BackgroundCerebral amyloid angiopathy-related inflammation (CAAri) is a subtype of cerebral amyloid angiopathy (CAA) characterised by an autoimmune reaction to cerebrovascular beta-amyloid deposits. ...There is a broad spectrum of clinical presentations which can include headache, cognitive or behavioural change, focal deficit, and seizures.Case DescriptionA 58-year-old male presented with subacute headache associated with minor cognitive difficulties. Symptoms were steroid responsive. Imaging demonstrated left occipital lobe oedema with associated pachymeninigeal enhancement as well as scattered periventricular and subcortical white matter changes. CSF was inflammatory with significantly elevated white cell count and protein. A variety of investigations were completed and ultimately, he underwent a brain biopsy which was reported as in keeping with inflammatory amyloid angiopathy.Interestingly, initial MRI did not have any microhaemorrhages and radiologically CAAri was not considered a differential. The diagnosis only became clear with the pathology. He has since developed microhaem- orrhages on imaging and would now meet radiological criteria. Neurologically he is stable and remains on treatment with prednisolone and mycophenolate.DiscussionWe present a case of CAAri (confirmed on biopsy) comparing the clinical and radiological features to those in the literature. Observational studies suggest a favourable response to early immuno- therapy (as in this case); however, management is challenging due to lack of randomised control trial evidence.
We update the prior standard operating procedure for magnetic resonance imaging of the prostate, and summarize the available data about the technique and clinical use for the diagnosis and management ...of prostate cancer. This update includes practical recommendations on the use of magnetic resonance imaging for screening, diagnosis, staging, treatment and surveillance of prostate cancer.
A panel of clinicians from the American Urological Association and Society of Abdominal Radiology with expertise in the diagnosis and management of prostate cancer evaluated the current published literature on the use and technique of magnetic resonance imaging for this disease. When adequate studies were available for analysis, recommendations were made on the basis of data and when adequate studies were not available, recommendations were made on the basis of expert consensus.
Prostate magnetic resonance imaging should be performed according to technical specifications and standards, and interpreted according to standard reporting. Data support its use in men with a previous negative biopsy and ongoing concerns about increased risk of prostate cancer. Sufficient data now exist to support the recommendation of magnetic resonance imaging before prostate biopsy in all men who have no history of biopsy. Currently, the evidence is insufficient to recommend magnetic resonance imaging for screening, staging or surveillance of prostate cancer.
Use of prostate magnetic resonance imaging in the risk stratification, diagnosis and treatment pathway of men with prostate cancer is expanding. When quality prostate imaging is obtained, current evidence now supports its use in men at risk of harboring prostate cancer and who have not undergone a previous biopsy, as well as in men with an increasing prostate specific antigen following an initial negative standard prostate biopsy procedure.
To compare the diagnostic accuracy and safety of a 14-gauge core needle versus a 22-gauge fine needle in the evaluation of thoracic lesions by CT-guided percutaneous transthoracic needle biopsy ...(TTNB).
Medical charts of all patients who underwent CT-guided percutaneous transthoracic core-needle biopsies (CNBs) with a 14-gauge Spirotome device (99 patients, 102 procedures) and fine-needle biopsies (FNBs) with a 22-gauge Rotex needle (92 patients, 102 procedures) between 2007 and 2013 at a single academic institution were retrospectively reviewed. Variables that could influence diagnostic accuracy and safety were collected.
The overall and cancer-specific diagnostic accuracy rates were 90% and 94%, respectively, with CNB, versus 82% and 89% with FNB. Precise cancer type/subtype was provided by 97% of CNBs versus 65% of FNBs (P < .001). In patients with lung cancer considered for targeted therapy, biomarker analyses were feasible in 80% of CNBs versus 0% of FNBs (P < .001). The rate of pneumothorax was significantly higher with CNB versus FNB (31% vs 19%; P = .004), but chest tube insertion rates were similar (10% vs 11%, respectively). Major bleeding complications occurred in 1% of CNBs versus 2% of FNBs and were associated with one death in the CNB group.
Percutaneous transthoracic CNB with a 14-gauge Spirotome needle provided better characterization of cancer lesions and allowed biomarker analyses without a significant increase in major procedural complications.
Objective
To evaluate the clinical and financial implications of a decade of prostate biopsies performed in the UK National Health Service (NHS) through the transrectal (TR) vs the transperineal (TP) ...route.
