The role of PET-FDG in questionable diagnosis of relapse in the presence of radionecrosis of brain tumors

INTRODUCTION: Although CT and MR are sensitive techniques for the detection of cerebral tumours, both have limitations in distinguishing between tumour relapse (TR) and post-treatment radionecrosis (RN). PATIENTS AND METHODS: In this study we have determined the usefulness of metabolic imaging with PET-FDG in such situations. We assessed 70 patients with CNS tumours (22 low grade astrocytomas, 25 high grade astrocytomas, 3 oligodendrogliomas, 13 metastatic tumours and 7 other tumours. All had been treated with radiotherapy and other treatments such as radiosurgery, chemotherapy or different types of surgery, and presented clinical pictures which made it necessary to decide the differential diagnosis of relapse or radionecrosis. RESULTS: In the PET-FDG study visual and semiquantitative analysis was done by SUV (Standardized Update Value). Confirmation of the findings was obtained in 44 cases (24 TR and 20 RN). MR was doubtful or inconclusive in most cases, whilst with PET correct diagnosis was made in all cases. CONCLUSIONS: Metabolic imaging with PET-FGD is better than anatomostructural imaging techniques for differential diagnosis between tumour relapse and radionecrosis in CNS tumours which have been treated. Prospective studies are necessary for evaluation of SUV as a factor for prognosis of survival.     

Role of electron microscopy and other special techniques in the diagnosis of childhood round cell tumors

A series of case presentations show unique challenges associated with childhood round cell tumors and the role of ancillary techniques in diagnosis. Electron microscopy is shown to be the most powerful individual technique. Immunohistochemistry is less effective but also essential. Other ancillary techniques may provide needed additional diagnostic information. Because this is an area where it is of great importance to secure the most rapid, accurate, and specific diagnosis possible, an integrated multimodal approach is recommended--incorporating light microscopic, electron microscopic, and immunohistochemical studies as a matter of routine, and providing for cytogenetic and/or molecular diagnostic studies as indicated.     

Postmortem angiocardiography in newborn infants with congenital malformation of the heart and great vessels

In congenital malformations of the heart and great vessels with a fatal outcome a postmortem angiocardiography may contribute to diagnosis. In this technique the heart is not dissected and the topographical relationships remain unchanged. A postmorten angiocardiography is of particular interest if no autopsy is to be performed. Some patho-anatomical details are demonstrated in three selected cases: newborn infants with 1. hypoplastic left heart syndrome, 2. truncus arteriosus communis with interruption of the aortic arch, and 3. aortic-left ventricular tunnel.     

The role of parental anxiety in the treatment of childhood anxiety

Sixty-seven children aged 7 to 14 who met diagnostic criteria for an anxiety disorder were assigned to conditions according to parental anxiety level. Within these conditions, children were randomly assigned to 1 of 2 treatments: child-focused cognitive-behavioral therapy (CBT) or child-focused CBT plus parental anxiety management (CBT + PAM). At posttreatment, results indicated that within the child-anxiety-only condition, 82% of the children in the CBT condition no longer met criteria for an anxiety disorder compared with 80% in the CBT + PAM condition. Within the child + parental anxiety condition, 39% in the CBT condition no longer met criteria compared with 77% in the CBT + PAM condition. At follow-up, these differences were maintained, with some weakening over time. Results were not consistent across outcome measures. The interpretation and potential clinical implications of these findings are discussed.     

The role of childhood sexual trauma in the etiology of borderline personality disorder: Considerations for diagnosis and treatment.

Highlights recent research findings that demonstrate a connection between severity and type of sexual abuse and presentation of borderline-like symptoms. Similarities are drawn between the type of symptoms that make up a posttraumatic stress disorder (PTSD) diagnosis, and those that compose borderline personality disorder (BPD). Neither the PTSD nor BPD diagnoses are completely adequate to address the conditions of psychiatric patients with sexual abuse histories. In PTSD, characterological dysfunction in response to severe abuse experiences is not represented in the diagnosis, while BPD attributes symptoms solely to characterological dysfunction without recognizing their adaptive nature in the face of childhood trauma. A more accurate and less stigmatizing diagnostic category for survivors of sexual abuse has a significant role in expanding the possibilities for successful treatment of these patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of cytokines in the failing human heart

Despite repeated attempts to develop a unifying hypothesis that explains the clinical syndrome of heart failure, no single conceptual paradigm has withstood the test of time. In this regard, recent studies have shown that a class of biologically active molecules, generically referred to as cytokines, are overexposed in heart failure. This article will review recent clinical and experimental material that suggest proinflammatory (stress activated) cytokines such as tumor necrosis factor-alpha (TFN-alpha), interleukin-1 (IL-1), and interleukin-6 (IL-6) may play a role in the pathogenesis of congestive heart failure. The scope of this article includes an overview of the biology of cytokines in the heart, as well as review of the clinical studies that have documented elevated levels of cytokines and cytokine receptors in patients with heart failure.     

The role of gender in heart transplantation

The position of chief information officer (CIO) is gaining popularity, especially in the health care field. The results of an informal electronic and telephone survey indicate that few medical librarians have made a career move to CIO even though this might seem like a logical step. This paper examines the qualities required of an effective information management executive, the role CIOs play within organizations, and the career advancement strategies for librarians interested in becoming CIOs. Questionnaire responses are reported from three medical librarians who have made the transition to CIO-type positions, and a case study illustrates the responsibilities of CIOs in health care organizations.     

