Edema Grade Research Articles

The clinical and radiological spectrum of posterior reversible encephalopathy syndrome: the retrospective Berlin PRES study

The aim of the study was to characterize the clinical and radiological spectrum of posterior reversible encephalopathy syndrome (PRES) in a large cohort. The radiological report data bases of the authors' university hospitals were searched for patients with PRES. Various imaging features at onset of symptoms and on follow-up as well as clinical and paraclinical data were tabulated in those patients fulfilling the criteria for PRES. Exploratory univariate analyses were performed. A total of 96 patients with PRES were included into the study. Wide differences in lesion location, diffusivity, distribution pattern, edema severity, hemorrhage, underlying diseases, symptoms, mean arterial pressure (MAP) and coagulation status were encountered. Hemorrhage occurred significantly more frequently in patients with altered coagulation state and was significantly associated with higher edema grades and with the presence of cytotoxic edema. There was a significant difference in MAP between toxic associations with higher MAP in infection, eclampsy and autoimmune disorders, while lower MAP was found in chemotherapy and immunsupression. In 82% of patients complete or near complete resolution of edema was noted during follow-up. Higher MAP levels were associated with incomplete edema resolution. In 43% of patients residual lesions were seen with a relatively even distribution between focal gliosis, infarction, posthemorrhagic residua, atrophy and laminar necrosis. PRES in this large hospital-based retrospective study comprises a wide radiological and clinical spectrum. Residual lesions were encountered more frequently than commonly expected. Our results point towards a differential contribution of high blood pressure to the course of PRES in different underlying etiologies.

Abstract 848: Prevention of colitis-associated colorectal cancer with 8-hydroxydeoxyguanosine

Abstract Colitis-associated colorectal cancer (CAC) is one of clear examples of inflammation-carcinogenesis sequence, based on which strict control of colitis provides the right rationale of the intervention of anti-inflammatory drug on the chemoprevention. We have shown that 8-OHdG, which traditionally has been acknowledged as a marker of oxidative stress-related mutagenesis, could paradoxically exerted potent anti-inflammatory and anti-oxidant action in various inflammation models (Ock CY et al, Biochem Pharmacol, 2010). Based on the fact that Rac1 binds and activates STAT3 which is significantly up-regulated in inflammatory bowel disease (IBD) as well as CAC, we hypothesized that attenuation of Rac1-STAT pathway by exogenous 8-OHdG treatment may block inflammatory bouts in dextran sodium sulfate (DSS) induced colitis and can reduce carcinogenesis promoted by azoxymethane (AOM) followed by DSS ingestion. First we have checked whether exogenous 8-OHdG can ameliorate IBD, for which IL10 knock-out mice, IBD prone mice, are designed to ingest 5% DSS in tap water ad libitum for a week, and 8-OHdG (50, 100, or 150 mg/kg) is given intraperitoneal route daily. Treatment with 8-OHdG significantly reduced complication rates, pathologic grade of inflammation and edema compared with DSS only group. On pathogenic basis, the expressions of various inflammatory mediators such as TNF-α, IL-6, COX-2 and iNOS were decreased, as well as Rac1 activity and phosphorylation of STAT3 in 8-OHdG treated group in a dose-dependent manner. Next, in order to document the chemoprevention effects of 8-OHdG, mice were injected AOM (10 mg/kg) intraperitoneally followed by drinking 2.5% DSS for a week, after which AIN76 diet that contains 0.03 % and 0.06 % 8-OHdG was given for 20 weeks. As results, mice which consumed 8-OHdG-contained diet were significantly reduced tumor incidence and tumor multiplicity. Increased activity of Rac1 and phosphorylation of STAT3 with AOM plus DSS administration were significantly attenuated in 8-OHdG treatment group. These results were further validated with human colorectal adenocarcinoma cell line Caco-2 in vitro model. Conclusively, for the very first time, we clearly showed chemopreventive effect of exogenous 8-OHdG against CAC. Since 8-OHdG, one of well-known by-products generated by oxidative stress, paradoxically blocks inflammation-carcinogenesis sequence in colitis-associated cancer model, 8-OHdG could be a promising chemopreventive drug for the patient suffering from longstanding and extensive IBD, high risk group for CAC. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 848. doi:10.1158/1538-7445.AM2011-848

A comparison of wound healing between a skin protectant ointment and a medical device topical emulsion after laser resurfacing of the perioral area

