Technetium-99m-MIBI and thallium-201 scintigraphy of primary lung cancer

We evaluated the usefulness of 99mTc-MIBI scintigraphy in primary lung cancer in comparison with 201Tl-chloride scintigraphy.

METHODS

There were 45 patients with primary lung cancer. All patients underwent dual-isotope imaging with 201Tl-chloride and 99mTc-MIBI. Regions of interest were placed over the tumors (T) and contralateral normal lung tissue (N) on one coronal view in the SPECT, and T/N ratio and retention index were calculated.

RESULTS

The positive rate was 98% in both the early and delayed images for 201Tl-chloride and 96% in the early and 89% in the delayed image for 99mTc-MIBI. Both early and delayed T/N ratios for 201Tl-chloride were higher than those for 99mTc-MIBI. There was no significant correlation between T/N ratio and histological type of tumor in both images. However, in both images, there was a tendency for the early and delayed ratios to increase as the tumor diameter became larger. The retention index of 201Tl-chloride was higher than that of 99mTc-MIBI. There were no significant differences in the retention index with respect to the histological type and tumor size.

CONCLUSION

The results of this preliminary clinical study suggest that 99mTl-MIBI can depict primary lung cancer similar to 201Tl-chloride. However, T/N ratio and retention index of 99mTc-MIBI in the tumor areas are significantly lower compared with those of 201Tl-chloride.

Laryngeal necrosis after combined chemotherapy and radiation therapy

Post-radiation necrosis of the larynx is a major complication after irradiation and has become rare. Recently, combined chemotherapy and radiation therapy has been introduced for head and neck tumours. The authors report a case of laryngeal necrosis after combination therapy for a patient with cervical lymph node metastases of nasopharyngeal carcinoma and review the literature on late laryngeal necrosis. Although radiation-induced laryngeal necrosis has become a rare complication, the combination of chemotherapy and radiation therapy may increase its incidence. We should always consider it as a possible late complication and treat it appropriately.

[Construction of pulmonary time-volume curve using MR: comparison with lung volume measurements using CT]

This study was conducted to investigate the effectiveness of dynamic pulmonary ventilation using MR and to compare it with lung volume measurements using CT. MR images during tidal breathing and CT images at resting expiratory level were obtained in 7 normal volunteers. The correlation between lung volume using CT and that using MR at resting expiratory level was significant (r = 0.993, p < 0.001). Pulmonary time-volume curves for each lobe were constructed by applying a Fourier series. The technique used in this study appears to be potentially useful to assess lobar lung function non-invasively and quantitatively.

A new type of hereditary motor and sensory neuropathy linked to chromosome 3

We report the clinical, pathological, and genetic findings of 23 patients in 8 families with hereditary motor and sensory neuropathy (proximal dominant form) (HMSN-P) in Okinawa, Japan. The clinical features were unique with respect to autosomal dominant inheritance, Kennedy-Alter-Sung syndrome-like proximal dominant neurogenic atrophy, obvious sensory involvement, painful muscle cramp, fasciculations, areflexia, and high incidences of elevated creatine kinase levels, hyperlipidemia, and diabetes mellitus. Electrophysiological and pathological studies revealed typical motor and sensory axonal neuropathy, and decreased numbers of anterior born and dorsal ganglion cells, which suggested the presence of neuronopathy in HMSN-P. Genetic linkage studies showed a lod score of 4.04 (two-point analysis) in DNA marker D3S1284. Haplotype analysis showed that the gene locus of the disease was mapped to 3p14.1-q13 bracketed by D3S1285 and D3S1281. In this region, the patients' chromosomes showed an obvious increase in the allele frequency of five markers. One allele in D3S1591 was identical in all patients but had a low frequency in the control population. This finding suggested the presence of linkage disequilibrium and a common origin of this allele in all patients with HMSN-P. The HMSN-P described here is a new clinical entity characterized by unique clinical manifestations and a new gene locus.

[Effectiveness of percutaneous transluminal angioplasty and intra-arterial papaverine infusion for symptomatic vasospasm after subarachnoid hemorrhage]

PURPOSE

To evaluate the clinical effectiveness of PTA and/ or intra-arterial infusion of papaverine (PPV) for the treatment of symptomatic vasospasm after subarachnoid hemorrhage.

MATERIALS AND METHODS

From September 1989 to March 1996, twenty patients with symptomatic vasospasm were treated by PTA and/or intra-arterial infusion of PPV. Nine of the patients were treated by only PTA, eight by only PPV infusion, and three by both PTA and PPV infusion. Early clinical results were evaluated within 48 hours after treatment. Changes in the mean flow velocity (MFV) of the M1 segment as determined by TCD before and after treatment were also evaluated.

