Search

Penile Mondor's disease is a rare condition characterized by sclerosing thrombophlebitis of the superficial dorsal penile vein. Usually its causes are benign, but it is also evident in cancer patients. We report the case of a 62-year-old man with a cT4 anal cancer (infiltration of corpora spongiosa and penile bulb), associated with extensive loco-regional lymphadenopathy, who developed painful lumps in the midline of the anterior penile surface while receiving radical chemoradiotherapy. Physical examination revealed two palpable cord-like swellings located 2 cm from the pubic symphysis. Color Doppler ultrasound established the diagnosis of Mondor's disease. The patient was successfully managed with non-steroidal anti-inflammatory drugs. The causative factors were pelvic malignancy and radiotherapy. The diagnosis was challenging since Mondor's disease is a rare condition and the differential diagnosis included malignancy progression. This is the first case report describing penile Mondor's disease in a patient with anal cancer under chemoradiotherapy.

During a human brain MRI acquisition the resulting image is formed out of 2D slices. The slices must then be aligned and reconstructed to provide a 3-dimensional (3D) visualization of the brain volume. We propose in this work, an integrated system for the register ion and 3D reconstruction of DICOM MRI images and lesions of the brain acquired from multiple sclerosis (MS) subjects at two different time intervals (time 0 (T0) and time 1 (T1)). The system facilitates the follow up of the MS disease development and will aid the doctor to accurately manage the follow up of the disease. It involves a 6-stage analysis (preprocessing, lesion segmentation, registration, 3D reconstruction, volume estimation and method evaluation), as well as module quantitative evaluation of the method. The system was evaluated based on one MRI phantom and one DICOM MRI image of the brain. The accuracy of the proposed registration and reconstruction (- / -) method was 78.5%/97.2% and 95.4%/95.8% for the phantom and the MRI images respectively. These preliminary results provide evidence that the proposed system could be applied in future in the clinical practice.

Background Performing minimally invasive interventions under direct MRI guidance offers significant advantages. Required accessibility to the patient inside the MRI scanner is fairly limited, and employment of robotic assistance has been proposed. The development of MR-compatible robotic systems entails engineering challenges related to geometric constraints and the magnetic nature of the scanning environment. Methods A novel, general-purpose, MR-compatible robotic manipulation system has been developed for the performance of minimally invasive interventions inside a cylindrical scanner under direct MRI guidance. The system is endowed with five degrees of freedom (DOF), is characterized by a unique kinematics structure and is manually actuated. Results The prototype system was shown to exhibit the required MR-compatibility characteristics and a task-space positioning ability of approximately 5 mm. Needle targeting testing demonstrated a 93% success rate in acquiring a 5 mm spherical target. Phantom testing was performed inside a 3 T scanner and results are reported for an experimental study simulating MRI-guided, manipulator-assisted, MR arthrography. Conclusions Robotic assistance provided by the developed manipulator may effectively facilitate the performance of various MRI-guided, minimally invasive interventions inside a cylindrical scanner. Copyright © 2013 John Wiley & Sons, Ltd.

Excess cardiac iron deposition leads to congestive cardiac failure and accounts for more than 70% of deaths in thalassemia major patients. In three separate studies involving 145 thalassemia patients, serum ferritin and magnetic resonance imaging (MRI) relaxation times T2 and T2* have been compared for assessing iron load levels during chelation treatment. In two studies, variable levels of cardiac iron load have been detected by T2 and T2* in patients treated with deferoxamine (DFO), which, however, were unrelated to serum ferritin. In most cases, similar range levels from normal to severe cardiac iron load could be identified by both the T2 and T2* methods. However, in a few cases there were substantial differences in the levels detected between the two methods. In the third study, the ferrikinetics of the normalization of the iron stores during the International Committee on Chelation (ICOC) deferiprone (L1)/DFO combination protocol was followed up using T2 and T2* and serum ferritin. Iron deposits were found not to be proportionally distributed between the liver and the heart or uniformly distributed within each organ. Iron mobilization in each patient varied and iron deposits in each organ were cleared at different rates. Despite some limitations, the application of the MRI relaxation times T2 and T2* offers the best diagnostic methods for iron overload estimations in most organs and especially the heart. These MRI methods and serum ferritin could also be used for the ferrikinetics of iron mobilization and removal during chelation therapy and the normalization of the iron stores during the ICOC L1/DFO combination protocol. There is a need to standardize the two MRI relaxation times T2 and T2* methods and identify the factors causing the differences between them.

