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Background: Autoimmune pancreatitis (AIP) is a chronic inflammatory condition characterized by IgG4-positive plasma cells. Recent evidence suggests that it is a systemic disease affecting various organs. Tubulointerstitial nephritis has been reported in association with AIP. Purpose: To investigate the incidence and types of renal involvement in patients with AIP. Material and Methods: Eighteen patients with no history of renal disease and a diagnosis of AIP (on the basis of histopathologic findings or a combination of characteristic imaging features, increased serum IgG4 levels, and response to steroid treatment) were included. All patients underwent computed tomography (CT) imaging and follow-up ranged from 6 months to 2 years. CT images were reviewed for the presence of renal lesions. Results: Seven patients had renal involvement (38.8%). None of the lesions was visible on non-contrast-enhanced CT scan. Parenchymal lesions appeared as multiple nodules showing decreased enhancement (four cases). Pyelonephritis, lymphoma, and metastases were considered in the differential diagnosis. An ill-defined low-attenuation mass-like lesion was found in one patient, while diffuse thickening of the renal pelvis wall was evident in the last two cases. Renal lesions regressed in all patients after steroid treatment, the larger one leaving a fibrous cortical scar. Conclusion: Different types of renal lesions in patients with AIP are relatively common, appearing as multiple nodules with decreased enhancement. These findings support the proposed concept of an IgG4-related systemic disease. Autoimmune disease should be suspected in cases of renal involvement in association with pancreatic focal or diffuse enlargement. [ABSTRACT FROM AUTHOR]

Abstract Introduction Post-traumatic pulmonary pseudocyst is an uncommon cavitary lesion of the lung and develops after blunt chest trauma and even more rarely following penetrating injuries. It is generally seen in young adults presenting with cough, chest pain, hemoptysis, and dyspnea. Post-traumatic pulmonary pseudocyst should be included in the differential diagnosis of cavitary pulmonary lesions. We describe the case of a 60-year-old Caucasian Greek woman who sustained traumatic pulmonary pseudocyst with hemopneumothorax due to a blunt chest trauma after a traffic accident. Case presentation After a traffic accident, a 60-year-old Caucasian Greek woman sustained a hemopneumothorax due to a blunt chest trauma. There was evidence of an extensive contusion in the posterior and lateral segments of the right lower lobe, a finding that was attributed to an early sign of a cavitation, and the presence of a thin-walled air cavity was detected on the anterior segment of the right lower lobe in the control computed tomography taken 24 hours after admission. Our patient was treated by catheter aspiration, and the findings of computed tomography evaluation about one month later showed complete resolution of one of the two air-filled cavitary lesions. The second pseudocyst also disappeared completely, as shown by the control computed tomography scan performed six months later. Conclusions Traumatic pulmonary pseudocyst is a rare complication of blunt chest trauma, and computed tomography is a more valuable imaging technique than chest radiograph for early diagnosis.

High-resolution manometry (HRM) is the gold-standard diagnostic tool for achalasia of the esophagus. Laparoscopic Heller-Dor technique is the preferred surgical approach with success rate estimated 90%. The use of intraoperative HRM provides real-time estimation of intraluminal esophageal pressures and identifies the exact points of esophageal luminal pressure during laparoscopy. Ten patients with achalasia underwent surgery. All patients preoperatively completed 1 manometric study and Quality of Life questionnaires (EORTC QLQ-C30 version 3.0) with Eckardt scores. We collected intraoperative manometry data and repeated manometric studies, EORTC QLQ-C30, and Eckardt scores postoperatively. Median Eckardt score was decreased from 7.5 to 0.5, mean resting pressure decreased from 51.4 to 11.9 mm Hg, whereas mean residual pressure diminished from 45.9 to 9.5 mm Hg postoperatively. The simultaneous use of HRM during the Heller-Dor technique may lead to an individualized management of the disease.

