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Background Contrast-enhanced ultrasonography (CEUS) features of primary hepatobiliary neoplasms have been reported in dogs but no information is available in cats. Methods Qualitative and quantitative features of bile duct adenomas (BDAs, n=20), bile duct carcinomas (BDCs, n=16), and hepatocellular carcinomas (HCCs, n=8) are described in 44 cats. Results There was an overlap in CEUS qualitative features between different histotypes, both in wash-in and wash-out phases. Distinction between different neoplasms based only on the CEUS qualitative features was not possible. At peak of enhancement, the BDAs, BDCs and HCCs showed a large range of echogenicities, from hypoenhancement to hyperenhancement, in comparison to the liver parenchyma. Eight of 20 BDAs showed inhomogeneous hyperenhancement during wash-in, which is a feature reported as typical of malignant lesions in dogs. BDC had a significantly faster wash-in compared with both BDA and HCC but the diagnostic accuracy of all the included quantitative variables was only moderate. No significant differences in the wash-out quantitative features of BDA and BDC were evident. Conclusion There is poor evidence that CEUS may be used to distinguish between different primary hepatobiliary neoplasms in cats.

Objective: This study explores the potential use of high-resolution magic angle spinning proton magnetic resonance spectroscopy as an ancillary diagnostic technique for papillary thyroid carcinoma in thyroid fine-needle aspiration biopsies. The method has already been shown to be effective in the classification of various other nonthyroid cancers. Study Design: Twenty-six samples (13 paired cytologic and histologic samples) from patients being evaluated for thyroid abnormalities at the Massachusetts General Hospital were spectroscopically analyzed, and included: papillary thyroid carcinomas (n = 4), follicular adenomas (n = 4), and normal thyroid samples (n = 5). Metabolic profiles were statistically generated based on the spectroscopy results, which were then correlated with the final cytologic and histologic diagnoses from the same samples to determine the diagnostic capacity of the profiles. Results: Principal component analysis of the tissue samples revealed statistically significant correlations among principal components and various cytologic and histologic features. Canonical score 1, calculated with principal components in correlation with analyzed pathologies, revealed the ability of the metabolic profile to differentiate all three examined histologic tissue groups (ANOVA, p < 0.0001). Applying coefficients of principal components and canonical scores obtained with tissue samples directly onto spectral results of cytology samples, the calculated canonical score 1 also revealed similar trends among the three fine-needle aspiration biopsy groups. In particular, the papillary thyroid carcinoma group exhibited significant differences from both the adenomatous and normal cytology groups (p < 0.0170). Conclusions: The results indicate the potential of high-resolution magic angle spinning proton magnetic resonance spectroscopy as an ancillary marker for papillary thyroid carcinoma in fine-needle aspiration biopsy specimens.

Objectives: There is little reliable quantitative information on preoperative quality of life of patients with brain tumours. The aim of this study was to clarify the effect of the volume, location, and histological grade of brain tumours on the preoperative quality of life of patients. Methods: The study population consisted of 101 successive patients with brain tumour at Oulu Clinic for Neurosurgery studied with CT or MRI for preoperative determination of tumour location and size. The Nottingham health profile (NHP) and Sintonen's 15D scale were used at that time to measure quality of life. Results: Tumour size did not correlate linearly with impairment of quality of life. Large tumours (>25 ml) were associated with poorer quality of life than small tumours (≤25 ml). The patients with a tumour located on the right side or in the anterior region reported a poorer quality of life than those with a tumour on the left side or posteriorly. Quality of life assessments made by doctors using the Karnofsky performance scale showed no differences between the two hemispheres. Patients with the most malignant gliomas (grades III-IV) displayed the poorest quality of life. Conclusions: Large tumours apparently damage several parts of the brain and/or raise intracranial pressure to a level that exceeds the brain's compensatory capacity. Contrary to earlier understanding, tumours in the right hemisphere seemed to be related to poorer quality of life. This effect was especially clear in the patients' subjective evaluation of their quality of life. As the location of the brain tumour thus affects perceived quality of life, any measurements of the quality of life of patients with brain tumours should take into account the location and laterality of the tumour.

