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The differential cross sections and unpolarized spin-density matrix elements for the reaction $��p\to p��$ were measured using the CBELSA/TAPS experiment for initial photon energies ranging from the reaction threshold to 2.5 GeV. These observables were measured from the radiative decay of the $��$ meson, $��\to��^0��$. The cross sections cover the full angular range and show the full extent of the $t$-channel forward rise. The overall shape of the angular distributions in the differential cross sections and unpolarized spin-density matrix elements are in fair agreement with previous data. In addition, for the first time, a beam of linearly-polarized tagged photons in the energy range from 1150 MeV to 1650 MeV was used to extract polarized spin-density matrix elements. These data were included in the Bonn-Gatchina partial wave analysis (PWA). The dominant contribution to $��$ photoproduction near threshold was found to be the $3/2^+$ partial wave, which is primarily due to the sub-threshold $N(1720)\,3/2^+$ resonance. At higher energies, pomeron-exchange was found to dominate whereas $��$-exchange remained small. These $t$-channel contributions as well as further contributions from nucleon resonances were necessary to describe the entire dataset: the $1/2^-$, $3/2^-$, and $5/2^+$ partial waves were also found to contribute significantly., 8 pages, 5 figures, accepted for publication in Physics Letters B

Item does not contain fulltext BACKGROUND AND PURPOSE: Patients with human papillomavirus-positive oropharyngeal squamous cell carcinomas have a better survival rate than those with human papillomavirus-negative oropharyngeal squamous cell carcinomas. DWI characterizes biologically relevant tumor features, and the generated ADC may also provide prognostic information. We explored whether human papillomavirus status and ADC values are independent tumor characteristics. MATERIALS AND METHODS: Forty-four patients with oropharyngeal squamous cell carcinomas underwent pretreatment DWI. ADC values for the primary tumors were determined by using 3 b-values in an ROI containing the largest area of solid tumor on a single section of an axial DWI image. Human papillomavirus status was determined with p16 immunostaining, followed by high-risk human papillomavirus DNA detection on the p16-positive cases. RESULTS: Twenty-two patients were human papillomavirus-positive (50.0%). ADC values were not significantly different between human papillomavirus-negative (ADC(mean) = 1.56 [1.18-2.18] x 10(3) mm(2)/s) and human papillomavirus-positive tumors (ADC(mean) = 1.46 [1.07-2.16] x 10(3) mm(2)/s). CONCLUSIONS: No significant association between ADC and human papillomavirus status was found in oropharyngeal squamous cell carcinomas. In our study population, differences in genetic and histologic features between human papillomavirus-positive and human papillomavirus-negative oropharyngeal squamous cell carcinomas did not translate into different ADC values. Long-term follow-up studies are needed to establish whether ADC has prognostic value and whether this is independent of the human papillomavirus status.

To the Editor, Chemoradiotherapy (CRT) is the standard treatment for locally advanced head and neck cancer (HNC), offering comparable survival to surgery with the benefit of organ preservation. How...

To assess the accuracy of high-resolution (HR) magnetic resonance imaging (MRI) in diagnosing early-stage optic nerve (ON) invasion in a retinoblastoma cohort. This IRB-approved, prospective multicenter study included 95 patients (55 boys, 40 girls; mean age, 29 months). 1.5-T MRI was performed using surface coils before enucleation, including spin-echo unenhanced and contrast-enhanced (CE) T1-weighted sequences (slice thickness, 2 mm; pixel size

BACKGROUND AND PURPOSE: Criteria for ultrasound-guided fine-needle aspiration cytology (USgFNAC) for the detection of occult lymph node metastasis in patients with clinically negative head and neck cancer are based on the morphology of cervical lymph nodes. To improve the selection of lymph nodes for USgFNAC, we examined the feasibility of fused freehand single-photon emission tomography ultrasound-guided fine-needle cytology (freehand SPECT-USgFNAC) of sentinel nodes in patients with early stage oral and head and neck skin cancer. MATERIALS AND METHODS: Six patients with early-stage head and neck cancer (4 oral and 2 head and neck skin cancers) and a clinically negative neck who were scheduled for transoral or local excision and a sentinel node procedure underwent USgFNAC and freehand SPECT-USgFNAC preoperatively. RESULTS: All freehand SPECT sonographic examinations were technically successful in terms of identifying sentinel nodes. All aspirates of sentinel nodes obtained by freehand SPECT-USgFNAC contained substantial radioactivity, confirming puncture of the sentinel nodes. USgFNAC evaluated 13 lymph nodes; freehand SPECT-USgFNAC, 19 nodes; and sentinel node biopsy, 13 nodes. Three sentinel nodes were histopathologically positive and were selected for aspiration cytology by freehand SPECT-USgFNAC, but not by conventional ultrasound. The cytologic examination findings of the aspirations were negative or inconclusive. CONCLUSIONS: Freehand SPECT ultrasound can identify sentinel nodes and could potentially improve USgFNAC in patients with head and neck cancer by better selection of lymph nodes at highest risk of having metastases (sentinel nodes), but its sensitivity is limited by sampling error and insufficient aspirated material for cytology.

