[A sarcophagus with a surprise: computed tomography of a mummy from the Late Period of ancient Egypt]. / Un sarcófago con sorpresa: estudio con tomografía computarizada de una momia egipcia de Baja Época.

INTRODUCTION: Diagnostic imaging techniques, at present especially computed tomography (CT), have become the most important noninvasive method for the study of mummies because they enable high resolution images and three-dimensional reconstructions without damaging the mummified subject. We present a sarcophagus with a mummy hidden inside that was acquired by a gallery in Barcelona. MATERIAL AND METHODS: The sarcophagus and mummy were examined by CT at the Hospital Universitari Sagrat Cor in Barcelona. A flexible clamp was used to obtain tissue samples for further study. RESULTS: The results showed the presence of an anatomically intact female human subject albeit with a destructured thorax and upper abdomen. Various metal objects were detected, corresponding to amulets, artificial eyes, and an external wooden brace. CONCLUSION: CT is an excellent noninvasive imaging technique for the detailed study of mummies, as it enables not only the anatomic identification of the mummified subject but also the obtainment of tissue samples for complementary analyses. The description of these findings enables us to know the major radiologic landmarks for the paleopathologic study of mummies.

Dilated aortic root is related to a global aortic dilating diathesis.

OBJECTIVE: The purpose of this study was to analyze the association between the dilatation of the aortic root and the diameters of the rest of the aorta and to identify some related factors that could be used to identify patients at higher risk of presenting with an aortic aneurysm. METHODS: In 71 consecutive patients with a dilated aortic root identified by transthoracic echocardiography, prospective helical computed tomography was performed. Aortic diameters were measured perpendicular to the flow at seven levels in the thoracic and abdominal aorta. RESULTS: Ascending aorta diameter showed a moderate correlation with aortic indexed diameters at the thoracic and abdominal level in tricuspid aortic valve patients (r ranging from 0.37-0.56), whereas in patients with a bicuspid aortic valve, a moderate correlation between the ascending aorta diameters and the thoracic descending aorta diameters was observed (r 0.51-0.53). In a multivariate analysis, age was independently related to indexed diameter at all aortic sites (ß ranging from 0.06-0.12 per year), whereas aortic regurgitation was independently related only to thoracic aorta diameter (ß ranging from 1.17-1.84). Age (P < .0001), body surface area (P < .0001), and grade of aortic valve regurgitation (P = .001) independently predicted aortic volume. CONCLUSION: Different patterns of aortic diameters were observed in patients with dilated aortic root, depending on age, aortic valve morphology, and function. When a dilated aortic root is detected in older patients with a tricuspid aortic valve, an accurate cardiovascular survey that includes the entire aorta is needed. These results provide further evidence about the systemic nature of aortic dilatation.

Liver fat deposition and mitochondrial dysfunction in morbid obesity: An approach combining metabolomics with liver imaging and histology.

AIM: To explore the usefulness of magnetic resonance imaging (MRI) and spectroscopy (MRS) for assessment of non-alcoholic fat liver disease (NAFLD) as compared with liver histological and metabolomics findings. METHODS: Patients undergoing bariatric surgery following procedures involved in laparoscopic sleeve gastrectomy were recruited as a model of obesity-induced NAFLD in an observational, prospective, single-site, cross-sectional study with a pre-set duration of 1 year. Relevant data were obtained prospectively and surrogates for inflammation, oxidative stress and lipid and glucose metabolism were obtained through standard laboratory measurements. To provide reliable data from MRI and MRS, novel procedures were designed to limit sampling variability and other sources of error using a 1.5T Signa HDx scanner and protocols acquired from the 3D or 2D Fat SAT FIESTA prescription manager. We used our previously described (1)H NMR-based metabolomics assays. Data were obtained immediately before surgery and after a 12-mo period including histology of the liver and measurement of metabolites. Values from (1)H NMR spectra obtained after surgery were omitted due to technical limitations. RESULTS: MRI data showed excellent correlation with the concentration of liver triglycerides, other hepatic lipid components and the histological assessment, which excluded the presence of non-alcoholic steatohepatitis (NASH). MRI was sufficient to follow up NAFLD in obese patients undergoing bariatric surgery and data suggest usefulness in other clinical situations. The information provided by MRS replicated that obtained by MRI using the -CH3 peak (0.9 ppm), the -CH2- peak (1.3 ppm, mostly triglyceride) and the -CH=CH- peak (2.2 ppm). No patient depicted NASH. After surgery all patients significantly decreased their body weight and steatosis was virtually absent even in patients with previous severe disease. Improvement was also observed in the serum concentrations of selected variables. The most relevant findings using metabolomics indicate increased levels of triglyceride and monounsaturated fatty acids in severe steatosis but those results were accompanied by a significant depletion of diglycerides, polyunsaturated fatty acids, glucose-6-phosphate and the ATP/AMP ratio. Combined data indicated the coordinated action on mitochondrial fat oxidation and glucose transport activity and may support the consideration of NAFLD as a likely mitochondrial disease. This concept may help to explain the dissociation between excess lipid storage in adipose tissue and NAFLD and may direct the search for plasma biomarkers and novel therapeutic strategies. A limitation of our study is that data were obtained in a relatively low number of patients. CONCLUSION: MRI is sufficient to stage NAFLD in obese patients and to assess the improvement after bariatric surgery. Other data were superfluous for this purpose.

