Liver metastases: improved detection with dynamic gadolinium-enhanced MR imaging?

PURPOSE

To compare dynamic gadolinium-enhanced with unenhanced magnetic resonance (MR) imaging in detection of liver metastases.

MATERIALS AND METHODS

Two groups of patients were prospectively examined with unenhanced and dynamic gadolinium-enhanced MR imaging. The first group (n = 48) had proved liver metastases; the second group (n = 49) did not. One set of unenhanced and one set of gadolinium-enhanced MR images were selected per patient. Three independent, blinded readers assessed the images for presence, number, location, and conspicuity of lesions. Data were analyzed with receiver operating characteristic curves, and contrast-to-noise ratios were calculated for the images.

RESULTS

There was no statistically significant difference between the use of unenhanced and gadolinium-enhanced MR images in the differentiation of patients with from patients without metastases. The numbers of false-positive and false-negative diagnoses of individual lesions were higher (not statistically significant) with dynamic MR images than with unenhanced MR images. At dynamic MR imaging, contrast-to-noise ratio was highest in the early phase (30 seconds after injection of the contrast agent) but was not significantly different from the contrast-to noise ratio of the T2-weighted images.

CONCLUSION

Dynamic gadolinium-enhanced MR imaging showed no improvement over unenhanced MR imaging in detectability of liver metastases.

Lung transplantation for treatment of infants with surfactant protein B deficiency

OBJECTIVE

To evaluate lung transplantation for treatment of surfactant protein B (SP-B) deficiency.

STUDY DESIGN

We compared surfactant composition and function from pretransplantation and posttransplantation samples of bronchoalveolar lavage fluid, somatic and lung growth, neurodevelopmental progress, pulmonary function, and pulmonary immunohistology in 3 infants with SP-B deficiency who underwent bilateral lung transplantation at 2 months of age and 3 infants who underwent lung transplantation for other reasons.

RESULTS

Two years after transplantation, the 2 surviving infants with SP-B deficiency exhibited comparable somatic growth and cognitive development to the comparison infants. All infants had delays in gross motor development that improved with time. Both groups have exhibited normal gas exchange, lung growth, and pulmonary function. The SP-B-deficient infants have also exhibited normal SP-B expression and pulmonary surfactant function after lung transplantation. In two SP-B-deficient infants antibody to SP-B developed. No pathologic consequences of this antibody were identified.

CONCLUSIONS

Apart from the development of anti-SP-B antibody, the outcomes for SP-B-deficient infants after lung transplantation are similar to those of infants who undergo lung transplantation for other reasons. Lung transplantation offers a successful interim therapy until gene replacement for this disease is available.

Posttraumatic stress disorder in patients with traumatic brain injury and amnesia for the event?

Frequency of DSM-III-R posttraumatic stress disorder (PTSD) was studied in 47 active-duty service members (46 male, 1 female; mean age 27 = 7) with moderate traumatic brain injury and neurogenic amnesia for the event. Patients had attained "oriented and cooperative" recovery level. When evaluated with a modified Present State Examination and other questions at various points from study entry to 24-month follow-up, no patients met full criteria for PTSD or met criterion B (reexperience); 6 (13%) met both C (avoidance) and D (arousal) criteria. Five of these 6 also had organic mood disorder, depressed type, and/or organic anxiety disorder. Posttraumatic amnesia following moderate head injury may protect against recurring memories and the development of PTSD. Some patients with neurogenic amnesia may develop a form of PTSD without the reexperiencing symptoms.

Organizational diagnosis of computer and information learning needs: the process and product

Organizational diagnosis views the organization as a single entity with problems and challenges that are unique to the organization as a whole. This paper describes the process of establishing organizational diagnoses related to computer and information learning needs within a clinical or academic health care institution. The assessment of a college within a state-owned university in the U.S.A. is used to demonstrate the process of organizational diagnosis. The diagnoses identified include the need to improve information seeking skills and the information presentation skills of faculty.

