Esophageal tumors: The keys to diagnosis by pneumo-computed tomography.

OBJECTIVE: To review and describe the most characteristic radiological findings of the most frequent esophageal tumor lesions, with emphasis on the esophago-gastric distention technique pneumo-computed tomography performed in our institution. To know the main advantage of this distension technique. CONCLUSION: Malignant tumor lesions (predominantly squamous cell carcinoma in the mid esophagus and adenocarcinoma in the distal esophagus) present as asymmetric wall thickening, mucosal irregularity, or mass extending into adjacent organs with lymph node involvement. Benign tumors (mainly leiomyoma being the most frequent and others such as lipoma) present as endoluminal growth, with defined borders and homogeneous attenuation. Post-contrast enhancement is scarce or moderate. The technique of computed tomography pneumotomography technique achieves an additional distension of the esophageal lumen in all cases. It allows delimiting the superior and inferior borders of the lesions, helping the surgeon to define the therapeutic strategy.

Correlation between pneumo-computed tomography and pathology findings for subepithelial gastric lesions.

OBJECTIVE: This article aims to show the usefulness of the pneumo-computed tomography gastric distention technique in the detection and morphological characterization of subepithelial gastric lesions. We correlate the pneumo-computed tomography and pathology findings in lesions studied at our institution and review the relevant literature. CONCLUSION: Pneumo-computed tomography, combined with multiplanar reconstructions, three-dimensional reconstructions, and virtual endoscopy, is useful for delineating the morphological details of subepithelial gastric lesions, thanks to the additional gastric distention. This technique better delimits and characterizes the upper and lower margins of the lesions. Pneumo-computed tomography can be considered a useful noninvasive imaging techniques for characterizing these lesions.

Correlación anatomopatológica con neumo-tomografía computarizada de lesiones gástricas subepiteliales / Correlation between pneumo-computed tomography and pathology findings for subepithelial gastric lesions

Objetivo: El propósito de este artículo es destacar la utilidad de la técnica de distensión gástrica neumo-tomografía computarizada en la detección y caracterización morfológica de las lesiones subepiteliales gástricas estudiadas en nuestra institución, con su correlación de anatomía patológica y una revisión de la literatura. Conclusión: La neumo-tomografía computarizada combinada con las reconstrucciones multiplanares, las reconstrucciones tridimensionales y la endoscopia virtual es útil para delinear los detalles morfológicos de las lesiones subepiteliales gástricas debido a la distensión gástrica adicional. Se logra una mejor delimitación de sus bordes superior e inferior, así como las características de sus márgenes. Puede considerarse una técnica de imagen útil y no invasiva para la caracterización de estas lesiones.(AU)

Objective: This article aims to show the usefulness of the pneumo-computed tomography gastric distention technique in the detection and morphological characterization of subepithelial gastric lesions. We correlate the pneumo-computed tomography and pathology findings in lesions studied at our institution and review the relevant literature. Conclusion: Pneumo-computed tomography, combined with multiplanar reconstructions, three-dimensional reconstructions, and virtual endoscopy, is useful for delineating the morphological details of subepithelial gastric lesions, thanks to the additional gastric distention. This technique better delimits and characterizes the upper and lower margins of the lesions. Pneumo-computed tomography can be considered a useful noninvasive imaging techniques for characterizing these lesions.(AU)

Mesenchymal hamartoma and undifferentiated embryonal sarcoma: diagnostic keys that radiologists need to know. / Hamartoma mesenquimatoso y sarcoma embrionario indiferenciado: claves diagnósticas que el radiólogo debe conocer.

OBJECTIVE: Hepatic tumors are uncommon in pediatric patients. Among the most common of these uncommon tumors are mesenchymal hamartoma and undifferentiated embryonal sarcoma, which have different origins but similar appearance on imaging studies. This paper reviews the characteristic findings and differential diagnosis of these entities. Ultrasonography is the first-line imaging test to study these tumors. Magnetic resonance imaging and computed tomography are useful for further characterizing the tumors and planning surgery. CONCLUSION: Radiologists need to be familiar with the imaging findings of the different disease entities and to evaluate them together with the patient's age, personal history, and bloodwork.