Currently, there is no standard of care for postlaser resurfacing treatment of the face. Ideally, treatment should speed re-epithelialization and reduce downtime, with minimal irritation. This study compared the wound healing efficacy and safety of Aquaphor Healing Ointment (AHO) (Beiersdorf Inc, Wilton, CT) and Biafine Topical Emulsion (BTE) (OrthoNeutrogena, Los Angeles, CA) treatment after laser resurfacing of the perioral area. In this double-blind, split-face study, 20 subjects with perioral rhytides received fractional carbon dioxide laser resurfacing. AHO and BTE were applied to opposite sides of the face 4 times daily after the resurfacing procedure. Clinical grading of erythema, edema, epithelial confluence, crusting/scabbing, subjective irritation, and general wound appearance were assessed using 5-point scales on days 2, 4, 7, and 14. Subjects ranked the two treatment sites daily as to which side of their face looked better. AHO resulted in significantly less erythema (days 2 and 7) and crusting/scabbing (days 2, 4, and 7) and higher epithelial confluence (day 4) than BTE (P ≤ .042). Subjective irritation assessments demonstrated significantly less stinging, itching, and tightness at day 2 and tightness at day 7 with AHO than with BTE (P ≤ .049). General wound appearance was graded significantly higher for AHO on days 2 and 7 (P ≤ .049). Significantly more subjects preferred AHO to BTE (P ≤ .046). This was a small study in a homogenous population of white women. AHO exhibited superiority to BTE in several wound healing parameters and in overall wound condition.

Brain Region-Selective Mechanisms Contribute to the Progression of Cerebral Alterations in Acute Liver Failure in Rats

Patients with acute liver failure (ALF) often die of intracranial pressure (IP) and cerebral herniation. Main contributors to increased IP are ammonia, glutamine, edema, and blood flow. The sequence of events and underlying mechanisms, as well as the temporal pattern, regional distribution, and contribution of each parameter to the progression of neurologic deterioration and IP, are unclear. We studied rats with ALF to follow the progression of changes in ammonia, glutamine, grade and type (vasogenic or cytotoxic) of edema, blood-brain barrier permeability, cerebral blood flow, and IP. We assessed whether the changes in these parameters were similar between frontal cortex and cerebellum and evaluated the presence, type, and progression of edema in 12 brain areas. ALF was induced by injection of galactosamine. The grade and type of edema was assessed by measuring the apparent diffusion coefficient by magnetic resonance imaging. Cerebral blood flow was measured by magnetic resonance and blood-brain barrier permeability by Evans blue-albumin extravasation. Increased IP arises from an early increase of blood-brain barrier permeability in certain areas (including cerebellum but not frontal cortex) followed by vasogenic edema. Ammonia and glutamine then increase progressively, leading to cytotoxic edema in many areas. Alterations in lactate and cerebral blood flow are later events that further increase IP. Different mechanisms in specific regions of the brain contribute, with different temporal patterns, to the progression of cerebral alterations and IP in ALF.

Phase III Study Comparing Prone Accelerated Whole Breast IMRT with a Daily vs. a Weekly Tumor Bed Boost: Interim Analysis Results

This prospective randomized trial is comparing hypofractionated (15 fraction) prone whole breast IMRT either with a daily concomitant boost to the tumor bed (Formenti et al, JCO 2007) or with a weekly Friday boost (FB), which may have a radiobiological advantage by counteracting tumor repopulation occurring over the weekend break. This trial is designed to test the hypothesis that toxicity, local control and cosmetic results are comparable in the two arms. We are reporting the results of a planned interim analysis for the acute toxicity endpoint. Stage 0-II breast cancer patients after lumpectomy with negative margins (>1 mm), and sentinel/axillary lymph node dissection were eligible. Patients were stratified by menopausal status and chemotherapy prior to radiation. Patients were CT scanned in the prone position on a specially designed prone table. Arm 1: Patients received 15 daily fractions of 2.7 Gy, Mon-Fri to the breast with a daily concomitant boost of 0.5 Gy to the tumor bed. Total dose: 40.5 Gy to the breast, 48.0 Gy to the tumor bed. Arm 2 (FB): Patients received 15 daily fractions of 2.7 Gy Mon-Fri to the breast with a Fri boost of 2.0 Gy to the tumor bed with Cone-beam CT. Total dose: 40.5 Gy to the breast, 46.5 Gy to the tumor bed, based on BED calculations. Interim analysis evaluated the study's primary endpoint of acute toxicity ≥ grade 2 occurring within 60 days after treatment. Between 3/2009 - 2/2010, 118 patients have enrolled to this protocol: 60 patients randomized to Arm 1 and 58 to Arm 2 FB. CTCAE v3.0 defined radiation dermatitis was evaluated in 55 patients of Arm 1 at a median 69 days post-treatment (range, 34-288), and in 52 patients on Arm 2 FB at a median of 76 days (range, 36-281). Erythema grade I: 50 (86%) Arm 1, 49 (91%) Arm 2. Grade II: 8 (14%) Arm 1, 4 (7%) Arm 2. Grade III: 1 (2%) Arm 2. Edema grade I: 19 (83%) Arm 1, 18 (86%) Arm 2. Grade II: 3 (13 %), 1 (4%). Grade III 1 (4%). There was no statistical difference between the two arms in RT-related acute toxicity. Interim analysis of the acute toxicities of patients enrolled on a Phase III randomized trial assessing concomitant vs. weekly (Friday) boost demonstrates equivalence between the two regimens. The trial continues accrual to 400 total patients (200 per arm) as planned.