Introduction: Splenic hamartoma is a primary benign tumor of the spleen, which is often found incidentally. Splenic hamartomas are very rare, with approximately 150 cases documented in the literature to date. They represent benign vascular proliferation. Histological findings consist of disorganized stroma and vascular channels of varying width, with or without lymphoid follicles., Case Presentation: We present the case of a 39-year-old Greek woman, with no significant medical history, who was diagnosed incidentally with an enormous splenic hamartoma on computed tomography, finally confirmed by surgery and histopathology. Hamartomas are benign lesions, and it is important to differentiate them from malignancy., Conclusion: Hamartoma represents a rare vascular entity characterized by a cluster of differentiation 8-positive immunophenotype. It is usually asymptomatic but large hamartomas may present with symptoms such as hemopoetic disorders, which resolve after splenectomy. It is important for radiologists to be able to differentiate splenic hamartoma from malignant entities.

Background: Laparoscopic sleeve gastrectomy (LSG) is a promising procedure for the treatment of morbid obesity. The stomach is usually transected near the angle of His; hence, the lower esophageal sphincter (LES) may be affected with consequences on postoperative gastroesophageal reflux disease (GERD). The purpose of this study was to examine the effect of LSG on the LES and postoperative GERD., Methods: Severely obese asymptomatic patients submitted to LSG underwent esophageal manometry and GERD evaluation preoperatively and at least 6 weeks postoperatively. Data reviewed included patient demographics, manometric measurements, GERD symptoms, and pathology. Statistical analysis was performed by SPSS software., Results: Twelve male and eleven female patients participated in the study. Mean age was 38.5 ± 10.9 years, and initial body mass index was 47.9 ± 5.1 kg/m(2). At follow-up examination, mean excess body mass index loss was 32.3 ± 12.7%. The LES total and abdominal length increased significantly postoperatively, whereas the contraction amplitude in the lower esophagus decreased. There was an increase in reflux symptoms postoperatively (p < 0.009). The operating surgeon who mostly approximated the angle of His resulted in an increased abdominal LES length (p < 0.01). The presence of esophageal tissue in the specimen correlated with increased total GERD score (p < 0.05)., Conclusions: LSG weakens the contraction amplitude of the lower esophagus, which may contribute to postoperative reflux deterioration. It also increases the total and the abdominal length of the LES, especially when the angle of His is mostly approximated. However, if this approximation leads to esophageal tissue excision, reflux is again aggravated. Thus, stapling too close to the angle of His should be done cautiously.

The present study describes a case of a painful supraclavicular soft-tissue metastasis of a skin melanoma invading the brachial plexus in a 38-year-old male. The patient was treated twice with radiofrequency ablation (RFA) under computed tomography (CT) guidance, which caused tumoral necrosis. The patient was originally referred with a 7-cm metastasis in the right supraclavicular fossa, which caused intractable pain and a degree of numbness. These symptoms were unresponsive to chemotherapy and radiotherapy and the pain was not controlled using narcotic analgesics. The lesion was treated with CT-guided RFA causing necrosis, relieving the pain and sparing the patient from using analgesics. The pain recurred 19 months thereafter and a CT scan revealed an 8-cm mass in the right supraclavicular space. The patient underwent repeat CT-guided RFA, which reduced the pain to a level that was controlled with minor oral analgesics. In conclusion, in this case of a painful supraclavicular soft-tissue metastasis invading the brachial plexus, which was intractable to chemotherapy and radiotherapy, RFA was feasible and offered substantial palliation of the symptoms, freedom from the use of narcotic analgesics and improvements to the quality of life.

