Whole-body MRI: comprehensive evaluation on a 48-channel 3T MRI system in less than 40 minutes. Preliminary results

OBJECTIVE: To evaluate a comprehensive MRI protocol that investigates for cancer, vascular disease, and degenerative/inflammatory disease from the head to the pelvis in less than 40 minutes on a new generation 48-channel 3T system. MATERIALS AND METHODS: All MR studies were performed on a 48-channel 3T MR scanner. A 20-channel head/neck coil, two 18-channel body arrays, and a 32-channel spine array were employed. A total of 4 healthy individuals were studied. The designed protocol included a combination of single-shot T2-weighted sequences, T1-weighted 3D gradient-echo pre- and post-gadolinium. All images were retrospectively evaluated by two radiologists independently for overall image quality. RESULTS: The image quality for cancer was rated as excellent in the liver, pancreas, kidneys, lungs, pelvic organs, and brain, and rated as fair in the colon and breast. For vascular diseases ratings were excellent in the aorta, major branch vessel origins, inferior vena cava, portal and hepatic veins, rated as good in pulmonary arteries, and as poor in the coronary arteries. For degenerative/inflammatory diseases ratings were excellent in the brain, liver and pancreas. The inter-observer agreement was excellent. CONCLUSION: A comprehensive and time efficient screening for important categories of disease processes may be achieved with high quality imaging in a new generation 48-channel 3T system.

Distribuição do nervo fibular comum em fetos de equinos e descrição anatômica de pontos para bloqueio anestésico

Analisou-se a distribuição do nervo fibular comum em 30 fetos de equinos, sem raça definida, provenientes do acervo do Laboratório de Anatomia Animal da Faculdade de Medicina Veterinária da Universidade Federal de Uberlândia, que foram injetados e conservados em solução aquosa de formaldeído a 10%. Contatou-se que o referido nervo deriva do isquiático, divide-se em nervos fibulares superficial e profundo, distribuindo-se para os músculos extensores lateral e longo do dedo, fibular terceiro e tibial cranial. Traçando-se uma linha imaginária na região médio-lateral da tuberosidade do osso tíbia, o nervo fibular comum pode ser bloqueado em sua parte proximal, no terço caudal, entre o tendão de inserção do músculo bíceps femoral e a face lateral do músculo gastrocnêmio lateral (terço médio); e o nervo fibular profundo, na parte proximal da tíbia, crânio-distalmente ao fibular comum. O bloqueio do nervo fibular superficial pode ser realizado em duas regiões da tíbia: na proximal, considerando-se a linha imaginária, distalmente ao ponto citado para o fibular comum e caudalmente ao descrito para o fibular profundo; e na distal, na face lateral da articulação tíbio-társica, entre os tendões de inserção dos músculos extensores lateral e longo do dedo.

A comparative radiographic investigation of femoroacetabular impingement in young patients with and without hip pain

OBJECTIVE: To compare the existence of radiographic abnormalities in two groups of patients, those with and without hip pain. METHODS: A total 222 patients were evaluated between March 2007 and April 2009; 122 complained of groin pain, and 100 had no symptoms. The individuals in both groups underwent radiographic examinations of the hip using the following views: anteroposterior, Lequesne false profile, Dunn, Dunn 45º, and Ducroquet. RESULTS: A total of 1110 radiographs were evaluated. Female patients were prevalent in both groups (52% symptomatic, 58% asymptomatic). There were statistically significant differences between the groups in age (p<0.0001), weight (p = 0.002) and BMI (p = 0.006). The positive findings in the group with groin pain consisted of the presence of a bump on the femoral head in the anteroposterior view (p<0.0001) or in the Dunn 45º view (p = 0.008). The difference in the a angle in the anteroposterior, Dunn, Dunn 45º, and Ducroquet views for all of the cases studied was p,0.0001. The joint space measurement differed significantly between groups in the Lequesne view (p = 0.007). The Lequesne anteversion angle (ρ) and the femoral offset measurement also differed significantly (p = 0.005 and p = 0.0001, respectively). CONCLUSIONS: We conclude that the best views for diagnosing a femoroacetabular impingement are the anteroposterior pelvic orthostatic, the Dunn 45º, and the Ducroquet views. The following findings correlated with hip pain: a decrease in the femoral offset, an increase in the α angle, an increase in the Lequesne ρ angle, a decrease in the CE angle of Wiberg, a thinner articular space and the presence of a bump on the femoral head-neck transition.