Effect of Optic Nerve Sheath Fenestration on Papilledema of the Operated and the Contralateral Nonoperated Eyes in Idiopathic Intracranial Hypertension

To evaluate the effect of optic nerve sheath fenestration (ONSF) on papilledema grade in the operated eyes and the contralateral nonoperated fellow eyes in patients with idiopathic intracranial hypertension (IIH). Retrospective review. A total of 78 patients underwent ONSF, and 20 patients served as controls. Charts of patients with IIH who had ONSF at the University of Iowa Hospital and Clinics were reviewed for age, gender, body mass index, and clinical findings. Optic disc photographs were graded by a masked observer using the Frisén papilledema grading scale at preoperative baseline and postoperatively at 2 weeks, 3 months, 6 months, and 12 months follow-up. Wilcoxon signed-rank test was used to examine the change in papilledema grade in both operated and nonoperated eyes at each time point. Grade of papilledema. Sixty-two patients (52 women and 10 men) with a mean age of 32 years (range, 13-57 years) underwent unilateral ONSF. The median grade of papilledema for operated and nonoperated eyes was 3 and 2, respectively, at preoperative baseline. Postoperatively the grade was 2 in each eye at 2 weeks (P<0.0001 and <0.0002 for operated and nonoperated eyes, respectively), 1 in each eye at 3 months (P<0.0001 for both operated and nonoperated eyes), 1 in each eye at 6 months (P<0.0001 for both operated and nonoperated eyes), and 0.5 and 1 for operated and nonoperated eyes, respectively, at 12 months follow-up (P<0.0001 for both operated and nonoperated eyes). There was no significant difference in grade of disc edema or reduction of disc edema on the basis of age, gender, or body mass index. Unilateral ONSF significantly decreases the grade of papilledema in both ipsilateral (operated) and contralateral (unoperated) eyes. The reduction of the papilledema and the stability of visual field in the contralateral (nonoperated) eyes suggest that bilateral ONSF may not always be necessary in patients with bilateral visual loss and papilledema due to IIH.

Diabetische Retinopathie

The aim of the study was to compare the diagnostic properties of a non-mydriatic 200° ultra-widefield scanning laser ophthalmoscope (SLO) with mydriatic ETDRS 7-field fundus photography for diabetic retinopathy screening. A consecutive series of 66 eyes from 34 patients with different levels of diabetic retinopathy (DR) were examined. Grading of DR and macular edema (ME) obtained from mydriatic ETDRS 7-field fundus photography were compared with grading obtained from Optomap Panoramic 200MA SLO images. All SLOs were performed with an undilated pupil and no additional clinical information was used for evaluation of images by two independent, masked experts. A total of 14 eyes from ETDRS 7-field fundus photography and 11 eyes from Optomap could not be graded by at least one grader due to poor image quality, yielding 48 eyes for comparison purposes. Of the 48 ETDRS 7-field fundus photographs, 9 (11 for grader 2) eyes had no or mild DR (ETDRS levels ≤20) and 17 (23 for grader 2) eyes had no ME. Agreement of Optomap retinopathy grading with ETDRS 7-field fundus photography was good, kappa 0.70 for grader 1 and kappa 0.66 for grader 2. There was good agreement between both techniques for ME, grader 1 kappa 0.68 and grader 2 kappa 0.74. Grading of DR levels from Optomap Panoramic 200MA non-mydriatic images showed a good correlation with mydriatic ETDRS 7-field fundus photography. Both techniques are of sufficient quality for a valid assessment of DR. Optomap Panoramic 200MA images cover a larger retinal area and might therefore offer additional diagnostic properties.

SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY FOR IMAGING ERM, RETINAL EDEMA, AND VITREOMACULAR INTERFACE

To evaluate images taken with OTI-OPKO Spectral domain optical coherence tomography (OCT; OTI-OPKO Health Inc, Miami, FL)/scanning laser ophthalmoscope (resolution of 5-8 microm) and compare them with conventional StratusOCT (Carl Zeiss Meditec Inc, Dublin, CA) in eyes with epiretinal membranes (ERMs), macular edema, and vitreoretinal interface abnormalities. We evaluated 79 consecutive eyes with retinal pathologies using Spectral OCT/scanning laser ophthalmoscope and StratusOCT at the Jacobs Retina Center, University of California San Diego, CA. Pathologies included ERM, macular edema, and vitreomacular traction. Two masked reviewers graded the pathologic findings on the basis of visibility (scale 0-III). A quantitative continuous scale grading system was also used. Statistical analysis showed significant differences in ERM visibility between the spectral OCT/scanning laser ophthalmoscope and StratusOCT (P < 0.0001; signed-rank test). Furthermore, posterior hyaloid visibility was significantly different (P < 0.0001) as was the macular edema grading (P < 0.0001). The Gaussian noise grading system was performed for a smaller subset of 40 eyes and it gave the same results. Spectral OCT was particularly useful in the diagnosis of subtle ERM, minimal diffuse macular edema, and morphology of macular cystic spaces, posterior vitreous detachment, and attachments of the posterior hyaloid. The Spectral OTI-OPKO instrument allows significantly better visualization of vitreoretinal surface diseases like ERM, posterior hyaloid, and retinal edema than StratusOCT. High-speed Spectral OCT/scanning laser ophthalmoscope allows rapid image acquisition, higher number of cuts, and better sampling yielding superior imaging of retinal pathology.

Morphologische Klassifikation des Reinke-Ödems mittels optischer Kohärenztomografie

Several classification systems for Reinke's edema have been proposed in the past, which are somewhat less than morphologically ideal. The objective of the present study is to evaluate the ability of optical coherence tomography (OCT) to attain a reproducible graduation of Reinke's edema. In a prospective study, 30 consecutive patients underwent endolaryngeal, microsurgical resection of their Reinke's edema. Graduation was performed through OCT based on morphologic criteria, where each result was compared with that of other classification systems. In Reinke's edema grade I according to Glanz, a feathered pattern is found, while Reinke's edema grade II demonstrates a lacunar and Reinke's edema grade III a confluent pattern. Correlation between the different classification systems was uniformly weak and not significant. Due to the three different recognizable patterns, OCT qualifies as an objective and reproducible aid for the graduation of Reinke's edema and gives certain insights in its pathogenesis.

Weekly Administration of Docetaxel and Epirubicin as First-Line Treatment for Hormone-Refractory Prostate Carcinoma

