Imaging glioma biology: spatial comparison of amino acid PET, amide proton transfer, and perfusion-weighted MRI in newly diagnosed gliomas.

PURPOSE: Imaging glioma biology holds great promise to unravel the complex nature of these tumors. Besides well-established imaging techniques such O-(2-[18F]fluoroethyl)-L-tyrosine (FET)-PET and dynamic susceptibility contrast (DSC) perfusion imaging, amide proton transfer-weighted (APTw) imaging has emerged as a promising novel MR technique. In this study, we aimed to better understand the relation between these imaging biomarkers and how well they capture cellularity and vascularity in newly diagnosed gliomas. METHODS: Preoperative MRI and FET-PET data of 46 patients (31 glioblastoma and 15 lower-grade glioma) were segmented into contrast-enhancing and FLAIR-hyperintense areas. Using established cutoffs, we calculated hot-spot volumes (HSV) and their spatial overlap. We further investigated APTw and CBV values in FET-HSV. In a subset of 10 glioblastoma patients, we compared cellularity and vascularization in 34 stereotactically targeted biopsies with imaging. RESULTS: In glioblastomas, the largest HSV was found for APTw, followed by PET and CBV (p < 0.05). In lower-grade gliomas, APTw-HSV was clearly lower than in glioblastomas. The spatial overlap of HSV was highest between APTw and FET in both tumor entities and regions. APTw correlated significantly with cellularity, similar to FET, while the association with vascularity was more pronounced in CBV and FET. CONCLUSIONS: We found a relevant spatial overlap in glioblastomas between hotspots of APTw and FET both in contrast-enhancing and FLAIR-hyperintense tumor. As suggested by earlier studies, APTw was lower in lower-grade gliomas compared with glioblastomas. APTw meaningfully contributes to biological imaging of gliomas.

Increased pregenual anterior cingulate glucose and lactate concentrations in major depressive disorder.

There is ample evidence that glucose metabolism in the pregenual anterior cingulate cortex (PACC) is increased in major depressive disorder (MDD), whereas it is still unknown whether glucose levels per se are also elevated. Elevated cerebrospinal fluid (CSF) lactate concentrations in MDD patients might indicate that increased glycolytical metabolization of glucose to lactate in astrocytes either alone or in conjunction with mitochondrial dysfunction results in an accumulation of lactate and contributes to pathophysiological mechanisms of MDD. However, until now, no study investigated in vivo PACC glucose and lactate levels in MDD. Proton magnetic resonance spectroscopy was therefore used to test the hypothesis that patients with MDD have increased PACC glucose and lactate levels. In 40 healthy and depressed participants, spectra were acquired from the PACC using a maximum echo J-resolved spectroscopy protocol. Results show significant increases of glucose and lactate in patients, which are also associated with depression severity. These findings indicate impaired brain energy metabolism in MDD with increased fraction of energy utilization via glycolysis and reduced mitochondrial oxidative clearance of lactate. Targeting these metabolic disturbances might affect the balance of metabolic pathways regulating neuronal energetics and result in an attenuation of the elevated basal activity of brain regions within the neural circuitry of depression.

Formula feeding and systemic hypoxia synergistically induce intestinal hypoxia in experimental necrotizing enterocolitis.

PURPOSE: Feeding and systemic hypoxia are major stresses inducing necrotizing enterocolitis (NEC). This study aims to investigate the role of systemic hypoxia in NEC and its effect before and after feeding. METHODS: Neonatal mice were studied in three groups. Control (N = 9): breast feeding; NEC A (N = 8), gavage feeding + lipopolysaccharide (LPS) + preprandial hypoxia; and NEC B (N = 9), feeding + LPS + postprandial hypoxia. Pimonidazole, a hypoxia marker, was injected intraperitoneally before ileum was harvested for histology and quantitative RT-PCR studies. Statistical analysis was done using the ANOVA and Chi-square test. RESULTS: NEC incidence was 62.5% in NEC A and 88.9% in NEC B. The mortality in NEC B (55.6%) but not A (25%) is significantly higher than control (0%, p < 0.05). Pimonidazole staining elevated in both NEC A and B with higher pimonidazole grade in NEC B (p < 0.01). Both NEC groups had increased the expression of hypoxia-related genes: HIF-1α, GLUT-1, and PHD-3 with GLUT-1 expressed more in NEC B compared with NEC A (p < 0.01). The inflammation marker, IL6, was similarly raised in both NEC A and B. CONCLUSION: Feeding and postprandial hypoxia synergistically induce intestinal hypoxia in NEC. As feeding increases intestinal oxygen demand, maintaining a balance between intestinal oxygen supply and demand is important to prevent NEC.

[Recurrent keratoconjunctivitis]. / Rezidivierende Keratokonjunktivitis.