Peritonitis esclerosante encapsulante: hallazgos en imágenes de una entidad poco frecuente / Sclerosing encapsulating peritonitis: imaging findings in an uncommon entity

OBJETIVOS: Describir los hallazgos radiológicos más característicos de la peritonitis esclerosante encapsulante en los diferentes métodos de imagen, con énfasis en la tomografía computarizada. CONCLUSIÓN: La peritonitis esclerosante encapsulante es una enfermedad de baja incidencia, aunque desconocida, su fisiopatología no está clara y se reconocen dos tipos: idiopática y secundaria; esta última generalmente como complicación de la diálisis peritoneal. Su diagnóstico suele ser tardío debido a la presentación clínica inespecífica y a la ausencia de marcadores serológicos. Por este motivo es importante conocer los signos radiológicos, que incluyen engrosamiento y calcificación del peritoneo, dilatación de asas intestinales con engrosamiento y calcificación de sus paredes, ya sea aislados o asociados con ascitis loculada. Si bien la ecografía permite valorar la complejidad de las colecciones, la tomografía computarizada es el método de mayor valor para la delineación general de los signos radiológicos mencionados

OBJECTIVES: To describe the most characteristic imaging findings for sclerosing encapsulating peritonitis, with an emphasis on the computed tomography findings. CONCLUSION: The incidence of sclerosing encapsulating peritonitis is low. The pathophysiology of this condition is unclear. Two types are recognized: idiopathic and secondary; the secondary type is generally a complication of peritoneal dialysis. Its nonspecific clinical presentation and the absence of blood markers mean that sclerosing encapsulating peritonitis is usually diagnosed late. Thus, it is important to know the imaging signs; these include thickening and calcification of the peritoneum and dilation of bowel loops with thickening and calcification of bowel walls, whether in isolation or in association with loculated ascites. Although ultrasonography allows the complexity of the collections to be evaluated, computed tomography is the most useful technique for the general assessment of the signs mentioned above

Sclerosing encapsulating peritonitis: imaging findings in an uncommon entity. / Peritonitis esclerosante encapsulante: hallazgos en imágenes de una entidad poco frecuente.

OBJECTIVES: To describe the most characteristic imaging findings for sclerosing encapsulating peritonitis, with an emphasis on the computed tomography findings. CONCLUSION: The incidence of sclerosing encapsulating peritonitis is low. The pathophysiology of this condition is unclear. Two types are recognized: idiopathic and secondary; the secondary type is generally a complication of peritoneal dialysis. Its nonspecific clinical presentation and the absence of blood markers mean that sclerosing encapsulating peritonitis is usually diagnosed late. Thus, it is important to know the imaging signs; these include thickening and calcification of the peritoneum and dilation of bowel loops with thickening and calcification of bowel walls, whether in isolation or in association with loculated ascites. Although ultrasonography allows the complexity of the collections to be evaluated, computed tomography is the most useful technique for the general assessment of the signs mentioned above.

Onset and temporal sequencing of lifetime anxiety, mood and substance use disorders in the general population.

Aims. To date, very few studies have examined the bi-directional associations between mood disorders (MDs), anxiety disorders (ADs) and substance use disorders (SUDs), simultaneously. The aims of the current study were to determine the rates and patterns of comorbidity of the common MDs, ADs and SUDs and describe the onset and temporal sequencing of these classes of disorder, by sex. Methods. Data came from the 2007 Australian National Survey of Mental Health and Wellbeing, a nationally representative household survey with 8841 (60% response rate) community residents aged 16-85. Results. Pre-existing mental disorders increase the risk of subsequent mental disorders in males and females regardless of the class of disorder. Pre-existing SUDs increase the risk of subsequent MDs and ADs differentially for males and females. Pre-existing MDs increase the risk of subsequent ADs differentially for males and females. Conclusions. Comorbidity remains a significant public health issue and current findings point to the potential need for sex-specific prevention and treatment responses.

Leukocyte counts in cerebrospinal fluid and blood following firategrast treatment in subjects with relapsing forms of multiple sclerosis.

