The symptomatology of aneurysmal bone cyst : the value of diagnostic imaging

Background: An aneurysmal bone cyst (ABC) is a benign lesion occurring mainly in children. Generally it is found in the metaphyses of long bones and in flat bones. Osteolysis, bone expansion, thinning of the cortex, osseous septa and fluid levels belong to the typical imaging findings in ABC cases. The purpose of the study was to determine the value of imaging methods: plain x-ray films, US, CT and MRI for the diagnosis of aneurysmal bone cyst and to work out the diagnostic algorithm for an ABC suspected on plain radiograms. Material/Methods: The material consists of 72 patients (44 boys, 28 girls) aged 2-23 years (mean age 12 yrs) with bone lesions diagnosed as aneurysmal bone cysts on pathologic examination. In all patients, plain radiographs were performed, in 26 - sonography (US), in 41 - computed tomography (CT), in 8 - magnetic resonance imaging (MRI). All the examinations were analyzed according to own system of evaluation of typical presentation in the particular methods. The histopathological diagnosis was established after biopsy or surgery. Results: The aneurysmal bone cysts were most frequently located in the long bones of the lower limbs (43%), in the long bones of the upper limbs (26.4%) and in flat bones (25%). The localization was mainly in the bone methaphyses (56.6%). On pathological examination, primary ABC was diagnosed in 65.3% of cases, secondary ABC in 23.6%, ABC and concomitant osteitis in 7%, ABC and giant cell tumor in 2.7%, ABC and chondrosarcoma in 1.4%. The application of four methods resulted in 72.2% consistency between diagnostic imaging and pathological examination. In case of only one method used the consistency was 75% for MRI, 63% for CT, 55.4% for plain films and 50% for US. In 100% of misdiagnosed cases there were no septa within osteolytic lesions on plain films, whereas in 43.8% features of malignancy were found. In 53% of misdiagnosed cases no fluid levels were observed on CT and in 69% on US. Conclusions: 1. The diagnosis of aneurismal bone cyst based on plain radiography is possible in cases with typical radiological signs. 2. Application of other methods significantly increases the percentage of correct diagnoses. 3. Lack of fluid levels does not exclude the diagnosis of ABC. 4. Imaging features of malignancy do not exclude the diagnosis of ABC

Opportunistic screening for skin cancer using a mobile unit in Brazil

Abstract Background Skin cancer is the most common malignancy in the white population worldwide. In Brazil, the National Cancer Institute (INCA) estimates that in 2010 there will be 119,780 and 5,930 new cases of non-melanoma skin cancer and melanoma, respectively. The aim of this study was to evaluate the use of a mobile unit in the diagnosis and treatment of skin cancer in several poor regions of Brazil. Methods The diagnosis of skin cancer was accomplished through active medical screening in the prevention Mobile Unit (MU) of Barretos Cancer Hospital (BCH). The study population consisted of patients examined in the MU between 2004 and 2007, and their suspicious lesions were subjected to histopathological evaluation. Data were collected prospectively from standardized forms and analyzed. Results During the screening, 17,857 consultations were carried out. A total of 2012 (11.2%) cases of skin cancer were diagnosed. The predominant histological type reported was basal cell carcinoma (n = 1,642 or 81.6%), followed by squamous cell carcinoma (n = 303 or 15.1%), Bowen's disease (n = 25 or 1.2%), malignant melanoma (n = 23 or 1.1%), basosquamous cell carcinoma (n = 3 or 0.1%), miscellaneous lesions (12 or 0.6%), and metatypical carcinoma (n = 4 or 0.2%). Only 0.6% of lesions were stage III. There were no stage IV non-melanoma skin lesions, as well as no melanomas stages III and IV, found. Conclusions It was observed that the MU can be a useful tool for early skin cancer diagnosis and treatment. This program probably is important, especially in developing countries with inadequate public health systems and social inequality

