Background: Diffusion-tensor (DT) magnetic resonance imaging (MRI) has the po tential to elucidate some characteristics of tissue microstructure inaccessible to other MRI techniques. Objective: To investigate whether ...Background: Diffusion-tensor (DT) magnetic resonance imaging (MRI) has the po tential to elucidate some characteristics of tissue microstructure inaccessible to other MRI techniques. Objective: To investigate whether normal-appearing bra in tissue abnormalities occur in patients with multiple sclerosis at the earlies t clinical stage and whether their severity is predictive of a short-term disea se evolution by using DT MRI. Design: Forty-five patients and 22 healthy contro l subjects were studied. All patients had had a clinically isolated syndrome wit hin the 3 months preceding study enrollment and paraclinical evidence of disease dissemination in space. During a single session, dual-echo, pulsed-gradient s pin-echo echo-planar, and postgadolinium T1-weighted images of the brain were obtained from each subject. In patients, dual-echo and enhanced images were ob tained after 3 and 12 months, to detect MRI signs of disease dissemination in ti me. An on-study neurological examination was also conducted to ascertain the oc currence of clinical relapses. Mean diffusivity and fractional anisotropy maps w ere derived from DT images. Normal-appearing white matter (N-AWM) and normal- appearing gray matter mean diffusivity and fractional anisotropy histograms were produced and analyzed. Results: During the study period, 29 patients showed MRI evidence of disease dissemination in time. When compared with healthy controls, patients showed higher average NAWM mean diffusivity (P=.01), lower average NAW M mean diffusivity peak height (P < .001), and fractional anisotropy (P < .001). The DT MRI characteristics of patients did not differ between those with and those without disease dissemina tion in time at follow-up. Conclusions: In patients with multiple sclerosis at the earliest clinical stage, the severity of NAWM damage does not predict new le sion formation in the short term, suggesting that the “diffuse”component of ti ssue damage is, at least partially, independent of the “discrete,”predominantl y inflammatory aspects of the disease since its clinical onset.展开更多
Objective:To see whether laparoscopy provides exact staging and effective treatment of endometrial cancer patients,compared with total abdominal hysterectomy,with shorter hospital stay,prompter recovery,and better qua...Objective:To see whether laparoscopy provides exact staging and effective treatment of endometrial cancer patients,compared with total abdominal hysterectomy,with shorter hospital stay,prompter recovery,and better quality of life. Method:This retrospective study identified 110 patients scheduled for surgery for early-stage endometrial cancer. Fifty-five (50%)-were treated by laparoscopic-assisted vaginal hysterectomy (LAVH) and 55 (50%) by total abdominal hysterectomy (TAH). All patients underwent pelvic lymphadenectomy. The majority of patients (79%) had stage I disease. Results:The mean number of lymph nodes removed was 17 for the LAVH group and 18.5 for the TAH group (p = 0.294). Compared with TAH,LAVH required a significantly longer operating time (220 vs. 175 min; p < 0.01); but shorter hospital stay (4 vs. 8.5 days; p < 0.001) and less estimated blood loss (177 cm3 vs. 285 cm3; p = 0.02). Overall,there were fewer post- operative complications in the LAVH group (6 vs. 11 cases; p < 0.001). Three TAH patients (5.4%) had recurrence of disease. No LAVH patients had recurrences and all are currently disease-free. Conclusion:These findings suggest LAVH gives correct staging of endometrial disease,like TAH,but with fewer complications and a slightly longer operating time.展开更多
Cervical cord magnetization transfer ratio (MTR) histograms were obtained from 45 patients at presentation with clinically isolated syndromes (CIS) suggestive ofmultiple sclerosis (MS). The mean values of MTR histogra...Cervical cord magnetization transfer ratio (MTR) histograms were obtained from 45 patients at presentation with clinically isolated syndromes (CIS) suggestive ofmultiple sclerosis (MS). The mean values of MTR histogram derived metrics were not different between CIS patients and healthy control subjects or between patients with and without evidence of disease dissemination in time. Only three patients showed significantly lower cord MTR values than control subjects. These findings suggest the absence of intrinsic structural damage of the cervical cord soon after the onset of CIS suggestive of MS, even in those patients with an early evolution to MS.展开更多
