As dores lombares acometem a maioria dos atletas, inclusive os equinos. Somente o exame clínico não é suficiente para identificar a localização exata do foco doloroso. O diagnóstico definitivo só é atingido através da utilização dos meios diagnósticos complementares, neste caso, a ultrassonografia. Caso sejam constatadas anomalias discal lombossacras e/ou artropatias ITLS e/ou SI, o veterinário ainda não é capaz de quantificar a influência destas sobre o desempenho atlético do cavalo de esporte. Face a esta dúvida, objetivou-se estabelecer uma relação entre os achados dos exames físicos e ultrassonográficos, executados em 200 cavalos atletas, de quatro raças diferentes (Trote Francês, Quarto de Milha, Puro Sangue Inglês e Cavalos de Sela Francesa e Brasileiro de Hipismo). Todos os animais estavam em treinamento, participando de provas, e não apresentavam claudicação. Após exame físico, os animais foram avaliados ultrassonograficamente, por via transretal, para visualização do aspecto ventral do disco LS (L6-S1), das articulações intertransversas (ITLS) e sacroilíacas (SI), direitas e esquerdas. Para a avaliação transretal os animais foram colocados em tronco de contenção, não tendo sido observada necessidade de sedação ou emprego de outros métodos físicos. Ato contínuo foi introduzido um transdutor linear de 5-7,5 MHz e imagens do disco lombossacro, das articulações intertransversas lombossacras e sacroilíacas foram obtidas. A determinação do número de animais que apresentavam alterações durante os exames de inspeção, palpação, mobilização e avaliação dinâmica assim como a caracterização dos tipos de anomalias discais (T1, T2, T3 e T4) e artropatias ITLS e SI, sugere que durante a execução do exame físico, cavalos que não apresentem sinais clínicos não devem ser descartados de possuírem algum tipo de anomalia discal lombossacra e/ou atropatias ITLS e/ou SI. Observou-se também que as artropatias SI podem afetar o desempenho dos cavalos de trote atrelado, já para as artropatias ITLS e anomalias LS não houve significância quanto às suas influências aos achados no desempenho. / Back pain affects most athletes, including horses. The clinical examination alone is not sufficient to identify the exact location of the painful focus. The definitive diagnosis is only achieved by using complementary diagnostic tools, in the case of this study the ultrasonography. Lumbosacral anomalies and intertransverse lumbosacral and sacroiliac arthropathies, if detected ultrasonographicaly, do not directly input in loss of performance or locomotor impairment. In order to assess this issue, this study aimed to establish a relationship between the findings of physical and ultrasound examinations, performed on 200 horses athletes, from 4 different breeds, French Trotters, Quarter Horse, Thoroughbred Horses and Show Jumpers. After physical examination, the animals were evaluated by a transrectal approach with ultrasonography and the images collected were, ventral aspect of the disc LS (L6-S1), intertransverse joints (ITLS) and sacroiliac (SI), right and left. To perform this evaluation, the animals were placed in the containment trunk with any sedation methods. Immediately thereafter introduced a 5 - 7.5 MHz linear transducer, images of lumbosacral, intertransverse lombossacral and sacroiliac joints were obtained. The determination of number of animals showing abnormalities during clinical examination of inspection, palpation, mobilization and dynamic examination as well as the characterization of the types of disc anomalies (T1, T2, T3 and T4) and arthropathies ITLS and SI, enabled the realization of the following framework, where even the patient, during the execution of the clinical examination, will not provide a positive signals for certain tests, this does not rule out the possibility it has some kind of anomaly in LS joint and/or arthropathy ITLS and/or SI. It was also observed that the arthropathy of SI can affect the performance of French Trotters, and anomalies of ITLS and LS have no significance or influence on athletic performance.

