Detection of Toxoplasma gondii DNA in naturally infected sheep's milk.

The objective of this study was to verify whether Toxoplasma gondii is excreted in the milk of naturally infected sheep. In order to accomplish this, 275 lactating ewes were used; these were bred extensively in 17 estates distributed across nine cities. Polymerase chain reaction amplification was used to detect T. gondii DNA in milk samples, and the indirect immunofluorescence test was employed for the detection of anti-T. gondii IgG antibodies in the sera, with a cut-off value of 1:64. It was possible to verify the presence of the parasite DNA in 6.5% (18/275) of the studied animals. Anti-T. gondii antibodies were present in 41.5% of the animals studied (114/275). There was no correlation between parasite excretion in milk and the presence of IgG in 38.9% of the studied animals (7/18). The high seropositivity and the presence of parasite DNA in the milk led to the conclusion that T. gondii infection is present in the sheep population in southern and southwestern Bahia, and that there is a risk of the human population becoming infected due to the consumption of raw, in natura milk.

A case report of synchronous osteoblastoma and fibromatosis.

Osteoblastoma is a rare bone tumour that accounts for 1% of all primary bone tumours and 3% of all benign bone tumours. Osteoblastoma occurring in long bones has a predilection for the meta-diaphysis. It bears a close histological resemblance to osteoid osteoma, but it is not growth limited - usually 2 cm or greater at diagnosis. The term "fibromatosis" covers a broad spectrum of benign fibrous tissue proliferations. It is characterized by infiltrative growth and a tendency for recurrence; however, unlike sarcoma, it never metastasizes. To our knowledge, this is the first case report in the English literature of a patient with synchronous presentation of an osteoblastoma and fibromatosis.

Do AshSplit haemodialysis catheters provide better flow rates in the long term?

BACKGROUND: Recently, interventional radiologists have adopted an increasingly prominent role in the placement and management of hemodialysis catheters, as well as in the research and development of new and better catheters. The purpose of this study was to evaluate the viability and hemodialysis efficiency of the AshSplit catheter and the Permcath catheter. METHODS: 204 consecutive patients requiring radiological insertion of hemodialysis catheters were followed, retrospectively, over a 42-month period. Both hemodialysis catheters were placed using a combination of ultrasonic and fluoroscopic guidance and tunneled appropriately. Information collected included catheter insertion sites, insertion complications, catheter duration, and final outcome. RESULTS: Over the study period of two years, 269 catheters were placed into 204 patients with end stage renal failure. Patients received either an AshSplit (101 patients, 127 catheters) or a Permcath (103 patients, 142 catheters). Vascular access route of choice was the right internal jugular vein (67% AshSplit, 71% Permcath). Insertion complications occurred in 18 patients overall (6.6%), with only 1 requiring further intervention (hemopneumothorax). Flow rates averaged 259 mls/min for AshSplits and 248 mls/min for Permcaths (p < 0.001). Follow-up of catheter viability for 42 months yielded a mean AshSplit catheter duration of 246 days (range 6-932) and 239 days (range 1-1,278) for Permcath (p = 0.46). Reasons for catheter failure and elective catheter removal were similar in both groups; however, Permcaths required significantly more thrombolysis than AshSplits, p < 0.001. CONCLUSION: The AshSplit provides significantly better flow rates and less thrombolysis compared to the Permcath, with similar catheter dwell times.

Malignant chest wall neoplasms of bone and cartilage: a pictorial review of CT and MR findings.

Malignant tumours of the chest wall are uncommon. The purpose of this pictorial essay is to describe the CT and MRI findings of malignant neoplasms affecting the bony skeleton of the chest wall and the costal cartilages. The most common primary malignant neoplasms involving the bony skeleton of the chest wall are chondrosarcoma, osteosarcoma and Ewing's sarcoma/primitive neuroectodermal tumour. Metastases, multiple myeloma and invasive primary lung cancer are the most frequent secondary lesions. We performed a retrospective review of the radiology and pathology archive at our institution from 1 July 2000 to 31 December 2004 and identified 31 of these lesions. Several of these tumours have distinctive radiological features, allowing a confident radiological diagnosis to be suggested.