Androgen-independent prostate carcinoma (AICP) is one of the tumors that continue to respond poorly to chemotherapy. Recently, protocols based on the use of docetaxel have significantly improved survival for patients in this disease. In other types of neoplastic disease, combined therapy with taxanes and anthracycline derivatives has been shown to produce additive effects in terms of growth inhibition, and superior tolerability when associated with weekly administration schedules. These findings prompted us to examine the tolerability and efficacy of weekly treatment of AICP with docetaxel (DOX) plus epirubicin (EPI). We enrolled 35 chemotherapy-naive men with AICP (mean age 72 years, range 68-77) and normal hepatic, renal, and cardiac function. The chemotherapy protocol provided for the IV administration of DOX (30 mg/m2) and EPI (30 mg/m2) on days 1, 8, and 15 every 28 days. Treatment was continued for 6 months or until disease progression and/or unacceptable toxicity was observed. Serum levels of prostate-specific antigen (PSA) were monitored in all patients, and reductions from baseline values of >50% were considered indicative of positive responses to treatment. Thirty-four patients were included in the analysis of toxicity, and objective responses to treatment were assessed in the 28 patients with measurable lesions. Nineteen patients (56%) experienced PSA reductions of >50% that persisted for more than 4 weeks. The response to therapy was classified as complete in 1 of the 28 patients (4%) with measurable disease (at the lymph node level). Thirteen others (13/28, 46%) had partial responses, in nine (32%) the disease remained unchanged, and progression was observed in the remaining five (18%); overall response rate was 50% (CR + PR). Of the 27 patients with pain at the time of enrollment, 16 (59%) experienced pain reduction during treatment. The median time to disease progression was 11.7 months (95% CI: 7.7-15.7) while the median survival time was 18.7 months (95% CI: 12.3-25.1). During the study, four patients developed grade 3 anemia and leukopenia, which was reversible in all cases. Lower grades of asthenia, nausea, vomiting, diarrhea, and peripheral edema were also observed. There were no cases of cardiotoxic effects. Alopecia was frequent but reversible in all cases. The results of this preliminary study indicate that the combined administration of DOX and EPI for treatment of AIPC is effective and well tolerated. The weekly administration of the drug combination appears to be a promising approach to the treatment of these tumors.

Histopathological changes of the nasal mucosa induced by smoking

Changes in the histopathology of the respiratory epithelium in response to cigarette smoking have been studied in depth in the lungs, but data on the nasal lining are lacking. The aim of the present retrospective study was to investigate the histological changes that occur in the nasal mucosa of smokers compared with non-smokers. The study group included 47 patients who underwent partial resection of the inferior turbinates. Archival nasal tissue samples were collected and examined by light microscopy: the number of goblet cells was counted, and the degree of inflammation, congestion, and edema was graded as mild, moderate, or severe. Epithelial thickness was measured as well. Findings were compared between smokers (n = 21) and non-smokers (n = 26). On statistical analysis, significant differences were found between the smokers and non-smokers in mean number of goblet cells in the nasal epithelium, 43.43 ± 16.80 vs. 16.23 ± 5.65 respectively (p < 0.0001), mean edema grade, 2.43 ± 0.75 vs. 1.12 ± 0.33 respectively (p < 0.0001), and mean epithelial thickness, 111.9 ± 25.8 μm vs. 60.4 ± 18.4 μm respectively (p < 0.0001). The corresponding mean values of congestion were 2 ± 0.71 and 1.27 ± 0.67 (p < 0.001), and of inflammation, 1.81 ± 0.60 and 1.81 ± 0.85 (NS). In conclusion, the histopathological findings in the nasal mucosa of smokers resemble reported findings in the bronchial respiratory epithelium. The main differences from non-smokers are greater goblet cell hyperplasia and thicker epithelium.

Gross-total hematoma removal of hypertensive basal ganglia hemorrhages: A long-term follow-up

Background and purpose Hypertensive basal ganglia hemorrhage (HBGH) accounts for 35%–44% of cases of hypertensive intracranial hemorrhage (ICH), which is one of the most devastating forms of cerebrovascular disease. In this study, intracerebral hematoma was evacuated with a burr hole craniectomy. The relationships of residue hematoma volume to brain edema, inflammation factors and the long-term prognosis of HBGH patients were studied. Methods One hundred and seventy-six patients with HBGH were randomly divided into gross-total removal of hematoma (GTRH) and sub-total removal of hematoma (STRH) groups. The pre-operative and post-operative data of the patients in the two groups were compared. The pre-operative data included age, sex, hematoma volume, time from the ictus to the operation, Glasgow Coma Scale (GCS) scores, and the European Stroke Scale (ESS) scores. The post-operative information included edema grade, level of thromboxane B2 (TXB2), 6-keto-prostaglandin F1ɑ (6-K-PGF1ɑ), tumor necrosis factor-ɑ (TNF-ɑ) and endothelin (ET) in hematoma drainage or cerebral spinal fluid (CSF), ESS and Barthel Index (BI). Results There was no statistical difference between the two groups ( P > 0.05) in the pre-operative data. The levels of TXB2, 6-K-PGF1ɑ, TNF-ɑ and ET in the GTRH group were significantly lower than those in the STRH group at different post-operative times. The ESS in the GTRH group increased rapidly after the operation and was higher than that in the STRH group. There was a significant difference between the two groups ( P < 0.05). The post-operative CT scan at different times showed that the brain edema grades were better in the GTRH group than in the STRH group. The BI was higher in the GTRH group than in the STRH group ( P < 0.05). Conclusions GTRH is an effective method to decrease ICH-induced injury to brain tissue. Such effect is related to decreased perihematomal edema formation and secondary injury by coagulation end products activated inflammatory cascade.