BACKGROUND: Molluscum contagiosum is a highly infectious viral disease of the skin and mucous membranes. These lesions are found particularly often in children and young adults and are generally self-limiting. Nevertheless, molluscum contagiosum lesions in close vicinity to the eyes should be actively removed if they cause conjunctival or corneal irritation. CASE REPORT: We report the case of a 14-year-old boy who was treated for approximately 9 months for recurrent chronic keratoconjunctivitis with corneal neovascularization. Careful inspection of the eyelids revealed molluscum contagiosum. After removal of the lesions on both sides, short-term anti-inflammatory therapy and long-term surface lubrication, a gradual improvement was observed so that an almost complete visual recovery was achieved. CONCLUSION: In long-standing keratoconjunctivitis refractory to treatment, special attention should be paid to the possible presence of molluscum contagiosum, particularly in children and the lesions should be promptly removed.

p53- and p73-independent activation of TIGAR expression in vivo.

TIGAR (TP53-induced glycolysis and apoptosis regulator) functions as a fructose-2,6-bisphosphatase and its expression results in a dampening of the glycolytic pathway, while increasing antioxidant capacity by increasing NADPH and GSH levels. In addition to being a p53 target, p53-independent expression of TIGAR is also seen in many human cancer cell lines that lack wild-type p53. Although human TIGAR expression can be induced by p53, TAp63 and TAp73, mouse TIGAR is less responsive to the p53 family members and basal levels of TIGAR expression does not depend on p53 or TAp73 expression in most mouse tissues in vivo. Although mouse TIGAR expression is clearly induced in the intestines of mice following DNA-damaging stress such as ionising radiation, this is also not dependent on p53 or TAp73.

Navigator based respiratory gating during acquisition and preparation phases for proton liver spectroscopy at 3 T.

Proton magnetic resonance spectroscopy ((1)H MRS) enables the non-invasive investigation of the human liver; however, because of technical difficulties it is not regularly used for diagnosis of liver diseases in clinical routine. Breathing motion is one of the major challenges, as it decreases spectral quality and leads to misplacement of the spectroscopic voxel. To overcome this problem, real-time navigator gating for spectral acquisition and preparation steps (B0 shimming, water frequency determination, receiver gain optimization, and water suppression) combined with short TE , optimized first order projection based B0 shimming, water suppression, and inner-volume saturated point resolved spectroscopy (PRESS) at 3 T is suggested. Simultaneous lipid and trimethylamine quantification is demonstrated by means of phantom, volunteer, and representative patient measurements. Precise localization of the voxel despite respiratory motion, increased spectral quality (higher signal-to-noise ratio and reduced linewidth) compared with measurements without respiratory gating, and the possibility of acquiring data without additional subject instructions regarding breathing enable robust and accurate liver (1)H MRS measurements with this novel acquisition protocol.

(1)H-MR spectroscopy in the human spinal cord.

SUMMARY: MR spectroscopy allows insight into the chemical composition of human tissue noninvasively. Thereby it can help to better characterize pathologic processes affecting the spinal cord and may provide important clinical markers for differential diagnosis. However, due to technical challenges, it has been rarely applied to the spinal cord. The aim of this review was to summarize the technical development and clinical studies using MR spectroscopy in the spinal cord. Main challenges of applying MR spectroscopy in the spinal cord are discussed, and a description of a state-of-the-art scan protocol is given. In conclusion, MR spectroscopy is a promising tool for research and diagnosis of the spinal cord because it can provide additional information complementary to other noninvasive imaging methods. However, the application of MR spectroscopy in the spinal cord is not straightforward, and great care is required to attain optimal spectral quality.

Dipyrrolyl precursors to bisalkoxide molybdenum olefin metathesis catalysts.

Addition of 2 equiv of lithium pyrrolide to Mo(NR)(CHCMe2R')(OTf)2(DME) (OTf = OSO2CF3; R = 2,6-i-Pr2C6H3, 1-adamantyl, or 2,6-Br2-4-MeC6H2; R' = Me or Ph) produces Mo(NR)(CHCMe2R')(NC4H4)2 complexes in good yield. All compounds can be recrystallized readily from toluene or mixtures of pentane and ether and are sensitive to air and moisture. An X-ray structure of a 2,6-diisopropylphenylimido species shows it to be an unsymmetric dimer, {Mo(NAr)(syn-CHCMe2Ph)(eta5-NC4H4)(eta1-NC4H4)}{Mo(NAr)(syn-CHCMe2Ph)(eta1-NC4H4)2}, in which the nitrogen in the eta5-pyrrolyl bound to one Mo behaves as a donor to the other Mo. All complexes are fluxional on the NMR time scale at room temperature, with one symmetric species being observed on the NMR time scale at 50 degrees C in toluene-d8. The dimers react with PMe3 (at Mo) or B(C6F5)3 (at a eta5-NC4H4 nitrogen) to give monomeric products in high yield. They also react rapidly with 2 equiv of monoalcohols (e.g., Me3COH or (CF3)2MeCOH) or 1 equiv of a biphenol or binaphthol to give 2 equiv of pyrrole and bisalkoxide or diolate complexes in approximately 100% yield.