OCT4, a POU-domain transcription factor is considered to be a key factor in maintaining the pluripotency of stem cells. Several OCT4 isoforms are differentially expressed in human pluripotent and non-pluripotent cells. Reactivation of OCT4 expression is postulated to occur in differentiated cells that have undergone tumorigenesis. To examine OCT4 expression in colorectal cancer (CRC) tissues, and to assess the efficacy of OCT4 as a potential biomarker for CRC, in this study, we investigated its expression in CRC tissues, evaluated its relationship to various clinicopathological parameters and defined the isoform of OCT4 that was found to be expressed in CRC cases. Primary tumor tissues and matching adjacent non-cancerous tissues were obtained from 84 CRC patients. OCT4 expression and isoform determination were documented by reverse transcription-PCR and real-time PCR. OCT4, Sox-2, and NANOG localization were performed using immunohistochemistry. The isoforms expressed in the studied cases were confirmed by sequencing. Twenty biopsy specimens representing healthy tissues, retrieved from colonoscopy were studied in parallel as controls. OCT4 expression levels were higher in CRC tissues compared to matching, adjacent non-cancerous tissues, and healthy controls. Additionally, the levels of OCT4 expression in CRC tissues correlated with tumor stage. OCT4 and Sox-2 were localized in the nuclei and the cytoplasm of CRC cells. In all CRC cases, we found that the OCT4B1 isoform is expressed. Over-expression of OCT4B1 was found in poorly and moderately differentiated CRC tissues. In conclusion, the data imply that OCT4B1 isoform may represent a potential biomarker for the initiation, progression, and differentiation of CRC., (Copyright © 2011 Wiley Periodicals, Inc.)

Background: Sleeve gastrectomy involves the creation of small gastric reservoir based on lesser curvature of the stomach, which is fashioned by a longitudinal gastrectomy that preserves the antrum and pylorus together with its vagal innervation. The main complications in the early postoperative course are bleeding and gastric leak. In order to reduce these complications the staple line can be reinforced in many different ways. The purpose of this study was to randomly compare two different techniques in laparoscopic sleeve gastrectomy (LSG): buttressing the staple line at the gastroesophageal junction (angle of Hiss) with Gore Seamguard and staple-line suturing with PDS 2.0., Methods: Between July 2009 and July 2010, 90 patients were prospectively and randomly enrolled in the two different techniques of handling the staple line during LSG. Forty-eight of these patients belonged in group A (application of Gore Seamguard) and 42 in group B (application of a continuous suture). Operative and postoperative complications were recorded., Results: Postoperative leak affected two patients in group A (4.2%) and bleeding occurred in one patient of group A (2%). Total complication rate was 6.2% for group A. No major surgical complication occurred in group B. The differences between the two groups did not reach statistical significance., Conclusions: No significant difference is evidenced in terms of bleeding and postoperative leak between the two techniques of enhancing the staple line in LSG. Suturing of the staple line may be more time consuming but costs are considerably less.

Introduction: Despite the various therapeutic combinations and the emergence of new targeted therapies, there is still no curative treatment for all stages of colorectal cancer. Through the query for the best possible combination and solution, a new theory approaching colorectal cancer as a stem cell disease appeared, with a continuously growing body of evidence supporting this idea. The inability to directly recognize cancer stem cells has led researchers to an attempt of distinguishing those using indirect markers., Discussion: This review focuses on colon cancer stem cell theory, the various findings supporting and contradicting this hypothesis, and the markers used up to now in characterizing stem cell populations in colorectal cancer. Despite the numerous unanswered questions on this new cancer hypothesis, it appears to have a justifiable role to play in colorectal cancer tumor biology, and furthermore, it may be the basis for the development of new therapeutic agents of the future. Therefore, every surgeon, oncologist, and physician who is implicated with this disease should be familiar with this novel colorectal cancer theory.

Laparoscopic sleeve gastrectomy is known to be a safe and effective procedure for treating morbid obesity and is performed with increasing frequency both in Europe and the USA. Despite its broad use, many questions about the remaining gastric tube diameter, its long-term efficacy, its effects on gastric emptying, and the hormones involved still remain to be answered. In order to use such a relatively new surgical procedure wisely, it is essential for every surgeon and physician to understand how sleeve gastrectomy acts in obesity and what its potential benefits on the patients' metabolism are. This review focuses on the most important pathophysiologic questions referred to sleeve gastrectomy on the literature so far, in an attempt to evaluate the different issues still pending on the subject.