Imaging features of foot osteoid osteoma

We performed a retrospective review of the imaging of nine patients with a diagnosis of foot osteoid osteoma (OO). Radiographs, computed tomography (CT) and magnetic resonance imaging (MRI) had been performed in all patients. Radiographic features evaluated were the identification of a nidus and cortical thickening. CT features noted were nidus location (affected bone-intramedullary, intracortical, subarticular) and nidus calcification. MRI features noted were the presence of an identifiable nidus, presence and grade of bone oedema and whether a joint effusion was identified. Of the nine patients, three were female and six male, with a mean age of 21 years (range 11-39 years). Classical symptoms of OO (night pain, relief with aspirin) were identified in five of eight (62.5%) cases (in one case, the medical records could not be retrieved). In five patients the lesion was located in the hindfoot (four calcaneus, one talus), while four were in the mid- or forefoot (two metatarsal and two phalangeal). Radiographs were normal in all patients with hindfoot OO. CT identified the nidus in all cases (89%) except one terminal phalanx lesion, while MRI demonstrated a nidus in six of nine cases (67%). The nidus was of predominantly intermediate signal intensity on T1-weighted (T1W) sequences, with intermediate to high signal intensity on T2-weighted (T2W) sequences. High-grade bone marrow oedema, limited to the affected bone and adjacent soft tissue oedema was identified in all cases. In a young patient with chronic hindfoot pain and a normal radiograph, MRI features suggestive of possible OO include extensive bone marrow oedema limited to one bone, with a possible nidus demonstrated in two-thirds of cases. The presence or absence of a nidus should be confirmed with high-resolution CT.

Antibiotics / anti-inflammatories for reducing acute inflammatory episodes in lymphoedema of the limbs

Lymphoedema is a chronic, progressive condition and one area of debate is the optimum management for infective/inflammatory episodes (AIE's). To determine whether antibiotic/anti-inflammatory drugs given prophylactically reduce the number and severity of AIE's in patients with lymphoedema. We searched the Cochrane Breast Cancer Group register in September 2003, the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2003), CINAHL, MEDLINE, PASCAL, SIGLE, UnCover, reference lists produced by The British Lymphology Society, the National Research Register (NRR) and the International Society of Lymphology congress proceedings. Randomised controlled trials testing an antibiotic or anti-inflammatory drug against placebo (with or without physical therapies) were included. Eligibility for inclusion was confirmed by two blinded reviewers. The papers were screened independently using a checklist of criteria relating to quality. Both reviewers extracted data from the eligible studies using a data extraction form. Four studies (364 randomised patients) were included. Two studied the effects of intensive physical treatment plus selenium or placebo in preventing AIE's, and two studied the effects of Ivermectin, Diethylcarbamazine (DEC) (anti-filarial agents) and penicillin as prophylactic treatment for adeno lymphangitis(ADL) versus placebo.Both selenium trials reported no inflammatory episodes during the trial period in the treated group but one case of infection in the two placebo groups respectively. Seven additional cases of infection in trial one and 14 cases in trial two required treatment in the three month follow up period.One anti-filarial trial reported 127 ADL episodes for all groups during the treatment year (compared with 684 episodes during the pre-treatment year). There were 228 ADL episodes during the trial follow-up year but no findings were significant. No link was found between the grade of oedema and the frequency of ADL episodes. There was a significant link between increased episodes and the rainy season. Penicillin reduced the mean number of inflammatory episodes from 4.6 to 0.5 after treatment, which increased to 1.9 at the end of follow-up. The effectiveness of selenium in preventing AIE in lymphoedema remains inconclusive in the absence of properly conducted randomised-controlled trials. Anti-filarials do not appear to reduce ADL episodes in filarial lymphoedema. Penicillin appears to contribute to a significant reduction in ADL when combined with foot-care. The importance of foot-care should be recommended, which may also apply to care of the arm following breast cancer treatment. Properly conducted trials are needed to demonstrate any efficacy of these interventions.