Minimally invasive techniques used for treatment of urolithiasis in children

The paediatric population is a special group among patients with urolithiasis. Within the past 25 years, the prevalence of this disease in the paediatric population has increased from 6% to 10%. The causes of this higher prevalence are not entirely clear but may be associated with various factors, such as: inappropriate eating habits, inappropriate diet, particularly rich in salt and animal protein, insufficient fluid intake, obesity, hypertension, pollution, faster pace of living as well as uncontrolled intake of multivitamin preparations and dietary supplements. The mean age of a paediatric patient with urolithiasis is 7–8 years. The aim of this publication is to present minimally invasive techniques used for treatment of urolithiasis in the paediatric population. Due to a high risk of disease recurrence, the selection of a treatment method that enables removal of calculi in the least invasive and the most effective way is vital in this group of patients. The choice of management depends on various factors, such as: location, size and composition of calculi, patient’s age, anatomical conditions, the degree of urinary outflow obstruction and recurring urinary tract infections. Surgical methods of urolithiasis treatment are identical in adults and in children. Minimally invasive techniques include extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), ureterorenoscopic lithotripsy (URSL; ureterolithotripsy) and retrograde intrarenal surgery (RIRS). Owing to the technical advancement, minimally invasive techniques are effective in children and help evacuate calculi fully, even with a single procedure. It must be remembered, however, that they should be performed by experienced urologists in highly specialised and well-equipped centres.Populacja pediatryczna stanowi szczególną grupę pacjentów z kamicą układu moczowego. W ciągu ostatnich 25 lat częstość występowania tej choroby w populacji pediatrycznej wzrosła z 6% do 10%. Przyczyny zwiększonej zachorowalności nie są do końca wyjaśnione, ale na wzrost częstości kamicy moczowej mogą mieć wpływ różne czynniki: nieprawidłowe nawyki żywieniowe, niewłaściwa dieta, zwłaszcza z dużą zawartością soli i pokarmów bogatych w białko zwierzęce, niedostateczna podaż płynów, otyłość, nadciśnienie tętnicze, zanieczyszczenie środowiska, przyspieszenie tempa życia, niekontrolowana podaż preparatów wielowitaminowych i suplementów. Przeciętny wiek pacjenta pediatrycznego z kamicą wynosi około 7–8 lat. Celem pracy jest przedstawienie technik małoinwazyjnych w leczeniu kamicy układu moczowego w populacji pediatrycznej. Ze względu na wysokie ryzyko nawrotu choroby w tej grupie zasadnicze znaczenie ma wybór takiej metody leczenia, która umożliwiłaby usunięcie złogów w sposób jak najmniej inwazyjny i jednocześnie skuteczny. Wybór odpowiedniego sposobu postępowania zależy od wielu czynników, takich jak: lokalizacja, wielkość i skład złogu, wiek pacjenta, warunki anatomiczne, stopień utrudnienia spływu moczu, nawracające zakażenia układu moczowego. Procedury chirurgicznego leczenia kamicy u dzieci są takie same jak u dorosłych. Wśród technik małoinwazyjnych należy wymienić litotrypsję pozaustrojową (extracorporeal shock wave lithotripsy, ESWL), nefrolitotrypsję przezskórną (percutaneous nephrolithotomy, PCNL), litotrypsję ureterorenoskopową (ureterolithotripsy, URSL) i wsteczną chirurgię śródnerkową (retrograde intrarenal surgery, RIRS). Metody małoinwazyjnego leczenia kamicy u dzieci dzięki zaawansowanemu rozwojowi techniki są efektywne i umożliwiają całkowitą ewakuację złogów już podczas pierwszej procedury. Należy jednak pamiętać, że powinny być wykonywane przez doświadczonych urologów, w wysokospecjalistycznych i dobrze wyposażonych ośrodkach

Trudności w diagnostyce guza okołonerkowego u rocznego dziecka z nadciśnieniem tętniczym nerkopochodnym

Background: Systemic hypertension is less common in children than in adults, but the incidence of hypertension In children is approximately 1-5%. Hypertension in younger children is usually indicative of an underlying disease process (secondary hypertension). In children, approximately 5-25% of secondary hypertension is attributable to renovasular disease. Case Report: The authors present the case of a 1-year-old child with perirenal tumor and renovascular hypertension. This caused clinical and diagnostic difficulties. Conclusions: Renal vessel malformation is a very uncommon congenital anomaly. It can be a cause of renovascular hypertension. Diagnosis was based on tests in the following order: USG, CT, MR, CT-angiography, and histopathology. Surgical treatment and nephrectomy was necessary; renal arteries were involved

Bilateral pneumothorax in a case of a 20-year-old woman with metastatic malignant mesenchymoma of the pelvis minor and perineum

We present a rare case of bilateral, recurrent and persistent pneumothorax, requiring suction drainage, as a complication of metastatic spread of a malignant neoplasm to the lungs

Obrazowanie MR u dzieci z nerwiakowłókniakowatością typu 1 (NF1) : zmiany wewnątrz- i pozaczaszkowe