Successful reinsertion of the artificial urinary sphincter after removal for erosion or infection

We present 5 cases involving reinsertion of an artificial urinary sphincter after either erosion or infection. All 5 patients now have socially acceptable urinary continence.

A full genome search in multiple sclerosis

The aetiology of multiple sclerosis (MS) is uncertain. There is strong circumstantial evidence to indicate it is an autoimmune complex trait. Risks for first degree relatives are increased some 20 fold over the general population. Twin studies have shown monozygotic concordance rates of 25-30% compared to 4% for dizygotic twins and siblings. Studies of adoptees and half sibs show that familial risk is determined by genes, but environmental factors strongly influence observed geographic differences. Studies of candidate genes have been largely unrewarding. We report a genome search using 257 microsatellite markers with average spacing of 15.2 cM in 100 sibling pairs (Table 1, data set 1 - DS1). A locus of lambda>3 was excluded from 88% of the genome. Five loci with maximum lod scores (MLS) of >1 were identified on chromosomes 2, 3, 5, 11 and X. Two additional data sets containing 44 (Table 1, DS2) and 78 sib pairs (Table 1, DS3) respectively, were used to further evaluate the HLA region on 6p21 and a locus on chromosome 5 with an MLS of 4.24. Markers within 6p21 gave MLS of 0.65 (non-significant, NS). However, D6S461, just outside the HLA region, showed significant evidence for linkage disequilibrium by the transmission disequilibrium test (TDT), in all three data sets (for DS1 chi2 = 10.8, adjusted P < 0.01)(DS2 and DS3 chi2 = 10.9, P < 0.0005), suggesting a modest susceptibility locus in this region. On chromosome 5p results from all three data sets (222 sib pairs) yielded a multipoint MLS of 1.6. The results support genetic epidemiological evidence that several genes interact epistatically to determine heritable susceptibility.

Hyperpolarizing, small-field, amacrine cells in cone pathways of cat retina

Intracellular recording and horseradish peroxidase (HRP) staining of amacrine cells in the isolated arterially perfused cat retina have revealed examples of small-field cells that hyperpolarize to light. Two were examined in detailed electron microscopic reconstructions to determine patterns of synaptic relationships within the inner plexiform layer (IPL). The cells were morphologically similar to A8 and A13 types as described in Golgi-impregnated material (Kolb et al. [1981] Vision Res. 21:1081-1114). Both types received ribbon synaptic input from rod and cone bipolar cells. The latter input was numerically predominant, occurred in both a and b sublaminae of the IPL, and arose from at least three cone bipolar types. Reciprocal synapses were evident between A13 cells and cone bipolar cells. Amacrine input occurred throughout the dendritic tree of both A8 and A13 types, and numerically exceeded bipolar cell input for A13. Gap junctions between stained, and similar-appearing unstained dendritic profiles were observed for both amacrine types. In addition, A8 engaged in gap junctions with cone bipolar profiles in sublamina b which also provided ribbon input. Synaptic output for both amacrine types occurred primarily upon amacrine and ganglion cells in sublamina a. Both cells were presynaptic upon single OFF-center beta ganglion cells running through the middle of their dendritic trees. Mixtures of rod and cone signals were found in the centrally evoked hyperpolarizations of each type. Center mechanism space constants of such types ranged from 100 to 400 microns, with antagonistic surround in 1 of 5 cases. Dopamine (250 microM) reduced receptive field space constants by one-third in one case. The synaptic organization and potential circuitry implications of these cone system-dominated amacrine types are compared and contrasted to the better-known AII and A17 types previously described for the rod system.

Biochemical cure of recurrent acromegaly by resection of cervical spinal canal metastases

Pituitary carcinoma with metastatic endocrine secreting tissue is rare. Eight cases of malignant, growth hormone-secreting tumours, all metastatic within the central nervous system have been previously described. Complete surgical resection was not possible and the patients died within 4 years of presentation with distant spread. Here we describe the first case of an apparent surgical cure of a somatotroph carcinoma metastatic to the cervical spine, documented by biochemical assessment and magnetic resonance and radioligand imaging. The possibility that intrathecal metastasis of somatotroph tumours may be responsible for some cases of treatment resistant acromegaly is discussed.