For the past 2-6 years, two groups of thalassemia patients, one of 16 patients on deferoxamine (DFO) monotherapy (35-80 mg/kg, 2-5 days/week) and the other group comprising 19 patients on a deferiprone (L1) and DFO combination therapy (L1 75-100 mg/kg/day and DFO 30-60 mg/kg, 1-5 days/week), have been studied and compared before and after the introduction of the combination therapy. The patients on the combination therapy were mainly those not complying or experiencing toxicity with DFO. The effects of chelation therapy on iron load was monitored using regular serum ferritin measurements and also magnetic resonance imaging (MRI) T2* relaxation time measurements at the end of the study. In both groups, cardiac MRI T2* levels were within the normal range (>19 ms) in more than 75% of the patients. There was a substantial improvement in serum ferritin levels and normalization of the MRI T2* levels of the liver in many cases treated with the combination therapy at effective doses by comparison to the DFO group, where the serum ferritin and MRI T2* levels were largely unchanged. It would appear that the major overall determining factor in the rapid clearance of excess iron in thalassemia patients and the maintenance of normal iron stores is the selection and implementation of effective chelation dose protocols. The International Committee on Chelation (ICOC) combination protocol L1 (80-110 mg/kg/day)/DFO (40-60 mg/kg at least 3 days per week) and to a lesser extent, DFO monotherapy at about 50 mg/kg/day, 5 days/week, appears to achieve this goal.

The incidence of cardiomyopathy was monitored in a 6-year follow-up study involving 56 transfused thalassemia patients treated with deferoxamine (DFO), deferiprone (L1) or their combination. During this period, five female patients on regular subcutaneous or intravenous DFO presented with cardiac complications. Three patients suffered congestive heart failure and the other two arrhythmias. Four of the five patients maintained serum ferritin levels of about 1 mg/L or below and the fifth about 1.5 mg/L for several years prior to the cardiomyopathy. Cardiac magnetic resonance imaging (MRI) T2* and T2 was performed in four patients after the cardiomyopathy, identifying the presence of moderate-to-heavy siderosis. The treatment of the five patients has since changed, involving mainly the use of L1. Low serum ferritin levels appear to be misleading for detecting cardiac iron overload and this may increase the risk of cardiomyopathy. The MRI T2 and T2* relaxation time measurements are a more accurate method of detecting cardiac iron overload. Chelation therapy using L1 or appropriate L1/DFO combinations can reduce cardiac iron overload and the mortality rate in thalassemia patients.

Effective new therapies and mechanisms have been developed for the targeting and prevention of iron overload and toxicity in thalassaemia and idiopathic haemochromatosis patients. A new era in the development of chelating drugs began with the introduction of deferiprone or L1, which as a monotherapy or in combination with deferoxamine can be used universally for effective chelation treatments, rapid iron removal, maintenance of low iron stores and prevention of heart and other organ damage caused by iron overload. Several experimental iron chelators such as deferasirox (4-[3,5-bis (2-hydroxyphenyl)-1,2,4-triazol-1-yl]-benzoic acid) or ICL670, deferitrin (4,5-dihydro-2- (2,4-dihydroxyphenyl)-4-methylthiazole-4 (S)-carboxylic acid) or GT56- 252, 1-allyl-2-methyl-3-hydroxypyrid-4-one or L1NAll and starch deferoxamine polymers have reached different stages of clinical development. The lipophilic ICL670, which can only be administered once daily is generally ineffective in causing negative iron balance but is effective in reducing liver iron. It is suspected that it may increase iron absorption and the redistribution of iron from the liver to the heart and other organs. The experimental iron chelators do not appear to have significant advantages in efficacy and toxicity by comparison to deferiprone, deferoxamine or their combination. However, the prospect of combination therapies using deferiprone, deferoxamine and new chelators will provide new mechanisms of chelator interactions, which may lead to higher efficacy and lower toxicity by comparison to monotherapies. A major disadvantage of the experimental chelators is that even if they are approved for clinical use, they are unlikely to be as inexpensive as deferiprone and become available to the vast majority of thalassaemia patients, who live in developing countries.