Background: The aim of the study is to look at laparoscopic sleeve gastrectomy as a procedure with intent to cure morbid obesity. Secondary endpoints are related to the safety profile of the procedure., Methods: This is a prospective clinical study conducted in a single university surgical clinic., Results: Two hundred sixty-one patients (2.5:1 female to male ratio, median age of 37 years) underwent sleeve gastrectomy. Median preoperative body mass index (BMI) was 45.2 kg/m(2). Mortality and morbidity rates were 0.7% and 8.4%, respectively. Risk factors for postoperative complications were history of diabetes mellitus under medical treatment (OR, 4.0; p = 0.014) and prior bariatric operation on the same patient (OR, 5.7, p = 0.034). Median follow-up was 12 months (range 1-29 months). A BMI > 50 kg/m(2) is connected with greater weight loss. Analysis of the percentage of excess weight loss (%EWL) during follow-up at specific time intervals showed a rapid increase for the first 12 months followed by a more gradual rise thereafter. The median %EWL for the first year of follow-up was 65.7 (range 33.8-102.3). The median BMI for the patients that had completed at least 1 year of follow-up was 30.5 kg/m(2) (range 21.2-42.7). The overall success rate after the first year was 74.3% when accounted for %EWL > 50 and 81.7% for BMI < 35 kg/m(2)., Conclusions: The actual long-term efficacy of the procedure remains to be confirmed. Morbidity rates may prove higher than expected especially during the learning curve.

Infected necrotizing pancreatitis is the most severe form of acute pancreatitis and is related with high rates of morbidity and mortality. The close cooperation and communication, working as a team, among interventional radiologists surgeons and gastroenterologists improves the successful treatment considerably. Therapeutic modalities such as percutaneous CT-guided catheter drainage can be helpful to save lives, changing dramatically the clinical aspect of the patient. The objective of this paper is to review the indications and techniques of image-guided percutaneous treatment of pancreatic infected pseudocysts and to report our clinical experience and observations made during primary CT-guided percutaneous catheter drainage of infected abscesses.

Background: Sexual function may be harmed after treatment for rectal cancer. This study aimed to evaluate prospectively the incidence of sexual dysfunction after rectal cancer treatment and to compare the effects of laparoscopic and traditional open approaches in terms of postoperative sexual function., Methods: Baseline and 3-, 6-, and 12-month assessments of sexual dysfunction using the International Index of Erectile Function (IIEF) and its specific domains prospectively took place for 56 patients who underwent rectal cancer surgery (38 open vs. 18 laparoscopic procedures, 38 low anterior vs. 18 abdominoperineal resections). The preliminary results are presented., Results: The average total IIEF and isolated IIEF response domain scores were significantly decreased after surgery (p < 0.01) except for the intercourse satisfaction and overall satisfaction scores at 12 months. An improvement in IIEF scores was observed between the 3- and 6-month assessment points (p < 0.01) except for the erectile function and orgasmic function scores. No significant differences were observed between the open and laparoscopic groups in the total IIEF and domain scores preoperatively and at the 3- and 6-month assessment points. The rates of sexual dysfunction did not differ significantly preoperatively or at 3 months postoperatively when open and laparoscopic procedures were compared, although there was a trend in favor of laparoscopic surgery at 6 months (p = 0.076). The baseline IIEF score and the baseline, 3-, and 6-month sexual desire scores were better (p = 0.035, 0.004, 0.017, and 0.061, respectively) in the low anterior resection group than in the abdominoperineal resection group., Conclusions: Rectal cancer resections were postoperatively associated with a significant reduction in IIEF scores and high rates of sexual dysfunction at 3 and 6 months. The IIEF and domain scores at different assessment points were comparable between the laparoscopic and open surgery groups. Extending the monitoring period and adding more patients in this ongoing prospective study will further elucidate postoperative sexual dysfunction after rectal cancer surgery.

