Cesarean scar pregnancy: MRI feature

A 34-year-old woman, gravida 4, para 2, presented at the emergency room with severe abdominal pain and red vaginal bleeding. Medical history revealed 2 previous cesarean sections at term gestation. Laboratory findings showed an elevated b-HCG consistent with an estimated gestational age of 6-7 weeks. Transabdominal ultrasound showed a well-circumscribed, thick-walled cystic mass within the lower part of the anterior myometrium. In the central cystic cavity a small mural nodule with discrete pulsatile flow was noticed. Subsequently a pelvic MRI exam was performed confirming the presence of the thick-walled, well-circumscribed mass in the lower part of the uterine wall (Fig. A). The mass extended beyond the expected contour of the uterus and no overlying myometrial tissue could be identified at the anterior border. At the cranial and posterior border of the mass a non-enhancing, T2 hypointense fibrous band was noticed, consistent with scar tissue of the two previous cesarean sections (Fig. B). The wall of the mass was T2 hyperintense, T1 iso-intense and showed a strong and heterogeneous enhancement following intravenous administration of gadolinium (Fig. C). The central portion of the mass was T2 hyperintense, T1 hypo-intense and showed no contrast enhancement. The cavity of the uterus was filled with T1 hyperintense, hemorrhagic fluid. A corpus gravidarum was seen on the left side. These findings were consistent of an ectopic pregnancy in a cesarean scar. Patient was successfully treated with a combination of chemotherapy and bilateral uterine artery embolization followed by a planned hysterectomy several weeks late

Eosinophilic cystitis mimicking bladder tumor

A 48-year-old man presented to the Urology Department with acute dysuria and macroscopic hematuria for 2 days. There was no frequency or nocturnal enuresis. Analysis of midstream urine showed hematuria and pyuria

Migraine in women: the role of hormones and their impact on vascular diseases

Migraine is a predominantly female disorder. Menarche, menstruation, pregnancy, and menopause, and also the use of hormonal contraceptives and hormone replacement treatment may influence migraine occurrence. Migraine usually starts after menarche, occurs more frequently in the days just before or during menstruation, and ameliorates during pregnancy and menopause. Those variations are mediated by fluctuation of estrogen levels through their influence on cellular excitability or cerebral vasculature. Moreover, administration of exogenous hormones may cause worsening of migraine as may expose migrainous women to an increased risk of vascular disease. In fact, migraine with aura represents a risk factor for stroke, cardiac disease, and vascular mortality. Studies have shown that administration of combined oral contraceptives to migraineurs may further increase the risk for ischemic stroke. Consequently, in women suffering from migraine with aura caution should be deserved when prescribing combined oral contraceptives

Polyp measurement and size categorisation by CT colonography: effect of observer experience in a multi-centre setting.

The extent measurement error on CT colonography influences polyp categorisation according to established management guidelines is studied using twenty-eight observers of varying experience to classify polyps seen at CT colonography as either 'medium' (maximal diameter 6-9 mm) or 'large' (maximal diameter 10 mm or larger). Comparison was then made with the reference diameter obtained in each patient via colonoscopy. The Bland-Altman method was used to assess agreement between observer measurements and colonoscopy, and differences in measurement and categorisation was assessed using Kruskal-Wallis and Chi-squared test statistics respectively. Observer measurements on average underestimated the diameter of polyps when compared to the reference value, by approximately 2-3 mm, irrespective of observer experience. Ninety-five percent limits of agreement were relatively wide for all observer groups, and had sufficient span to encompass different size categories for polyps. There were 167 polyp observations and 135 (81%) were correctly categorised. Of the 32 observations that were miscategorised, 5 (16%) were overestimations and 27 (84%) were underestimations (i.e. large polyps misclassified as medium). Caution should be exercised for polyps whose colonographic diameter is below but close to the 1-cm boundary threshold in order to avoid potential miscategorisation of advanced adenomas

Effects of increased extracellular glutamate levels on the local field potential in the brain of anaesthetized rats