RESULTS

Six of the nine patients (66.7%) treated only by PTA, six of the eight patients (75%) treated only by PPV, and all three patients (100%) treated by both PTA and PPV infusion showed improvement of neurological deficits within 48 hours after treatments.

CONCLUSION

PTA was effective for main trunk vasospasm, while PPV infusion was more effective for peripheral severe vasospasm in recovery from neurological deterioration after subarachnoid hemorrhage. Use of both treatments further increased the effectiveness.

Growth properties of neural cell lines immortalized with the tsA58 allele of SV40 large T antigen

In vitro growth properties of three CNS-derived cell lines were compared under a variety of culture conditions. The M213-20 and J30a cell lines were each derived from embryonic CNS culture with the temperature-sensitive (ts) allele of SV40 large T antigen, tsA58, while the A7 cell line was immortalized using wild-type SV40 large T antigen. Cells immortalized with tsA58 SV40 large T proliferate at the permissive temperature, 33 degrees C, while growth is expected to be suppressed at the nonpermissive temperature, 39.5 degrees C. Both the M213-20 and J30a cell lines were capable of proliferating at 39.5 degrees C continuously for up to 6 mo. All three cell lines showed no appreciable differences in growth rates related to temperature over a 7-day period in either serum-containing or defined serum-free media. The percentage of cells in S-phase of the cell cycle did not decrease or was elevated at 39.5 degrees C for all three cell lines. After 3 wk at 39.5 degrees C, the three cell lines also showed positive immunostaining using two monoclonal antibodies reacting with different epitopes of SV40 large T antigen. Double strand DNA sequence analyses of a 300 base pair (bp) fragment of the large T gene from each cell line, which included the ts locus, revealed mutations in both the J30a and M213-20 cell lines. The J30a cell line ts mutation had reverted to wild type, and two additional loci with bp substitutions with predicted amino acid changes were also found. While the ts mutation of the M213-20 cells was retained, an additional bp substitution with a predicted amino acid change was found. The A7 cell line sequence was identical to the reference wild-type sequence. These findings suggest that (a) nucleic acid sequences in the temperature-sensitive region of the tsA58 allele of SV40 large T are not necessarily stable, and (b) temperature sensitivity of cell lines immortalized with tsA58 is not necessarily retained.

[Effect of glucose-insulin infusion on thallium-201 chloride tumor imaging]

Thallium-201 chloride (201Tl) kinetics, may be affected by serum insulin levels like potassium kinetics. The purpose of the present study was to use glucose and insulin to improve 201Tl accumulation in the tumor. The results showed that the tumor-to-normal tissue ratio after simultaneous injection of 201Tl, glucose and insulin was significantly higher than that after the injection of only 201Tl, and that a ring appearance seemed to occur after glucose and insulin injection. This preliminary study suggests that 201Tl accumulation in the tumor is enhanced by glucose and insulin administration.

Autosomal dominant early onset dementia and leukoencephalopathy in a Japanese family: clinical, neuroimaging and genetic studies

We report here the results of clinical, neuroimaging and genetic studies of autosomal dominant dementia and leukoencephalopathy in a Japanese family. Twenty-two individuals in this family were examined clinically (17 living, 5 deceased), neuroradiologically and genetically (16 of 17 living members). Ten (5 deceased) of 22 individuals had early onset dementia (age of onset: 45.2 +/- 12.1 years on average) and four of them had multiple white matter lesions and brain atrophy on brain MRI without history of brain ischemic attack. Another four individuals had abnormal white matter lesions on brain MRI without dementia. Linkage studies for chromosome 1q31-42, 14q24.3 and 21q21 responsible for Alzheimer's disease, chromosome 19p13.1-13.2 for cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) and chromosome 3 for familial non-specific dementia suggested no specific haplotypes cosegregated with the disease. Apo E genotypes were E2/2 and E2/3 in this family. Clinical, neuroimaging and genetic studies revealed that the disease in this family was distinguished from known familial dementia. This is the first report of a large Japanese family with autosomal dominant early onset dementia and leukoencephalopathy.

Intraarterial infusion of papaverine in experimental cerebral vasospasm

PURPOSE

To determine the effectiveness of intraarterial infusion of papaverine hydrochloride (PPV) in an experimental model of cerebral vasospasm and to measure the mean blood flow velocity of the middle cerebral artery (MCA).

