Fluorine-18 fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography scan contributes to the diagnosis and management of brucellar spondylodiskitis

BACKGROUND: Limited data suggest that fluorine-18 fluoro-2-deoxy-D-glucose (F-18 FDG) positron emission tomography combined with computed tomography (PET/CT) scan may be useful for diagnosing infections of the spine. Brucellar spondylodiskitis might be devastating and current imaging techniques lack sensitivity and specificity. The aim of this prospective study was to determine the role of F-18 FDG PET/CT scan in the diagnosis of brucellar spondylodiskitis and in monitoring the efficacy of its treatment. METHODS: Ten consecutive patients with brucellar spondylitis were prospectively evaluated with PET/CT. Baseline evaluation included also magnetic resonance imaging (MRI) of the affected spine, indices of inflammation, the slide agglutination test (SAT), and the standard hematology and biochemistry. All cases were treated with suitable antibiotics until resolution or significant improvement of clinical and radiological (MRI) findings. Upon completion of treatment, they were re-evaluated with follow-up PET/CT scan. The maximum standardized uptake values (SUV) were measured and compared with SAT. RESULTS: In all patients there was an increased F-18 FDG activity in the infected spine region detected by the initial MRI. F-18 FDG PET/CT provided additional information, compared to MRI, in 4 (40%) patients. More specifically it revealed additional spine lesions (in 3 patients), lymphadenitis, arthritis, organomegaly, as well as new paravertebral soft tissue involvement and epidural masses. This additional information had an impact on the duration of treatment in these patients. At the end of treatment all patients had a complete clinical response; 5 patients had positive serology, 6 patients had residual MRI findings, while 9 had a positive PET/CT but with significantly decreased FDG uptake compared to baseline (median 2.6, range 1.4 – 4.4 vs. median 5.5, range 2.8 – 9.4, p = 0.005). During the follow up period (median 12.5 months) no relapses have been observed. No significant association was observed between the SUV and SAT. CONCLUSIONS: Our study suggests that in patients with brucellar spondylodiskitis F-18 FDG PET/CT scan can provide additional information on the spread of the infection, compared to MRI. Successful treatment is associated with a significant decrease in SUVmax values; thus, PET/CT scan may be a complementary method for determining the efficacy of treatment

Enriching Arts Education through Aesthetics. Experiential Arts Integration Activities for Early Primary Education

Enriching Arts Education through Aesthetics examines the use of aesthetic theory as the foundation to design and implement arts activities suitable for integration in school curricula in pre-school and primary school education. This book suggests teaching practices based on the connection between aesthetics and arts education and shows that this kind of integration promotes enriched learning experiences.　 The book explores how the core ideas of four main aesthetic approaches – the representationalist, the expressionist, the formalist, and the postmodernist – translate into respective ways of designing and implementing experiential aesthetics-based activities. Containing relevant examples of interventions used in classes, it analyzes the ways in which the combination of different aesthetic approaches can support varied, multifaceted, multimodal and balanced teaching situations in school