BACKGROUND AND PURPOSE: Firategrast is an orally bioavailable alpha4 beta1/alpha4 beta7 integrin antagonist designed to reduce trafficking of lymphocytes into the central nervous system (CNS). This could decrease multiple sclerosis (MS) activity, but may compromise CNS immune surveillance. We aimed to quantitate the effect of firategrast treatment on cerebrospinal fluid (CSF) lymphocyte count and the extent/speed of recovery after its discontinuation. METHODS: Forty-six subjects with relapsing forms of MS were treated for up to 24 weeks with open-label firategrast, 900 (females) or 1200 (males) mg twice daily. CSF and blood cell counts, and lymphocyte composition were determined using flow cytometry. RESULTS: Median (n, range) CSF lymphocyte counts (cells/µl) at weeks 0, 24, 28 and 36 were: 5.3 (44, 0.3-70.2), 3.3 (31, 0.0-99.0), 3.0 (32, 0.0-58.2) and 3.5 (29, 0.0-274.8). CD4+, CD8+ T- and CD19+ B-lymphocyte counts followed a similar pattern. Minimal changes were observed for CD3-CD16+CD56+ natural killer cells. Median CD4 : CD8 ratios were: 2.9 (41, 1.1-10.9), 2.2 (29, 0.6-5.9), 3.8 (28, 1.6-9.0) and 3.8 (21, 2.1-9.4). Blood lymphocyte counts were elevated at weeks 4 and 24, consistent with the mechanism of firategrast, and returned to baseline when firategrast was discontinued. There were minimal changes in CD4 : CD8 ratios. CONCLUSIONS: Firategrast treatment was associated with modest decreases in median CSF total, CD4, CD8 and CD19 lymphocyte counts. The generally small magnitude of decreases suggests that sufficient numbers of lymphocytes can access the subarachnoid space, preserving CNS immune surveillance.

Impact of chronic atrial fibrillation in patients with severe heart failure and indication for CRT: data of two registries with 711 patients (1999-2006 and 2007-6/2008).

AIMS: Atrial fibrillation (AF) is a relevant comorbidity in heart failure (HF) patients. In milestone cardiac resynchronization therapy (CRT) studies, patients with AF were excluded. We sought to investigate the influence of chronic atrial fibrillation (AF) on patients with CRT. AV node (AVN) ablation is frequently recommended. Converting AF to sinus rhythm (SR) is not a standard concept. METHODS: A total of 584 consecutive patients with CRT devices were included in a single-center registry from 1999-2006 (retrospective registry) and 127/324 patients from 2007-06/2008 (prospective registry). The impact of persistent AF (group 1) on clinical and echocardiographic improvement compared with patients in SR (group 2) after 12 (6) months follow-up were analyzed. Re-establishing SR after initial cardioversion or need for AVN ablation was examined. RESULTS: In the retrospective registry, 139 (24%) patients presented with AF (group 1) and 445 with SR (group 2). The groups differed in age, gender, and left atrium (LA) size but not in NYHA class, ejection fraction (EF), left ventricular end-diastolic dimension (LVEDD), B-type natriuretic peptide (BNP) levels, QRS width, and underlying disease. After 1 year, CRT improvement of NYHA class and EF was similar with higher mortality in group 1 (12% vs. 7%; OR 1.80; 95% confidence interval 0.95-3.4). The AF group presented with SR in 33/82 (40%) patients and 11% needed AVN ablation. The prospective data showed 27 (21%) patients in AF with conversion to SR in 41% after 6 months. CONCLUSION: Patients with severe HF and chronic AF had a comparable improvement with CRT as those in SR. CRT is a successful treatment option in patients with chronic AF offering the potential to restore SR in a significant number of patients.

Osprey distribution, abundance, reproductive success and contaminant burdens along lower Columbia River, 1997/1998 versus 2004.

