Whole-body biodistribution and radiation dosimetry of [18F]PR04.MZ: a new PET radiotracer for clinical management of patients with movement disorders

Purpose [18F]PR04.MZ is a new PET imaging agent for dopamine transporters, providing excellent image quality and allowing for the evaluation of patients with movement disorders such as Parkinson’s disease. The objective of this study was to evaluate the biodistribution and radiation dosimetry of [18F]PR04.MZ by serial PET imaging. Methods Six healthy subjects (n = 3 males, n = 3 females) were enrolled in this study. A series of 14 whole-body PET/CT scans were acquired until 5.5 h post-injection of 200 ± 11 MBq of [18F]PR04.MZ. After rigid co-registration, volumes of interest were outlined either on CT or PET images. Time-integrated activity coefficients were calculated for selected source organs. Organ absorbed doses, and the effective dose were calculated using IDAC-Dose 2.1. Results Physiological uptake of [18F]PR04.MZ was mainly observed in the striatum, brain, liver, gall bladder, intestine, red marrow and cortical bone. [18F]PR04.MZ was primarily excreted via hepatobiliary clearance and, to a lower extent, via renal clearance. The normalized absorbed doses were highest in gall bladder wall (32.2 ± 6.4 µGy/MBq), urinary bladder wall (27.2 ± 4.5 µGy/MBq), red marrow (26.5 ± 1.4 µGy/MBq), cortical bone surface (26.3 ± 2.5 µGy/MBq), liver (22.5 ± 1.8 µGy/MBq) and kidneys (21.8 ± 1.1 µGy/MBq). The effective dose according to ICRP 60 and 103 was 16.3 ± 1.1 and 16.6 ± 1.5 µSv/MBq, respectively. Conclusion [18F]PR04.MZ has a favourable dosimetry profile, comparable to those of other 18F-labelled PET tracers, and is suitable for larger clinical applications. Trial registration CEC SSM Oriente, Santiago, Chile, permit 20140520.

Correlation of Bladder Wall Endometriosis Histological Location, To Infertility Patients’ Clinical Characteristics and Severity of Peritoneal Endometriosis

Study question: What is the correlation of bladder wall endometriosis histological location, to the severity of peritoneal endometriosis in infertility patients? Summary answer: Secondary infertility, back pain, micturition problems, history of ectopic pregnancy and number of abortions can probably be considered as high-risk factors for bladder wall endometriosis for infertility patients. What is known already: Bladder and/or ureter endometriosis occur in 70–85% among patients with deep infiltrating endometriosis. The knowledge regarding the bladder wall involvement with endometriosis in association to peritoneal endometriosis and infertility patients’ clinical characteristics is limited. Study design, size, duration: Retrospective, longitudinal cohort, Sixty-six, primary and secondary infertility patients, collection of surgical and clinical data between 2010 to 2018. Participants/materials, setting, and methods: An experienced histopathologist on endometriosis was asked to review all the patients’ histopathological results. The histopathological reported findings were reviewed prior to the study to reassure the bladder wall depth of endometriosis involvement. The operation and tissue macroscopic description reports before processing were also reviewed. Attention was paid for possible discrepancies or missed important data that could influence the histopathological results. In cases where results were equivocal, the paraffin blocks were available for additional sections for reassuring the diagnosis. An extra effort was made to meticulously observe and identify the involvement of the bladder serosa, muscularis and mucosa with endometriotic cells and glands. Main results and the role of chance: Primary infertility was the indication for the current laparoscopic surgeries in 32 out of 66 (48.5%) patients and secondary infertility for the rest of the group. The highest incidence of bladder endometriosis (BE) was detected on the serosa of 12 patients and in the detrusor muscle (DM) of 11 cases. Bladder serosa endometriosis (BSE) was significantly more prominent among patients with history of ectopic pregnancy (p=0.004) and among patients with secondary infertility (p=0.029). Destrusor muscle endometriosis (DME) was significantly more frequent (p=0.012) in patients with increasing number of abortions. DME highest rates of 37.7% were observed among the severe spread of abdominal endometriosis as compared to 19% of the cases with bladder serosa endometriosis. No statistically significant difference found between serosa and detrusor muscle endometriosis involvement, when compared to severity and spread of endometriosis within the abdominal cavity. Back pain was most prominent with statistical significant difference (p=0.007) in 8 patients with BSE + DME as compared with other groups of patients (4 BSE, 3 DME and 3 BME+DME patients). Among 30 cases with an ovarian endometrioma detected by TVU, DME was diagnosed in 13 patients, in serosa of 10, and in serosa and DM of 6 patients. Statistical analysis was performed using Pearson chi-square, Fisher’s exact tests and the Kruskal-Wallis test by STATA version 15 SE (StataCorp. 2017). Limitations, reasons for caution: This is a cohort retrospective study. There is a possibility that other areas with endometriosis were also involved in the BW other than those diagnosed and treated. The mixture of patients with primary and secondary infertility could also affect the results, although statistical analysis did not show any significance in BWE, clinical symptoms and surgical findings. BE is rarely an isolated condition, and other forms of endometriosis are frequently concomitant Wider implications of the findings: Detrusor muscle endometriosis involvement was in 68% and bladder serosa in 32% of all cases with bladder endometriosis and infertility investigated. The severity of the peritoneal endometriosis can probably direct to meticulous intraoperative investigation for bladder endometriosis.