This article has been withdrawn at the request of the Editor in Chief. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy., (Copyright © 2011. Published by Elsevier Ltd.. All rights reserved.)

Background: Several techniques for liver resection have been developed. We compared radiofrequency-assisted (RF) and clamp-crush (CC) liver resection (LR) in terms of blood loss, operating time and short-term outcomes in primary and metastatic tumour resection., Methods: From 2002 to 2007, 196 consecutive patients with primary or metastatic hepatic tumours underwent RF-LR (n= 109; group 1) or CC-LR (n= 87; group 2) in our unit. Primary endpoints were intraoperative blood loss (and blood transfusion requirements) and total operative time. Secondary endpoints included postoperative complications, mortality and intensive care unit (ICU) and hospital stay. Data were collected retrospectively on all patients with primary or secondary liver lesions., Results: Blood loss was similar (P= 0.09) between the two groups of patients with the exception of high MELD score (>9) cirrhotic patients, in whom blood loss was lower when RF-LR was used (P < 0.001). Total operative time and transection time were shorter in the CC-LR group (P= 0.04 and P= 0.01, respectively), except for high MELD score (>9) cirrhotic patients, in whom total operation and transection times were shorter when RF-LR was used (P= 0.04). Rates of bile leak and abdominal abscess formation were higher after RF-LR (P= 0.04 for both)., Conclusions: Clamp-crush LR is reliable and results in the same amount of blood loss and a shorter operating time compared with RF-LR. Radiofrequency-assisted LR is a unique, simple and safe method of resection, which may be indicated in cirrhotic patients with high MELD scores.

Aim: Advanced glycation end products (AGEs) formation is implicated in diabetic complications. Exogenous AGEs, namely glycotoxins, are present in certain foods and are absorbed from the gastrointestinal tract. Experimental data suggest that lifestyle interventions reducing their content in diet have beneficial effect., Methods: Fourteen healthy (age: 42.14 +/- 12.38 years; body mass index [BMI]: 27.85 +/- 7.06 kg/m2) and ten women with type 2 diabetes (T2DM) (age: 48.70 +/- 9.31 years; BMI: 32.55 +/- 7.14 kg/m2) were enrolled in the study. A meal rich in AGEs was provided in a two-day protocol and on day 2, 240 mg of Orlistat were administered post-meal., Results: On day 1, serum AGEs levels showed a rise at 3 hours post-meal compared to baseline values in both groups (controls: 12.2%; P<0.001), T2DM: 2.6%; P=0.013), but at 5 hours post-meal only in the controls (control: 12.2%; P<0.001); T2DM: 1.9%; P=0.075). On day 2 at 3 hours post-meal control values showed a rise of 3.1% (P=0.003); T2DM of 1.9% (P=0.013); at 5 hours post-meal rise for controls was 4.6% (P=0.012); and for T2DM was 1.8% (P=0.009). The corresponding rise was significantly lower on day 2 only in controls at 3 and 5 hours post-meal (P=0.003; P=0.05, respectively)., Conclusions: Orlistat reduced the absorption of glycotoxins acutely and improved the metabolic profile in the control group, without an apparent beneficial effect in the diabetic group. The clinical significance of this observation should be further investigated in normal population, while in diabetics long-term studies may be required to demonstrate possible clinically significant effects.