Morphology of accessory genital glands of spotted paca(Agouti paca Linnaeus, 1766)

The spotted paca is the second largest rodent in Brazil, where it is of great economic interestin impoverished regions in view of its prominence as a low-cost source of protein. Littleis known about the morphology of the accessory genital glands of this species. Thus, westudied the position and morphology of the genitals in ten adult male spotted pacas. Theanimals were divided into two groups, five animals were used for fixing of samples in 10%aqueous formaldehyde for macroscopic studies and the other five animals were designatedfor microscopic analysis. These were arranged in pairs and had the vesicular, prostate,coagulating and bulbourethral glands identified, being structured as mucous glands, whichlead into the pelvic urethra. It was concluded that the accessory genital glands found in thepaca are the same as those found in most rodents, showing similar histological aspects

Metachronic malignant transformation of small bowel and rectal endometriosis in the same patient

[ES] Background: Malignant transformation of intestinal endometriosis is a rare event with an unknown rate of incidence. Metachronous progression of endometriosis to adenocarcinoma from two distant intestinal foci happening in the same patient has not been previously reported. Case presentation: We describe a case of metachronic transformation of ileal and rectal endometriosis into an adenocarcinoma occurring in a 45-year-old female without macroscopic pelvic involvement of her endometriosis. First, a right colectomy was performed due to intestinal obstruction by an ileal mass. Pathological examination revealed an ileal endometrioid adenocarcinoma and contiguous microscopic endometriotic foci. Twenty months later, a rectal mass was discovered. An endoscopic biopsy revealed an adenocarcinoma. En bloc anterior rectum resection, hysterectomy and bilateral salpingectomy were performed. A second endometrioid adenocarcinoma arising from a focus of endometriosis within the wall of the rectum was diagnosed. Conclusion: Intestinal endometriosis should be considered a premalignant condition in premenopausal women.

New molecular approaches to control rhabdomyosarcoma onset and metastasis in preclinical systems

Rhabdomyosarcoma is the most common soft tissue sarcoma of childhood. The aim of this study was to identify molecular events involved in rhabdomyosarcoma onset for the development of new therapeutic approaches against specific molecular targets. BALB-p53neu mice develop pelvic rhabdomyosarcoma and combines the activation of HER-2/neu oncogene with the inactivation of an allele of p53 oncosuppressor gene. Gene expression profiling led to the identification of genes potentially involved in rhabdomyosarcoma genesis and therefore of candidate targets. The pattern of expression of p53, HER-2/neu, CDKN2A/p19ARF and IGF-2 suggested that these alterations might be involved in gender-, site- and strain-specific development of rhabdomyosarcoma. Other genes such as CDKN1A/p21 might be involved. The role of IGF-2, CDKN2A/p19ARF and CDKN1A/p21 in tumor growth was investigated with siRNA in murine rhabdomyosarcoma cells. Silencing of p19ARF and p21 induced inhibition of growth and of migration ability, indicating a possible pro-tumor and pro-metastatic role in rhabdomyosarcoma in absence of p53. In addition the autocrine IGF-2/IGF-1R loop found in early phases of cancer progression strengthens its key role in sustaining rhabdomyosarcoma growth. As rhabdomyosarcoma displays defective myogenic differentiation, a therapeutic approach aimed at enhancing myogenic differentiation of rhabdomyosarcoma cells. Forced expression of myogenin was able to restore myogenic differentiation, significantly reduced cell motility and impaired tumor growth and metastatic spread. IL-4 treatment increased rhabdomyosarcoma cell growth, decreased myogenin expression and promoted migration of cells lacking myogenin. Another approach was based on small kinase inhibitors. Agents specifically targeting members of the HER family (Lapatinib), of the IGF system (NVP-AEW541) or downstream signal transducers (NVP-BEZ235) were investigated in vitro in human rhabdomyosarcoma cell lines as therapeutic anti-tumor and anti-metastatic tools. The major effects were obtained with NVP-BEZ235 treatment that was able to strongly inhibit cell growth in vitro and showed anti-metastatic effects in vivo.