Background: Transrectal ultrasound is commonly performed in the clinical evaluation of the prostate. Ultrasound-guided randomized sextant biopsy became the standard procedure for the diagnosis of carcinoma of the prostate (CaP). A guided biopsy of sonographically irregular lesions of the prostate is not performed in randomized biopsies. An almost generally accepted opinion is that hypoechoic lesions are suspicious for the presence of CaP. However, the role of prostatic lesions with an echogenicity other than iso- or hypoechoic, e.g. hyperechoic or irregular lesions in relation to CaP is not clear. The intention of the present prospective study was to clarify the role of different prostatic ultrasound findings with a new-generation ultrasound probe in regard to their relevance concerning the presence of cancer. Material and Methods: 265 patients who were referred for prostatic evaluation because of an elevated PSA serum level or a positive digital rectal examination were enrolled in a prospective study. All patients had a systematic ultrasound-guided sextant biopsy of the prostate and a 4-core biopsy of the transition zone. All biopsy cores taken were guided by transrectal ultrasound. In case of a sonographically suspicious lesion, biopsy was always directed into this area. The predominant ultrasound appearance was separately recorded for each core. Results: Carcinoma of the prostate was detected in 87 (32.8%) of the 265 patients. Biopsy cores with isoechoic ultrasound findings revealed CaP in 7.6%. The data for hypoechoic, hyperechoic, mixed-echoic and anechoic lesions were 34.5, 26.9, 21.1 and 0%, respectively. Hypoechoic ultrasound findings were less frequently found in the transition zone of the prostate, but the rate of CaP detection was the same as in the peripheral zone of the prostate. Conclusions:The transrectal ultrasound pattern of the prostate yields important information about the presence of carcinoma of the prostate. Especially hypoechoic lesions indicate the presence of CaP in a significant proportion of cases. However, hyperechoic lesions and lesions of mixed or irregular echogenicity were found to contain cancer in significant numbers as well, and should therefore be considered to be suspicious for cancer when performing transrectal ultrasound of the prostate. Directed biopsy of irregular ultrasound patterns in the prostate seems therefore to be recommendable. / Hintergrund: Der transrektale Ultraschall ist die häufigste bildgebende Untersuchung zur klinischen Beurteilung der Prostata. Zur Diagnostik des Prostatakarzinoms (PCa) hat sich die ultraschallgesteuerte Sextanten-Biopsie als Standardverfahren etabliert. Eine gezielte Biopsie irregulärer Ultraschallbezirke ist hier nicht vorgesehen. Es ist jedoch bekannt, daß sonographisch echoarm erscheinende Areale suspekt für die Präsenz eines PCa sind. Die Wertigkeit nicht einheitlicher oder echoreicher Ultraschallmuster ist jedoch bisher nicht zweifelsfrei geklärt. Ziel der vorliegenden Arbeit war es, mit einem Ultraschallgerät der neuesten Generation die Bedeutung der verschiedenen Ultraschallmuster bezüglich des Vorhandenseins von Prostatakarzinomen zu klären. Material und Methoden: 265 Patienten mit erhöhten PSA-Serumwerten oder suspekten Tastbefunden der Prostata wurden in die prospektive Untersuchung eingeschlossen. Bei allen Patienten wurden systematische, ultraschallgesteuerte Prostatabiopsien, wie in der Sextantenbiopsie vorgesehen, und 4 Zylinder aus der Transitionalzone entnommen. Bei der Biopsie wurde jedoch gezielt die Punktion in Bereichen von – falls vorhanden – irregulärem Ultraschallmuster vorgenommen und das entsprechende Ultraschallbild dokumentiert. Ergebnisse: Bei 87 der 265 Patienten (32,8%) wurden Prostatakarzinome nachgewiesen. Biopsiezylinder aus isodensen Bereichen wiesen in 7,6% ein Prostatakarzinom auf. Die Karzinomhäufigkeit bei Biopsie von echoarmen und echoreichen Arealen sowie von Arealen mit unterschiedlichen Echomustern und von zystischen Arealen wurde mit 34,5, 26,9, 