Specificity and sensitivity of Heidelberg retina tomograph macular edema maps and the effect of exudate and hemorrhage

Abstract Purpose To assess the specificity and sensitivity of the Macular Edema Module (MEM) of the Heidelberg Retina Tomograph (HRT, Heidelberg Engineering, Heidelberg, Germany) versus Stereoscopic Color Fundus Photographs (SCFP) for patients with different grades of diabetic macular edema (ME) and non‐diabetic subjects. The effect of local exudates and hemorrhage on the specificity and sensitivity of MEM was also investigated. Methods The study included 20 eyes of 20 normal subjects without diabetes and 60 eyes of 60 diabetic patients. Eyes of diabetic patients were classified as without ME (n = 20), with questionable ME (n =20) and with Clinically Significant Macular Edema (CSME, n =20). All participants underwent a full ophthalmological evaluation, plus SCFP and HRT II MEM assessment. The sectors with exudate and/or hemorrhage on the SCFP were removed from the CSME group to generate a modified group (n=20) with CSME and without exudate or hemorrhage. Results In the normal subject group, the specificity of MEM was 92.2%. In the diabetes without macular edema group, the specificity of MEM was 91.7%. In the questionable ME group, the specificity of MEM was 93.1%. In the CSME group, the specificity of MEM was 87.3%, and the sensitivity for detecting CSME was 77.1%. In the modified group with CSME and without exudate or hemorrhage, the specificity of MEM was 85.7% and the sensitivity for detecting CSME was 96.9%. Conclusion The determination of diabetic macular edema by MEM shows good to moderate sensitivity and very good specificity. Furthermore, removing the influence of the exudate and/or hemorrhage resulted in excellent sensitivity and very good specificity.

Early initiation of external beam radiotherapy (EBRT) may increase the risk of long-term toxicity in patients undergoing intraoperative radiotherapy (IORT) as a boost for breast cancer

Background Intraoperative radiotherapy (IORT) during breast-conserving surgery is increasingly used. We analyzed the influence of the interval between an IORT boost and external beam radiotherapy (EBRT) on late toxicity. Methods Forty-eight patients received 20 Gy IORT (50 kV X-rays (Intrabeam, Carl Zeiss, Oberkochen, Germany) followed by 46–50 Gy EBRT with a median interval of 36 days (14-197). Late toxicity was assessed with the modified LENT SOMA score after a median of 36 months. Results Twelve patients developed a higher grade fibrosis (°II–III), three teleangiectases, one a breast edema grade °II, six retractions, four hyperpigmentations and five pain (°II–III). The median interval between IORT and EBRT was significantly shorter in these patients ( n = 18) compared to the 30 patients without higher grade toxicity (29.5 days vs. 39.5 days, p = 0.023, Mann–Whitney U-test). Conclusion Starting EBRT about 5–6 weeks after IORT appears to be associated with a decreased risk of chronic late toxicity compared with a shorter interval. The impact on local recurrence of prolonged gaps between IORT and EBRT is not known.

Value of minipig as a recommended second (nonrodent/nonprimate) species for regulatory studies to assess the risk, and relative efficacy of topical and systemic antifungals

Close resemblance of human and minipig skin in hair density, pigmentation, morphology, vasculature, and immunological reactivity makes minipig highly suitable for visual grading of erythema, edema, inflammatory reactions, sensitization, and photo damage. Rabbit is highly sensitive to irritants. Thicker epidermis (50–140μ m) in pig/human absorbs much less than rodents (10–20μ m). Dermal esterases converting prodrug to drug have similar efficiency in pig/human; it is 3 orders of magnitude greater in rat. Similar total hepatic cyt 450 concentration in pig and human is 48 and 93% less than in rat and rabbit, respectively. Properties of pig P450 isozymes are similar to human homologs. Because of longer GI, transit time in pig/man is 4 times greater than dog. Extrapolation of risk from pig to human is probably more realistic. Also similar cardiovascular, pulmonary, urogenital, and GI systems, clinical pathology, moderate growth (2kg/month), more tissue/fluids, and reuse of animals after wash also make minipig desirable for PK/PD, repeat dose, safety pharmacology, and juvenile studies. Hypothetical examples using mini pigs experimentally infected with T. mentagrophytes (dermatophytoses), C. albicans (candidiasis), and A. fumgatus (aspergillosis) to evaluate the safety and efficacy of antifungal combination dermal products shall be discussed. Abstract content are not related to any policy or guideline of FDA