Caratteristiche cliniche ed ecografiche dei Sarcomi Uterini

Obiettivo: descrivere le caratteristiche ecografiche e flussimetriche dei sarcoma uterini Materiali e Metodi: Dall'archivio anatomopatologico di due cliniche Universitarie sono state reclutate retrospettivamente tutte le pazienti con diagnosi anatomopatologica di sarcoma uterino. Tutte le cartelle cliniche, le immagini e i filmati digitalizzati sono stati analizzati e dati raccolti in un database. Risultati: Sono stati inclusi nello studio 49 casi, che comprendono 17 leiomiosarcoma, 14 sarcoma dello stroma endometriale e 18 carcinosarcoma. L'età media alla diagnosi è stata 62 anni (range 35-87). L'ottanta per cento delle pazienti erano in menopausa al momento della diagnosi. Circa la metà delle pazienti presentavano sanguinamento anomalo e il 20% dolore pelvico. La maggior parte delle lesioni sono apparse iso-ipoecogene, senza coni d’ombra (47/49;96%). Conclusioni: I sarcomi uterini sono un gruppo eterogeneo di tumori che presentano aspetti ecografici diversi anche in relazione all’istotipo. Conoscere le diverse caratteristiche può essere utile ai fini di una corretta diagnosi. Nel nostro studio l’assenza dei coni d’ombra risulta essere l’aspetto più significativo.

Protonterapia nel trattamento del tumore prostatico

Obiettivo: Il nostro obiettivo è stato quello di confrontare la tomoterapia (HT) e la protonterapia ad intensità modulata (IMPT) nel trattamento del tumore prostatico, seguendo un protocollo di boost simultaneo (SIB) e moderatamente ipofrazionato. Materiali e metodi: Abbiamo selezionato 8 pazienti, trattati con HT e abbiamo rielaborato i piani con 2 campi IMPT. La dose prescritta è stata di 74 Gy sul PTV1 (prostata e vescicole seminali prossimali), 65.8 Gy sul PTV2 (vescicole seminali distali) e 54 Gy sul PTV3 (linfonodi pelvici). Risultati: Sia con IMPT che con HT abbiamo ottenuto una copertura e una omogeneità di dose del target sovrapponibile. Oltre i 65 Gy, HT e IMPT erano equivalenti per il retto, mentre con l’IMPT c’era maggior risparmio della vescica e del bulbo penieno da 0 a 70 Gy. Da 0 fino a 60 Gy, i valori dosimetrici dell’IMPT erano molto più bassi per tutti gli organi a rischio (OARs), eccetto che per le teste femorali, dove la HT aveva un vantaggio dosimetrico rispetto all’IMPT nel range di dose 25-35 Gy. La dose media agli OARs era ridotta del 30-50% con l’IMPT. Conclusioni: Con le due tecniche di trattamento (HT e IMPT) si ottiene una simile distribuzione di dose nel target. Un chiaro vantaggio dosimetrico dell’IMPT sul HT è ottenuto dalle medie e basse dosi. Le attuali conoscenze sulle relazioni dose-effetto e sul risparmio delle madie e basse dosi con l’IMPT non sono ancora state quantificate dal punto di vista clinico.

Trattamento radioterapico ipofrazionato ad alte dosi del carcinoma prostatico con tecnica ad intensità modulata (IMRT) guidata dalle immagini (IGRT)