The osprey (Pandion haliaetus) population nesting along the lower portion of the Columbia River (river mile 29 to 286) increased from 94 in 1997 to 103 occupied nests in 1998 (9.6% annual rate of increase) to 225 occupied nests in 2004 (13.9% annual rate of increase). The more recent rate of population increase was associated with higher reproductive rates than in 1997/1998, and significantly lower egg concentrations of most organochlorine (OC) pesticides, polychlorinated biphenyls (PCBs), polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs). A comparison of observed egg residue concentrations in 2004 with effect-level information for ospreys indicated that reproduction at few, if any, nests was adversely affected. As recent as 1997/1998, dichlorodiphenyldichloroethylene (DDE) was still adversely affecting reproductive success for a portion of this population. Mercury was the only contaminant evaluated in both 1997/1998 and 2004 that showed a significant increase in eggs over time, but concentrations in 2004 (0.09 microg g(-1) ww) remained below established effect levels for birds (generally reported at 0.50 microg g(-1) ww or higher). The significant increase in mercury justifies the need for future monitoring. All contaminants mentioned that biomagnify up food chains can be effectively monitored in osprey eggs. The osprey has been shown to be an excellent sentinel species for long-term monitoring with their many useful traits described.

Mercury and drought along the lower Carson River, Nevada: I. Snowy egret and black-crowned night-heron annual exposure to mercury, 1997-2006.

The dynamic nature of the annual volume of water discharged down the Carson River over a 10-year period, which included a century flood and drought, was examined in order to gain a better understanding of mercury movement, biological availability, and exposure to waterbirds nesting at Lahontan Reservoir. Total annual water discharge directly influenced total mercury (THg) in unfiltered water above the reservoir and downstream of a mining area, whereas methyl mercury (MeHg) at the same site was negatively related to annual discharge. Annual water storage at Lahontan Reservoir in the spring and early summer, as expected, was directly related to annual Carson River discharge. In contrast to the findings from above the reservoir, annual MeHg concentrations in water sampled below the reservoir were positively correlated with the total discharge and the amount of water stored in the reservoir on 1 July; that is, the reservoir is an important location for mercury methylation, which agrees with earlier findings. However, unfiltered water MeHg concentrations were about 10-fold higher above than below the reservoir, which indicated that much MeHg that entered as well as that produced in the reservoir settled out in the reservoir. Avian exposure to mercury at Lahontan Reservoir was evaluated in both eggs and blood of young snowy egrets (Egretta thula) and black-crowned night-herons (Nycticorax nycticorax). Annual MeHg concentrations in unfiltered water below the reservoir, during the time period (Julian Days 90-190) when birds were present, correlated significantly with mercury concentrations in night-heron blood (r(2 )= 0.461, p = 0.027), snowy egret blood (r(2 )= 0.474, p = 0.024), and night-heron eggs (r(2) = 0.447, p = 0.029), but not snowy egret eggs. A possible reason for lack of an MeHg water correlation with snowy egret eggs is discussed and relates to potential exposure differences associated with the food habits of both species. THg concentrations in water collected below the reservoir were not related to egg or blood mercury concentrations for either species.

Intracoronary photodynamic therapy reduces neointimal growth without suppressing re-endothelialisation in a porcine model.

OBJECTIVE: To examine the effects of intracoronary PhotoPoint photodynamic therapy (PDT) with a new photosensitiser, MV0611, in the overstretch balloon and stent porcine models of restenosis. METHODS: 28 pigs were injected with 3 mg/kg of MV0611 systemically 4 h before the procedure. Animals were divided into either the balloon overstretch injury (BI) group (n = 19) or the stented group (n = 9). After BI, a centred delivery catheter was positioned in the artery to cover the injured area, and light (532 nm, 125 J/cm(2)) was applied to activate the drug (n = 10). Control arteries (n = 9) were not activated by light. In the stented group, the drug was light activated before stent deployment. Serial sections of vessels were processed 14 days after treatment in the BI group and 30 days after treatment in the stented group for histomorphometric or immunohistochemical analysis. RESULTS: Intracoronary PDT significantly reduced intimal thickness in both BI and stented arteries (about 65%: 0.22 (SEM 0.05) mm v 0.62 (0.05) mm, p < 0.01; and about 26%: 0.40 (0.04) mm v 0.54 (0.04) mm, p < 0.01, respectively). PDT increased luminal area by

[Cardiac resynchronization therapy (CRT) and anodal stimulation]. / Kardiale Resynchronisationstherapie (CRT) und anodale Stimulation.

We describe a biventricular stimulation mode to pace both ventricles with a single electrical stimulus between the tip of the left ventricular electrode and the tip of the right ventricular electrode: one ventricle is stimulated cathodal the other anodal.