Performing minimally invasive interventions under direct MRI guidance offers significant advantages. Required accessibility to the patient inside the MRI scanner is fairly limited, and employment of robotic assistance has been proposed. The development of MR-compatible robotic systems entails engineering challenges related to geometric constraints and the magnetic nature of the scanning environment.A novel, general-purpose, MR-compatible robotic manipulation system has been developed for the performance of minimally invasive interventions inside a cylindrical scanner under direct MRI guidance. The system is endowed with five degrees of freedom (DOF), is characterized by a unique kinematics structure and is manually actuated.The prototype system was shown to exhibit the required MR-compatibility characteristics and a task-space positioning ability of approximately 5 mm. Needle targeting testing demonstrated a 93% success rate in acquiring a 5 mm spherical target. Phantom testing was performed inside a 3 T scanner and results are reported for an experimental study simulating MRI-guided, manipulator-assisted, MR arthrography.Robotic assistance provided by the developed manipulator may effectively facilitate the performance of various MRI-guided, minimally invasive interventions inside a cylindrical scanner.

Introduction Mean Fractional Anisotropy (FA) along with Longitudinal and Transverse Apparent Diffusion Coefficients (ADC) are the established measures in assessing white matter (WM) integrity in TBI patients. A question is raised whether mean FA performs better than Shannon Entropy (SE) as a measure of discrimination between controls and patients with moderate to severe TBI. Purpose To assess WM integrity in moderate to severe TBI patients utilizing the established diffusion tensor measures, and compare FA with Shannon Entropy as measures of assessment of WM integrity. Materials and methods A group of 13 patients with moderate to severe TBI, 2–8 years post-ictus, has been compared with a group of 14 matched healthy controls. Diffusion Tensor Imaging (DTI) data were obtained at 3T with a pulse sequence employing 32 diffusion-encoding gradient directions. After data preprocessing, Tract Based Spatial Statistics (FSL-FMRIB) for FA, whole-brain histogram analysis for SE and Receiver Operating Curve (ROC) analysis for both FA and SE have been performed. Results Higher axial and transverse diffusivity and lower FA have been observed in TBI patients ( p P = 0.007), Global mean FA (0.8, P = 0.0066) and SE (0.8, p = 0.008). Conclusion Axial and transverse diffusivity are increased in TBI patients compared to controls. Diffuse Axonal Injury (DAI) is evident as global reduction of FA in TBI patients, which is driven by increased transverse diffusion changes. No significant difference is observed between FA and SE in TBI patient discrimination. Disclosure The authors declare no conflicts of interest including financial, consultant, institutional, and other relationships that might lead to bias or a any other conflict of interest. This work was supported by the Cyprus Research Promotion Foundation through a grant co-funded by the Cyprus Government and the European Regional Development Fund (F.C., PI; NEW INFRASTRUCTURE/STRATEGIC/0309/37). The authors would like to thank the study volunteers who participated in the project.

Hemodynamic parameters such as time averaged wall shear stress (TAWSS), wall shear stress temporal gradient (WSSTG) and Oscillatory Shear Index (OSI) have previously been cited as parameters associated with the development of atherosclerotic disease at the human carotid bifurcation [1,2]. The sensitivity of these important parameters however, with variations of driving flow waveform, flow division and posture changes are not well known. To investigate these changes, we have used image based CFD, to analyze the flowfield of the carotid bifurcation of a healthy volunteer for five different input waveforms, three flow division ratios and two head postures.Copyright © 2008 by ASME

Objective Acute non-traumatic bone marrow edema (BME) in the knee is a common clinical problem. The aim of the present study is to present the MR imaging findings of the uncommon transient migratory pattern of this syndrome. Materials and methods Twenty-two patients (21 men, 1 woman, age range 35–73 years, mean 49.4 ± 7.6) who presented with pain in the knee joint (ranging from 2 weeks to 6 months) and BME in the MR imaging examination, were included in the study. In all cases, the knee joint BME was either preceded or followed by another site of BME in the same or another joint. All patients were studied with plain X-rays and MR imaging at presentation and with MR imaging after resolution of symptoms. Results The eight patients with initial involvement in the knee showed migration either intra-articularly (5), or/and in the contralateral knee (2) and only 1 case showed migration to the ipsilateral hip joint. In two patients the BME shifted from the hip first to the foot and then to the knee. The median migration period was 4 months for the second involvement in all patients and 3 months for the third involvement (10 patients). Conclusions The present study reports the largest series of patients with regional migratory osteoporosis involving the knee. In most of the cases, shifting of BME remains in the joint or moves to the contralateral knee. In only one case the BME shifted from the knee elsewhere. All lesions were transient.

