Joint EANM/ESNR and ESCMID-endorsed consensus document for the diagnosis of spine infection (spondylodiscitis) in adults

Purpose: Diagnosis of spondylodiscitis (SD) may be challenging due to the nonspecific clinical and laboratory findings and the need to perform various diagnostic tests including serologic, imaging, and microbiological examinations. Homogeneous management of SD diagnosis through international, multidisciplinary guidance would improve the sensitivity of diagnosis and lead to better patient outcome. Methods: An expert specialist team, comprising nuclear medicine physicians appointed by the European Association of Nuclear Medicine (EANM), neuroradiologists appointed by the European Society of Neuroradiology (ESNR), and infectious diseases specialists appointed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), reviewed the literature from January 2006 to December 2015 and proposed 20 consensus statements in answer to clinical questions regarding SD diagnosis. The statements were graded by level of evidence level according to the 2011 Oxford Centre for Evidence-based Medicine criteria and included in this consensus document for the diagnosis of SD in adults. The consensus statements are the result of literature review according to PICO (P:population/patients, I:intervention/indicator, C:comparator/control, O:outcome) criteria. Evidence-based recommendations on the management of adult patients with SD, with particular attention to radiologic and nuclear medicine diagnosis, were proposed after a systematic review of the literature in the areas of nuclear medicine, radiology, infectious diseases, and microbiology. Results: A diagnostic flow chart was developed based on the 20 consensus statements, scored by level of evidence according to the Oxford Centre for Evidence-based Medicine criteria. Conclusions: This consensus document was developed with a final diagnostic flow chart for SD diagnosis as an aid for professionals in many fields, especially nuclear medicine physicians, radiologists, and orthopaedic and infectious diseases specialists

3D MRI-based tumor delineation of ocular melanoma and its comparison with conventional techniques

The aim of this study is to (1) compare the delineation of the tumor volume for ocular melanoma on high-resolution three-dimensional (3D) T2-weighted fast spin echo magnetic resonance imaging (MRI) images with conventional techniques of A- and B-scan ultrasound, transcleral illumination, and placement of tantalum markers around tumor base and (2) to evaluate whether the surgically placed marker ring tumor delineation can be replaced by 3D MRI based tumor delineation. High-resolution 3D T2-weighted fast spin echo (3D FSE) MRI scans were obtained for 60 consecutive ocular melanoma patients using a 1.5 T MRI (GE Medical Systems, Milwaukee, WI), in a standard head coil. These patients were subsequently treated with proton beam therapy at the UC Davis Cyclotron, Davis, CA. The tumor was delineated by placement of tantalum rings (radio-opaque markers) around the tumor periphery as defined by pupillary transillumination during surgery. A point light source, placed against the sclera, was also used to confirm ring agreement with indirect ophthalmoscopy. When necessary, intraoperative ultrasound was also performed. The patients were planned using EYEPLAN software and the tumor volumes were obtained. For analysis, the tumors were divided into four categories based on tumor height and basal diameter. In order to assess the impact of high-resolution 3D T2 FSE MRI, the tumor volumes were outlined on the MRI scans by two independent observers and the tumor volumes calculated for each patient. Six (10%) of 60 patients had tumors, which were not visible on 3D MRI images. These six patients had tumors with tumor heights <= 3 mm. A small intraobserver variation with a mean of (-0.22 +/- 4)% was seen in tumor volumes delineated by 3D T2 FSE MR images. The ratio of tumor volumes measured on MRI to EYEPLAN for the largest to the smallest tumor volumes varied between 0.993 and 1.02 for 54 patients. The tumor volumes measured directly on 3D T2 FSE MRI ranged from 4.03 to 0.075 cm(3). with a mean of 0.87 +/- 0.84 cm3. The tumor shapes obtained from 3D T2 FSE MR images were comparable to the tumor shapes obtained using EYEPLAN software. The demonstration of intraocular tumor volumes with the high-resolution 3D fast spin echo T2 weighted MRI is excellent and provides additional information on tumor shape. We found a high degree of accuracy for tumor volumes with direct MRI volumetric measurements in uveal melanoma patients. In some patients with extra large tumors, the tumor base and shape was modified, because of the additional information obtained from 3D T2 FSE MR images. (c) 2005 American Association of Physicists in Medicine