Impaired distensibility of ascending aorta in patients with HIV infection

Background: Our aim was to investigate the aortic distensibility (AD) of the ascending aorta and carotid artery intima-media thickness (c-IMT) in HIV-infected patients compared to healthy controls.Methods: One hundred and five HIV-infected patients (86 males [82%], mean age 41 ± 0.92 years), and 124 age and sex matched HIV-1 uninfected controls (104 males [84%], mean age 39.2 ± 1.03 years) were evaluated by high-resolution ultrasonography to determine AD and c-IMT. For all patients and controls clinical and laboratory factors associated with atherosclerosis were recorded.Results: HIV- infected patients had reduced AD compared to controls: 2.2 ± 0.01 vs. 2.62 ± 0.01 10-6 cm2 dyn-1, respectively (p < 0.001). No difference was found in c-IMT between the two groups. In multiadjusted analysis, HIV infection was independently associated with decreased distensibility (beta –0.45, p < 0.001). Analysis among HIV-infected patients showed that patients exposed to HAART had decreased AD compared to HAART-naïve patients [mean (SD): 2.18(0.02) vs. 2.28(0.03) 10-6 cm2 dyn-1, p = 0.01]. In multiadjusted analysis, increasing age and exposure to HAART were independently associated with decreased AD.Conclusion: HIV infection is independently associated with decreased distensibility of the ascending aorta, a marker of subclinical atherosclerosis. Increasing age and duration of exposure to HAART are factors further contributing to decreased AD.Σκοπός: Να μελετηθεί η διατασιμότητα της ανιούσας αορτής [aortic distensibility (AD)] και το πάχος του μέσου χιτώνα της καρωτίδας [carotid artery intima-media thickness (c-IMT)] σε ασθενείς με HIV-λοίμωξη, σε σύγκριση με υγιείς μάρτυρες. Μέθοδοι: Εκατόν πέντε ασθενείς με HIV-λοίμωξη (86 άνδρες [82%], διάμεση ηλικία 41 ± 0.92 έτη), και 124 υγιείς μάρτυρες με αντίστοιχη ηλικία και φύλο (104 άνδρες [84%], διάμεση ηλικία 39.2 ± 1.03 έτη) μελετήθηκαν με υπερηχογράφημα υψηλής ευκρίνειας για τον καθορισμό της AD και του c-IMT. Για όλους τους ασθενείς και τους μάρτυρες καταγράφηκαν όλοι οι κλινικοί και εργαστηριακοί παράγοντες που σχετίζονται με την αθηροσκλήρωση. Αποτελέσματα: Οι ασθενείς με HIV-λοίμωξη είχαν ελαττωμένη AD σε σχέση με τους μάρτυρες: 2.2 ± 0.01 vs. 2.62 ± 0.01 10-6 cm2 dyn-1, αντίστοιχα (p < 0.001). Δεν βρέθηκαν διαφορές στις τιμές του c-IMT μεταξύ των δύο ομάδων. Στην πολυπαραγοντική ανάλυση η HIV λοίμωξη σχετιζόταν ανεξάρτητα με ελαττωμένη διατασιμότητα (beta –0.45, p < 0.001). Η στατιστική ανάλυση στην ομάδα των ασθενών με HIV- λοίμωξη έδειξε ότι οι ασθενείς που είχαν λάβει HAART είχαν ελαττωμένη AD συγκρινόμενοι με τους ασθενείς που δεν είχαν λάβει ποτέ HAART- [μέση τιμή (SD): 2.18(0.02) vs. 2.28(0.03) 10-6 cm2 dyn-1, p = 0.01]. Στην πολυπαραγοντική ανάλυση, η αυξανόμενη ηλικία και η έκθεση σε HAART σχετιζόταν ανεξάρτητα με ελαττωμένη AD.Συμπεράσματα: Η HIV λοίμωξη είναι ανεξάρτητος παράγων κινδύνου για ελαττωμένη διατασιμότητα της ανιούσας αορτής, που αποτελεί δείκτη πρώιμης αθηροσκλήρωσης. Η αυξανόμενη ηλικία και η διάρκεια έκθεσης στη HAART αποτελούν παράγοντες που ελαττώνουν ακόμα περισσότερο την AD

Idiopathic spontaneous perforation of the upper urinary tract. A presentation of 4 cases

Spontaneous perforation of the collecting system constitutes a rare entity masked by the presentation of a typical renal colic. However, it should not be forgotten when managing patients with colic, since missed diagnoses may carry significant morbidity. We herein present a series of spontaneous perforation of the collecting system without an apparent obstruction site evident in helical CT urography. Four consecutive patients who presented with typical renal colic were initially subjected to KUB and renal ultrasound imaging and were ultimately diagnosed with perforation of the collecting system via contrast enhanced- helical CT urography. Despite thorough evaluation, the cause responsible obstructive was not discovered and an exclusion diagnosis of idiopathic collecting system perforation was assigned to all patients. Due to the rarity of a spontaneous perforation traditional retrograde urography was performed in an effort to identify the possible cause but was also unrevealing. All patients were successfully treated with endourological means. Perforation of the collecting system without an evident obstructive cause is a rare entity with obscure etiology. A reasonable but yet unconfirmed speculation is that of a transient obstruction capable of a significant increase of intraluminal pressures