METHODS

Seven Japanese monkeys were divided into three groups: those studied 3 days-after surgery (the third-day group, n = 3); those studied 7 days after surgery (the seventh-day group, n = 3); and a control group (n = 1). Vasospasm was induced in the experimental groups by placing a blood clot in the subarachnoid space around the top of the internal carotid siphon. PPV (5 mg/kg) was infused (over 60 minutes) into the internal carotid artery (ICA). The vascular diameters of the ICA and MCA were measured on angiograms before and after infusion. The mean blood flow velocity in the MCA was measured on transcranial Doppler sonograms before and 24 hours after infusion. After fixation, the MCA was dissected out, stained, and examined microscopically.

RESULTS

After vasospasm induction, both arteries were narrowed more than 30% in the third-day group and more than 50% in the seventh-day group. After PPV infusion in both groups, vascular dilatation of about 20% was seen. The mean increase in blood flow velocity in the third-day group (30%) was smaller than in the seventh-day group (70%). The mean blood flow velocity in the MCA decreased by about 30% in both groups, but increased again after 24 hours nearly to the level before PPV infusion. The intimal layer was more corrugated in the seventh-day group, and hypertrophy in the smooth muscle layer was also seen. Clinical examination showed no neurologic deficit in the third-day group 24 hours after PPV infusion; neurologic deficits were observed in the seventh-day group.

CONCLUSION

PPV infusion may be more effective in early stages of vasospasm when vascular walls have fewer histologic changes.

Benign osteoblastoma of the temporal bone

We report a case of benign osteoblastoma arising in the temporal bone of a 28-year-old woman. Plain radiography showed a mass with an amorphous calcified matrix and a thin radiolucent marginal zone. CT and MR imaging were useful in delineating the extent of the tumor, and angiography showed its hypervascularity. Preoperative transarterial embolization was effective in reducing bleeding during surgery.

[131I SPECT-imaging with body outline using convenient lightweight source]

In order to make the body outline clearly in SPECT images, we devised a simple line source holder with the objectives to have a lightweight line source, to reduce the radiation exposure to the staff and to make the system readily available. This technique was applied to evaluate the localizing lesions in patients with radioiodine treatment of thyroid cancer. 131I-SPECT imaging with body outline was found to be effective in 86.7 percent (13/15) of the cases compared with planar imaging. Clinically, the results significantly helped in the discrimination between cervical lymph node metastasis and thyroid bed, and between mediastinal lymph node metastasis and bone metastasis. In the case of multiple lung metastasis demonstrating diffuse accumulation in the lung fields, 131I-SPECT imaging with body outline did not provide an increase in sensitivity compared with planar imaging. This method is easy to perform and it is considered to be useful for localization of abnormal accumulation, relative to the body outline.

Accumulation of Tc-99m MIBI in breast lymphoma: comparison with Ga-67 citrate

We report 2 cases of malignant lymphoma of the breast which were clearly shown on total body imaging as well as on SPECT with Ga-67 and Tc-99m MIBI. Tumor accumulation of Ga-67 was seen in all cases including a recurrent tumor. Ga-67 scintigraphy is useful for follow up in detecting relapse, as well as in predicting responses to therapy. Tc-99m MIBI was found to accumulate in the malignant lymphoma of the breast, and especially SPECT images of breast lesions provided better contrast than planar images, and Tc-99m MIBI SPECT could diagnose localization of the tumor because there was no uptake by the breast. But the Tc-99m MIBI accumulation of the tumor was lower than Ga-67.

[Evaluation of 99mTc-MIBI to predict chemotherapeutic response in patients with small cell lung carcinoma]

The purpose of this study was to evaluate the relationship between 99mTc-MIBI (MIBI) accumulation and the response to chemotherapy. Twelve patients with small cell lung carcinoma (SCLC) underwent MIBI SPECT before chemotherapy. SPECT data were acquired 15 minutes and 2 hours after the injection of 600MBq MIBI. The early ratio (ER), delayed ratio (DR) and retention index (RI) was measured. Tumor response were classified into complete remission (CR), partial remission (PR) and no change (NC) by follow-up CT examination. The mean +/- standard deviation of ER was 3.10 +/- 0.85 (n = 4) for CR, 2.72 +/- 0.46 (n = 5) for PR and 2.43 +/- 0.95 (n = 3) for NC. DR was 3.05 +/- 1.11 for CR, 2.64 +/- 0.30 for PR and 1.90 +/- 0.82 for NC. RI was -3.0 +/- 11.69 for CR, -1.84 +/- 11.03 for PR and -18.19 +/- 38.51 for NC. CR, DR and RI were not significantly correlated with tumor response (CR, PR, NC) MIBI has the potential to predict the response to chemotherapy in SCLC.