Pilimiction, A Rare Presentation of Ovarian Teratoma: A Case Report

Background: Adnexal teratoma involving the urinary bladder is a very rare condition. Presentation is variable ranging from irritative LUTS (lower urinary tract symptoms) to pilimiction or trichiuria (passage of hair in the urine).Case presentation: We report a case of a 42-year-old woman who presented with pilimiction and lower abdominal pain. Contrast-enhanced computed tomography scan (CECT) and Cystoscopy were used for the diagnosis. Tumor markers were negative. Right side salpingo-oophorectomy and partial bladder wall excision were performed. Histopathology of the specimen showed features consistent with mature teratoma. The Patient-reported improvement of symptoms in the subsequent follow-up visits.Conclusion: Pilimiction is a pathognomonic sign of bladder teratomas. Therefore, it is wise to think of this pathology in patients who report the passage of hair through the urine (trichiuria or pilimiction), as in our case. Cystoscopy and cross-sectional imaging aided in the initial diagnosis. However, a definitive diagnosis was provided by histopathology.We performed right-side salpingo-oophorectomy and partial cystectomy. Transurethral resection is associated with a high recurrence rate and is not recommended for secondary bladder teratomas.

Case Report: Anaesthetic Management of Placenta Percreta

Background: The placenta is a complicated organ and is partially understood. It is the essential part for physiological changes leading to a successful pregnancy. Placenta percreta is the most severe and least common form of placenta accreta in which villi penetrate the entire myometrial thickness and reach or traverse the serosa to encroach adjacent organs. Patients with placenta percreta are at a greater risk of life-threatening perioperative bleeding as well as massive and deadly thromboembolic events. Case report: Our patient was a 34-year-old gravida 5female who underwent elective cesarean section at 37 weeks of gestation with a diagnosis of placenta accreta or percreta. Intraoperative findings showed placenta percreta with bladder wall involvement. Hence, hysterectomy was done. Anticipated intraoperative haemorrhage and hemodynamic instability were managed properly. Discussion: Placenta percreta is the most serious among abnormal placentation, sometimes leading to catastrophic blood loss and very high maternal mortality and morbidity up to 10%. The most important risk factor in placenta percreta is placenta previa (low lying placenta) after cesarean delivery. Our patient met all these risk factors. Prenatal diagnosis of an invasive placenta is paramount for reducing maternal morbidity and mortality by implementing a multidisciplinary approach. Keywords: haemorrhage, placenta percreta, hysterectomy, high-risk pregnancy.

Malakoplakia of the urinary bladder in a young French Bulldog

CASE DESCRIPTION A 4-month-old 5.9-kg sexually intact female French Bulldog was presented because of recurrent urinary tract infections in combination with pollakiuria, hematuria, and urinary incontinence. CLINICAL FINDINGS A diagnosis of malakoplakia was made on the basis of results of hematologic and serum biochemical testing, abdominal ultrasonography, bacterial culture, and cystoscopic biopsies of the urinary bladder wall. Biopsy samples were sent for routine histologic examination and fluorescence in situ hybridization to confirm the presence of intracellular and subendothelial bacteria. TREATMENT AND OUTCOME Treatment with enrofloxacin was started after the diagnosis of malakoplakia was confirmed. During treatment, polypoid changes in the urinary bladder decreased dramatically but did not disappear. On follow-up ultrasonography after 12 weeks of treatment, marked improvement was visible and results of repeated bacterial culture and fluorescence in situ hybridization of bladder wall samples were negative. The patient was free from clinical signs and had an ultrasonographically normal urinary bladder 59 weeks after antimicrobial treatment was discontinued. CLINICAL RELEVANCE Malakoplakia, a granulomatous disease characterized by impaired histiocytes that are unable to completely digest phagocytized bacteria, is a very rare disease in dogs, but early suspicion of the condition is essential to allow timely diagnosis and avoid disease progression and the need for prolonged treatment. Malakoplakia should be considered in young dogs with chronic urinary tract infections; the diagnosis can be made through a combination of histologic examination and fluorescence in situ hybridization of bladder wall biopsy samples.