The role of neuroendoscopy in the treatment of pineal region tumors

The authors describe a technique for the initial management of patients with pineal region neoplams and symptomatic hydrocephalus. Endoscopic third ventriculostomy and, if possible, tumor biopsy are performed through a single precoronal burr hole. When indicated, formal tumor resection can be performed nonemergently, without the need for ventricular drainage or shunting.     

The role of echocardiography in the indications for heart transplantation

Mono- and B-mode echocardiography is inferior to clinical evaluation and haemodynamic studies for timing of cardiac transplantation in idiopathic and/or ischemic cardiopathy. Some echo- and Doppler-derived variables are of prognostic significance as predictive guides in patients assessed for cardiac transplantation.     

The role of fine-needle aspiration biopsy in the initial diagnosis of pediatric bone and soft tissue tumors: an institutional experience

A 13-year-old girl developed atonic seizure at 2 years of age. At the age of 10 years, gelastic seizures were noted. Magnetic resonance imaging (MRI) revealed a hypothalamic mass protruding down into the basal cistern and up into the third ventricle. An interictal electroencephalogram (EEG) showed paroxysmal spike and wave complex discharges. Since the seizures failed to respond to medical therapy, it was decided to try to control them by removing the mass. The operation was carried out through an interhemispheric trans-lamina terminalis approach. The lesion was so similar to normal brain tissue that the resection had to be limited enough to avoid complications. Histological examination of the mass showed a hamartoma. Postoperative MRI showed residual mass, but no seizure has been noted since the operation. The EEG recorded one year after the operation showed no spike and wave complex discharge, although she was still on anticonvulsant drugs. The authors propose that surgical therapy should be considered as a treatment for intractable gelastic epilepsy with hypothalamic hamartoma and that the first operation should be conservative enough to avoid complications, because it can bring about good results even if it is only a partial resection.     

The role of echography in the diagnosis of pelvic masses

The authors confirm the fundamental role of the pulse-echo technique in the study of pelvic masses; they outline the usefulness of the ultrasonography in the early presumptive diagnosis of the possible neoplastic alterations of such masses. The authors present five clinical cases in which the use of the pulse-echo technique has allowed to locate, in spite of a scanty clinical symptomatology, the presence of pathologies requiring a rapid surgical resolution.     

The role of echocardiography in the diagnosis of infectious endocarditis

Echocardiography is irreplaceable in the diagnosis of infectious endocarditis. If in easily examined patients transthoracic examination suffices, in all other cases transoesophageal echocardiography is essential. It is important to emphasize the importance of searching carefully for complications, of assessment of the patient's risk and whether it is suitable to repeat the examination during treatment.     

The role of nitric oxide in ischemia-reperfused heart

The objective of this study was to estimate the dominance variance for postweaning gain in Limousin cattle. Data included 215,326 records of postweaning gain from 205 to 365 d, provided by the North American Limousin Foundation. Parental dominance subclasses were formed and related using the method of Hoeschele and VanRaden. Variance components were estimated using Method R based on six samples of 50%. Fixed effects in the model included contemporary group and covariates for inbreeding and breed composition (percentage Limousin). Heterozygosity was negatively correlated with breed composition (< -.99) and was therefore not included in the model. Two types of contemporary groups used as original groups from the National Cattle Evaluation were partially based on breed composition. Original contemporary groups that were too homogeneous for breed composition were replaced by herd-year-sex classes. Two models were used with the two data sets. Model 1 contained the fixed effects described above and an additive genetic effect. Model 2 included a dominance effect in addition to the effects contained in Model 1. In total, four combinations of contemporary group x model were used. Dominance variance was computed as being four times the estimated parental subclass variance. Estimates for inbreeding depression and breed composition (percentage Limousin) were all small and not greatly affected by inclusion of dominance effects or changes in contemporary groups. Estimates of the additive variance (expressed as percentage of the phenotypic variance) were only slightly affected, with values between 20 and 21%. Dominance estimates were highly affected when passing from original (10%) and to alternative contemporary groups (18%). Such large values may indicate that dominance is important for postweaning gain. Results showed the advantage of an individual dominance approach based on sire-dam combinations; therefore, expected gains through the use of specific combination ability as a part of the mating selection criteria for growth might be high.     

The role of myocardial apoptosis in the development of heart failure

Heart failure can result from a variety of causes, including volume or pressure overload and contractile disturbances of the myocardium. Loss of myocytes is an important mechanism in the development of cardiac failure. In general, myocyte death resulting in progressive deterioration of myocardial function is attributed to necrosis, but recently the involvement of programmed cell death (mainly apoptosis) has been suggested. The authors review the possible role of myocardial apoptosis in developing of heart failure. Subcellular genetic regulatory processes as well as the pharmacological susceptibility of programmed cell death are also discussed. In heart failure, significant amount of cardiac myocytes undergoes apoptosis, that unlike necrosis can be prevented. Specific inhibition of this process could mean a considerable part of cardioprotection after thorough understanding of the underlying cellular mechanisms.