21,1 bzw. 0% ermittelt. Echoarme Befunde wurden seltener in der Transitionalzone nachgewiesen, waren jedoch dort in etwa gleicher Häufigkeit mit einem Karzinom verbunden wie in der peripheren Zone. Schlußfolgerungen: Das transrektale Ultraschallmuster in der Prostata liefert wichtige Hinweise auf das Vorhandensein eines Prostatakarzinoms. Insbesondere echoarme Läsionen deuten auf ein PCa hin. Echoreiche Läsionen und solche mit unterschiedlichen Echomustern enthielten jedoch Karzinome in so bedeutender Anzahl, daß diese Läsionen ebenfalls als karzinomverdächtig eingestuft werden müssen und auch eine gezielte Biopsie dieser Areale im Rahmen der Sextantenbiopsie empfehlenswert erscheint. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Den vanligaste cancerformen hos män är prostatacancer, med 10 000 nya dödsfall årligen. Vid prostatacancerdiagnostik utförs prostata biopsi. För att minska risken för komplikationer i samband med biopsi ges i Sverige en singeldos av antibiotikapreparatet Ciprofloxacin. Andelen bakterier som är resistenta mot ciprofloxacin har ökat. För detektion av genmutationer som orsakar antibiotikaresistens kan droplet digital PCR (ddPCR) användas. Det är en metod som ger en absolut kvantifiering av antalet DNA-sekvenser. Den är baserad på vatten olja-emulsionsdroppsystem.  Syftet med denna studie var att optimera och validera en digital droplet PCR för att detektera och kvantifiera mutationen S83L i gyrA genen från faecesprover, samt att jämföra digital droplet resultat från studieprover med odlingsresultat från resistensbestämning och ration mellan S83L allelen och vildtyps allelen i prover tagna före och efter biopsi. För att optimera och validera metoden användes prover tagna före och efter biopsi från nio patienter som genomgått en transrektal prostatabiopsi och fått en dos antibiotika profylax i samband med ingreppet.  Den optimala annealingtemperaturen bedömdes vara 60°C och den optimala  primer- och probekoncentrationen bestämdes till 1,2 µM respektive 0,4µM. Dessa koncentrationer gav lägst antal falskt positiva droppar. Den minsta detektionsnivån för S83L gyrA (EC40) var 160 kopior/ml och för vildtyps gyrA (EC108) var det 78 kopior/ml. Resultatet från valideringen visade att både vildtyps gyrA och S83L gyrA kunde detekteras och kvantifieras i rektalprover från samtliga patienter. / The most common form of cancer in men is prostate cancer, with 10,000 new deaths annually. In prostate cancer diagnosis, prostate biopsy is performed. To reduce the risk of complications in connection with biopsy, a single dose of the antibiotic drug Ciprofloxacin is given in Sweden. The proportion of bacteria that are resistant to ciprofloxacin has increased. For the detection of gene mutations that cause antibiotic resistance, droplet digital PCR (ddPCR) can be used. It is a method that provides an absolute quantification of a DNA sequence in a sample. It is based on water oil emulsion drop system.  The purpose of this study was to optimize and validate a digital droplet PCR to detect and quantify the S83L mutation in the gyrA gene from faecal samples and to compare digital droplet results from study samples with culture results from resistance determination and the ration between the S83L allele and the wild-type allele in samples taken before and after biopsy. To validate the method, samples taken before and after biopsy were used from nine patients who had undergone a transrectal prostate biopsy and received a dose of ciprofloxacin or trimethoprim in connection with the procedure.  The optimal annealing temperature was determined to be 60 °C and the optimal primer and probe concentrations were determined to be 1.2 µM and 0.4µM, respectively. These concentrations gave the lowest number of false positive droplets. The minimum detection level for S83L gyrA (EC40) was 160 copies/ml and for wild-type gyrA (EC108) it was 78 copies/ml. The results showed that both wild-type gyrA and S83L gyrA could be detected and quantified in rectal samples from all nine patients.