Methods
We conducted an evaluation of the TR vs the TP biopsy approach in the context of 28 days post‐procedure complications and readmissions. A secondary evaluation of burden of expenditure in NHS hospitals over the entire decade (2008–2019) was conducted through examination of national Hospital Episode Statistics (HES) data.
Results
In this dataset of 486 467 prostate biopsies (387 879 TR and 98 588 TP biopsies), rates of infection and sepsis were higher for the TR compared to the TP cohort (0.53% vs 0.31%; P < 0.001, confidence interval 99% ). Rates of sepsis have more than doubled for TR biopsies in the last 2 years compared to the previous decade (1.12% vs 0.53%). Infective complications were the main reasons for readmissions in the TR cohort, whereas urinary retention was the predominant reason for readmission in the TP cohort. Over the last decade, non‐elective (NEL) readmissions seem higher for the TP group; however, in the last 2 years these have reduced compared to the TR group (3.54% vs 3.74%). The cost estimates for NEL readmissions for the entire decade were £33,589,527.00 and £7,179,926.00 respectively, for TR and TP cohorts (P < 0.001). Estimated costs per patient readmission were £2,225.00 and £1,758.00 in the TR and TP groups (P < 0.001).
Conclusions
Evaluation of nearly half a million prostate biopsies in the NHS over the entire decade gives sufficient evidence for the distinct advantages of the TP route over the TR route in terms of reduced infections and burden of expenditure. In addition, there is a potential for savings both in upstream and downstream costs if biopsy is performed under a local anaesthetic.
Background
While the majority of bleeding complications after a percutaneous kidney biopsy (PKB) occur early (≤24 h), delayed onset bleeding complications (>24 h) have been rarely reported and can be ...catastrophic for the patient.
Purpose
To describe the incidence, risk factors, and outcomes of delayed bleeding complications after PKB.
Material and Methods
We retrospectively studied native and graft kidney biopsies in patients who developed delayed bleeding complications (>24 h) after the biopsy performed in the Department of Nephrology and Renal Transplantation of a tertiary care medical institution in north India between January 2014 to December 2018.
Results
Of the 4912 renal biopsies reviewed, 20 patients (16 men, 4 women; 0.40%) had a delayed biopsy bleeding complication. Of these patients, 95% had major bleeding complications requiring blood transfusions and 85% needed intervention like gelfoam/coil embolization. Despite intervention, one patient (5%) had mortality due to complications of bleeding and sepsis. When compared to a control group of patients with early biopsy bleed, patients with the delayed biopsy bleed had similar demographic and clinical profiles except for higher pre-biopsy hemoglobin and lower systolic and diastolic blood pressure.
Conclusion
A post-PKB delayed onset bleed is not uncommon, and the vast majority of these patients had major bleeding complications requiring blood transfusions and/or intervention like embolization. They had a similar demographic and clinical profile presentation as early bleed patients. Meticulous outpatient monitoring and patient education after discharge may be useful to detect this complication promptly and to intervene early to have good patient outcome.
This meta-analysis was conducted to compare the safety and diagnostic performance between computed tomography (CT)-guided core needle biopsy (CNB) and fine-needle aspiration biopsy (FNAB) in lung ...nodules/masses patients.
All relevant studies in the Pubmed, Embase, and Cochrane Library databases that were published as of June 2020 were identified. RevMan version 5.3 was used for all data analyses.
In total, 9 relevant studies were included in the present meta-analysis. These studies were all retrospective and analyzed outcomes associated with 2175 procedures, including both CT-guided CNB (n = 819) and FNAB (n = 1356) procedures. CNB was associated with significantly higher sample adequacy rates than was FNAB (95.7% vs 85.8%, OR: 0.26; P < .00001), while diagnostic accuracy rates did not differ between these groups (90.1% vs 87.6%, OR: 0.8; P = .46). In addition, no differences in rates of pneumothorax (28.6% vs 23.0%, OR: 1.15; P = .71), hemorrhage (17.3% vs 20.1%, OR: 0.91; P = .62), and chest tube insertion (5.9% vs 4.9%, OR: 1.01; P = .97) were detected between these groups. Significant heterogeneity among included studies was detected for the diagnostic accuracy (I2 = 57%) and pneumothorax (I2 = 77%) endpoints. There were no significant differences between CNB and FNAB with respect to diagnostic accuracy rates for lung nodules (P = .90). In addition, we detected no evidence of significant publication bias.
CT-guided CNB could achieve better sample adequacy than FNAB did during the lung biopsy procedure. However, the CNB did not show any superiorities in items of diagnostic accuracy and safety.