Rounded atelectasis formation following decrease of pleural effusion: a case report

We present a case of rounded atelectasis (RA) observed continuously following decrease of pleural effusion. The collapsed right lower lobe adjacent to pleural effusion changed its shape from wedge-shaped consolidation with air-bronchogram to oval and flat formation at last. The vessels and bronchi curving into RA were detected by CT and we called it horizontal comettail sign. When a mass is detected following decrease of pleural effusion and vessels and bronchi are curving into the mass, the mass may be diagnosed as RA and no further examination may be necessary.

Cytokine production by endothelial cells infected with human T cell lymphotropic virus type I

OBJECTIVE

To investigate the ability of human T cell lymphotropic virus type I (HTLV-I) to infect endothelial cells and induce cytokine production by these cells.

METHODS

Human umbilical vein endothelial cells (HUVEC) were cocultured with HTLV-I infected T cell line (MT-2 cells) or uninfected T cell line (CEM cells).

RESULTS

Following coculture with MT-2 cells, endothelial cells expressed HTLV-I specific core antigens. Endothelial cells cocultured with MT-2 cells produced significant amounts of several cytokines, including interleukin (IL)-1 alpha, IL-6, granulocyte colony stimulating factor (G-CSF), and granulocyte/macrophage colony stimulating factor (GM-CSF), compared with endothelial cells cocultured with CEM cells. Coculturing of endothelial cells with MT-2 and CEM cells failed to produce detectable amounts of IL-1 beta and tumour necrosis factor alpha (TNF-alpha). The production of cytokines by endothelial cells cocultured with MT-2 cells was more persistent than that by endothelial cells cocultured with CEM cells after several passages. Furthermore, the production was blocked by cocultivation of endothelial cells and MT-2 cells using the Millicell system. Finally, after cocultivation of endothelial cells and MT-2 cells, endothelial cells positive for HTLV-I antigen were stained by anti-GM-CSF antibody.

CONCLUSIONS

HTLV-I can infect endothelial cells, resulting in their active production of several cytokines, such as IL-1 alpha, IL-6, G-CSF, and GM-CSF. These findings strongly suggest that the excess production of these cytokines by HTLV-I infected endothelial cells may be involved in the pathogenesis of HTLV-I associated inflammatory diseases.

Increased circulating serum amyloid A protein derivatives in rheumatoid arthritis patients with secondary amyloidosis

Secondary amyloidosis, a serious complication of chronic inflammatory diseases, is caused by the deposition of amyloid fibrils in various organs. The major component of amyloid fibrils is derived from serum amyloid A protein (SAA) by proteolysis. To explore the mechanisms of amyloidogenesis, we measured SAA concentrations in the sera of 38 patients with rheumatoid arthritis (RA) without secondary amyloidosis and in the sera of 18 RA patients with secondary amyloidosis, using the latex agglutination immunoassay. We also determined whether SAA was present as a full-length protein in the sera of RA patients by immunoblotting. Although SAA concentrations were elevated in the sera, there were no significant differences in these concentrations between RA patients without amyloidosis (128.2 +/- 145.4 micrograms/ml) and RA patients with amyloidosis (165.0 +/- 162.9 micrograms/ml). To test for qualitative abnormalities of SAA, the isolated SAA proteins from individual RA patients were analyzed by anti-SAA immunoblot. In addition to full-length SAA protein, 6-kd and 4.5-kd SAA-derived fragments were detected in the sera of RA patients, and the ratio of these fragments to total SAA proteins was significantly higher in RA patients with amyloidosis (37.0% +/- 0.7%) compared with that of RA patients without amyloidosis (15.0% +/- 5.5%). Although a high serum level of SAA is a predisposing condition for amyloid formation in RA patients, our data suggest that the increased circulating proteolytic cleavage of SAA may potentially contribute to the development of AA-amyloid deposition.

Radiologic manifestation of spinal accessory neurinoma: a case report

Spinal accessory nerve neurinoma is very rare; only 12 cases have been reported in the literature. We describe a 54-year-old woman who had a cisterna magna tumor expanding extracranially to the C1 cervical body. The tumor originated from the spinal root of the right accessory nerve. The radiological features including CT, MRI, and angiography are discussed. There have been reports on cranial MRI studies of spinal accessory neurinoma. MRI suggested an extra-axial tumor. The histological diagnosis was mixed Antoni A and B neurinoma. The neuroradiological findings of 12 cases of neurinoma of the accessory nerve reported in the literature are reviewed.