Transition zone biopsies have been found to increase the detection rates of cancer of the prostate in patients with negative digital rectal examination. There are however no data available whether the higher biopsy rate is associated with greater morbidity. The present study was therefore designed to evaluate the complication rate of extended sextant biopsy. In this prospective study, 162 consecutive patients who presented for prostatic evaluation were included. After starting prophylactic antibiotic treatment 48 h prior to the procedure, transrectal ultrasound-guided core biopsies were obtained from each lobe: three each from the peripheral zone (apex, mid-zone and base) and two from the transition zone of each prostatic lobe. In all patients a questionnaire was obtained 10–12 days after the procedure. Major complications occurred in 3 patients. In 2 of the 3 cases major macroscopic hematuria was treated by an indwelling catheter for 1 or 2 days and 1 patient developed fever >38.5°C for 1 day. Minor macroscopic hematuria was present in 68.5% of the patients. In 17.9% of these cases, the hematuria lasted for more than 3 days. Hematospermia was observed in 19.8% and minor rectal bleeding occurred in 4.9%. Ten-core biopsies did not lead to an increase in adverse effects or complications when compared to the results of sextant biopsies reported in the literature. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Prostatacancer är den vanligaste cancerformen hos män. Prostatan tillhör de manliga reproduktionsorganen och producerar bland annat prostataspecifikt antigen (PSA) som kan påvisas i blodet. Förhöjda värden av PSA kan bero på prostatacancer. Transrektalt ultraljuds (TRULS)-ledda systematiska biopsier används i högre frekvens än magnetkamera med riktad biopsi. Röntgensjuksköterskans möte med dessa patienter är före, under och efter bildtagningen med magnetkameran. Syftet var att göra en översikt av den diagnostiska träffsäkerheten för TRULS-ledda systematiska biopsier och magnetresonans (MR)-undersökning med riktade biopsier vid misstanke om prostatacancer. Metoden bestod av en litteraturöversikt med systematisk ansats. Inkluderingskriterier var vetenskapliga artiklar skrivna mellan 2015–2020. Artiklarna skulle vara peer-reviewed och etiskt granskade. Databasen Medline användes till sökningen. Kvalitetsgranskning gjordes med granskningsprotokoll hämtade från Avdelningen för omvårdnad på Hälsohögskolan. I resultatet inkluderades 15 artiklar som visade att skillnaden i den diagnostiska träffsäkerheten för prostatacancer hos män inte var stor mellan metoderna. Däremot hittade MR-undersökning med riktade biopsier större andel kliniskt signifikanta cancrar och mindre del insignifikanta cancrar än vad TRULS-ledda systematiska biopsier gjorde. MR-undersökning med riktad biopsi är en bra metod för att öka träffsäkerheten att hitta kliniskt signifikant cancer. Dock går det inte utesluta TRULS-ledda systematiska biopsier då kontraindikationer och missade cancrar på MR-undersökning med riktade biopsier förkommer. / Prostate cancer is the most common cancer in men. The prostate belongs to the male reproductive organs and produces, among other things, prostate-specific antigen (PSA) that can be detected in the blood. Elevated levels of PSA may be due to prostate cancer. Transrectally ultrasound (TRULS)-guided systemic biopsies are used at higher frequency than magnetic cameras with directed biopsy. The X-ray nurse's meeting with these patients is before, during and after the imaging with the magnetic camera. The aim was to make an overview of the diagnostic accuracy of TRULS guided systematic biopsies and MRI with targeted biopsies on suspicion of prostate cancer. The method consisted of a literature review with systematic approach. Inclusion criteria were scientific articles written between 2015-2020. The articles would be peer-reviewed and ethically approved. The Medline database was used for the search. Quality review was done with review protocols obtained from the Department of Nursing at the School of Health. The result included 15 articles showing that there was no big difference in the diagnostic accuracy of prostate cancer in men between the methods. In contrast, MRI with targeted biopsies found a greater proportion of clinically significant cancers and a smaller proportion of insignificant cancers than TRULS guided systematic biopsies did. MRI with targeted biopsy is a good method for increasing the accuracy of finding clinically significant cancer. However, TRULS guided systematic biopsies cannot be ruled out as contraindications and missed cancers on MRI with targeted biopsies occur.