Virus nomenclature below the species level : a standardized nomenclature for filovirus strains and variants rescued from cDNA

Specific alterations (mutations, deletions, insertions) of virus genomes are crucial for the functional characterization of their regulatory elements and their expression products, as well as a prerequisite for the creation of attenuated viruses that could serve as vaccine candidates. Virus genome tailoring can be performed either by using traditionally cloned genomes as starting materials, followed by site-directed mutagenesis, or by de novo synthesis of modified virus genomes or parts thereof. A systematic nomenclature for such recombinant viruses is necessary to set them apart from wild-type and laboratoryadapted viruses, and to improve communication and collaborations among researchers who may want to use recombinant viruses or create novel viruses based on them. A large group of filovirus experts has recently proposed nomenclatures for natural and laboratory animal-adapted filoviruses that aim to simplify the retrieval of sequence data from electronic databases. Here, this work is extended to include nomenclature for filoviruses obtained in the laboratory via reverse genetics systems. The previously developed template for natural filovirus genetic variant naming,\virus name[(\strain[/)\isolation host-suffix[/ \country of sampling[/\year of sampling[/\genetic variant designation[-\isolate designation[, is retained, but we propose to adapt the type of information added to each field for cDNA clone-derived filoviruses. For instance, the full-length designation of an Ebola virus Kikwit variant rescued from a plasmid developed at the US Centers for Disease Control and Prevention could be akin to ‘‘Ebola virus H.sapiens-rec/COD/1995/Kikwit-abc1’’ (with the suffix ‘‘rec’’ identifying the recombinant nature of the virus and ‘‘abc1’’ being a placeholder for any meaningful isolate designator). Such a full-length designation should be used in databases and the methods section of publications. Shortened designations (such as ‘‘EBOV H.sap/COD/95/ Kik-abc1’’) and abbreviations (such as ‘‘EBOV/Kik-abc1’’) could be used in the remainder of the text, depending on how critical it is to convey information contained in the full-length name. ‘‘EBOV’’ would suffice if only one EBOV strain/variant/isolate is addressed.http://link.springer.com/journal/705hb201

Retrobulbar anesthesia complicated by combined central retinal vein and artery occlusion and massive vitreoretinal fibrosis

Retrobulbar anaesthesia is routine procedure in ocular surgery. Complication are infrequent but often severe, involving both retina and the optic nerve. we report a case of combined central retinal vein and artery occlusion, secondary to retrobulbar anaesthesia, which evolved into retinal ischemia and Vitreoretinal fibrosis. This is the first time to our knowledge that such a dramatic evolution of post traumatic retinal occlusion has been reported

Sequential contrast-enhanced magnetic resonance imaging in the diagnosis of growth hormone deficiencies

The purpose of the present study was to assess the presence and the time-course of contrast-enhancement in the pituitary gland and pituitary stalk of 24 patients with isolated growth hormone (GH) deficiency and multiple pituitary hormone deficiency. The patients were evaluated clinically (auxological measurements), endocrinologically (spontaneous GH secretion and GH stimulation tests) and with conventional MRI scans. In addition, fast-framing dynamic magnetic resonance imaging (MRI) with Gd-DTPA enhancement was used to quantitate the time course of contrast enhancement within the neurohypophysis, pituitary stalk, postero-superior adenohypophysis and antero-inferior adenohypophysis. In 3 patients without evidence of abnormalities at normal conventional MRI scans (normal anterior lobe and pituitary stalk, normal posterior lobe) and a high response to the GRF provocation test, sequential time-resolved Gd-enhanced MRI demonstrates reduced contrast enhancement in the pituitary stalk. These findings are consistent with impairment in stalk vasculature, presumably located at the level of the portal venous system, and could play a role in the pathogenesis of pituitary hormonal deficiency