Evaluation of a fall detector based on accelerometers: a pilot study.

As falls and fall-related injuries remain a major challenge in the public health domain, reliable and immediate detection of falls is important so that adequate medical support can be delivered. Available home alarm systems are placed on the hip, but have several shortcomings. A fall detector based on accelerometers and placed at head level was developed, as well as an algorithm able to distinguish between activities of daily living and simulated falls. Accelerometers were integrated into a hearing-aid housing, which was fixed behind the ear. The sensitivity of the fall detection was assessed by investigation into the acceleration patterns of the head of a young volunteer during intentional falls. The specificity was assessed by investigation into activities of daily living of the same volunteer. In addition, a healthy elderly woman (83 years) wore the sensor during the day. Three trigger thresholds were identified so that a fall could be recognised: the sum-vector of acceleration in the xy-plane higher than 2 g; the sum-vector of velocity of all spatial components right before the impact higher than 0.7 m s(-1); and the sum-vector of acceleration of all spatial components higher than 6 g. The algorithm was able to discriminate activities of daily living from intentional falls. Thus high sensitivity and specificity of the algorithm could be demonstrated that was better than in other fall detectors worn at the hip or wrist at the same stage of development.

[Ultrasound-guided hydrostatic reduction of intussusception]. / Ultrahanggal vezérelt hidrosztatikus desinvaginatio.

In our country, the hydrostatic reduction is performed in three different ways. 1. A method with negative contrast material (gas enema) and fluoroscopy is performed only in one hospital. 2. A second method is performed with the use of Gastrographin and guided with ultrasound examination, and finally controlled with x-ray, this method is used in the most places. 3. Sonographically guided enema using physiological saline solution which has been performed by the authors for five years is only used in the Transdanubian region and is getting more and more popular in the resent years. The case history of 34 patients with intussusception was analysed retrospectively and the results of hydrostatic reduction with ultrasound guidance were reviewed. In 22 of 34 patients vomiting was noticed, blood in the stool was found in approximately one-third of all cases, the abdominal pain as the most important sign was presented by all patients. In 24 of 34 patients with intussusception, a single hydrostatic reduction was completely successful, but 10 patients were operated on. With the use of author's method, the following advantages were noticed: control X-ray examination was not needed, and in cases of multiple intussusception of the small intestines all of the lesions were detected.

[The role and value of urodynamics in the follow-up of children with surgical bladder augmentation and substitution]. / Az urodinámia helye és értéke gyermekekben végzett húgyhólyag-megnagyobbítás és -pótlás nyomon követésében.

The authors investigated postoperative capacity, compliance of the urinary bladder and urinary continence in children who underwent bladder augmentation and/or bladder substitution for various forms of urinary incontinence. In 20 children, bladder augmentation and/or bladder substitution procedures were performed because of urinary incontinence, upper urinary tract deterioration and/or failure of conservative treatment (oxybutynin, clean intermittent catheterization--ICC). In 2 patients, reaugmentation was necessary. Urodynamic studies were performed on a regular basis, preoperatively and postoperatively. Based on their experiences, the authors conclude that recognition of changes in bladder capacity and/or compliance and especially the risk of developing upper urinary tract changes is only possible by performing urodynamic studies regularly. Urodynamics is also essential in decision making processes regarding redo surgeries (reaugmentation, transient or permanent urinary diversion).

Does the posterior sagittal approach with perirectal dissection impair fecal continence in a normal rectum?

The aim of this study was to determine, using human material and animal experiments, whether the posterior sagittal approach with perirectal dissection (PSAPD) in patients with an intact anorectum is a suitable means of exposure for the correction of complicated anomalies of the genitourinary tract without impairment of fecal continence. Over the last 6 years, the authors have performed PSAPD in seven children with an intact anorectum. At the time of operation, their ages ranged from 8 months to 14 years. All patients showed normal fecal continence at the end of follow-up (averaging 32 months). Only after completion of the study did the authors read that Peña et al had found that PSAPD provoked severe changes in bowel control in dogs. This contradiction prompted the authors to repeat the animal experiments, and they could not reproduce the favorable results obtained in children. This might be explained by the following factors: the surgical dissection used in the dogs was more extensive, anatomic differences between man and dog, the relatively much younger age of the animals (versus the patients), and the shorter follow-up and lack of educability of the dogs. The authors conclude that PSAPD is a suitable approach for selected lesions of the genitourinary tract in children who have a normal rectum and it does not impair fecal continence.