Soft tissue tumours and mass-like lesions of the chest wall: a pictorial review of CT and MR findings.

Soft tissue tumours and tumour-like lesions of the chest wall are uncommon. The purpose of this pictorial essay is to describe the imaging findings of chest wall soft tissue tumours and tumour-like lesions. We searched the radiological and pathological archive at our institution retrospectively and reviewed the literature on soft tissue tumours of the chest wall. Common chest wall soft tissue tumours and mass-like lesions include peripheral nerve tumours, lipomas, liposarcomas, haemangiomas, elastofibromas, metastases, lymphoma and abscesses. Other lesions encountered include desmoid tumours and malignant fibrous histiocytoma. Many have distinctive radiological findings or occur in specific locations, allowing a specific radiological diagnosis to be suggested.

Bouveret's syndrome: a rare complication of cholecystolithiasis.

Bouveret's syndrome is obstruction of the stomach or the duodenum from a gallstone that has migrated through a biliogastric or bilioduodenal fistula. This rare syndrome has been described in a number of case reports.

Accuracy of Voxel-Based and Algebraic Formula-Based Methods in Quantifying Cerebral Aneurysm Volume by 3D-Rotational Digital Subtraction Angiography. An In-Vitro and In-Vivo Study.

SUMMARY: Accurate knowledge of cerebral aneurysm volume would be valuable in guiding the volume of embolized material required for optimal filling of an aneurysm sac and recording percentage volume filling. Algebraic volumes are frequently estimated by algebraic volume formulae. 3D digital subtraction angiography (DSA) aids endovascular treatment planning and yields volumetric data. Our aim was to define the accuracy of 3D-DSA in quantifying aneurysm volume using an automated voxel-based volumetric method (voxel volume method) and compare results to volumes calculated by ellipsoid and cylindrical algebraic formulae (algebraic volume method). We constructed 13 latex aneurysm moulds and measured their true volumes using a micropipette in-vitro. 3D-DSA was performed on contrast filled moulds and experimental volume estimated by both voxel and algebraic methods. In our in-vivo study we quantified the voxel and algebraic volumes from the 3D data sets of 75 cerebral aneurysms. The linear regression test provided correction values between voxel and algebraic methods. The in-vitro study showed that the voxel volume method was the most accurate (mean percentage deviation from true volume 3.7 +/- 3.5%; p=0.9). The ellipsoid method significantly underestimated - 11.2 +/- 13.6%; p < 0.05) and the cylindrical method overestimated (42.6 +/- 35.7%; p < 0.05) true aneurysm volume. Similar results were obtained in-vivo. While algebraic measurements could be corrected by an equation, the clinical usefulness of this equation is questionable due to the large volume range to achieve a 95% confidence interval. The voxel volume method is accurate in quantifying aneurysm volume. Aneurysms in-vivo do not conform to simple algebraic geometry. Aneurysm volume on 3D-DSA should be calculated by the voxel-based method and not by algebraic formulae.

A prospective comparison of two types of tunneled hemodialysis catheters: the Ash Split versus the PermCath.