[Second phase 99mTc-HMDP accumulation using three phase bone scintigraphy in a case of primary breast cancer]

Accumulation of 99mTc-HMDP was recognized by three-phase bone scintigraphy in a case of primary breast cancer. A 67-year-old female was found to have a 14 x 13 mm mass in the upper lateral area of the left breast. At operation the histopathological finding was a proven solid-tubular carcinoma. On the first phase images, there was no abnormal accumulation in the tumor. On the second phase images, there was abnormal accumulation in the tumor, however, abnormal accumulation was observed followed by a decrease in accumulation. The third phase image showed no abnormal extra-skeletal accumulation. Color Doppler ultrasound sonography showed an abundance of color signals within the breast tumor. Increased 99mTc-HMDP accumulation in the second phase image might reflect tumor hypervascularization. It is concluded that three-phase bone scintigraphy using 99mTc-HMDP has the ability of positive description in primary breast cancer.

CT-pathologic correlation in the tumor margins of lung cancer

A CT-pathologic correlative study concerning the nature of the tumor margin was performed in 22 lung cancer cases with solitary nodules in the peripheral lung field. Three of 14 adenocarcinoma cases showed an ill-defined margin and an adjacent subtle high attenuation area on CT, representing alveoli lined by tumor cells. In the other 11 cases, both ill- and well-defined margins were seen on CT. A well-defined margin of the mass represented alveoli filled entirely with mucinous material or tumor cells. In three of six squamous cell carcinomas an ill-defined margin in CT represented the infiltration of lymphatic cells surrounding the tumor and continuous spread of tumor cells from neighboring alveoli. A well-defined margin in the other cases and two small cell carcinoma cases represented alveoli filled entirely with tumor cells. CT was shown to be very useful in the assessment of the nature of the margin of the tumor.

Septal structure of incomplete interlobar fissures of the lung

RATIONALE AND OBJECTIVES

Some septal structures have been observed in the areas of incomplete interlobar fissures (IIFs) in resected lungs. We describe the anatomy of IIFs with or without the presence of septal structures.

METHODS

Twenty fused areas from 16 autopsy cases were examined histologically. Other septal structures outside the areas of IIFs also were examined.

RESULTS

In 10 of the 20 fused areas, there was a mixture of septal structures with and without defects. In the remaining 10, there were no septal structures. The septal structures consisted of two inner layers from both lobes. Other septal structures examined were the same as ones observed in the IIFs.

CONCLUSION

Linear shadows seen at interlobar fissures and on computed tomography scans do not necessarily depict the presence of complete interlobar fissures. The absence of linear shadows does not necessarily imply the absence of septal structures.

[Untoward effects of low dose methotrexate therapy in rheumatoid arthritis]

Sixty patients with rheumatoid arthritis who were administered weekly low dose methotrexate (MTX) were retrospectively analyzed for their untoward effects of MTX by interviewing to the patients and by the medical records. Cough and sputa were the most frequent symptoms (23.3%) and gastrointestinal symptoms were the next (20%). Five of 60 patients (8.2%) showed liver function test abnormalities, and four (6.7%) exhibited transient exacerbation of arthralgia for several hours to a few days after MTX administration. Three patients (5%) suffered from interstitial pneumonitis. Hair loss was seen in 3 patients (5%), and headache, leucocytepenia, fever, skin eruption, abnormal taste, hemorrhagic cystitis, and flashing were experienced in a patient, respectively. Three (5%) suffered from fungal infection, and herpes zoster, sepsis, and osteomyelitis were experienced in each one patient, respectively. MTX was withdrawn in three patients (5%) because of cough and sputa the drug was withdrawn in other three patients because of the interstitial pneumonia, and was drawn in another three patients because of transient exacerbation of arthralgia. The drug was withdrawn in each one patient, because of nausea and vomiting, skin eruption, osteomyelitis, and sepsis, respectively. Overall, MTX were withdrawn in 21 patients (35%), and, of those, 13 patients (21.7%) because of untoward effects and 8 patients (13.3%) because of the lack of efficacy.

Transvenous embolization of high flow carotid cavernous fistula: a case report

We treated a patient with a high flow traumatic carotid-cavernous fistula (CCF) by embolization using detachable balloons and metallic coils, by transarterial and transvenous approaches. The patient was a 20-year-old woman who had fractures in the skull base from a traffic accident. She was admitted to our hospital one month after the accident due to exophthalmos, chemosis, and periorbital bruit. Cerebral angiograms demonstrated left traumatic CCF and steal phenomenon of blood flow. Balloon embolization by transarterial approach performed three times was unsuccessful, probably because of balloon puncture due to bone fragments. Embolization using metalic coils via the superior ophthalmic vein route was then attempted. As a result of this approach, complete obliteration of CCF was obtained, and clinical symptoms subsided within a few days. Treatment of CCF by transvenous approach is one alternative when transarterial occlusion is difficult.