Objective: The objective of our study was to compare theoretic estimations of the dose to the patient's skin during CT-guided interventional procedures with measurements performed using radiation therapy verification films., Materials and Methods: In each of the 12 interventions studied, a Kodak EDR2 film was positioned under the patient's anatomic area of concern. After processing, each film was scanned with a medical-grade scanner to produce a digital image from which the gray-scale profiles were obtained using the appropriate software. From these data and respective data from a series of calibration films, the entrance skin dose (ESD) profiles were derived. These ESD profiles were compared with the ESD profiles produced using a theoretic model and its revised version, which utilizes the DICOM data of each slice (i.e., tube potential, tube loading, slice thickness, slice location, pitch, and table height) and air-kerma output measurements from the CT tube., Results: In general, the ESD profiles calculated using the revised theoretic method were in better agreement with the profiles derived from the verification films than the ESD profiles derived from the original theoretic method. The deviations from the peak skin doses (PSDs) derived from the digital film images were within -3% and 27% of the PSDs derived from the verification films. The respective deviations of the ESD profiles calculated with the original theoretic method were quite larger., Conclusion: The theoretic model provides a useful tool for estimating skin doses during CT-guided interventions with a reasonable level of accuracy. With further refinement and a little automation this method could be implemented for daily use.

Objective: The aim of the study was to compare Acute Physiology and Chronic Health Evaluation II score and C-reactive protein as a clinical index and computed tomography-based severity index (CTSI) in predicting the course of acute pancreatitis., Methods: One hundred forty-eight patients with acute pancreatitis were enrolled in the study during a 2-year period. All data concerning etiology, Atlanta classification, CT findings, Acute Physiology and Chronic Health Evaluation score, C-reactive protein levels, stay in the intensive care unit, length of hospital stay, treatment, complications, and deaths were analyzed with Mann-Whitney U, Wilcoxon, Pearson, and Spearman statistical tests. The CT was performed on a spiral unit after intravenous administration of contrast material. Images were graded according to the Balthazar-CTSI scoring system., Results: A very good correlation was noticed between Balthazar-CTSI scores and local complications, whereas no statistically significant correlation was found between CT scores and stay in the intensive care unit. Among survivors and nonsurvivors, there were no statistically significant differences as far as CT scores were concerned., Conclusions: Although the extent of necrosis as defined on contrast-enhanced CT examinations is considered as a risk factor for a negative prognosis, our findings suggest that the initially documented disease severity according only to imaging parameters is not highly important for the final patient outcome.

Objective: To correlate cross-sectional imaging findings with histological results in patients with histopathologically proven lymphoplasmacytic sclerosing pancreatitis (LSP) after surgery., Methods: Four cases of resectable pancreatic lesions that were proven to represent LSP are presented in our study. All patients were thought to harbor malignancy. A detailed research in patients' records was retrospectively done concerning clinical presentation and imaging studies., Results: Characteristic imaging findings consistent with fibrotic changes were evident in only one case on magnetic resonance imaging. A discrete mass was evident on imaging in 2 patients that correlated well with pathology results. In the other patients, the extent of inflammatory changes on microscopic examination correlated well with the degree of pancreatic head enlargement on imaging studies., Conclusions: Lymphoplasmacytic sclerosing pancreatitis is a particular form of benign inflammatory pancreatic disease that is extremely difficult to diagnose preoperatively. Familiarization with the variable imaging findings is essential and may result in the reduction of the number of patients with LSP who undergo surgical resection.

Objective: The purpose of this study was to determine patient effective dose (E) and peak absorbed dose to the skin of the patient from various CT-guided interventional procedures performed without CT fluoroscopy assistance., Materials and Methods: In total, 49 interventions were retrospectively studied: 14 biopsies, 14 radiofrequency ablations, 14 abscess drainages, and seven nephrostomies. CT images were acquired from the department's PACS system and reviewed to record the scan parameters of each slice. Entrance surface dose and E were estimated using the Impactscan database and the related Monte Carlo conversion coefficients., Results: Median values of E for biopsies, radiofrequency ablations, abscess drainages, and nephrostomies were 23, 35.3, 16.2, and 11.5 mSv, respectively. Respective ranges were 5.8-46.6, 18.4-57.2, 10.9-31.5, and 5.1-32.7 mSv. The corresponding median values and ranges for the peak absorbed dose were 281, 557, 155, and 145 mGy and 133-982, 147-699, 94-315, and 75-297 mGy. The diagnostic scans obtained before the interventions were responsible for 63%, 33% 40%, and 51% of E, respectively. The largest contribution to the peak absorbed dose was due to positioning of the tissue acquisition biopsy gun in biopsies (48%), the radiofrequency needle in ablations (57%), and the catheter in abscess drainages (41%) and nephrostomies (49%)., Conclusion: For the CT interventions studied, and especially for biopsies and radiofrequency ablations, patient effective doses were considerably high. Maximum peak absorbed dose observed was about 1 Gy, considerably lower than the threshold for deterministic effects (2 Gy).