PURPOSE: In a prospective randomized study a standard dual-tip hemodialysis catheter (PermCath, Sherwood Medical, St. Louis, MO, USA) was compared with a newer split-lumen catheter (Ash Split, Medcomp, Harleysville, PA, USA). METHODS: Sixty-nine patients (42 men, 27 women; mean age 62 years) were randomized to receive either the Ash Split (AS) or the PermCath (PC) catheter. The catheters were inserted into the internal jugular vein. The primary outcome evaluated was blood flow measurements during the first six hemodialysis sessions. Secondary outcomes included: technical difficulties encountered at insertion, early complications and late complications requiring catheter removal or exchange. RESULTS: A total of 69 hemodialysis catheters, 33 AS and 36 PC, were successfully inserted in the internal jugular vein (right 60, left 9) of 69 patients. Mean blood flow during dialysis (Qb) was 270.75 ml/min and 261.86 ml/hr for the AS and PC groups respectively (p = 0.27). Mean duration of catheter use was 111.7 days (range 5.4-548.9 days) and 141.2 days (range 7.0-560.9 days) in the AS and PC groups respectively (p = 0.307). Catheter failures leading to removal or exchange occurred in 20 patients: 14 in the AS group and six in the PC group. Survival curves with censored endpoints (i.e., recovery, arteriovenous fistula formation, peritoneal dialysis and transplantation) showed significantly better outcome with PermCath catheters (p = 0.024). There was no significant difference in ease of insertion or early complication rates. CONCLUSION: The Ash Split catheter allows increased rates of blood flow during hemodialysis but this increase was not significant at the beginning (p = 0.21) or end (p = 0.27) of the first six hemodialysis sessions. The Ash Split catheter is more prone to minor complications, particularly dislodgment, than the PermCath catheter.

Intracranial giant cell arteritis with fatal middle cerebral artery territory infarct.

A 37 year-old man who developed a fatal middle cerebral territory infarct was found at autopsy, to have widespread granulomatous angiitis involving meningeal and intracranial--extracerebral vessels but not intracerebral vessels or other extra-cranial vessels. The findings are unique and overlap with those of granulomatous angiitis of the nervous system (GANS) and classic giant cell arteritis (GCA). A possible precipitant for this devastating illness was a recent Chlamydia infection. The salient clinical and pathologic differences between GANS and GCA of the nervous system are discussed.

Informed consent for interventional radiology procedures: a survey detailing current European practice.

PURPOSE: Official recommendations for obtaining informed consent for interventional radiology procedures are that the patient gives their consent to the operator more than 24 hr prior to the procedure. This has significant implications for interventional radiology practice. The purpose of this study was to identify the proportion of European interventional radiologists who conform to these guidelines. METHODS: A questionnaire was designed consisting of 12 questions on current working practice and opinions regarding informed consent. These questions related to where, when and by whom consent was obtained from the patient. Questions also related to the use of formal consent forms and written patient information leaflets. Respondents were asked whether they felt patients received adequate explanation regarding indications for intervention, the procedure, alternative treatment options and complications. The questionnaire was distributed to 786 European interventional radiologists who were members of interventional societies. The anonymous replies were then entered into a database and analyzed. RESULTS: Two hundred and fifty-four (32.3%) questionnaires were returned. Institutions were classified as academic (56.7%), non-academic (40.5%) or private (2.8%). Depending on the procedure, in a significant proportion of patients consent was obtained in the outpatient department (22%), on the ward (65%) and in the radiology day case ward (25%), but in over half (56%) of patients consent or re-consent was obtained in the interventional suite. Fifty percent of respondents indicated that they obtain consent more than 24 hr before some procedures, in 42.9% consent is obtained on the morning of the procedure and 48.8% indicated that in some patients consent is obtained immediately before the procedure. We found that junior medical staff obtained consent in 58% of cases. Eighty-two percent of respondents do not use specific consent forms and 61% have patient information leaflets. The majority of respondents were satisfied with their level of explanation regarding indications for treatment (69.3%) and the procedure (78.7%). Fifty-nine percent felt patients understood alternative treatment options. Only 37.8% of radiologists document possible complications in the patient's chart. Comments from respondents indicated that there is insufficient time for radiologists to obtain consent in all patients. Suggestions to improve current local policies included developing the role of radiology nursing staff and the use of radiology outpatient clinics. CONCLUSIONS: More than 50% of respondents are unhappy with their policies for obtaining informed consent. Interventional societies have a role to play in advocating formal consent guidelines.