Effective new therapies and mechanisms have been developed for the targeting and prevention of iron overload and toxicity in thalassaemia and idiopathic haemochromatosis patients. A new era in the development of chelating drugs began with the introduction of deferiprone or L1, which as a monotherapy or in combination with deferoxamine can be used universally for effective chelation treatments, rapid iron removal, maintenance of low iron stores and prevention of heart and other organ damage caused by iron overload. Several experimental iron chelators such as deferasirox (4-[3,5-bis (2-hydroxyphenyl)-1,2,4-triazol-1-yl]-benzoic acid) or ICL670, deferitrin (4,5-dihydro-2- (2,4-dihydroxyphenyl)-4-methylthiazole-4 (S)-carboxylic acid) or GT56-252, 1-allyl-2-methyl-3-hydroxypyrid-4-one or L1NAll and starch deferoxamine polymers have reached different stages of clinical development. The lipophilic ICL670, which can only be administered once daily is generally ineffective in causing negative iron balance but is effective in reducing liver iron. It is suspected that it may increase iron absorption and the redistribution of iron from the liver to the heart and other organs. The experimental iron chelators do not appear to have significant advantages in efficacy and toxicity by comparison to deferiprone, deferoxamine or their combination. However, the prospect of combination therapies using deferiprone, deferoxamine and new chelators will provide new mechanisms of chelator interactions, which may lead to higher efficacy and lower toxicity by comparison to monotherapies. A major disadvantage of the experimental chelators is that even if they are approved for clinical use, they are unlikely to be as inexpensive as deferiprone and become available to the vast majority of thalassaemia patients, who live in developing countries.

To explore the potential role of computed tomographic cholangiography (CTC) in relation to magnetic resonance cholangiography (MRC) in cases in which knowledge of biliary kinetics and functional information are important for therapeutic decisions, 31 patients (14 men and 17 women) underwent MRC followed by CTC. We examined nine post-cholecystectomy cases with right upper quadrant abdominal pain, six cases with a previous biliary-enteric anastomosis and clinical evidence of cholangitis, eight biliary strictures with pain or symptoms of cholangitis, four cases with strong clinical evidence of sclerosing cholangitis, three cases with suspected post-laparoscopic cholecystectomy bile leakage, and one case with chronic pancreatitis and a common bile duct stent associated with cholangitis. In relation to MRC, CTC provided additional biliary functional information as follows: abnormal biliary drainage through the ampulla in 7/9 cholecystectomy cases, impaired drainage in 3/6 biliary-enteric anastomoses, and complete obstruction in 2/8 biliary strictures. CTC diagnosed early sclerosing cholangitis in 4/4 cases and confirmed suspected bile leakage in 1/3 post-laparoscopic cholecystectomy patients, and the patency of the biliary stent in the patient with chronic pancreatitis. Thus, CTC provides clinically important information about the function and kinetics of bile and complements findings obtained by MRC.

To investigate the feasibility of contrast-enhanced magnetic resonance cholangiography (CE-MRC) and compare it with single-shot turbo spin-echo magnetic resonance cholangiography (SSTSE-MRC).Fifteen patients with suspected metastatic liver disease (n = 10) or biliary tree abnormalities (n = 5) underwent a magnetic resonance imaging (1.5-T system) examination before and after mangafodipir administration. Contrast-enhanced MRC with a three-dimensional fast low-angle shot sequence after mangafodipir trisodium administration was compared with SSTSE-MRC. Four anatomic segments were evaluated: the intrapancreatic and extrapancreatic common bile duct segments, the cystic duct, and the area of hepatic bifurcation. Contrast-enhanced MRC and SSTSE-MRC were separately analyzed on a 5-point grading scale in terms of ductal segment visualization and lumen narrowing or dilatation.There was no difference (P = 0.375) in segment visualization between CE-MRC and SSTSE-MRC; 56 of the 60 segments were visualized by both techniques. In the evaluation of ductal narrowing or dilatation, nonsignificant differences (P = 0.500) were observed. Contrast-enhanced MRC was not influenced by fluid superimposition and provided additional information from background tissues.Contract-enhanced MRC is a feasible technique showing anatomic correlation with SSTSE-MRC, and it can in addition provide functional information. Contrast-enhanced MRC may be used in selected patients when traditional SSTSE-MRC is inconclusive.