The photoproduction of 2$��^0$ mesons off protons was studied with the Crystal Barrel/TAPS experiment at the electron accelerator ELSA in Bonn. The energy of photons produced in a radiator was tagged in the energy range from 600\,MeV to 2.5\,GeV. Differential and total cross sections and $p��^0��^0$ Dalitz plots are presented. Part of the data was taken with a diamond radiator producing linearly polarized photons, and beam asymmetries were derived. Properties of nucleon and $��$ resonances contributing to the $p��^0��^0$ final state were determined within the BnGa partial wave analysis. The data presented here allow us to determine branching ratios of nucleon and $��$ resonances for their decays into $p��^0��^0$ via several intermediate states. Most prominent are decays proceeding via $��(1232)��$, $N(1440)1/2^+��$, $N(1520)3/2^-��$, $N(1680)5/2^+��$, but also $pf_0(500)$, $pf_0(980)$, and $pf_2(1270)$ contribute to the reaction., 28 pages, 17 figures, 7 tables

A heterogeneous group of 55 patients with neck pain showed impaired smooth pursuit performance compared with healthy controls. Performance declined with increasing neck torsion, but only for predictable moving targets. The observed oculomotor disturbances in patients with whiplash are therefore unlikely to be induced by impaired neck proprioception alone. Study Design. This is a cross-sectional study. Objective. The purpose of this study is to support and extend previous observations on oculomotor disturbances in patients with neck pain and whiplash-associated disorders (WADs) by systematically investigating the effect of static neck torsion on smooth pursuit in response to both predictably and unpredictably moving targets using video-oculography. Summary of Background Data. Previous studies showed that in patients with neck complaints, for instance due to WAD, extreme static neck torsion deteriorates smooth pursuit eye movements in response to predictably moving targets compared with healthy controls. Methods. Eye movements in response to a smoothly moving target were recorded with video-oculography in a heterogeneous group of 55 patients with neck pain (including 11 patients with WAD) and 20 healthy controls. Smooth pursuit performance was determined while the trunk was fixed in 7 static rotations relative to the head (from 45° to the left to 45° to right), using both predictably and unpredictably moving stimuli. Results. Patients had reduced smooth pursuit gains and smooth pursuit gain decreased due to neck torsion. Healthy controls showed higher gains for predictably moving targets compared with unpredictably moving targets, whereas patients with neck pain had similar gains in response to both types of target movements. In 11 patients with WAD, increased neck torsion decreased smooth pursuit performance, but only for predictably moving targets. Conclusion. Smooth pursuit of patients with neck pain is affected. The previously reported WAD-specific decline in smooth pursuit due to increased neck torsion seems to be modulated by the predictability of the movement of the target. The observed oculomotor disturbances in patients with WAD are therefore unlikely to be induced by impaired neck proprioception alone.

BACKGROUND AND PURPOSE: Intratumoral calcifications are very important in the diagnosis of retinoblastoma. Although CT is considered superior in detecting calcification, its ionizing radiation, especially in patients with hereditary retinoblastoma, should be avoided. The purpose of our study was to validate T2*WI for the detection of calcification in retinoblastoma with ex vivo CT as the criterion standard. MATERIALS AND METHODS: Twenty-two consecutive patients with retinoblastoma (mean age, 21 months; range, 1–71 months) with enucleation as primary treatment were imaged at 1.5T by using a dedicated surface coil. Signal-intensity voids indicating calcification on T2*WI were compared with ex vivo high-resolution CT, and correlation was scored by 2 independent observers as poor, good, or excellent. Other parameters included the shape and location of the signal-intensity voids. In 5 tumors, susceptibility-weighted images were evaluated. RESULTS: All calcifications visible on high-resolution CT could be matched with signal-intensity voids on T2*WI, and correlation was scored as excellent in 17 (77%) and good in 5 (23%) eyes. In total, 93% (25/27) of the signal-intensity voids inside the tumor correlated with calcifications compared with none (0/8) of the signal-intensity voids outside the tumor. Areas of nodular signal-intensity voids correlated with calcifications in 92% (24/26), and linear signal-intensity voids correlated with hemorrhage in 67% (6/9) of cases. The correlation of signal-intensity voids on SWI was better in 4 of 5 tumors compared with T2*WI. CONCLUSIONS: Signal-intensity voids on in vivo T2*WI correlate well with calcifications on ex vivo high-resolution CT in retinoblastoma. Gradient-echo sequences may be helpful in the differential diagnosis of retinoblastoma. The combination of funduscopy, sonography, and high-resolution MR imaging with gradient-echo sequences should become the standard diagnostic approach for retinoblastoma.

Objective: To determine the degree of axonal damage in relationship to signal abnormalities on T2-weighted high-resolution MRI in spinal cord tissue of patients with MS. Methods: Spinal cord specimens of nine patients with MS and four controls were imaged at high resolution (4.7 T) in an axial plane and scored for lesions with increased signal intensity (SI). Histopathologic sections were cut and immunostained with NE14 (neurofilament marker) and Luxol fast blue (myelin stain). For each area, axonal density and diameter were quantified; axonal irregularity, NE14 axonal staining intensity, and myelin content were semiquantitatively scored. Included were 209 areas from MS cases and 109 areas from control cases distributed over lateral, posterior, and anterior columns. Results: In control cases, no SI changes were found, average density of axons was 26,989/mm2, average diameter was 1.1 μm, and all scores for axonal irregularity, NE14 staining intensity, and myelin were normal. In MS cases, areas with increased SI were found, average axonal density was 11,807/mm2 (p < 0.0001), and average axonal diameter 2.0 μm (p = 0.001). Areas with high SI on MRI had lowest axonal density (average count: 10,504/mm2; range: 3,433 to 26,325/mm2), largest diameter (average: 2.3 μm; range: 1.0 to 4.0 μm), and highest axonal irregularity and NE14 staining intensity compared to normal appearing cord tissue (NACT). However, NACT of MS cases also had lower axonal density (14,158/mm2) and higher average axonal diameter (1.6 μm) than controls. Conclusions: Marked axonal loss occurs in MS spinal cords, largely independent of the degree of signal abnormality on T2-weighted MRI.