[Implantation of a biventricular pacing system via a persistent left-sided superior vena cava]. / Biventrikuläre Schrittmacherimplantation über eine persistierende linke obere Hohlvene.

Cardiac resynchronization therapy by multisite biventricular pacing presents an additive therapeutic option in the treatment of severe heart failure. Biventricular pacemaker implantation is challenging in patients with persistent left superior vena cava. We describe in this case report the implantation of a biventricular pacemaker using a left-sided approach in a patient with persistent left superior vena cava.

[The arrhythmogenic right ventricular cardiomyopathy (ARVC)]. / Die arrhythmogene rechtsventrikuläre Cardiomyopathie (ARVC)Typische Befunde anhand eines Fallbeispieles.

The following report illustrates the case of a 40-year old patient, who was transferred to our hospital because of a symptomatic sustained ventricular tachycardia (VT). The documented VT showed typical left bundle branch block morphology with an inferior axis, which was accompanied by repolarization abnormalities in the right precordial leads, as revealed by the surface ECG. While coronary angiography allowed the exclusion of an obstructive coronary heart disease and confirmed an intact left ventricular function, the right ventricular angiography as well as the MRI demonstrated not only reduced right ventricular function but also regional abnormalities of contraction in the inferior and diaphragmal regions and typical "outpouchings" and "bulgings". The MRI also provided evidence for sporadic fatty infiltrations of the right ventricle. In the electrophysiological study, sustained VT could be reproducibly induced, while showing the typical RVOT configuration, which corresponded to the clinically apparent VT. Since these examination results matched with the criteria of McKenna et al., arrhythmogenic right ventricular cardiomyopathy was diagnosed. The patient underwent implantation of a cardioverter-defibrillator (ICD) and medical treatment with metoprolol. This particular case report was selected because it shows a typical presentation of an ARVC. Furthermore, the present example offers the possibility of demonstrating that in the case of an ARVC in the regions of the right ventricle, arrhythmogenic areals can also be found which seem morphologically inconspicuous.

Test-retest reliability of the aerobic power index component of the tri-level fitness profile in a sedentary population.

Use of maximal aerobic power (VO2(max)) testing, which requires subjects to exercise to physiological limits, may deter eligible candidates from volunteering for trials and may also be contraindicated in patients suffering from various medical illnesses. An alternative to maximal testing is submaximal testing. The Aerobic Power Index, which represents the aerobic component of the Tri-level Fitness Profile, is a submaximal test that has been shown to be reliable in trained athletes. The purpose of this study was to establish reliability of the Aerobic Power Index, as well as associated variables of VO2 (ml x kg(-1) x min(-1) and rate of perceived exertion (RPE), in a group of sedentary subjects. Results for the 20 subjects who participated in a test-retest trial indicated high reliability (ICC r = 0.98, %TEM 3.87 W x kg(-1); SEM 0.04 W x kg(-1) for the main measurement outcome of Watts per kilogram (W x kg(-1)). Oxygen uptake (ml x kg(-1)min(-1)) also demonstrated high reliability (ICC r = 0.92; %TEM 4.63 ml x kg(-1) x min(-1); SEM 0.58 ml x kg(-1) min (-1), as did RPE (ICC r = 0.97,%TEM 7.78; SEM 0.63). Limits of agreement were -0.02+/-0.16 W x kg(-1). -0.41+/-2.31 ml x kg(-1) x min(-1) for VO2 and -0.05 < or = 2.10 for RPE. These results indicate that the Aerobic Power Index is a reliable submaximal exercise test for use in sedentary subjects.

Detection of Helicobacter pylori specific DNA in human atheromatous coronary arteries and its association to prior myocardial infarction and unstable angina.