文摘Background: Diffusion-tensor (DT) magnetic resonance imaging (MRI) has the po tential to elucidate some characteristics of tissue microstructure inaccessible to other MRI techniques. Objective: To investigate whether normal-appearing bra in tissue abnormalities occur in patients with multiple sclerosis at the earlies t clinical stage and whether their severity is predictive of a short-term disea se evolution by using DT MRI. Design: Forty-five patients and 22 healthy contro l subjects were studied. All patients had had a clinically isolated syndrome wit hin the 3 months preceding study enrollment and paraclinical evidence of disease dissemination in space. During a single session, dual-echo, pulsed-gradient s pin-echo echo-planar, and postgadolinium T1-weighted images of the brain were obtained from each subject. In patients, dual-echo and enhanced images were ob tained after 3 and 12 months, to detect MRI signs of disease dissemination in ti me. An on-study neurological examination was also conducted to ascertain the oc currence of clinical relapses. Mean diffusivity and fractional anisotropy maps w ere derived from DT images. Normal-appearing white matter (N-AWM) and normal- appearing gray matter mean diffusivity and fractional anisotropy histograms were produced and analyzed. Results: During the study period, 29 patients showed MRI evidence of disease dissemination in time. When compared with healthy controls, patients showed higher average NAWM mean diffusivity (P=.01), lower average NAW M mean diffusivity peak height (P < .001), and fractional anisotropy (P < .001). The DT MRI characteristics of patients did not differ between those with and those without disease dissemina tion in time at follow-up. Conclusions: In patients with multiple sclerosis at the earliest clinical stage, the severity of NAWM damage does not predict new le sion formation in the short term, suggesting that the “diffuse”component of ti ssue damage is, at least partially, independent of the “discrete,”predominantl y inflammatory aspects of the disease since its clinical onset.
文摘Objective:To see whether laparoscopy provides exact staging and effective treatment of endometrial cancer patients,compared with total abdominal hysterectomy,with shorter hospital stay,prompter recovery,and better quality of life. Method:This retrospective study identified 110 patients scheduled for surgery for early-stage endometrial cancer. Fifty-five (50%)-were treated by laparoscopic-assisted vaginal hysterectomy (LAVH) and 55 (50%) by total abdominal hysterectomy (TAH). All patients underwent pelvic lymphadenectomy. The majority of patients (79%) had stage I disease. Results:The mean number of lymph nodes removed was 17 for the LAVH group and 18.5 for the TAH group (p = 0.294). Compared with TAH,LAVH required a significantly longer operating time (220 vs. 175 min; p < 0.01); but shorter hospital stay (4 vs. 8.5 days; p < 0.001) and less estimated blood loss (177 cm3 vs. 285 cm3; p = 0.02). Overall,there were fewer post- operative complications in the LAVH group (6 vs. 11 cases; p < 0.001). Three TAH patients (5.4%) had recurrence of disease. No LAVH patients had recurrences and all are currently disease-free. Conclusion:These findings suggest LAVH gives correct staging of endometrial disease,like TAH,but with fewer complications and a slightly longer operating time.
文摘Cervical cord magnetization transfer ratio (MTR) histograms were obtained from 45 patients at presentation with clinically isolated syndromes (CIS) suggestive ofmultiple sclerosis (MS). The mean values of MTR histogram derived metrics were not different between CIS patients and healthy control subjects or between patients with and without evidence of disease dissemination in time. Only three patients showed significantly lower cord MTR values than control subjects. These findings suggest the absence of intrinsic structural damage of the cervical cord soon after the onset of CIS suggestive of MS, even in those patients with an early evolution to MS.