The objective of this study was to assess patency of the internal jugular vein following modified radical or selective neck dissection and microvascular flap reconstruction by power Doppler ultrasound and its impact on free flap survival. In 23 patients who underwent selective or modified radical neck dissection and microvascular flap reconstruction the patency of the internal jugular vein was examined by power Doppler ultrasound on the first post-operative day and after follow-up of at least four months. On the first post-operative day in one patient partial thrombosis was found, while in the other 22 patients the internal jugular vein was normal patent. During follow-up in 17 (74 per cent) patients a normal patent internal jugular vein was found, while partial and complete thrombosis were found in three (13 per cent) patients each. On the first post-operative day 22 of the 23 (96 per cent) free flap veins were visualized. There was no free flap loss during follow-up. Power Doppler ultrasound is a valuable diagnostic technique for determination of internal jugular vein patency and may be useful as screening method or in case of clinical suspicion of thrombosis to determine internal jugular vein patency. Late internal jugular vein thrombosis may probably not effect free flap survival due to neovascularization.

Background Management of the N0 neck in patients with head and neck squamous cell carcinoma (SCC) remains controversial. We describe the outcome of patients who underwent transoral tumor excision and a wait-and-see policy for the neck staged N0 by ultrasonography-guided cytology (USgFNAC). Because selection of lymph nodes for USgFNAC is currently based on size criteria, we investigated the additional value of sentinel node (SN) identification. Methods The outcome of 161 patients with T1–T2 oral/oropharyngeal SCC was determined. In a subgroup of 39 patients the SN was identified and aspirated in addition. Results SN identification and aspiration was possible in 38 of 39 patients but without decreasing the false-negative rate of USgFNAC. During follow-up (12–99 months) 34 of 161 (21%) patients developed lymph node metastases. After therapeutic neck dissection and postoperative radiotherapy, 27 of 34 (79%) could be salvaged (88% regional control). Conclusions Wait-and-see seems justified in case of negative USgFNAC. Strict follow-up with USgFNAC is required. SN identification and aspiration is feasible but did not improve lymph node selection. © 2002 Wiley Periodicals, Inc. Head Neck 24: 282–289, 2002; DOI 10.1002/hed.10018

Imaging is playing a major role in the assessment of cervical lymphadenopathy. In infectious disease, the assessment of abscess formation and the relation of the abscess to surrounding vital structures is crucial for its management. In head and neck malignancies, imaging can be helpful for staging. Imaging of the neck for the assessment of nodal metastases can be used to detect occult metastases or to assess operability of palpable metastases. The detection of small occult metastases has limitations, as micrometastases cannot be depicted; however, imaging can fulfill a role in diminishing the risk of occult metastases, and thus influence management. For this purpose a very sensitive technique is necessary. The currently used radiological criteria are not sensitive enough to accomplish enough reduction of the risk of occult metastases; therefore, more sensitive CT and MRI criteria, but especially ultrasound-guided aspiration, should be employed to assess the clinically negative neck.

The Nπ^{0}π^{0} decays of positive-parity N^{*} and Δ^{*} resonances at about 2 GeV are studied at ELSA by photoproduction of two neutral pions off protons. The data reveal clear evidence for several intermediate resonances: Δ(1232), N(1520)3/2^{-}, and N(1680)5/2^{+}, with spin parities J^{P}=3/2^{+}, 3/2^{-}, and 5/2^{+}. The partial wave analysis (within the Bonn-Gatchina approach) identifies N(1440)1/2^{+} and the N(ππ)_{S wave} (abbreviated as Nσ here) as further isobars and assigns the final states to the formation of nucleon and Δ resonances and to nonresonant contributions. We observe the known Δ(1232)π decays of Δ(1910)1/2^{+}, Δ(1920)3/2^{+}, Δ(1905)5/2^{+}, Δ(1950)7/2^{+}, and of the corresponding spin-parity series in the nucleon sector, N(1880)1/2^{+}, N(1900)3/2^{+}, N(2000)5/2^{+}, and N(1990)7/2^{+}. For the nucleon resonances, these decay modes are reported here for the first time. Further new decay modes proceed via N(1440)1/2^{+}π, N(1520)3/2^{-}π, N(1680)5/2^{+}π, and Nσ. The latter decay modes are observed in the decay of N^{*} resonances and at most weakly in Δ^{*} decays. It is argued that these decay modes provide evidence for a 3-quark nature of N^{*} resonances rather than a quark-diquark structure.

Summary Background and purpose Previously identified high risk factors for development of distant metastases are: three or more lymph node metastases, bilateral lymph node metastases, lymph nodes larger than 6 cm, low jugular lymph node metastases, locoregional tumor recurrence and second primary tumors. The aims of this study were to validate these specific risk factors and to investigate the impact of time (i.e. during screening or follow-up) of detection of distant metastases on survival. Material and methods From a total of 301 HNSCC patients with high risk factors who were scheduled for extensive treatment and underwent pretreatment screening on distant metastases using chest CT and/or whole body PET(-CT) (in some patients combined with whole body MRI), the high risk factors, the development and time point of distant metastases and survival were analyzed. Results Forty-four percent developed distant metastases. Multivariate analysis revealed that bilateral lymph node metastases is the strongest predictive factor. Locoregional recurrence and second primary tumor were the risk factors associated with the lowest cumulative incidence. However, if the risk factor locoregional recurrence was split into local and regional recurrences, regional recurrence became a high risk factor. The more high risk factors a patient had the lower the 5-year distant metastases free survival was. Patients with distant metastases detected pretreatment has a significant worse survival (corrected for lead time bias) compared to patients with distant metastases diagnosed during follow-up. Conclusions The validity of three or more lymph node metastases, bilateral lymph node metastases, lymph nodes larger than 6 cm, low jugular lymph node metastases and regional recurrence as high risk factors for the development of distant metastases was confirmed. If more high risk factors are present the cumulative incidence of distant metastases increases significantly. The detection of distant metastases by pretreatment screening worsens the overall survival as compared to distant metastases detected during follow-up.