Obiettivo: valutare la tossicità ed il controllo di malattia di un trattamento radioterapico ipofrazionato ad alte dosi con tecnica ad intensità modulata (IMRT) guidata dalle immagini (IGRT) in pazienti affetti da carcinoma prostatico a rischio intermedio, alto ed altissimo di recidiva. Materiali e metodi: tutti i pazienti candidati al trattamento sono stati stadiati e sottoposti al posizionamento di tre “markers” fiduciali intraprostatici necessari per l’IGRT. Mediante tecnica SIB – IMRT sono stati erogati alla prostata 67,50 Gy in 25 frazioni (EQD2 = 81 Gy), alle vescichette 56,25 Gy in 25 frazioni (EQD2 = 60,35 Gy) e ai linfonodi pelvici, qualora irradiati, 50 Gy in 25 frazioni. La tossicità gastrointestinale (GI) e genitourinaria (GU) è stata valutata mediante i CTCAE v. 4.03. Per individuare una possibile correlazione tra i potenziali fattori di rischio e la tossicità registrata è stato utilizzato il test esatto di Fisher e la sopravvivenza libera da malattia è stata calcolata mediante il metodo di Kaplan-Meier. Risultati: sono stati arruolati 71 pazienti. Il follow up medio è di 19 mesi (3-35 mesi). Nessun paziente ha dovuto interrompere il trattamento per la tossicità acuta. Il 14% dei pazienti (10 casi) ha presentato una tossicità acuta GI G ≥ 2 e il 15% (11 pazienti) ha riportato una tossicità acuta GU G2. Per quanto riguarda la tossicità tardiva GI e GU G ≥ 2, essa è stata documentata, rispettivamente, nel 14% dei casi (9 pazienti) e nell’11% (7 pazienti). Non è stata riscontrata nessuna tossicità, acuta o cronica, G4. Nessun fattore di rischio correlava con la tossicità. La sopravvivenza libera da malattia a 2 anni è del 94%. Conclusioni: il trattamento radioterapico ipofrazionato ad alte dosi con IMRT-IGRT appare essere sicuro ed efficace. Sono comunque necessari ulteriori studi per confermare questi dati ed i presupposti radiobiologici dell’ipofrazionamento del carcinoma prostatico.

Caratterizzazione morfologica e neurochimica dei neuroni sensitivi e motori del trigono vescicale e del muscolo uretrale di maiale

Il trigono della vescica urinaria (UBT) è un'area limitata attraverso la quale penetrano nella vescica la maggior parte dei vasi e fibre e in cui le fibre nervose e neuroni intramurali sono più concentrati. Mediante l’utilizzo combinato di un tracciante retrogrado(FB) e dell’immunoistochimica sono stati valutati il fenotipo e l’area del soma dei neuroni dei gangli spinali (DRG), dei neuroni post-gangliari, il fenotipo dei gangli della catena simpatica (STG) e i gangli mesenterici caudali (CMG) innervanti l’UBT. - Caratterizzazione dei neuroni dei DRG con: peptide correlato al gene della calcitonina (CGRP)(30±3%, 29±3%, rispettivamente), sostanza P(SP)(26±8%, 27±12%), ossido nitrico sintasi neuronale (nNOS)(21±4%; 26±7%), neurofilamento 200kDa (NF200)(75±14%, 81±7% ) , transient receptor potential vanilloid1 (TRPV1)(48±13%, 43±6%) e isolectina-B4-positivi (IB4) (56±6%;43±10%). I neuroni sensoriali, distribuiti da L2 a Ca1 (DRG), hanno presentato una localizzazione segmentale, mostrando maggior densità nei DRG L4-L5 e S2-S4. I neuroni sensoriali lombari sono risultati significativamente più grandi di quelle sacrali (1.112±624μm2 vs716±421μm2). Complessivamente, questi dati indicano che le vie lombari e sacrali probabilmente svolgono ruoli diversi nella trasmissione sensitiva del trigono della vescica urinaria. -I neuroni FB+ della STG e dei CMG sono risultati immunoreattivi per la tirosina idrossilasi (TH)(66±10,1%, 53±8,2%, rispettivamente), la dopamina beta-idrossilasi (DβH)(62±6,2%, 52±6,2%), neuropeptideY (NPY)(59±8%; 66±7%), CGRP(24±3%, 22±3%), SP(22±2%; 38±8%), polipeptide intestinale vasoattivo (VIP)(19±2%; 35±4%), nNOS(15±2%; 33±8%), trasportatore vescicolare dell'acetilcolina (VAChT)(15±2%; 35±5%), leu-encefalina (LENK)(14±7%; 26±9%), e somatostatina (SOM)(12±3%;32±7%).Il numero medio di neuroni FB+ (1845,1±259,3) era nella STG in L1-S3, con i pirenofori più piccoli (465,6±82.7μm2). Un gran numero (4287,5±1450,6) di neuroni FB+ di piccole dimensioni (476,1±103,9μm2) sono stati localizzati lungo il margine dei CMG. Il maggior numero (4793,3±1990,8) di neuroni FB + è stato osservato nel plesso pelvico, dove i neuroni marcati erano raggruppati in micro-gangli e con pirenoforo ancora più piccolo (374,9±85,4 μm2).