Splenic abscess is a rare entity normally associated with underlying diseases. We report a case of splenic abscess with large gas formation in a non-diabetic and non-immunosuppressed patient after surgery for colon perforation. The most frequent cause of splenic abscess is septic embolism arising from bacterial endocarditis. Splenic abscess has a high rate of mortality when it is diagnosed late. Computed tomography resolved any diagnostic doubt, and subsequent surgery confirmed the diagnosis.

Hydatid disease is a rare entity that mostly affects the liver and lung, but almost any organ, forming cysts. Although diagnosis is confirmed by serology and imaging studies, a high index of suspicion is required based on the epidemiological background of the patient. However, rare locations of the cysts remain a diagnostic and therapeutic dilemma. Surgical exploration with special attention to avoid parasite spillage is justified in these situations because diagnostic puncture is usually contraindicated. Pericystectomy or fenestration and omentoplasty is strongly recommended, along with the excision of involved organs when feasible.

Purpose: To measure radiation doses for computed tomography (CT) of the head, chest, and abdomen and compare them with the diagnostic reference levels, as part of the International Atomic Energy Agency Research coordination project., Materials and Methods: The local ethics committees of all participating institutions approved the study protocol. Written informed consent was obtained from all patients. All scanners were helical single-section or multi-detector row CT systems. Six hundred thirty-three patients undergoing head (n = 97), chest (n = 243), or abdominal (n = 293) CT were included. Collected data included patient height, weight, sex, and age; tube voltage and tube current-time product settings; pitch; section thickness; number of sections; weighted or volumetric CT dose index; and dose-length product (DLP). The effective dose was also estimated and served as collective dose estimation data., Results: Mean volumetric CT dose index and DLP values were below the European diagnostic reference levels: 39 mGy and 544 mGy . cm, respectively, at head CT; 9.3 mGy and 348 mGy . cm, respectively, at chest CT; and 10.4 mGy and 549 mGy . cm, respectively, at abdominal CT. Estimated effective doses were 1.2, 5.9, and 8.2 mSv, respectively., Conclusion: Comparison of CT results with diagnostic reference levels revealed the need for revisions, partly because the newer scanners have improved technology that facilitates lower patient doses., ((c) RSNA, 2006.)

Exogenous advanced glycation endproducts (AGEs, known atherogenic molecules) abundant in everyday precooked, rich in fat, overheated meals can possibly contribute to the increased risk for diabetes and cardiovascular disease in women with polycystic ovary syndrome (PCOS). The aim of the present study was to investigate the effect of a lipase inhibitor on absorbed food glycotoxins in healthy women and those with PCOS. A 2-day protocol was followed. In the first day, a meal rich in AGE was provided, which on the second day was followed by two 120-mg capsules of lipase inhibitor, orlistat. Serum AGE levels were evaluated at baseline (0 hours), and at 3 and 5 hours postmeal during the study. Thirty-six women were studied, 15 controls (mean age, 28.80 +/- 5.47 years; body mass index, 25.85 +/- 6.73 kg/m(2)) and 21 with PCOS (mean age, 25.29 +/- 5.06 years; body mass index, 30.40 +/- 7.51 kg/m(2)) (University Hospital, Athens, Greece, institutional practice). Serum AGE levels, on day 1, were significantly increased both in the control group and in the PCOS group as compared with basal values (control group, 14.1%; PCOS group, 6.0%; P < .001). The corresponding rise was significantly lower on day 2 when the same meal was combined with orlistat (control group, 4.1%; PCOS group, 2.0%; P < .01). A limitation of the study is that it is a nonplacebo, nonrandomized therapeutic trial where each subject is considered as its own control. In conclusion, this study demonstrated the beneficial effect of orlistat on the absorption of food glycotoxins.