Diffusion-weighted MRI (DW-MRI) has potential to predict chemoradiotherapy (CRT) response in head and neck squamous cell carcinoma (HNSCC) and is generally performed using echo-planar imaging (EPI). However, EPI-DWI is susceptible to geometric distortions. Half-fourier acquisition single-shot turbo spin-echo (HASTE)-DWI may be an alternative. This prospective pilot study evaluates the potential predictive value of EPI- and HASTE-DWI and 18F-fluorodeoxyglucose PET-CT (18F-FDG-PET-CT) early during CRT for locoregional outcome in HNSCC.Eight patients with advanced HNSCC (7 primary tumors and 25 nodal metastases) scheduled for CRT, underwent DW-MRI (using both EPI- and HASTE-DWI) and 18F-FDG-PET(-CT) pretreatment, early during treatment and three months after treatment. Median follow-up time was 38 months.No local recurrences were detected during follow-up. Median Apparent Diffusion Coefficient (ADC)EPI-values in primary tumors increased from 77×10(-5) mm(2)/s pretreatment, to 113×10(-5) mm(2)/s during treatment (P=0.02), whereas ADCHASTE did not increase (74 and 74 mm(2)/s, respectively). Two regional recurrences were diagnosed. During treatment, ADCEPI tended to be higher for patients with regional control [(117.3±12.1)×10(-5) mm(2)/s] than for patients with a recurrence [(98.0±4.2)×10(-5) mm(2)/s]. This difference was not seen with ADCHASTE. No correlations between ΔADCEPI and ΔSUV (Standardized Uptake Value) were found in the primary tumor or nodal metastases.HASTE-DWI seems to be inadequate in early CRT response prediction, compared to EPI-DWI which has potential to predict locoregional outcome. EPI-DWI and 18F-FDG-PET-CT potentially provide independent information in the early response to treatment, since no correlations were found between ΔADCEPI and ΔSUV.

This systematic review gives an extensive overview of the current state of perfusion-weighted magnetic resonance imaging (MRI) for head and neck squamous cell carcinoma (HNSCC). Pubmed and Embase were searched for literature until July 2014 assessing the diagnostic and prognostic performance of perfusion-weighted MRI in HNSCC. Twenty-one diagnostic and 12 prognostic studies were included for qualitative analysis. Four studies used a T2(∗) sequence for dynamic susceptibility (DSC)-MRI, 29 studies used T1-based sequences for dynamic contrast enhanced (DCE)-MRI. Included studies suffered from a great deal of heterogeneity in study methods showing a wide range of diagnostic and prognostic performance. Therefore we could not perform any useful meta-analysis. Perfusion-weighted MRI shows potential in some aspects of diagnosing HNSCC and predicting prognosis. Three studies reported significant correlations between hypoxia and tumor heterogeneity in perfusion parameters (absolute correlation coefficient |ρ|>0.6, P

Intra-abdominal esophageal duplications are rare entities in adults. They are mostly asymptomatic, but since they can lead to complications surgical excision is advised for all duplication cysts. We present a case of a 20-year-old male with colic-like abdominal pain, mimicking symptoms of cholecystolithiasis. However after cholecystectomy the symptoms were still present. A computed tomography-scan of the abdomen and an endoscopic ultrasound revealed a cyst of the esophagus of 3.0 cm × 2.3 cm in size. Diagnostic laparoscopy was planned, during which we observed a para-esophageal cyst at the gastro-esophageal junction. Laparoscopic excision of this cyst was performed. Pathophysiological examination revealed an esophageal duplication cyst. We report a rare case of a symptomatic intra-abdominal esophageal duplication cyst in an adult. One must consider this diagnosis when more common diagnoses to account for the patient’s symptoms are excluded. Removal of duplication cysts can be done laparoscopically.

Photoproduction off protons of the p pi(0)eta three-body final state was studied with the Crystal Barrel/TAPS detector, at the electron stretcher accelerator ELSA in Bonn, for incident energies from the pi(0)eta production threshold up to 2.5 GeV. Differential cross sections and the total cross sections are presented. The use of linearly polarized photons gives access to the polarization observables Sigma, I-s, and I-c, the latter two characterize beam asymmetries in case of three-body final states. Delta(1232)(eta), N(1535)1/2(-) pi, and pa(0)(980) are the dominant isobars contributing to the reaction. The partial wave analysis confirms the existence of some nucleon and Delta resonances, for which so far only fair evidence was reported. A large number of decay modes of known nucleon and Delta resonances is presented. It is shown that detailed investigations of decay branching ratios may provide a key to unravelling the structure of nucleon and Delta resonances.

Photoproduction off protons of the pπ 0 η three-body final state was studied with the Crystal Barrel/TAPS detector, at the electron stretcher accelerator ELSA in Bonn, for incident energies from the π 0 η production threshold up to 2.5 GeV. Differential cross sections and the total cross sections are presented. The use of linearly polarized photons gives access to the polarization observables Σ, I s , and I c , the latter two characterize beam asymmetries in case of three-body final states. Δ(1232)η, N(1535)1/2− π, and pa 0(980) are the dominant isobars contributing to the reaction. The partial wave analysis confirms the existence of some nucleon and Δ resonances, for which so far only fair evidence was reported. A large number of decay modes of known nucleon and Δ resonances is presented. It is shown that detailed investigations of decay branching ratios may provide a key to unravelling the structure of nucleon and Δ resonances.