Chest CT findings in patients with inflammatory myopathy and Jo1 antibodies

Thoracic high-resolution computed tomography scans (HRCT) of 17 patients with inflammatory muscle disorders (IMD) and positive Jo1 antibodies were retrospectively reviewed regarding presence, extension, and distribution of pathological findings. Abnormal findings were found in 14 (82.3%) patients. The predominant CT abnormality was ground glass attenuation, which was present in seven patients (41.1%), having a bilateral and diffuse distribution. In general, lesions tended to appear in the lower lobes and more specifically in the lung bases. lnterlobular septal thickening was found in six patients (35.3%); it was seen in the upper and lower lobes with peripheral distribution and bilateral localization in five out of six patients. Bronchiectases, reticular opacities, and honeycombing were found in six patients (35.3%). Air space consolidation was seen in about 17% of the patients. Lung involvement is a frequent feature of IMD patients with positive Jo1 antibodies and its most common radiological pattern is that of nonspecific interstitial pneumonia. (c) 2007 Elsevier Ireland Ltd. All rights reserved

The prevalence and relevance of adrenal masses in patients with sporadic gastroenteropancreatic neuroendocrine tumours (GEP-NET)

Objective The widespread application of abdominal computerized tomography (CT) imaging has revealed that 0 center dot 984 center dot 0% of individuals harbour adrenal lesions (incidentalomas). There is, however, paucity of information regarding the prevalence of adrenal lesions in patients with gastroenteropancreatic neuroendocrine tumours (GEP-NETS). Purpose of this study was to estimate the prevalence of adrenal lesions in patients with GEP-NETS and identify their radiological features and clinical significance. Design The prevalence of adrenal lesions was estimated retrospectively in 438 patients with GEP-NETS who underwent abdominal imaging. Secretory status and changes in size were documented during subsequent follow-up. MEN-1 patients and ectopic ACTH-secreting tumours were excluded. Results Adrenal lesions were detected in 32 (8 center dot 4%) of 383 patients included. The majority (22 patients 69%) were located at the left adrenal gland and the mean size was 23 center dot 6mm. In two patients, one with a well and another with a poorly differentiated tumour, clinicopathological features suggested adrenal metastases. During a mean follow-up period of 69 center dot 5months, no subsequent growth of any adrenal lesion was observed. Endocrine evaluation documented subclinical glucocorticoid hypersecretion in 4 cases (14%). The presence of adrenal lesions did not correlate to distant metastases, however, they were observed more frequently in patients with G3 tumours. Conclusion The prevalence of adrenal lesions in patients with GEP-NETs was found to be higher than the general population and mostly represent benign adrenal adenomas (except patients with G3 tumours). Nevertheless, individualized assessment of imaging characteristics should be still considered

Impaired distensibility of ascending aorta in patients with HIV infection

<p>Abstract</p> <p>Background</p> <p>Our aim was to investigate the aortic distensibility (AD) of the ascending aorta and carotid artery intima-media thickness (c-IMT) in HIV-infected patients compared to healthy controls.</p> <p>Methods</p> <p>One hundred and five HIV-infected patients (86 males [82%], mean age 41 ± 0.92 years), and 124 age and sex matched HIV-1 uninfected controls (104 males [84%], mean age 39.2 ± 1.03 years) were evaluated by high-resolution ultrasonography to determine AD and c-IMT. For all patients and controls clinical and laboratory factors associated with atherosclerosis were recorded.</p> <p>Results</p> <p>HIV- infected patients had reduced AD compared to controls: 2.2 ± 0.01 vs. 2.62 ± 0.01 10^-6 cm² dyn^-1, respectively (p < 0.001). No difference was found in c-IMT between the two groups. In multiadjusted analysis, HIV infection was independently associated with decreased distensibility (beta –0.45, p < 0.001). Analysis among HIV-infected patients showed that patients exposed to HAART had decreased AD compared to HAART-naïve patients [mean (SD): 2.18(0.02) vs. 2.28(0.03) 10^-6 cm² dyn^-1, p = 0.01]. In multiadjusted analysis, increasing age and exposure to HAART were independently associated with decreased AD.</p> <p>Conclusion</p> <p>HIV infection is independently associated with decreased distensibility of the ascending aorta, a marker of subclinical atherosclerosis. Increasing age and duration of exposure to HAART are factors further contributing to decreased AD.</p