BACKGROUND: Chronic infections have been proposed to play a role in the aetiology or progression of atherosclerotic plaques. Increased risk of coronary artery disease has been suggested in patients seropositive for Helicobacter pylori. AIM: To analyse coronary specimens in patients with severe (coronary artery disease) for Helicobacter pylori specific DNA. PATIENTS AND METHODS: Atherosclerotic plaques were obtained in 46 consecutive patients (9 female, 37 male, mean age 62.7+/-9.17 years) during coronary bypass procedures. Serum was analysed for IgG -/cagA-antibodies specific for Helicobacter pylori. Polymerase chain reaction and sequence analysis were used to identify bacterial DNA. Coronary artery biopsies from 19 autopsies without coronary artery disease were examined as a control group. RESULTS: Of the 46 coronary artery disease patients, 32 (69.6%) were Helicobacter pylori seropositive. Positive results for Helicobacter pylori DNA showed 18 seropositive and 4 seronegative (with anamnesis of eradication therapy). A total of 22 patients (47.8%) of the coronary artery disease group but none of controls revealed positive DNA. In the coronary artery disease group, a correlation between DNA presence and prior myocardial infarction (p=0.008) and unstable angina (p<0.001) was found. CONCLUSION: Identification of DNA in atherosclerotic plaques of patients with severe coronary artery disease supports the hypothesis that Helicobacter pylori infection may influence the development of atherosclerosis. Our results may indicate an direct involvement of Helicobacter pylori in the progression and instability of plaques in these patients.

Acute haemodynamic effects of AV-synchronous pacemaker stimulation in patients with congestive heart failure and left bundle branch block.

INTRODUCTION: The therapeutical limits of drug and surgical therapy for severe chronic heart failure make the research for adjunctive treatment options necessary. After the positive effects of AV-synchronous pacemaker stimulation in patients with dilatative cardiomyopathy and 1st degree AV-block, this study was to evaluate the benefit of transient pacemaker stimulation in patients with dilated cardiomyopathy and left bundle branch block. METHODS AND PATIENTS: 19 patients (14 male, 5 female, age 60 +/- 8 yrs) were included in the study. Inclusion criteria were congestive heart failure, stage NYHA III or greater and left bundle branch block. Transient stimulation of the myocardium was applied via two electrodes (right atrium and right ventricle) in VDD mode, whereby a series of AV-delay-times between 80 and 180 ms was tested. Thermodilution was used to determine cardiac output, pulmonary capillary pressure and pulmonary arterial pressure. RESULTS: In 16 patients, pacemaker stimulation led to a significant increase of cardiac output (3.8 +/- 0.5 l/min to 4.6 +/- 0.5 l/min; p < 0.002), cardiac index (1.90 +/- 0.20 l/min/m2 to 2.3 +/- 0.2 l/min/m2; p < 0.002) and of stroke volume (51 +/- 8 ml to 62 +/- 6 ml; p < 0.002) as well as a significant reduction of mean pulmonary capillary pressure (19 +/- 1 mmHg to 15 +/- 1 mmHg; p < 0.01). The mean pulmonary arterial pressure remained unchanged. Three patients did not benefit from the treatment. CONCLUSION: AV-sequential pacemaker-stimulation (right ventricular electrode placement) can be a valuable adjunctive therapy in selected patients with late stage congestive heart failure and left bundle branch block.

[25-year experience with reusable heart catheters]. / 25 Jahre Erfahrung mit wiederaufbereiteten Herzkathetern.

For 25 years, cardiac catheters have been prepared for reuse in a hospital for heart and vessel diseases, in the beginning by the hospital itself, later on by a specialized company with a standardize, validated certified procedure. Experiences with almost 100,000 interventions with flow directed catheters, diagnostic left-heart- and angiography-catheters, balloon- and electrophysiology-catheters, which were performed with reused material in more than half of these cases, are reported. All patients were informed that disposable catheters were reused. Neither the duration of the intervention, the x-ray load for the patient, the consumption of contrast media and the change rate of catheters, nor the catheter dependent complication rates were increased for reused catheters in comparison to single use. Therefore the reuse of cardiac catheters does not affect patients' safety, but is a cost-saving strategy.

[Effect of body mass index on success rate of external and internal cardioversion]. / Einfluss des Body-Mass-Index auf die Erfolgsrate der externen und internen Kardioversion.

Atrial fibrillation is due to complications a frequent clinical problem. Internal cardioversion shows a high effectiveness with conversion rates from up to 85%. Aim of this study was to evaluate the influence of body weight (body-mass-index [BMI]) on the effectiveness of different cardioversion procedures.