We used high-resolution MRI to study the post-mortem appearance of spinal cord multiple sclerosis in relation to histopathology and low-resolution images. Fifty-nine 3 cm long formalin-fixed spinal cord specimens from 19 multiple sclerosis patients and three controls were studied. Clinical characteristics of each patient were reviewed. High-field MRI consisted of proton-density weighted spin-echo imaging with an in-plane resolution of 80 μm. Specimens were also imaged at 1.0 T, with 1 mm pixel resolution. After MRI, the specimens were cut at 5 mm intervals and stained for myelin (Luxol fast blue/cresyl violet) and axons (Bodian method). Two observers scored the MRIs for abnormalities and divided them into (i) well-delineated areas of high signal intensity (SI) and (ii) poorly defined areas of mildly increased SI. Abnormalities were scored semiquantitatively, white matter and grey matter separately. In 81 sections the total area of abnormalities per section was measured on both histopathology sections and on matched high-field MRIs. Abnormalities ranged from just a few abnormal areas to complete involvement of the spinal cord specimen. Patients with an aggressive disease course had more abnormalities than patients with a mild or intermediate disease course. Areas of mildly increased SI were seen in all specimens, and were often found around focal high-SI lesions. However, in six patients, areas of mildly increased SI were the predominant finding on the MRIs, correlating with a primary progressive disease course. Histopathologically, high-SI areas correlated with complete demyelination, while mildly increased SI corresponded with partial demyelination. All areas scored as abnormal by the neuropathologist were also found on the MRIs, and sizes measured using both methods correlated well ( r = 0.85, P < 0.01). On conventional MRIs, abnormalities could be recognized fairly well. However, better differentiation could be made between high-SI and mildly increased SI abnormalities on the 4.7 T images. In conclusion, high-resolution MRI revealed a great range of abnormalities in spinal cord multiple sclerosis, which related to disease course during life. Furthermore, we found very good correlation between the extent of abnormalities shown by histopathology and the SI changes on proton-density MRIs, mainly relating to demyelination revealed histopathologically.

The current optimal imaging protocol in spinal cord MR imaging in patients with multiple sclerosis includes a long TR conventional spin-echo (CSE) sequence, requiring long acquisition times. Using short tau inversion recovery fast spin-echo (fast STIR) sequences both acquisition time can be shortened and sensitivity in the detection of multiple sclerosis (MS) abnormalities can be increased. This study compares both sequences for the potential to detect both focal and diffuse spinal abnormalities. Spinal cords of 5 volunteers and 20 MS patients were studied at 1.0 T. Magnetic resonance imaging included cardiac-gated sagittal dual-echo CSE and a cardiac-gated fast STIR sequence. Images were scored regarding number, size, and location of focal lesions, diffuse abnormalities and presence/hindrance of artifacts by two experienced radiologists. Examinations were scored as being definitely normal, indeterminate, or definitely abnormal. Interobserver agreement regarding focal lesions was higher for CSE (kappa = 0.67) than for fast STIR (kappa = 0.57) but did not differ significantly. Of all focal lesions scored in consensus, 47% were scored on both sequences, 31% were only detected by fast STIR, and 22% only by dual-echo CSE (n.s.). Interobserver agreement for diffuse abnormalities was lower with fast STIR (kappa = 0.48) than dual-echo CSE (kappa = 0.65; n. s.). After consensus, fast STIR showed in 10 patients diffuse abnormalities and dual-echo CSE in 3. After consensus, in 19 of 20 patients dual-echo CSE scans were considered as definitely abnormal compared with 17 for fast STIR. The fast STIR sequence is a useful adjunct to dual-echo CSE in detecting focal abnormalities and is helpful in detecting diffuse MS abnormalities in the spinal cord. Due to the frequent occurrence of artifacts and the lower observer concordance, fast STIR cannot be used alone.

We examined the value of spinal cord magnetic resonance imaging (MRI) in the diagnostic work-up of multiple sclerosis (MS). Forty patients suspected of having MS were examined within 24 months after the start of symptoms. Disability was assessed, and symptoms were categorized as either brain or spinal cord. Work-up further included cerebrospinal fluid analysis and standard proton-density, T2-, and T1-weighted gadolinium-enhanced brain and spinal cord MRI. Patients were categorized as either clinically definite MS (n = 13), laboratory-supported definite MS (n = 14), or clinically probable MS (n = 4); four patients had clinically probable MS, and in nine MS was suspected. Spinal cord abnormalities were found in 35 of 40 patients (87.5 %), consisting of focal lesions in 31, only diffuse abnormalities in two, and both in two. Asymptomatic spinal cord lesions occurred in six patients. All patients with diffuse spinal cord abnormality had clear spinal cord symptoms and a primary progressive disease course. In clinically definite MS, the inclusion of spinal imaging increased the sensitivity of MRI to 100 %. Seven patients without a definite diagnosis had clinically isolated syndromes involving the spinal cord. Brain MRI was inconclusive, while all had focal spinal cord lesions which explained symptoms and ruled out other causes. Two other patients had atypical brain abnormalities suggesting ischemic/vascular disease. No spinal cord abnormalities were found, and during follow-up MS was ruled out. Spinal cord abnormalities are common in suspected MS, and may occur asymptomatic. Although diagnostic classification is seldom changed, spinal cord imaging increases diagnostic sensitivity of MRI in patients with suspected MS. In addition, patients with primary progressive MS may possibly be earlier diagnosed. Finally, differentiation with atypical lesions may be improved.

