cystoplasty in children with neurogenic bladder disorder. MATERIAL AND METHODS: From 1991 to 1997 sigmoid augmentation cystoplasty with modified clam technique was performed in 18 cases with neuropathic bladder pathologies. In 4 cases, ureteroneocystostomy was performed, 2 of whom were bilateral. Age range of these patients was 5-17 years (mean 10.3 years) and follow-up period was from 16 to 70 months (mean 41 months). RESULTS: Pyuria was detected in 10 cases and 2 of them were symptomatic. Clinical acidosis was detected in only 1 case. Fifteen cases (83%) were continent by using CISC with 4-6 hourly and detrusor pressure lower than 30 cm water at maximal bladder capacity. CONCLUSION: In children with neurogenic bladder pathologies refractory to conservative management, augmentation cystoplasty with CISC is an effective treatment modality in protecting the upper urinary tract and preventing incontinence.

Penile implants in erectile impotence. The importance of clinical experience on outcome.

PURPOSE: We assessed maximum patient and partner acceptance and satisfaction by informed preoperative prosthesis selection. MATERIALS AND METHODS: Six months to 5 years after penile prosthesis implantation, 71 men and partners were interviewed personally. Evaluation was focused on delineating not only the etiologic factors but also factors most likely to affect prosthesis recommendation and contribute to prognosis. RESULTS: Overall, 94% of the patients and 95% of the partners were satisfied, and 90% of these believed that they had equal erections to previously without the implant, and 81% reported an improvement in nonsexual relations with their partners after the device was implanted. 83 and 17% of the patients said they had increased or had no change in sexual desire, respectively. No one had a decrease in sexual desire. 86% of all the patients believed that their orgasm was improved. 89% of the patients were completely satisfied with the fit of their clothes after prosthesis implantation. 93% of the patients reported good to excellent emotional adjustment to the prosthesis and the prosthesis produced a positive change in self-esteem in 94% of all the patients. CONCLUSIONS: A detailed assessment of patient-partner expectations is essential in order to be able to predict more accurately which patients will be best suited to the implant and which may need either concurrent counseling or preimplant education. A team was formed in which urologists and psychologists worked together, provided comprehensive information on several personality variables of interest in treatment planning and postoperative satisfaction. Our results clearly demonstrate that not only patient preference but also clinical data are important factors in enhancing patient and partner satisfaction.

Combined transurethal resection and vaporization of the prostate using newly designed electrode: a promising treatment alternative for benign prostatic hyperplasia.

BACKGROUND AND OBJECTIVE: Postoperative irritative symptoms and lack of tissue samples for histologic examination are the two main disadvantages of transurethral electrovaporization of the prostate. To decrease the postoperative irritative symptoms while minimizing intraoperative and postoperative bleeding and also to obtain tissue samples, we have combined the techniques of transurethral resection and vaporization, a procedure we have termed Vapor-cut, by using the Wolf Wing gold-plated electrode. PATIENTS AND METHODS: Forty-eight patients with symptomatic benign prostatic hyperplasia (BPH) were enrolled in the study. Adverse events during the procedure, including serial changes in both serum hematocrit and sodium, and postoperative irritative symptoms were recorded after removal of the urethral catheter. Preoperative and postoperative symptom scores and maximum flow rates (Qmax) were obtained in each patient. The volume of the prostate was measured preoperatively and postoperatively using transrectal ultrasonography. RESULTS: During the procedure, there was minimal bleeding, and serum sodium and hematocrit levels were not changed significantly. The mean operative time was 49.3 minutes. The catheterization time and hospital stay were 48 and 60 hours, respectively. Only five patients (10%) reported transient and intermittent postoperative hematuria lasting for 1 week. After removal of the urethral catheter, four patients (8%) had irritative voiding symptoms. No patients experienced postoperative urinary retention or required subsequent catheterization. At 3-month follow-up, the improvement in the mean Qmax was 114%, and the decrease in the symptom score was 72%. The average reduction in the weight of the prostate was 55%. CONCLUSION: Vapor-cut of the prostate appears to be a safe, effective alternative to the standard loop resection and vaporization. It has the advantages of minimal blood loss, excellent operative visibility, decreased postoperative irritative symptoms, and availability of tissue samples with short catheterization and hospitalization times.