Introduction/PurposeRoutine surgical collection of vessels limits pathophysiological understanding of vascular disorders, particular those of the central nervous system. This problem in turn slows ...the development of diagnostic techniques and therapies. To address this issue, endovascular biopsy techniques have been developed and validated. To refine these techniques, we compared device performance as it relates to the yield of endothelial cells (ECs) harvested from vessels.Materials and methodsCell harvesting procedures performed initially in rabbits and subsequently in humans were analyzed. The number of ECs sampled during each procedure along with subject, device, and technical features were tabulated. Species was noted, as was disease state interrogated, if any. Diseases present included aneurysm, arteriovenous malformation, and extra- and intracranial atherosclerosis. Locations sampled were classified as intracranial, extracranial, and body. Devices from which ECs were sampled included microwires, angioplasty balloons, stent delivery catheters, coils, Phenox clot retriever (PCR), retrievable stents, and vascular plug devices. For devices with roughly cylindrical shape that contacts the vessel wall (balloons, PCRs, stentrievers), the number of cells harvested per square mm was calculated by the equation, cells/(π*width*length). Chi-square analysis was performed to compare means of ECs harvested between the above-listed variables.Results70 sampling procedures were performed, 33 in rabbits and 37 in humans. Normal vessels were sampled in 25 cases. ECs were sampled in 24 aneurysms, 14 arteriovenous malformations, 4 extracranial atherosclerotic lesions, and 3 intracranial plaques. Mean ECs collected by device type are summarized in Table 1. No differences were found for species, location, or pathology. PCRs and stentrievers yielded more ECs than other types of devices, χ²(1, N = 70) = 55.06, p = 0.001. Among cylindrical devices, no difference was noted in EC yield or EC/mm2. PCR devices were deployed in vessels with smaller diameters (1-3 mm) compared to balloons and stentrievers (4-8 mm).ConclusionAmong devices studied for EC harvesting, PCRs and stentrievers yield more cells than other devices. PCRs appear more suitable for harvesting ECs in small vessels, while stentrievers are better for harvesting from large vessels. Further study of these devices for EC sampling is warranted to initiate and refine its use in humans for this purpose.Abstract E-068 Table 1 ECs by Device Device n Mean ECs Harvested Mean ECs/mm2 Balloon 8 4.5 0.017 Catheter 2 7.0 n/a Coil 45 5.3 n/a Microwire 2 4.0 n/a PCR 2 42 0.88 Plug 3 2.7 n/a Stentriever 8 350 1.3 Disclosures: M. Alexander: 1; C; Joe Niekro Foundation Research Award. R. Darflinger: None. H. McGregor: None. M. Conrad: None. Z. Sun: None. D. Cooke: 1; C; SNIS Foundation Research Grant, Joe Niekro Research Grant.
Gap junctions (GJs) enable intercellular communication between adjacent cells through channels of connexins. Using a three-dimensional construct, we previously showed that endothelial and tumor cells ...formed GJs, allowing melanoma-specific T lymphocytes to recognize and kill melanoma-derived endothelial cells. We demonstrate here on histological sections of melanoma biopsies that GJ formation occurs in vivo between tumor and endothelial cells and between T lymphocytes and target cells. We also show an in vitro increase of GJ formation in melanoma and endothelial cells following dacarbazin and interferon gamma (IFN- gamma ) treatment or hypoxic stress induction. Our data indicate that although connexin 43 (Cx43), the main GJ protein of the immune system, was localized at the immunological synapse between T lymphocyte and autologous melanoma cells, its over-expression or inhibition of GJs does not interfere with cytotoxic T lymphocyte (CTL) clone lytic function. In contrast, we showed that inhibition of GJs by oleamide during stimulation of resting PBMCs with Melan-A natural and analog peptides resulted in a decrease in antigen (Ag) specific CD8 super(+) T lymphocyte induction. These Ag-specific CD8 super(+) cells displayed paradoxically stronger reactivity as revealed by CD107a degranulation and IFN- gamma secretion. These findings indicate that Cx43 does not affect lytic function of differentiated CTL, but reveal a major role for GJs in the regulation of antigen CD8 super(+)-naive T lymphocyte activation. Key message: GJ formation occurs in vivo between T lymphocytes and tumor cellsCx43 localized at the immunological synapse between T and autologous melanoma cellsInhibition of GJs resulted in a decrease in Ag-specific CD8 super(+) T lymphocyte inductionA role for GJs in the regulation of antigen CD8 super(+)-naive T lymphocyte activation
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