Background: One of the hallmarks of the psoriatic plaque is increased epidermal proliferation. Whether this is the result of an increased recruitment of cycling epidermal cells or a decrease in cell cycle time has been a matter of debate for years. Objective: Calculating cell-kinetic information from the number of S phase cells in psoriasis by in situ hybridisation using a histone probe and the number of cycling epidermal cells by immunohistochemistry using the MIB-1 antibody. Methods: Immunohistochemistry and non-isotopic in situ hybridisation were performed on serial sections of 33 untreated psoriatic samples and 14 tacalcitol-treated samples. Results: The labelling index (number of cells in S phase/number cycling cells per millimetre length of section) in psoriatic untreated as well as in treated plaques is 16%. The amount of S phase cells in our experiment is equal compared with the number of cells in S phase as determined by BrdU incorporation. Conclusion: Using this direct approach to study cell-kinetic behaviour of psoriatic skin, we reconfirm that the psoriatic abnormality is due to a defect in the G₀–G1 recruitment mechanism (by increased recruitment of G₀ cells), a decrease in apoptosis or an increase in the number of cell divisions in the transit-amplifying compartment, rather than a reduction in the cell cycle time.

si descrive un grave caso di osteomielite della seconda e terza falange associata ad artrite settica della seconda interfalangea in una puledra. La revisione chirurgica della lesione portava all'asportazione di tre frammenti ossei deperiostati che corrispondevano a parte della III falange ed all'intera terza falange. Controllata la sepsi, la lesione evolveva verso la guarigione con un discreto recupero funzionale. A due anni la cavalla sviluppava a carico dello stesso arto una pododermatite cronica ipertrofica, che esitava in guarigione dopo intervento chirurgico di revisione endoungueale. Al controllo a 3 anni la cavalla aveva raggiunto un ottimo adattamento funzionale.

Imaging of the neck for the assessment of nodal metastases can be used to detect occult metastases or to assess operability of palpable metastases. The detection of small occult metastases has limitations, as micrometastases cannot be depicted. However, imaging can diminish the risk of occult metastases and thus influence management; for this purpose a very sensitive technique is necessary. The currently used radiologic criteria are not sensitive enough to accomplish enough reduction in the risk of occult metastases. Therefore, more sensitive CT and MRI criteria, but especially ultrasound guided aspiration, should be used to assess the clinically negative neck.

We studied the eiect of tacalcitol (1a,24 dihydroxy vitaminD3) ointment on clinical and immunohistochemical e⁄cacyin psoriatic patients during 2 months of treatment.The psor-iasis area and severity index decreased signi¢cantly afteronly 1 month and the total body surface index decreased55% after 2 months.To characterize the epidermal compart-ment keratin 14, keratin 16, epidermal growth factor recep-tor, apoptotic and Ki-67 positive cells were examined. After1week of treatment no signi¢cant changes were found in anyof these parameters. After 2 months, keratin 16 reached thelevels observed in normal skin and Ki-67 and keratin 14expression also reduced signi¢cantly. Epidermal growth fac-tor receptor staining and the number of apoptotic cells didnot alter during treatment. We conclude that tacalcitol iseiective in the treatment of plaque psoriasis. Because themain epidermal eiect observed immunohistochemically is areduction in proliferation, a combination therapy usingeither corticosteroids, vitamin A derivatives or dithranolseems rational.Key words: psoriasis; epidermis; vitamin D3;immunohistochemistry.(Accepted September 23, 1998.)Acta Derm Venereol (Stockh) 1999; 79: 111^114.F. A. C. M. Castelijns, Department of Dermatology, Univer-sity Hospital of Nijmegen, PO Box 9101, NL-6500 HB Nijme-gen, The Netherlands. Email: F.Castelijns@derma.azn.nl.Tacalcitol, 1a,24-dihydroxyvitamin D3 has a well-establishede⁄cacy in the treatment of psoriasis (1, 2).The recruitment ofcyclingepidermalcellsisprofoundlyinhibitedbytacalcitolandhyperproliferation-associated keratin 16 is markedly reducedduring tacalcitol treatment (3).The inhibitory eiect of tacalci-tol on epidermal proliferation has also been substantiated bymeasurement of DNA content using £ow cytometry (4, 5).Involucrin, ¢laggrin and transglutaminase are also modulatedduring tacalcitol treatment, indicating that tacalcitol has aneiect on various phases of epidermal diierentiation (3, 6). Anin vitro study indicated that active vitamin D3 enhancesapoptosis (7).The aim of the present study was to evaluate the eiect oftacalcitol on various characteristics of the epidermis duringtreatment of the psoriatic plaque. In particular we addressedthe following questions: to what extent are markers for earlyphenomena of psoriasis (epidermal growth factor receptor(EGFR), keratin 16), for intermediate phenomena (Ki-67antigen) and for late phenomena of psoriasis (keratin 14)aiectedbytacalcitoltreatment?And,doestacalcitoltreatmentresult in enhanced apoptosis?MATERIALS AND METHODS

In photoproduction experiments, a large number of final states yielding various resonance contributions are accessible. To extract resonance parameters via partial-wave analysis not only the measurement of differential cross-sections is necessary, but also the determination of polarization observables. At the electron accelerator ELSA (Bonn) the coherent bremsstrahlung method was used to generate a linearly polarized photon beam. Using the CBELSA/TAPS detector setup, the beam asymmetry Σ in the reaction γp → pπ 0 η was determined as a function of various masses and angles for photon energies between 970MeV and 1650MeV.

