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PURPOSE: Mesenchymal Stem Cell therapy is an evolving therapeutic approach to intervertebral disc regeneration. The objective of this study was to evaluate IODEX labelled Mesenchymal Precursor Cells (MPCs) with magnetic resonance imaging (MRI) and histological studies using an ovine model. METHOD(S): Disc degeneration (DD) was induced in the L2/3, L3/4, L4/5 lumbar discs of six adult female sheep utilizing a validated annular injury protocol. L1/2 and L5/6 discs served as untreated controls. Three months following annular injury, ovine IODEX labelled MPCs were injected into the degenerate discs. Three labelled MPC regimens were examined. Animals were euthanized at 2, 4 and 8 weeks post injection. 3T and 9.4T MRI was performed. Paraffin embedded histological sections of all discs were stained and scanned for FITC fluorescence. RESULT(S): The histological studies and Pfirrmann grading scores of all injured discs confirmed DD. Hypointense signal areas visualized on 9.4T MRI in all MPC injected groups up to 8 weeks after implantation confirmed the presence of MPCs. Hypointense regions in the nucleus pulposus were significantly larger in discs injected with dead cells compared to live cells. 9.4T MRI sequences and histological studies provided evidence of MPC migration to the annulus fibrosus injury site. CONCLUSION(S): This study has demonstrated the feasibility of tracking IODEX labelled MPCs in degenerate discs using MRI, and indicated MPC tracking to the site of annular injury. The histological studies also revealed ingrowth of capillaries, fibrosis and innervation of the injured annulus. Immunohistochemical studies are currently in progress to identify the MPC mediators responsible for disc repair.

Introduction: Flexible cystoscopy is recognised as the gold standard investigation for detecting bladder cancer. CT urography is accepted as the most sensitive and specific investigation for upper tract lesions. We conducted a retrospective cohort study to assess CT urography and ultrasound in the detection of bladder cancer. Patients and Methods: Records of 290 consecutive referrals to a Monash Health haematuria clinic, from May 2010 to April 2013, were retrospectively reviewed. We analysed the imaging for detection of bladder cancer by reviewing the radiologist report. Reports suggesting likely or possible bladder cancer were considered positive. These were compared to histopathology results. Sensitivity, specificity, positive predictive value and negative predictive were calculated for each modality and compared to flexible cystoscopy. Result(s): A total of 290 patients were included with 23 bladder cancers detected. 278 had flexible cystoscopy, 227 CT urography and 163 ultrasound. (Table Presented) Conclusion(s): Both CT urography and ultrasound have a high specificity for detecting bladder cancer in patients with haematuria. Patients with bladder cancer identified on imaging should be referred directly for rigid cystoscopy and resection. Results from previous research, suggesting CT urography could replace flexible cystoscopy as an investigative tool, were not replicated in this group. Our study shows flexible cystoscopy remains a necessary investigation for patients with haematuria.

Introduction: It is accepted that scrotal exploration should be undertaken if testicular torsion is suspected. We set out to assess the incidence of torsion in patients undergoing scrotal exploration, and whether pre-operative ultrasound influenced the decision to operate. Method(s): We conducted a 3-year audit of emergency scrotal explorations for acute scrotal pain at the Monash Hospital network, (undertaken by paediatric surgery, urology and general surgery). Patient and hospital/surgical team demographics were collected, as well as information about duration of pain, time to proceeding to surgery, incidence of torsion, orchidopexy (uni/bilateral) and orchidectomy. We also assessed the numbers of patient who received preoperative ultrasound, the ultrasound results, and whether this correlated to clinical findings at the time of surgery. Result(s): There were 290 scrotal explorations, 106 confirmed torsions and 15 orchidectomies. Age range of presentation was 2 days to 56 years (mean 13.9). Duration of pain prior to presentation was 15 minutes to 5 weeks (mean 31 hours). Time from presentation to commencement of surgery was 39-2880 minutes (mean 203 minutes). Highest incidence of exploration occurred in 12-15 year olds. 45 patients underwent preoperative ultrasound; 25 suggested definitive torsion. Of these, 22 were confirmed at operation. Of remaining ultrasounds, most suggested alternative pathology but stated 'torsion cannot be excluded', and 3 suggested intermittent torsion. Of those equivocal reports, 1 of 18 patients was torted at operation. (Table Presented) Conclusion(s): Torsion was more common in adolescents as expected. Ultrasound may be useful in select cases of scrotal pain where there is low clinical suspicion of torsion, but does not replace clinical judgement, and should not delay prompt surgical exploration in suspected torsion.