Die Microsauria des mitteleuropäischen Rotliegend

ZusammenfassungrnAlle bekannten Exemplare der Amphibien-Gruppe Microsauria des mitteleuropäischen Rotliegend wurden untersucht sowie – für die kladistische Untersuchung – ihre nächsten Verwandten. Im Saar-Nahe-Becken sind vier Arten aus zwei Microsauria-Gattungen nachzuweisen: Batropetes niederkirchensis n. sp., Batropetes palatinus n. sp., Batropetes appelensis n. sp. und Altenglanerpeton schroederi n. sp.. Aus dem Döhlen-Becken bei Dresden stammt Batropetes fritschi.rnDie Rekonstruktionen legen nahe, dass die in Seeablagerungen gefundenen Batropetes-Arten kleine, terrestrisch lebende Microsaurier waren, die sich von Insekten oder deren Larven ernährten. Ihre mittlere Gesamtlänge beträgt fast 8 cm, ihr Rumpf ist auffallend kurz mit je nach Art 17 oder 19 Präsakralwirbeln. Sie besitzen große von Wülsten umgebene Augenöffnungen, ein großes Pinealforamen, drei längs angeordnete Grübchen auf den Frontalia, dreispitzige Zähne, einen zahnlosen Gaumen und vier kurze kräftige Extremitäten. Becken- und Schultergürtel sind komplett verknöchert, außer den bei Batropetes appelensis und Batropetes fritschi knorpeligen Coracoid-Anteilen. Die Batropetes-Arten unterscheiden sich bezüglich Form, Proportionen bzw. Verknöcherungsgrad einiger Knochen im cranialen und postcranialen Skelett. rnDie kladistischen Untersuchungen ergeben für die Arten der monophyletische Gattung Batropetes, dass Batropetes appelensis den übrigen Arten gegenübersteht und Batropetes palatinus mit Batropetes fritschi eine Schwestergruppe zu Batropetes niederkirchensis bildet. Mit den etwas jüngeren texanischen Gattungen Carrolla und Quasicaecilia bildet Batropetes die monophyletische Familie Brachystelechidae. rnAltenglanerpeton schroederi, nur durch ein schlecht erhaltenes Exemplar überliefert, besitzt einen massiv gebauten Schädel, kaum länger als breit mit annähernd dreieckigem Umriss, ohne Anzeichen für Seitenlinien, mit kleiner rundlicher Orbita, sehr breiter Interorbitalregion und bis weit vor die Orbita reichendem Jugale. Sein langer Rumpf umfasst mindestens 30 lepospondyle Präsakralwirbel. Wegen der unvollkommenen Entwicklung der Gliedmaßen kann diese Art nicht auf vier Beinen gelaufen sein und lebte möglicherweise in der Laubschicht wühlend oder in Sümpfen. Altenglanerpeton ist keiner bestimmten Microsauria-Familie zuzuordnen und steht den Pantylidae, Gymnarthridae, Goniorhynchidae und Ostodolepidae am nächsten, wobei zu letzteren die meisten morphologischen Ähnlichkeiten bestehen.rnAußerdem sind mit isolierten Einzelknochen, insbesondere Wirbeln, Microsauria und andere Gruppen lepospondyler Amphibien ohne Bestimmung der Gattung und Art aus wenigen stratigraphischen Niveaus des Saar-Nahe-Beckens überliefert. rn

Studio retrospettico sul ruolo della strumentazione nei fallimenti meccanici a seguito di Trattamento Chirurgico nelle Scoliosi dell'adulto