Background: Type 1 neurofibromatosis (NF1) may be manifested by a variety of changes in the central nervous system (CNS) and in other organs. The risk of malignancy is increased in these patients. The purpose of the study was to present the utility of magnetic resonance imaging (MRI) in the visualization of lesions and in monitoring of the disease and its therapy in children with NF1. Material/Methods: We analyzed retrospectively 128 MRI scans in 44 children diagnosed with NF1, treated in the Institute of Mother and Child in Warsaw. The analyzed group consisted of 19 boys and 25 girls, aged 1-24 years, mean age 10.8 yrs. MRI examinations were performed in the years 2004-2008 with a 1.5 T scanner. There were 76 brain scans and 52 examinations of other regions of the body. Results: Brain lesions were found on MRI in 27 children (64.2%); there were UBOs in 26/42 (62.2%) patients and optic nerves gliomas in 11/42 (26.2%) children. In 3 cases, evolution of UBOs was observed over the time. Extracranial lesions were visualized in 52 MR examinations in 20 children. Very extensive plexiform neurofibromas compressing abdominal and pelvic organs were observed, and 3 cases of spinal canal invasion, with spinal cord compression in one patient. Malignant lesions were found in 3 patients: 2 malignant peripheral nerve sheath tumors (MPNST) and 1 rhabdomyosarcoma (RMS). The MRI characteristics of intra- and extracranial lesions is presented. Conclusions: Children with NF1 require constant care in the specialized center with a multidisciplinary team and MRI equipment available. MR examination in the best imaging method in children with NF1, allowing both diagnosis and monitoring of the patients, especially evaluation of lesions suspicious of malignancy, as well as treatment planning

Medulloblastoma with extensive nodularity : US, CT and MRI findings

Background: Medulloblastoma accounts for up to 25% of all paediatric CNS tumours. According to WHO classification (2007) medulloblastoma with extensive nodularity (MBEN) is a separate rare entity associated with younger age and better prognosis. Case Reports: A 9-month-old girl was admitted and examined because of macrocephaly and disturbed psychomotor development. Transfontanel ultrasound revealed dilated ventricular system and hyperechoic mass in the posterior cranial fossa. Computed tomography showed hyperdense mass in the cerebellum. Magnetic resonance imaging revealed a mass with gyriform pattern and strong contrast enhancement after gadolinium administration. Differential diagnosis included dysplastic heterotopic cortex, Lhermitte-Duclos disease, atypical teratoid/rhabdoid tumour (AT/RT), and medulloblastoma (MB). The patient was operated on. Medulloblastoma with extensive nodularity (MBEN) was finally diagnosed. The authors present and discuss three other cases of this rare entity. Conclusions: Transfontanel sonografic examination is capable of detection of the posterior fossa tumour as a cause of hydrocephalus and macrocephaly. The mass in a child’s posterior cranial fossa that is hyperdense on unenhanced CT and gyriform, nodular, and markedly enhancing on MRI may strongly suggest medulloblastoma with extensive nodularity (MBEN)

Postradiotherapeutic changes and their evolution in MRI in children with aggressive soft tissue tumors

Background: Magnetic resonance imaging is a commonly used method of monitoring of soft tissue tumours. The aim of the work was to describe precisely the typical changes within soft tissues and bones occurring after radiotherapy in children treated for sarcomas and other soft tissue tumours. With time, the changes undergo evolution and their characteristics and comparison with previous examinations help in a difficult differentiation between tumour lesions and posttherapeutic changes. Material/Methods: Fifteen children and young adolescents (9 boys and 6 girls) aged between 2 and 22 years (mean age of 13.4 years) with diagnosed aggressive soft tissue tumours, were treated with radiotherapy. There were 102 MRI examinations analysed in the period from February 2004 to February 2008. The examinations were performed with a 1.5T MRI scanner in the following sequences: SE T1, SE T1+fatsat, before and after gadolinium administration (Gd), FSE T2 and STIR in three planes, and, in some selected cases, a dynamic gadolinium-enhanced (DCE MRI) examination with FAME sequence. Histopathological examinations showed: rhabdomyosarcoma (RMS) in 8 cases, synovial sarcoma - 3, agressive desmoid fibroma - 3, mesenchymoma mal. - 1. MRI examinations were performed at different postradiotherapeutic stages, several times in one patient (12 times at the most). Results: Every postirradiation stage revealed a typical picture of posttherapeutic changes. We distinguished four stages and described changes in different sequences within soft tissues and bones, as well as features of contrast enhancement and enhancement curves in a dynamic study. The stages included: I stage - early, up to 3 months after rth, II stage - chronic, from 3 months to 12 months after rth, with some differences between the following periods: • 3-9 months; 9-12 months; III stage - late, from 1 to 3 years after rth, IV stage - distant, more than 3 years after rth. In the early stage, there were 2 cases with a suspicious, equivocal image of postradiotherapeutic changes. In the chronic stage, there was one recurrence and one case of increasing changes after the therapy. However, the changes resolved in subsequent examinations. In the distant stage, we found two cases of a local recurrence. Conclusions: 1. MRI is a method of choice in the monitoring of treatment of aggressive soft tissue tumours and in diagnosis of recurrence. 2. To interpret the examination results, it is very important to know the MRI characteristics of changes after radiotherapy and their evolution with time. 3. Interpretation of MRI images and differentiation between postradiotherapeutic and neoplastic changes is difficult, especially at an early postradiotherapeutic stage. 4. A dynamic MRI examination may be useful in the differentiation between postradiotherapeutic and neoplastic changes but it may be unreliable at an early postradiotherapeutic stage. 5. When interpreting the results, it is very important to compare the image with the previous ones. It is therefore indicated to carry out a baseline MRI in the early postradiotherapeutic stage, and then further follow-up images, at several-month intervals