Predicting Factors for Spontaneous Passage of Ureteral Calculi Based on Unenhanced Helical CT Findings

Purpose: We performed a prospective study to determine whether unenhanced helical computed tomography (UHCT) findings predict the spontaneous passage of ureteral calculi. Materials and Methods: Between April 2006 and June 2007, 175 patients with a single ureteral calculus <1cm in diameter were enrolled in this study, and a UHCT was performed. All of the patients were managed conservatively for 2 weeks. Patients without spontaneous passage of ureteral calculi within 2 weeks were treated by ureteroscopy or extracorporeal shock wave lithotripsy (ESWL). The secondary signs (hydronephrosis, perinephric edema, and the tissue rim sign) were graded on a scale of 0-3. We evaluated whether spontaneous passage of ureteral calculi was associated with stone diameter, location, Hounsfield units (HU), and the degree of secondary signs. Results: Ninety-two patients (52.6%) had spontaneous passage of ureteral calculi. The mean stone diameter was significantly smaller in the passage group than the non-passage group (4.28mm vs. 6.73mm, p=0.002). The rate of spontaneous passage was significantly higher involving distal ureteral calculi (66.1%) than proximal ureteral calculi (30.3%, p<0.001). The incidences of hydronephrosis and perinephric edema were significantly lower in the spontaneous passage group than the non-passage group (8.7% vs. 73.5% and 5.4% vs. 69.9%, respectively). The grades of hydronephrosis and perinephric edema were significantly lower in the spontaneous passage group than the non-passage group (p=0.001). Although there was a tendency toward increasing grades of hydronephrosis and perinephric edema with increasing stone size, the grades were more frequent and severe in the non-passage group in patients with similarly sized stones. Conclusions: The degree of hydronephrosis and perinephric edema are useful ancillary signs in predicting the likelihood of spontaneous passage of ureteral calculi. (Korean J Urol 2008;49:1094-1099) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

睡眠障害患者における音声障害と酸逆流症に関する検討

Dysphonia is one of the symptom of gastroesophageal reflux disease (GERD). We examined the relationship of dysphonia and reflux in sleep disorder patients. A sample population of 208 answered questionnaire about presence of dysphonia during the course of study. Of the 208 responders, FSSG (frequency scale for the symptoms of GERD) questionnaires were further conducted on 170 (81.7%) and 135 (64.9%) had laryngeal fiberscopy exams. 37.5% of the sample population was found to have dysphonia and 53.3% had glottic edemas. The ratio of GERD cases was 44.1%. With the presence of dysphonia, a significant difference was found in the grade of vocal cord edema, each score of acid reflux related to the symptoms of 3 out of 7 items, and the total score of the FSSG inquiry list.The likelihood of edema of the vocal cords being found in cases having dysphonia was higher than in subclinical cases of sleep disorder patients, and acid reflux was recognized as a cause of dysphonia, as suggested from the questionnaire results.

INTRACRANIAL MENINGIOMA SURGERY IN THE NINTH DECADE OF LIFE

The aims of this study are to assess the surgical outcome of elderly patients aged 80 years or more, to analyze the factors influencing postoperative course, and to propose a grading system to standardize the surgical indication of intracranial meningioma in the elderly. Between 1990 and 2005, we surgically treated 74 consecutive patients aged 80 years or more for intracranial meningiomas (47 women, 27 men; mean age, 82 yr; age range, 80-90 yr). The median follow-up period was 94 months (range, 15-147 mo). We retrospectively analyzed the factors influencing surgical outcome and retained the significant factors to form the Sex, Karnofsky Performance Scale, American Society of Anesthesiology Class, Location of Tumor, and Peritumoral Edema (SKALE) grading system. There was no perioperative mortality, and the 1-year mortality rate was 9.4%. Postoperative mortality was lower in women with a Karnofsky Performance Scale score of 60 or greater, an American Society of Anesthesiology Class of 1 or 2, a noncritical tumor location, and a moderate or absent peritumoral edema. Patients with a SKALE score of more than 8 had an excellent outcome, whereas those with a SKALE score of less than 8 had a poor outcome. The rate of postoperative complications was 9.4%. Large tumors, critical locations, severe peritumoral edema, and total surgical excision were associated with a higher risk of postoperative complications. Surgery of intracranial meningioma in elderly patients is feasible when the SKALE score is 8 or greater. Prospective studies are required to validate this grading system.