18F-FDG PET/CT in a Case of Urothelial Carcinoma in the Urachus Presenting as Colon Cancer

Urachal cancer arises from an embryologic remnant of the urogenital sinus and allantois and accounts for approximately 1% of bladder malignancies. The most encountered histologic subtype is adenocarcinoma. We present a 76-year-old man suspected to have an advanced sigmoid cancer infiltrating nearby organs. A supplemental 18F-FDG PET/CT showed high tracer uptake in a tumorous process coherent with the dome of the bladder wall involving the sigmoid colon. Cystoscopy revealed a normal bladder wall, except for a small edematous area in the anterior bladder. Biopsies from the sigmoid colon and transurethral resection from the bladder confirmed a urothelial carcinoma originating from the urachus.

Improved bladder contractility after transplantation of human mesenchymal stem cells overexpressing hepatocyte growth factor into underactive bladder from bladder outlet obstruction models of rats

Introduction An underactive bladder can lead to difficulty in voiding that causes incomplete emptying of the bladder, suggesting the need for a new strategy to increase bladder contractility in such patients. This study was performed to investigate whether human mesenchymal stem cells (hMSCs) were capable of restoring bladder contractility in rats with underactive bladder due to bladder outlet obstruction (BOO) and enhancing their effects by overexpressing hepatocyte growth factor (HGF) in hMSCs. Materials and methods The hMSCs were transplanted into the bladder wall of rats. Fifty female Sprague-Dawley rats at six weeks of age were divided into five groups: group 1: control; group 2: sham intervention; group 3: eight-week BOO; group 4: BOO rats transplanted with hMSCs; and group 5: BOO rats transplanted with hMSCs overexpressing HGF. Two weeks after the onset of BOO in groups 4 and 5, hMSCs were injected into the bladder wall. Cystometry evaluation was followed by Masson’s trichrome staining of bladder tissues. Realtime PCR and immunohistochemical staining were performed to determine for hypoxia, apoptosis, and angiogenesis. Results Collagen deposition of bladder increased in BOO but decreased after transplantation of hMSCs. The increased inter-contraction interval and residual urine volume after BOO was reversed after hMSCs transplantation. The decreased maximal voiding pressure after BOO was restored by hMSCs treatment. The mRNA expression of bladder collagen1 and TGF-β1 increased in BOO but decreased after hMSCs transplantation. The decrease in vWF-positive cells in the bladder following BOO was increased after hMSCs transplantation. Caspase 3 and TUNEL-positive apoptosis of bladder cells increased in BOO but decreased after transplantation of hMSCs. These effects were enhanced by overexpressing HGF in hMSCs. Conclusion Transplantation of hMSCs into bladder wall increased the number of micro-vessels, decreased collagen deposition and apoptosis of detrusor muscle, and improved bladder underactivity. The effects were enhanced by overexpressing HGF in hMSCs. Our findings suggest that the restoration of underactive bladder using hMSCs may be used to rectify micturition disorders in patients following resolution of BOO. Further studies are needed before hMSCs can be used in clinical applications.

Rare Presentation of Gall Bladder Adenomyomatosis

Introduction: Adenomyomatosis is a benign alterations of gall bladder wall that can be found in 9% of patients. We present a case of gall bladder adenomyomatosis of young male presented with right upper quadrant pain. Case Report: A 22 year old male admitted with a history of pain over right upper quadrant for 8 months. The patient’s physical examination revealed tenderness over the right hypochondrium region. Contrast enhanced computed tomography showed - gall bladder wall appeared diffusely thickened with multiple small cystic areas noted. Conclusion: Symptomatic gall bladder adenomyomatosis is an indicator for cholecystectomy, which results in complete disappearance of symptoms. Asymptomatic cases are not an indication for surgery, but the radiological diagnosis must be beyond any doubt. If there is a any diagnostic doubt about the possibility of gall bladder cancer, a cholecystectomy is justified.

Application of improved percutaneous cystolithotripsy in patients with benign prostatic hyperplasia

Introduction. The article presents an improved method of percutaneous cystolithotripsy. The results of its application are described and a comparison is made with the traditional method of transurethral cystolithotripsy with lithoextraction. The study objective is development of a comprehensive method of treating patients with bladder stones arising against the background of bladder outlet obstruction caused by benign prostatic hyperplasia (BPH), assessment of its effectiveness and safety.Materials and methods. The treatment was carried out in 56 patients with bladder stones arising on the background of BPH at the age from 42 to 89 years. According to the proposed method, 20 patients with BPH (main group) were operated on. Transurethral cystolithotripsy (control group) was performed in 36 patients. The results of the performed operations were compared with each other.Results. According to the comparison results, it is noted that the proposed method of percutaneous cystolithotripsy is performed faster and more efficiently, due to the fixation of the calculus in the basket. Due to the presence of a laparoscopic bag that completely isolates the stone from the bladder wall, there were no intraoperative complications. Drug therapy made it possible to quickly level the symptoms of cystitis. The patients were discharged 4-6 days after surgery with a cystostomy, which was removed after treatment for BPH.Conclusion. The proposed complex treatment of patients with bladder stones on the background of BPH is a safe method and has clear advantages over traditional transurethral, contact cystolithotripsy with lithoextraction.