Imaging of complications after limb prostheses implantation in children with bone tumors

BACKGROUND: Tumors of the developmental age are an important problem in clinical practice. Primary bone tumors constitute 1-1.5% of all tumors, and 7% of all tumors diagnosed in the developmental age. The aim of the study was to assess the capabilities of imaging methods in diagnosing complications of limb endoprostheses in children with osteoarticular tumors. MATERIAL AND METHODS: We included 155 patients with limb endoprostheses, aged 7-26 years. There were 113 patients with knee prostheses, 1 patient with bilateral knee prostheses, 16 patients with shoulder prostheses, 14 patients with hip prostheses, 11 patients with hip and knee prostheses, and 1 patient with a femoral prosthesis. All patients underwent plain radiography and an ultrasound study. RESULTS: Complications were found in 50 patients (32% of all patients). The following complications were seen - inflammatory changes in soft tissues and bones (12 patients, 7.7%), stump fractures (11 patients, 7%), lack of elongation effect or shortening of the prosthesis (7 patients, 4.5%), prosthesis fractures (4 patients, 2.5%), crural fractures (4 patients, 2.5%), loosening of the prosthesis (3 patients, 1.9%), joint dislocation (2 patients, 1.3%), stump and prosthesis fracture (1 patient, 0.6%) and local recurrence (6 patients, 3.9%). Prostheses were exchanged for the following reasons - fractures (5 patients, 3.2%), inflammation (2 patients with 3 exchanges, 1.9%). Local recurrence and inflammation were confirmed by a biopsy. CONCLUSIONS: Radiography and ultrasonography are of crucial importance in monitoring patients after implantation of limb endoprostheses. The findings did not require confirmation in additional studies: CT and MRI. Suspicion of local recurrence and inflammation required a biopsy confirmation

Evaluation of observing and modeling requirements for the balancoaAtmosferico regional de carbono na Amazonia (BARCA) Project

A study of basin-wide carbon balance for Amazonia (Balanço Atmosférico Regional de Carbono na Amazônia -- BARCA) is being planned, involving systematic observations of variations of trace gas mixing ratios, simulation analysis of atmospheric transport, and regional flux estimation by inverse methods. In addition to proposed campaign observations to be made by aircraft, a longer-term program of ongoing trace gas measurements may provide information about the time-mean carbon budget. We have conducted a series of observing system simulation experiments using a coupled model of meteorology, atmospheric transport, and surface exchanges of energy/water/carbon (SiB-BRAMS). Observations of atmospheric trace gas mixing ratio were simulated in the model by releasing imaginary particles into an adjoint of the simulated transport field using a Lagrangian Particle Dispersion Model (LPDM) driven from the SiB-BRAMS meteorology. Backward-in-time transport was calculated by the LPDM from each hypothetical sample according to model parameterizations of advection, turbulence, and vertical motion associated with both deep and shallow convective clouds. Samples were specified hourly from each LBA eddy covariance site, twice weekly as profiles from two locations (Santarem and Fortaleza) using light aircraft, and weekly from the existing global flask network. Results show that time-mean fluxes over much of the Amazon Basin can be strongly constrained by such a sampling network, but highlight uncertainties associated with model transport and the treatment of diurnal and synoptic variations of surface fluxes. An analytical framework is recommended in which surface fluxes are divided into components due to photosynthesis, ecosystem respiration, and a time-mean flux by unspecified processes. Balanced component fluxes due to photosynthesis and respiration can be constrained using eddy covariance data, satellite imagery, and regional meteorology, and time-mean fluxes constrained by observed variations in atmospheric composition. Transport model error, especially related to turbulent and convective processes, must also be treated in the analysis