The most common hormonal disorder that infertile women suffer from is hyperandrogenemia, a disorder believed to show its first signs even from puberty. We discuss the impact of hyperandrogenemia on the normal ovary as well as its potential role and contribution to anovulation and infertility. The early diagnosis and management of hyperandrogenemia in women has been proved to be essential for their health and fertility.

The administration of recombinant human erythropoietin (rhEPO) increases the maximum oxygen consumption capacity, and is therefore abused as a doping method in endurance sports. The detection of erythropoietin (EPO) abuse is based on direct pharmacological and indirect haematological approaches, both of which have several limitations. In addition, current detection methods cannot cope with the emerging doping strategies of EPO mimicry, analogues and gene doping, and thus novel detection strategies are urgently needed. Direct detection methods for EPO misuse can be either pharmacological approaches that identify exogenous substances based on their physicochemical properties, or molecular methods that recognise EPO transgenes or gene transfer vectors. Since direct detection with molecular methods requires invasive procedures, it is not appropriate for routine screening of large numbers of athletes. In contrast, novel indirect methods based on haematological and/or molecular profiling could be better suited as screening tools, and athletes who are suspect of doping would then be submitted to direct pharmacological and molecular tests. This article reviews the current state of the EPO doping field, discusses available detection methods and their shortcomings, outlines emerging pharmaceutical and genetic technologies in EPO misuse, and proposes potential directions for the development of novel detection strategies.

Five cases (5.5%) of lymphocysts were diagnosed and treated, among 80 type III modified radical hysterectomies performed for cervical cancer St. Ia2-IIa, in the last 6 years. Identification was initially made by palpation and confirmed by CT or US, in 4/5 cases in the first 2 postoperative months. Pelvic pain, fever and pressure symptoms were the most common clinical findings. A conservative approach was successful in 4/5 cases. Spontaneous regression was observed in one, while needle aspiration under radiologic guidance with (1/3) or without (2/3) tube insertion was applied in the rest. Conservative treatment failed in the last case presenting with a 12 cm cyst. An intestinal fistula developed, necessitating partial resection of the ileus and marsipulization. The complicated course of this patient's disease may indicate that a more aggressive treatment is warranted for large persisting cysts located in the irradiated field.

Magnetic resonance imaging (MRI) features in a case of malignant glomus jugulare tumour are reported. Chemodectomas are benign in 95 per cent of cases and malignant in five per cent. Only one case report of CT findings in this unusual CP angle tumour with pulmonary metastases has been cited in the literature. It is concluded that MRI can provide useful information about the nature of chemodectomas although it cannot distinguish between benign and malignant tumours, except when regional lymph nodes are involved or when distant metastases exist.

The principal features of computed tomography in hydatid disease of the lungs were reviewed in ten patients with surgically verified hydatid disease of the lungs. On the basis of localization and multiplicity, hydatid cysts of the lungs can be classified in three distinct categories: single unilateral unilocular cysts with or without daughter cysts, unilateral multiple cysts with or without daughter cysts, and bilateral multiple cysts. Cystobronchial communication may lead to cavitary lesions, while infection of the cyst may alter the attenuation values and produce a solid appearance. On the basis of density and clinical symptoms, hydatid cysts of the lungs can be classified as simple cysts, complicated cysts, and ruptured cysts, including cystobronchial communication.