1. It is generally considered that glutamate-mediated transmission can be altered from a physiological to neurotoxic action when extracellular glutamate levels become excessive subsequent to impaired uptake and/or excessive release. However, high extracellular glutamate does not consistently correlate with neuronal dysfunction and death in vivo. The purpose of this study was to examine in situ the local depolarizations, as indicated by negative shifts of the extracellular field (d.c.) potential, produced by local inhibition of high-affinity glutamate uptake, with or without co-application of exogenous glutamate, in three brain regions of anaesthetized rats. 2. Microdialysis probes incorporating an electrode were used to apply exogenous glutamate and/or its uptake inhibitor L-trans-pyrrolidine-2,4-dicarboxylate (L-trans-PDC), and to monitor the resulting changes in extracellular glutamate and d.c. potential at the sites of application within the cortex, striatum and hippocampus. 3. Perfusion of 1 to 10 mM L-trans-PDC markedly and concentration-dependently increased extracellular glutamate levels (by up to 1700% of basal level in the parietal cortex). Despite their large magnitude, glutamate changes were associated with minor negative shifts of the d.c. potential (<2 mV), which were not suppressed by the N-methyl-D-aspartate (NMDA)-channel blocker, dizocilpine (MK-801, 2 mg kg(−1), i.v.), or the α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA)/kainate-receptor antagonist, 6-nitro-7-sulphamoylbenzo(f)quinoxaline-2,3-dione (NBQX, 30 mg kg(−1), i.p.). L-trans-PDC had virtually identical concentration-dependent effects on dialysate glutamate in the hippocampus and striatum, but those induced in the cortex were around 40% larger (P<0.002). In contrast, the associated depolarizations were around twice as large in the striatum and cortex as in the hippocampus (P<0.002). Finally, co-application of L-trans-PDC did not enhance the d.c. potential changes evoked by perfusion of 5 or 20 mM glutamate. 4. As the neurotoxic potency of glutamate agonists is considered to be linked to excessive opening of glutamate-operated ion channels, these results challenge the notion that high extracellular glutamate levels may be the key to excitotoxicity in neurological disorders. In particular, they do not support the hypothesis that high extracellular glutamate causes the sudden negative shifts of the d.c. potential associated with ischaemia (i.e. anoxic depolarization), traumatic brain injury and spreading depression. Impaired uptake and excessive release of glutamate may well lead to excitotoxicity, but only at the synaptic level, not by spreading through the interstitial fluid

CT colonography interpretation times: effect of reader experience, fatigue, and scan findings in a multi-centre setting

h Stedelijk Ziekenhuis, Roeselare, Belgium i Cancer Research UK, St. Mark's Hospital, London, United Kingdom j Candiolo Oncologic Hospital, Turin, Italy k Bradford Royal Infirmary, Bradford, United Kingdom l University of Pisa, Pisa, Italy m Hope Hospital, Salford, United Kingdom View additional affiliations Retrieving additional affiliations... -------------------------------------------------------------------------------- View references (10) Abstract Our purpose was to assess the effect of reader experience, fatigue, and scan findings on interpretation time for CT colonography. Nine radiologists (experienced in CT colonography); nine radiologists and ten technicians (both groups trained using 50 validated examinations) read 40 cases (50% abnormal) under controlled conditions. Individual interpretation times for each case were recorded, and differences between groups determined. Multi-level linear regression was used to investigate effect of scan category (normal or abnormal) and observer fatigue on interpretation times. Experienced radiologists (mean time 10.9 min, SD 5.2) reported significantly faster than less experienced radiologists and technicians; odds ratios of reporting times 1.4 (CI 1.1, 1.8) and 1.6 (1.3, 2.0), respectively (P≤0.001). Experienced and less-experienced radiologists took longer to report abnormal cases; ratio 1.2 (CI 1.1,1.4, P<0.001) and 1.2 (1.0, 1.3, P=0.03), respectively. All groups took 70% as long to report the final five cases as they did with an initial five; ratio 0.7 (CI 0.6 to 0.8), P<0.001. For technicians only, accuracy increased with longer reporting times (P=0.04). Experienced radiologists report faster than do less-experienced observers and proportionally spend less time interpreting normal cases. Technicians who report more slowly are more accurate. All groups reported faster as the study period progressed