The spinal column performs important functions in the body, including the support of the entire weight of the human body, the ability to orientate the head in space, bending, flexing and rotating the body. Diseases affecting the spine are manifold: the most frequent is scoliosis, which often affects the female population. It is often treated surgically with a very high percentage of failures. The aim of the thesis is to study the role of instrumentation in mechanical failures encountered 12 months after surgery in the treatment of scoliosis. For the purposes of the study, we analyzed specific biomechanical parameters. The pelvic angles determine the position of the pelvis, while the imbalance parameters the structure of the body. We infer other parameters by analyzing the characteristics of the implanted instrumentation. Initially, the anatomy is described of the spine and vertebrae, the equipment used and the possible failures that may occur after surgery. Subsequently, the materials and methods used for the analysis of the above-mentioned parameters for the 61 patients are reported. All data are obtained by the observation of pre and post-operative x-rays with a special program, by reading reports from operators and by medical records. In the fourth chapter, we report the results: the overall failure rate is 60.9%; the types of failures that occurred are rupture of bars and rupture of bars simultaneously to PJK. The most influential parameters on results of the progress of the surgery are the type of material used and the BMI. It is estimated a high percentage of failures in patients treated with implants of cobalt chromium alloys (90.0%). According to the results obtained, it is possible to understand the aspects that in the future should be studied, in order to find a solution to the most frequent surgical failures.

Development of in vitro methods to test acetabular prosthetic reconstructions (messa a punto di metodi in vitro per la caratterizzazione biomeccanica di ricostruzioni acetabolari)

The revision hip arthroplasty is a surgical procedure, consisting in the reconstruction of the hip joint through the replacement of the damaged hip prosthesis. Several factors may give raise to the failure of the artificial device: aseptic loosening, infection and dislocation represent the principal causes of failure worldwide. The main effect is the raise of bone defects in the region closest to the prosthesis that weaken the bone structure for the biological fixation of the new artificial hip. For this reason bone reconstruction is necessary before the surgical revision operation. This work is born by the necessity to test the effects of bone reconstruction due to particular bone defects in the acetabulum, after the hip prosthesis revision. In order to perform biomechanical in vitro tests on hip prosthesis implanted in human pelvis or hemipelvis a practical definition of a reference frame for these kind of bone specimens is required. The aim of the current study is to create a repeatable protocol to align hemipelvic samples in the testing machine, that relies on a reference system based on anatomical landmarks on the human pelvis. In chapter 1 a general overview of the human pelvic bone is presented: anatomy, bone structure, loads and the principal devices for hip joint replacement. The purpose of chapters 2 is to identify the most common causes of the revision hip arthroplasty, analysing data from the most reliable orthopaedic registries in the world. Chapter 3 presents an overview of the most used classifications for acetabular bone defects and fractures and the most common techniques for acetabular and bone reconstruction. After a critical review of the scientific literature about reference frames for human pelvis, in chapter 4, the definition of a new reference frame is proposed. Based on this reference frame, the alignment protocol for the human hemipelvis is presented as well as the statistical analysis that confirm the good repeatability of the method.

MicroRNAs may mediate the down-regulation of neurokinin-1 receptor in chronic bladder pain syndrome

Bladder pain syndrome (BPS) is a clinical syndrome of pelvic pain and urinary urgency-frequency in the absence of a specific cause. Investigating the expression levels of genes involved in the regulation of epithelial permeability, bladder contractility, and inflammation, we show that neurokinin (NK)1 and NK2 tachykinin receptors were significantly down-regulated in BPS patients. Tight junction proteins zona occludens-1, junctional adherins molecule -1, and occludin were similarly down-regulated, implicating increased urothelial permeability, whereas bradykinin B(1) receptor, cannabinoid receptor CB1 and muscarinic receptors M3-M5 were up-regulated. Using cell-based models, we show that prolonged exposure of NK1R to substance P caused a decrease of NK1R mRNA levels and a concomitant increase of regulatory micro(mi)RNAs miR-449b and miR-500. In the biopsies of BPS patients, the same miRNAs were significantly increased, suggesting that BPS promotes an attenuation of NK1R synthesis via activation of specific miRNAs. We confirm this hypothesis by identifying 31 differentially expressed miRNAs in BPS patients and demonstrate a direct correlation between miR-449b, miR-500, miR-328, and miR-320 and a down-regulation of NK1R mRNA and/or protein levels. Our findings further the knowledge of the molecular mechanisms of BPS, and have relevance for other clinical conditions involving the NK1 receptor.