Objectives Carcinogenic action of meat-related exposures, such as heterocyclic amines (HCAs), polycyclic aromatic hydrocarbons (PAHs), and N-nitroso compounds (NOCs), might explain positive associations between red and processed meat and colorectal neoplasia. Single nucleotide polymorphisms in xenobiotic metabolizing enzyme (XME) genes could alter activation/detoxfication of these compounds. Methods We evaluated interactions between several XME genes (CYP1A1, CYP1B1, CYP2A6, CYP2C9, CYP2E1, CYP3A4, EPHX1, GSTM1, GSTM2, GSTT1, NAT1, NAT2, NQO1, SULT1A1, and SULT1A2) and meat-related exposures using a pathway-based approach in 720 advanced colorectal adenoma cases of the distal colon or rectum and 746 controls from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Using meat-related databases, we estimated intake of the HCAs, 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline (MeIQx) and 2-amino-1-methyl-6-phenyl-imidazo[4,5-b]pyridine (PhIP), the PAH, benzo[a]pyrene (B[a]P), and nitrate/nitrite, as NOC precursors. Results There were possible interactions between PhIP and CYP1B1 (Pinteraction=0.019) and NQO1 (Pinteraction=0.007), B[a]P and CYP1B1 (Pinteraction=0.005) and CYP3A4 (Pinteraction=0.021), and nitrate/nitrite and CYP1A1 (Pinteraction=0.022) in relation to colorectal adenoma. However, none of these interactions were statistically significant using a false discovery rate threshold of 0.20. Conclusions Common variants in XME genes may modify the association of HCAs, PAHs, and nitrate/nitrite with advanced colorectal adenoma, but investigation in other populations is required, especially within consortia.

Background In the vast majority of patients with primary hyperparathyroidism (HPT) the causative pathology is a benign solitary adenoma. The conventional surgical approach for HPT has involved bilateral cervical exploration with attempted identification of all four parathyroids and resection of enlarged glands. However, in recent years new techniques have permitted accurate preoperative localisation of the single parathyroid tumour in many patients. This has facilitated a focused unilateral operation to be performed in patients with a solitary parathyroid adenoma. More recently we have progressed to a minimally invasive surgical approach for such individuals in whom the tumour has been localised preoperatively. Patients & Methods Between September 2004 and July 2006, 24 patients with proven HPT, underwent focused, unilateral cervical exploration through a short (2.5–3 cm) incision placed low on the appropriate side of the neck. Preoperatively, each patient had been shown to have a single focus of activity after parathyroid isotope scanning. Results There were 21 females and 3 males in the study group with a mean age of 61.5 years (range 25 - 84 years) at the time of operation. The approach was successful in 22 patients with a mean operating time of 49 minutes (range 22–85 minutes). Postoperatively, the serum calcium level returned to normal in every patient and has remained so during a mean follow up period of 11.5 months (range 1–22 months). No individual developed postoperative hypocalcaemia although one patient developed a temporary unilateral vocal cord paralysis. Conclusion A short incision cervical approach for HPT due to solitary adenoma is a viable alternative for appropriately selected patients.

Background: The micturition reflex is under the tonic influence of suprapontine structures including the anteromedial frontal cortex, basal ganglia, and hypothalamus. However, there have been few reports about the role of the hypothalamus on the lower urinary tract (LUT) function in humans. Objective: To investigate LUT function in patients with pituitary adenomas. Methods: Urodynamic studies were carried out in three patients with LUT symptoms who had pituitary adenomas extending upwards to the hypothalamus. Results: All three male patients (age 28 to 62 years) developed LUT symptoms (urinary urgency and frequency (3); urinary incontinence (3); voiding difficulty and retention (2)) along with weight loss, psychiatric symptoms, unsteady gait, and/or visual disturbances. One had the syndrome of inappropriate secretion of antidiuretic hormone, but none had diabetes insipidus. Two had resection of the tumour and subsequent radiation therapy, but LUT dysfunction persisted. The third patient had partial resection of the tumour to ameliorate hydrocephalus. Urodynamic studies showed detrusor overactivity during the storage phase in all patients; during the voiding phase there was underactive detrusor in two and non-relaxing sphincter in one. Conclusions: Hypothalamic lesions can cause severe LUT dysfunction in both the storage and voiding phases of micturition. This may reflect the crucial role of the hypothalamus in regulating micturition in humans.

Objective: To report the quantitative assessment of visual fields (VF) in patients with pituitary macroadenomas, and the time course and predictive factors for recovery of vision. Methods: Retrospective study of 41 patients with pituitary adenomas and visual disturbance. Patients underwent pre- and postoperative VF assessment at one week, three to six months, one year, two years, and five years using the Humphrey field analyser, which gives a quantitative measure of VF in each quadrant. Results: 36/41 patients (88%) presented with a visual disturbance. Mean (SEM) duration of symptoms was 94 (50) weeks (range 0.5 to 1500); 12 (29%) had optic atrophy at presentation. Impairment of VF was greatest in the upper temporal quadrant, followed by the lower temporal. VF recovery was progressive and apparent even at the five year follow up (p