We reviewed the clinical and MRI findings in primary nerve-sheath tumours of the trigeminal nerve. We retrospectively reviewed the medical records, imaging and histological specimens of 10 patients with 11 primary tumours of the trigeminal nerve. We assessed whether tumour site, size, morphology or signal characteristics were related to symptoms and signs or histological findings. Histological proof was available for 8 of 11 tumours: six schwannomas and two plexiform neurofibromas. The other three tumours were thought to be schwannomas, because they were present in patients with neurofibromatosis type 2 and followed the course of the trigeminal nerve. Uncommon MRI appearances were observed in three schwannomas and included a large intratumoral haemorrhage, a mainly low-signal appearance on T2-weighted images and a rim-enhancing, multicystic appearance. Only four of nine schwannomas caused trigeminal nerve symptoms, including two with large cystic components, one haemorrhagic and one solid tumor. Of the five schwannomas which did not cause any trigeminal nerve symptoms, two were large. Only one of the plexiform neurofibromas caused trigeminal nerve symptoms. Additional neurological symptoms and signs, not related to the trigeminal nerve, could be attributed to the location of the tumour in three patients.

Objective: To assess the outcome of patients who underwent transoral tumor excision and a wait-and-see policy for the N0 neck, using ultrasonographic-guided fine-needle aspiration cytology (US-FNAC) of the neck for both selecting patients for neck treatment or observation and for follow- up. Design: Retrospective outcome analysis of a patient cohort without palpable or US-FNAC detectable nodal metastases undergoing transoral tumor excisions. Patients were followed up for 1 to 4 years using palpation and US- FNAC. Setting: Academic center. Patients: A consecutive sample of 77 patients mainly with oral carcinomas. Excluded were patients who had neck dissections, radiotherapy, or no US-FNAC during follow-up. Intervention: Transoral tumor excision. Neck dissection with radiotherapy for regional failure. Outcome Measure: The recurrence rate in the neck, without failure at the primary site and the salvage rate of these neck recurrences were the most important measures. Treatment delay and histopathology findings were assessed as well. Results: Fourteen patients (18%) had occult lymph node metastases and neck failures. Of the 14 neck failures, 9 were detected within 7 months of which 6 were no palpable. Ten (71%) of these 14 patients were successfully salvaged and 4 died of uncontrolled disease. Three of the 4 patients also had distant metastases. Conclusions: The low recurrence rate (18%) can be attributed to the initial US-FNAC. The high salvage rate (71%) indicates that strict US- FNAC follow-up enables early detection of recurrence in the neck. A wait- and-see policy thus seems warranted, provided regular US-FNAC examinations during follow-up can be guaranteed.

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Magnetic resonance imaging (MRI) monitoring of disease progression in multiple sclerosis is limited by the lack of correlation of abnormalities seen on T2-weighted imaging, and disability. We studied the histopathology of multiple sclerosis lesions, as depicted by MRI, in a large postmortem sample, focusing on axonal loss. Tissue samples from 17 patients were selected immediately postmortem for histopathological analysis on the basis of T2-weighted imaging, including normal appearing white matter and T1 hypointense lesions. In each region, we measured magnetization transfer ratios (MTR), T1 contrast ratio, myelin, and axonal density. T2 lesions (109 samples) were heterogeneous with regard to MRI appearance on T1 and MTR, whereas axonal density ranged from 0% (no residual axons) to 100% (normal axonal density). Of 64 T2 lesions, 17 were reactive (mild perivascular inflammation only), 21 active, 15 chronically active, and 11 chronically inactive. MTR and T1 contrast ratio correlated strongly with axonal density. Also in normal appearing white matter (24 samples), MTR correlated with axonal density. In conclusion, postmortem tissue sampling by using MRI revealed a range of pathology, illustrating the high sensitivity and low specificity of T2-weighted imaging. T1 hypointensity and MTR were strongly associated with axonal density, emphasizing their role in monitoring progression in multiple sclerosis.

SUMMARY: We report a 6-month-old boy who presented with unilateral leukocoria, retinal detachment, and a retrolental mass in a microphthalmic eye based on retinal dysplasia with concurrent optic nerve aplasia. Dysplastic retinal tissue, a rare congenital defect, may create a clinical and radiologic picture of an intraocular mass closely resembling tumor tissue. MR imaging findings with histopathologic correlation are presented to facilitate discrimination of the more common causes of leukocoria.

PURPOSE: To assess the diagnostic yield of magnetic resonance (MR) imaging in patients with symptoms and signs related to the trigeminal nerve. MATERIALS AND METHODS: Medical records and MR imaging studies in 112 consecutive patients referred for MR imaging over 5 years were evaluated. MR images were independently reviewed by two neuroradiologists unaware of the clinical findings. Signs and symptoms at presentation were associated with either a positive or negative MR imaging outcome. Logistic regression analysis was performed to identify clinical variables related to imaging results. RESULTS: Sixty-eight (61%) patients had positive MR imaging findings related to symptoms and signs. Trigeminal neuralgia was correlated with a negative MR imaging outcome (P < .001). Numbness (P < .01), impaired sensation (P < .001), other neurologic symptoms and signs (P < .01), progression of symptoms and signs (P < .001), and duration of symptoms of less than 1 year (P < .001) corresponded to a positive MR imaging outcome. Two regression models, each with three clinical parameters (progression, duration < 1 year, and trigeminal neuralgia or impaired sensation), had comparable accuracy for prediction of the MR imaging outcome. CONCLUSION: Clinical findings can be used to identify groups in which a high or a low yield of MR imaging is correlated with symptoms and signs related to the trigeminal nerve