Discitis in childhood: Integrated neuroradiological imaging in diagnosis and follow-up of one case

Discitis is an inflammatory disease of the intervertebral disc which has usually a benign evolution in childhood. It often recognizes an infectious etiology. Still discussed however is the possibility of a primitive discal involvement (not secondary to a vertebral inflammation) or of a non infectious etiology and the subsequent more correct diagnostic-therapeutic procedures. We report a case of a girl with discitis diagnosed early and treated with antibiotics and orthopedic corset, whose follow-up shows a benign evolution. We underline the importance of modern neuroradiological imaging: in particular, MR plays a major role in the inflammatory diseases of the column, both in diagnosis and in follow-up. MR scans of the involved disc allow frequent controls without radiogenic risks and with a good resolution because of the multiplanarity typical of the method

EFFECTS OF CORTICOTROPIN RELEASING FACTOR ON MONOAMINE RELEASE IN RAT HIPPOCAMPAL SLICES.

The neuropeptide corticotropin releasing factor (CRF) is known to play a role in the stress response in the central nervous system. CRF is co-localized with noradrenaline (NE) and serotonin (5-HT), as well as with glutamate (Glu) and GABA in brain areas involved in the modulation of mood and behaviour (1). Electrophysiological and immunocytochemical studies have shown complex interactions between CRF, monoamines and amino acid transmitters (2, 3). Aim of the present study was to directly investigate the influence exerted by CRF on 5-HT and NE release, with an in vitro approach. Rat hippocampal slices (400 µm thick) were labelled with either [3H]-NE or [3H]-5-HT (0.1 µM) and superfused with Krebs solution, containing either 1 µM desipramine or 3 µM paroxetine. Electrical 1 Hz stimulation was applied for 2 min at the 45th (St1) and the 75th (St2) min of superfusion, and the St2/St1 ratio was calculated (4). CRF, 10-300 nM, added to the superfusion medium from the 75th min onward, concentration-dependently increased [3H]-NE efflux (Emax = 133±8% of the controls, P<0.05). The effect was prevented by the antagonist α-helical-CRF(9-41), 300 nM. To test the hypotesis that the observed effects were indirect, the influences of glutamate and GABA antagonists were challenged. In the presence of the NMDA antagonist MK 801, 10 µM, and of the AMPA/KA antagonist CNQX, 10 µM, the facilitation induced by 300 nM CRF on [3H]-NE efflux was not only prevented, but even reversed into inhibition (70±9%, P< 0.05 vs. controls and vs. CRF alone). The latter was cancelled by the GABA antagonist, bicuculline, 10 µM. Serotonin neurotransmission was modulated by CRF in an opposite way: the neuropeptide, 10-100 nM, inhibited in a concentration-dependent manner 5-HT efflux from electrically stimulated hippocampal slices (Emax = 49±6% of the controls, P<0.01). Both α-helical-CRF(9-41) and bicuculline prevented CRF effect, suggesting the involvement of GABA in the neuropeptide action. These findings, consistent with data obtained on prefrontal cortex and locus coeuruleus neurons (2, 3), suggest that CRF is able to modulate monoaminergic transmission in the hippocampus, and that this action involves aminoacidergic neurotransmission. 1) Carrasco G. A. and Van de Kar L. D.(2003) Eur. J. Pharmacol., 463:235-272. 2)Tan H., Zhong O. and Yan Z. (2004) J. Neurosci. 24: 5000-5008. 3) Valentino R. J. et al. (2001) Neuroscience 106: 375-384. 4) Siniscalchi A. et al. (2002) Br. J. Pharmacol. 136: 1178-1184