[Urogenital sinus and cloacal malformations in infancy and childhood: surgical considerations]. / Sinus urogenitalis és cloaca malformatio gyermekkorban: sebészi szempontok.

The relative rarity of urogenital sinus and cloacal anomalies, the wide range of their anatomical variants furthermore the number of different surgical options makes the successful management of a child with such urogenital abnormality one of the greatest challenges to the paediatric surgeon. Based on their own experience and the literature the authors give a review of embryology, pathology, and diagnosis of urogenital sinus and cloacal abnormality. They detail the new surgical therapy developed by Hendren and Pena which has been adopted in their routine. This therapy has significantly improved the functional outcome and prognosis of these anomalies. Over the past 20 years 25 patients with urogenital sinus and cloacal abnormalities were surgically treated in the author's institute.

[Ambulatory pediatric surgery--from the parents' view]. / Ambuláns gyermeksebészet--ahogy a szülök látják.

In recent years "day-care surgery" has been the treatment of choice for an ever increasing number of paediatric surgical patients in countries with an efficient Health Service. The reasons for this are the decreased psychological trauma to the children and the dramatic fall in expenses. In view of the important role played by parental attitude in the spreading of day-care surgery, nearly 200 parental opinions about day-care surgery have been studied. From them it became clear that the parents were convinced of advantages of this form of treatment over the conventional form requiring longer hospitalization. The authors believe that nowadays "day-care surgery" should be resorted to in the majority of a well circumscribed group of paediatric surgical conditions, from which both child and parents, and also our National Health Service will benefit.

[Continent urinary diversion in children: enterocystoplasty + appendiceo-cutaneostomy]. / Kontinens vizeleteltérítés gyermekkorban: enterocystoplasztika + appendico-cutaneostomia.

A continent urinary diversion was done by bladder augmentation using a cecal-colonic segment in total urinary incontinence in 3 patients aged 13, 16 and 21 years. The distal end of the appendix was brought to the skin. The narrow lumen of the appendix provides a closure mechanism in a low pressure urinary reservoir. A watertight, easily catheterizable urinary diversion might mean that there is no need to implant the distal end of the appendix into the bladder or colon in a submucous non-refluxing fashion as recommended by Mitrofanoff. The intermittent clean catheterization of the augmented bladder via the appendix was carried out at intervals of 3 hrs. 12-24 months after the establishment of urinary diversion the patients are free of complaints, socially fully accepted.

Venoconstrictor agents mobilize blood from different sources and increase intrathoracic filling during epidural anesthesia in supine humans.

The authors studied the effects of dihydroergotamine (DHE) and etilefrine hydrochloride (E) on the regional distribution of 99mTc-marked erythrocytes during epidural anesthesia in eight supine men to determine if vasoactive agents with venoconstrictor action would enhance cardiac filling during epidural anesthesia. Radioactivity was recorded with a gamma camera, and its distribution determined in the thorax, abdomen, and limbs. Arterial and central venous pressure, heart rate, and calf volume by plethysmography were measured. During epidural anesthesia with a sensory block up to T4/5, DHE (7.5 micrograms/kg) reduced the radioactivity, i.e., blood volume, in both the innervated (-5.9 +/- 3.5%) and denervated muscle/skin (-16.9 +/- 7%) regions, and increased it in both the intrathoracic (+7.0 +/- 2.3%), and splanchnic vasculature (+4.2 +/- 3.2). In contrast, E (6 micrograms X kg-1 X min-1) decreased the blood volume most markedly in the splanchnic region (-5.4 +/- 0.7%) and increased it in the thorax (+2 +/- 0.6%). All these changes were statistically significant. The combined effects were estimated to be equivalent to a transfusion of nearly 1.01 of blood. Both drugs reversed the hypotensive action of epidural anesthesia. During epidural anesthesia, DHE preferentially constricted the capacitance vessels in skeletal muscle and skin irrespective of the state of innervation, whereas E preferentially constricted the splanchnic vasculature. In the doses used, the two agents replenished in an additive fashion the central circulation during epidural anesthesia.

Clinical symptoms and therapy of lung separation.

This paper refers to the different terminology used in so-called lung separation/sequestration and to the standpoint of the pathologist. Theories of development are discussed. Clinical symptoms, diagnosis, indications for operation and operative technique are described, and nine cases of lung separation (six with extralobar and three with intralobar forms) tabulated analysed. Among them there is a 5-month-old female infant with extralobar lung separation in the right hemithorax resulting in recurrent pleural effusions with severe respiratory insufficiency. There was evidence of aeration in the pathohistological preparation. Pleural effusion and the origin of the aeration in the separated lung are discussed.