Cysticercosis of the brain. The value of computed tomography

Incidence and radiologic findings of neurocysticercosis were investigated in a series of 23,800 consecutive head examinations using computed tomography (CT). The condition was diagnosed in 168 cases (0.7%). The parenchymatous form was the most common presentation (96.3%), while the meningeal form corresponded to only 11.9 per cent of cases. These two forms coexisted in some cases. These findings reversed the knowledge on the condition based on conventional radiography. The different CT appearances in the brain are described and a new radiologic protocol for the CT evaluation of the condition is advocated, which includes a follow-up after a trial cure with Praziquantel in the presence of cysts not associated with suggestive brain calcifications. CT was more sensitive than conventional radiography in the differentiation between dead and living larvae, thus having an impact on the therapeutic management of the patients.     

Assessment of the potential in vivo genotoxicity of fluoranthene

Fluoranthene is a ubiquitous environmental pollutant. Althoughfluoranthene is mutagenic in bacterial and mammalian in vitrocell systems following metabolic activation by rat liver fraction,information on in vivo mutagenicity is lacking and studies ontumour initiating activity in mice are equivocal. In the presentstudy, the potential genetic hazard to man was assessed usingthe mouse bone marrow micronucleus and rat liver unscheduledDNA synthesis test systems. Fluoranthene did not show any evidenceof genotoxicity in either of the in vivo assays following acuteoral administration at levels of up to 2000 mg/kg b.w. ¹To whom correspondence should be addressed     

Total versus tube-related additional work of breathing in ventilator-dependent patients

BACKGROUND: In tracheally intubated or tracheostomized spontaneously breathing patients, tube resistance can highly increase the patient's work of breathing. In this study we focused upon the relationship between total (WOBtot) and tube-related additional inspiratory work of breathing (WOBadd) and compared different ventilatory modalities for proper tube compensation. METHODS: In ten tracheostomized spontaneously breathing patients we measured WOBtot and WOBadd in the continuous positive airway pressure (CPAP) mode, under inspiratory pressure support of 5, 10, and 15 cmH2O in the pressure support ventilation (PSV) mode, and under flow-adjusted pressure support in the automatic tube compensation (ATC) mode. WOBadd and WOBtot were calculated on the basis of measured tracheal pressure and esophageal pressure, respectively. Inspiratory peak tracheal pressure above PEEP was taken as an estimate of pressure support beyond mere tube compensation (i.e., overcompensation). RESULTS: The percentage of the tube-related WOBadd on WOBtot in the CPAP mode was 52%. It decreased with increasing pressure support in the PSV mode from 32% (PSV 5 cmH2O) to 17% (PSV 15 cmH2O). WOBadd was only 15% of WOBtot in the ATC mode. In contrast to the other ventilatory modes, reduction of WOBadd in the ATC mode was achieved with the smallest amount of overcompensation, i.e. with minimal pressure assist beyond mere tube compensation. CONCLUSION: In tracheally intubated or tracheostomized spontaneously breathing patients, adequate compensation of tube resistance (i.e. with minimal overcompensation and minimal undercompensation) is best done by the ATC mode.     

Low-iodine diet revisited: importance in nuclear medicine imaging and management

PURPOSE: The need for a low-iodine diet (LID) to maximize the results of radioactive iodine uptake (RAIU), nuclear medicine thyroid scintigraphy, and ultimately treatment of thyroid cancer patients is widely accepted. Failure to follow the prescribed diet can alter RAIU results, thyroid scan findings, and poststudy management. OBJECTIVE: Provided is a case presentation that illustrates the need for adequate patient understanding and compliance with the LID. METHODS: We present the clinical history, laboratory values, and pertinent imaging of a 21-year-old woman with papillary thyroid cancer. The patient's post-thyroidectomy I-123 and 2 subsequent thyroid (I-123 and post-RAI ablation I-131) scintigraphy examinations are reviewed as well as the patient's urine iodine levels. RESULTS: In this case of a woman with papillary thyroid cancer, the nuclear medicine whole body and neck pinhole images revealed that compliance to an LID positively impacts the overall management. After an LID was followed, the patient's urine iodine level appropriately declined from the previously elevated level. Initial negative results on thyroid scintigraphy caused by noncompliance with the LID became positive when the patient adhered to the prescribed dietary regimen. CONCLUSION: An LID is an integral element in the management of differentiated thyroid cancer. Proper guidance and emphasis on the implementation of the diet needs to be provided to patients. Noncompliance may lead to false negative imaging results, misleading the medical professionals and patient. Potentially inadequate management of the patient's thyroid cancer may follow.     

Effective photodynamic therapy of actinic keratoses on the head and face with a novel, self-adhesive 5-aminolaevulinic acid patch

Background:  Photodynamic therapy (PDT) is increasingly used for the treatment of actinic keratosis (AK).
Objectives:  To investigate both the efficacy of different application times and the safety of a novel patch (PD P 506 A) containing aminolaevulinic acid in the PDT of mild to moderate AK.
Methods:  Applications of PD P 506 A for 0.5, 1, 2 and 4 h were compared in a multicentre, randomized, blinded-observer, parallel-group study. After patch removal, study lesions were illuminated with red light ( λ _em ≈ 630 nm; 37 J/cm²). Study lesions were not pretreated (e.g. by curettage) prior to PDT. Efficacy was evaluated 4 and 8 weeks after treatment. Safety and tolerability were determined through laboratory analyses and documentation of both local reactions and adverse events.
Results:  A total of 149 patients were initially enrolled. Of these, 140 patients (520 lesions) completed the study according to protocol. Eight weeks after treatment, 86% of the AK lesions (74% of the patients) treated with 4-h patch application showed complete clearance. The complete clearance rates of lesions (patients) for the 2-, 1- and 0.5-h treatment arms were 73% (47%), 72% (50%) and 51% (24%), respectively. Statistically, the 4-h application was identified as the 'best treatment'. Patients with clearance seemed to experience local reactions to a greater extent than patients without clearance. Local reactions to study treatments did not exceed the expected range.
Conclusions:  The results of this first clinical efficacy study suggest excellent therapeutic outcomes with a single PD P 506 A PDT with a 4-h application.     

Urinary symptoms, sexual intercourse and significant bacteriuria in male patients attending STD clinics.

OBJECTIVE: To assess the relationship between sexual behaviour, urinary symptoms, urinalysis and bacteriuria in men attending STD clinics. DESIGN: A prospective study recording sexual behaviour, urinary symptoms and collecting mid-stream urine specimens. SETTING: Two West Midlands STD clinics, UK. SUBJECTS: 1086 new male patients. RESULTS: 704 patients had had sexual intercourse (SI) within 14 days of testing, 424 had urinary symptoms and 122 had pyuria. All 13 patients with positive culture had SI < 14 days before testing, urinary symptoms and pyuria. No association was found between sexual orientation, type of SI, number of sexual partners, condom usage and bacteriuria. CONCLUSION: Bacteriuria does not behave as an STD but SI may be a factor in acquiring bacteriuria. Dysuria with or without urethral discharge is the most predictive symptom of bacteriuria. Pyuria has a high sensitivity for predicting bacteriuria among males.