During the last decade, novel analogues of 1alpha,25-dihydroxy vitamin D3 have been developed for the treatment of psoriasis. Recently, the efficacy of short-term treatment with the novel derivative tacalcitol (1alpha,24-dihydroxy vitamin D3) has been documented. However, data on the long-term effect of tacalcitol on psoriatic skin are sparse. In this study, we assessed the cell characteristics of the psoriatic epidermis after treatment with tacalcitol for up to 24 weeks. We investigated how long-term treatment with tacalcitol modulates the percentages of differentiated keratinocytes, inflammation cells and basal keratinocytes, and the percentage of cells in the SG2M phase in the basal cell population. From 11 patients who were treated with tacalcitol for up to 18 months, we obtained single-cell suspensions of a representative psoriatic lesion after 0, 8, 12, 18 and 24 weeks of treatment. A Psoriasis Area and Severity Index was performed at each visit as well. Cell suspensions were stained with markers for inflammation (Vim3B4), differentiation (RKSE60) and proliferation (TO-PRO-3 iodide) and analysed flow cytometrically. Clinically, patients improved significantly after 8 weeks of treatment. This clinical effect was preserved for the rest of the period of treatment with no further significant improvement. Proliferative activity also decreased significantly after 8 weeks of treatment. Proliferation did not show further significant decreases or habituation after 12, 18 and 24 weeks. For inflammation, no statistically reliable trends could be seen. Differentiation improved significantly after 8 weeks of treatment, but decreased again significantly after 12 weeks. In the period from 12 to 24 weeks, no further significant change was observed. We conclude that tacalcitol is an effective antipsoriatic drug. Prolonged treatment with tacalcitol will generally maintain improvement at the level reached after 8 weeks. Owing to the beneficial effect on both clinical state and proliferation, tacalcitol is likely to be an adequate maintenance therapy.

Lymphatic metastasis is the most important mechanism in the spread of head and neck squamous cell carcinomas. The rate of metastasis probably reflects the aggressiveness of the primary tumor and is an important prognosticator. 55,59,94,128 Not only the presence, but also the number of nodal metastases, the level in the neck, the size of the nodes, and the presence of extranodal spread are important prognostic features. In most institutions throughout the world, the neck is mainly staged by palpation. Although palpation has the advantage of being both easy and inexpensive to perform and repeat, it is generally accepted to be inaccurate. Both the sensitivity and specificity are in the range of 60% to 70%, depending on the tumor site studied. 4,90 As a consequence of the low sensitivity of palpation, a neck side without palpable metastases is at risk of harboring occult metastasis. This risk is to a large extent dependent on the size and site and other characteristics of the primary tumor. 34,56,60,71 For example, in glottic carcinomas and in small sinonasal carcinomas the risk of occult metastases is far below 10%. On the other hand, nasopharyngeal carcinomas, and to a lesser extent other pharyngeal carcinomas, have a risk of occult metastases of 50% or more. For most T1 to T3 oral, oropharyngeal, and supraglottic tumors this risk of occult metastases is in the range of 20% to 50%, with significant differences between different sites and studies. 46,58,64,74,87,93,96 In many head and neck primaries not only the ipsilateral site of the neck is at risk but the contralateral site has a significant risk to harbor metastases as well, especially when the primary has grown close to or extends over the midline. Because of the fallibility of palpation, it is widely accepted to treat the neck electively if the risk of occult metastases is high. The "acceptable" risk to perform elective treatment is very hard to define. As most clinicians do not treat the neck electively in small T1 oral carcinomas that carry a risk of around 15% of occult metastases, this figure is often quoted. Recently a meta-analysis using a decision analysis model on the basis of prognostic literature data was performed. In this study, a risk of occult metastases higher than 20% was calculated to be optimal for elective treatment. 134

We investigated various magnetic resonance MRI parameters for both brain and spinal cord to see if any improved the clinicoradiological correlation in multiple sclerosis. Ninety-one multiple sclerosis patients (28 relapsing-remitting, 32 secondary progressive and 31 primary progressive) were imaged using conventional T1, proton density- and T2-weighted MRI of the brain and spinal cord. Focal brain and spinal cord lesion load was scored, as were diffuse signal abnormalities, brain ventricular volume and spinal cord cross-sectional area. Clinical measures included the expanded disability status scale (EDSS), the functional systems score and a dedicated urology complaint questionnaire. Secondary progressive patients differed from relapsing-remitting and primary progressive patients by a larger number of hypointense T1 lesions in the brain, ventricular enlargement and spinal cord atrophy. Primary progressive patients more often had diffuse abnormalities in the brain and/or spinal cord than did relapsing-remitting and secondary progressive patients. In the entire study population, EDSS correlated with both brain and spinal cord MRI parameters, which were independent. The urological complaint score correlated only with spinal cord MRI parameters. In relapsing-remitting and secondary progressive multiple sclerosis, the correlation between MRI and clinical parameters was better than in the entire population. In this subgroup EDSS variance could be explained best by T1 brain lesion load, ventricle volume and spinal cord cross-sectional area. In the primary progressive subgroup the clinicoradiological correlation was weak for brain parameters but was present between spinal cord symptoms and spinal cord MRI parameters. In conclusion, the different brain and spinal cord MRI parameters currently available revealed considerable heterogeneity between clinical subtypes of multiple sclerosis. In relapsing-remitting and secondary progressive multiple sclerosis both brain and spinal cord MRI may provide a tool for monitoring patients, while in primary progressive multiple sclerosis the clinicoradiological correlation is weak for brain imaging.