Transition zone biopsies have been found to increase the detection rates of cancer of the prostate in patients with negative digital rectal examination. There are however no data available whether the higher biopsy rate is associated with greater morbidity. The present study was therefore designed to evaluate the complication rate of extended sextant biopsy. In this prospective study, 162 consecutive patients who presented for prostatic evaluation were included. After starting prophylactic antibiotic treatment 48 h prior to the procedure, transrectal ultrasound-guided core biopsies were obtained from each lobe: three each from the peripheral zone (apex, mid-zone and base) and two from the transition zone of each prostatic lobe. In all patients a questionnaire was obtained 10–12 days after the procedure. Major complications occurred in 3 patients. In 2 of the 3 cases major macroscopic hematuria was treated by an indwelling catheter for 1 or 2 days and 1 patient developed fever >38.5°C for 1 day. Minor macroscopic hematuria was present in 68.5% of the patients. In 17.9% of these cases, the hematuria lasted for more than 3 days. Hematospermia was observed in 19.8% and minor rectal bleeding occurred in 4.9%. Ten-core biopsies did not lead to an increase in adverse effects or complications when compared to the results of sextant biopsies reported in the literature. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

[Truncated abstract] Transrectal ultrasound (TRUS) has become the urologist’s primary tool for diagnosing and staging prostate cancer due to its real-time and non-invasive nature, low cost, and minimal discomfort. However, the interpretation of a prostate ultrasound image depends critically on the experience and expertise of a urologist and is still difficult and subjective. To overcome the subjective interpretation and facilitate objective diagnosis, computer aided analysis of ultrasound images of the prostate would be very helpful. Computer aided analysis of images may improve diagnostic accuracy by providing a more reproducible interpretation of the images. This thesis is an attempt to address several key elements of computer aided analysis of ultrasound images of the prostate. Specifically, it addresses the following tasks: 1. modelling B-mode ultrasound image formation and statistical properties; 2. reducing ultrasound speckle; and 3. extracting prostate contour. Speckle refers to the granular appearance that compromises the image quality and resolution in optics, synthetic aperture radar (SAR), and ultrasound. Due to the existence of speckle the appearance of a B-mode ultrasound image does not necessarily relate to the internal structure of the object being scanned. A computer simulation of B-mode ultrasound imaging is presented, which not only provides an insight into the nature of speckle, but also a viable test-bed for any ultrasound speckle reduction methods. Motivated by analysis of the statistical properties of the simulated images, the generalised Fisher-Tippett distribution is empirically proposed to analyse statistical properties of ultrasound images of the prostate. A speckle reduction scheme is then presented, which is based on Mallat and Zhong’s dyadic wavelet transform (MZDWT) and modelling statistical properties of the wavelet coefficients and exploiting their inter-scale correlation. Specifically, the squared modulus of the component wavelet coefficients are modelled as a two-state Gamma mixture. Interscale correlation is exploited by taking the harmonic mean of the posterior probability functions, which are derived from the Gamma mixture. This noise reduction scheme is applied to both simulated and real ultrasound images, and its performance is quite satisfactory in that the important features of the original noise corrupted image are preserved while most of the speckle noise is removed successfully. It is also evaluated both qualitatively and quantitatively by comparing it with median, Wiener, and Lee filters, and the results revealed that it surpasses all these filters. A novel contour extraction scheme (CES), which fuses MZDWT and snakes, is proposed on the basis of multiresolution analysis (MRA). Extraction of the prostate contour is placed in a multi-scale framework provided by MZDWT. Specifically, the external potential functions of the snake are designated as the modulus of the wavelet coefficients at different scales, and thus are “switchable”. Such a multi-scale snake, which deforms and migrates from coarse to fine scales, eventually extracts the contour of the prostate