Influenza-like infection can result in diffuse fluordeoxyglucose uptake in the lungs.

A 32-year-old man underwent an F-18 fluordeoxyglucose positron emission tomography (FDG-PET/CT) scan for response assessment of mediastinal bulky non-Hodgkin lymphoma after completion of a CHOP therapy regimen. The F-18 FDG-PET/CT scan showed complete response regarding the mediastinal lesion. However, an unexpected pattern of prominent lung and abdominal muscular uptake was detected. The patient's clinical history was reassessed for differential diagnosis purposes. The medical records confirmed an episode of self-resolved influenza-like infection 4 days before the PET scan.This case underlines the importance of careful history taking before interpretation of PET scans. Viral infections should be included in the differential diagnosis of pulmonary diffuse F-18 FDG uptake.

Un sarcófago con sorpresa: estudio con tomografía computarizada de una momia egipcia de Baja Época / A sarcophagus with a surprise: computed tomography of a mummy from the Late Period of ancient Egypt

Introducción. Las técnicas de diagnóstico por imagen, y actualmente la tomografía computarizada (TC), se han convertido en el método no invasivo más importante en el estudio de momias, ya que permiten obtener imágenes de alta resolución y efectuar reconstrucciones tridimensionales sin dañar al individuo. Presentamos un sarcófago egipcio de Baja Época adquirido por una galería de Barcelona en el que se halló una momia oculta hasta entonces. Material y método. El sarcófago y la momia fueron examinados mediante TC en el Hospital Universitari Sagrat Cor de Barcelona. Mediante una pinza flexible se obtuvieron muestras de tejido para su estudio. Resultados. Los resultados mostraron la presencia de un individuo femenino en conexión anatómica, aunque desestructurado en el tórax y la parte superior del abdomen. Se detectaron varios objetos metálicos, que se correspondían con amuletos, ojos artificiales y un tutor externo de madera. Conclusión. La TC es una técnica de imagen no invasiva excelente para el estudio detallado de momias, ya que permite no solo su identificación anatómica, sino también la obtención de muestras de estudio para análisis complementarios. La descripción de estos hallazgos nos permite conocer los principales hitos de la radiología en el estudio paleopatológico de momias (AU)

Introduction. Diagnostic imaging techniques, at present especially computed tomography (CT), have become the most important noninvasive method for the study of mummies because they enable high resolution images and three-dimensional reconstructions without damaging the mummified subject. We present a sarcophagus with a mummy hidden inside that was acquired by a gallery in Barcelona. Material and methods. The sarcophagus and mummy were examined by CT at the Hospital Universitari Sagrat Cor in Barcelona. A flexible clamp was used to obtain tissue samples for further study. Results. The results showed the presence of an anatomically intact female human subject albeit with a destructured thorax and upper abdomen. Various metal objects were detected, corresponding to amulets, artificial eyes, and an external wooden brace. Conclusion. CT is an excellent noninvasive imaging technique for the detailed study of mummies, as it enables not only the anatomic identification of the mummified subject but also the obtainment of tissue samples for complementary analyses. The description of these findings enables us to know the major radiologic landmarks for the paleopathologic study of mummies (AU)

Anastrozole versus tamoxifen as first-line therapy in postmenopausal patients with hormone-dependent advanced breast cancer: a prospective, randomized, phase III study.

A prospective phase III trial comparing anastrozole with tamoxifen as first-line therapy in postmenopausal, hormone-dependent, advanced breast cancer (ABC). Patients were randomized to anastrozole 1 mg daily (n = 121) or tamoxifen 40 mg daily (n = 117). Efficacy and tolerability were evaluated after 3 months' therapy, and survival was evaluated at median time of follow-up. At a median follow-up of 13.3 months, clinical benefit (CB) was achieved in 83% and 56% of anastrozole and tamoxifen patients, respectively (p < 0.001); median time to disease progression (TTP) in patients achieving CB was 18.0 months and 7.0 months, respectively, (hazard ratio [HR] = 0.13, 95% CI = 0.08-0.20, p < 0.01). At data cutoff, 89% of tamoxifen patients had died, compared with 60% of anastrozole patients; median time to death was 17.4 months and 16.0 months, respectively (HR = 0.64, 95% CI = 0.47-0.86, p = 0.003). Therapy was well tolerated in both groups. Anastrozole showed significant advantages over tamoxifen for CB, median TTP in patients gaining CB, and survival. These data further support routine use of anastrozole as first-line treatment for postmenopausal hormone-dependent ABC.