The trajectory of client progress. A longitudinal pilot study

Successful nonchemical drug treatment is a transformative experience: client change is the goal of treatment. Two domains in which programs intend to facilitate change are emotional well-being and the therapeutic relationship. Little previous research has addressed the question of what changes clients in drug treatment actually undergo while in treatment. This article presents results from a pilot longitudinal study of clients in two short-term drug treatment programs in Houston, TX. Results showed measurable increases in self-esteem and connection to counselor and decreases in anxiety and depression over the course of treatment for clients who completed treatment. Program graduates and early withdrawals showed distinctly different patterns of progress as measured by emotional and relationship scales.

ON-OFF amacrine cells in cat retina

We studied the morphology, photic responses, and synaptic connections of ON-OFF amacrine cells in the cat retina by penetrating them with intracellular electrodes, staining them with horseradish peroxidase, and examining them with the electron microscope. In a sample of seven cells, we found two different morphological types: the A19, which ramifies narrowly in stratum 2 (sublamina a) of the inner plexiform layer, and the A22, which ramifies mostly in stratum 4 (sublamina b) but extends some dendrites to sublamina a. Both of these cell types have axon-like processes that extend > 800 microns from the conventional dendritic arbor. ON-OFF amacrine cells in our sample had receptive fields (1.7 +/- 0.3 mm diameter) that were broader than their dendritic arbors (425 +/- 35 microns diameter) and that extended over the region of axon-like processes. In addition, we found many features in common with ON-OFF amacrine cells in poikilotherm vertebrates: a broad receptive field without surround antagonism, two sizes of spike-like events, narrow dynamic range (1 log unit intensity), and excitatory postsynaptic potentials at light on and light off. Two A19 amacrine cells were examined in the electron microscope: most synaptic inputs (93 and 76%, respectively) to either cell were from amacrine cells, with minor inputs from cone bipolar cells. Synaptic outputs were to bipolar, amacrine, and ganglion cells, including the OFF-alpha cell.

Real-time evaluation of somatostatin subtype 2 receptor activity employing the technique of cytosensor microphysiometry

Five types of somatostatin (SS) receptors (sst1-5) have been cloned and are widely distributed in the central nervous system and variably expressed in target tissues of the periphery. At the cellular level, adenylate cyclase inhibition has been classically described in native and transfected cells expressing sst subtypes. In addition, ion channel modulation (K+, Ca2+), phospholipase C, phospholipase A2, and tyrosine phosphatase activation have also been reported. The present study describes a novel in vitro approach based on quantifying receptor-activated metabolic rate changes to evaluate SS biological activity in cells (CHO-K1) stably expressing the human (h) sst2 receptors. Real-time metabolic rate changes were evaluated by determining the rate of extracellular acidification (microphysiometry). The metabolic rate was transiently and potently (EC50 1 nM) increased in response to natural SS ligands, SS-14 and SS-28. The peak activation time was approximately 2 min. Pharmacological analysis for the sst2 receptor yielded rank order of potency for SS analogues of: MK-678 > BIM-23027 > octreotide > BIM-23014C << L-362,855 > BIM-23052 << BIM-23056. Similar rank orders were obtained from in vitro receptor binding studies in the same cell line. These results demonstrate that microphysiometry is a rapid and valid technique to evaluate the pharmacology SS receptor activation.

Lisofylline inhibits transforming growth factor beta release and enhances trilineage hematopoietic recovery after 5-fluorouracil treatment in mice

The effectiveness of endogenous or exogenously administered colony-stimulating factors may be modulated by the presence of hematopoietic inhibitory molecules. Cytotoxic therapy may result in the induction of hematopoietic inhibitors contributing to prolonged myelosuppression, whereas preventing the induction of such inhibitors may accelerate multilineage recovery. Lisofylline [LSF; (R)-1-(5-hydroxyhexyl)-3,7, dimethyl-xanthine], inhibits the signaling and/or release of certain hematopoietic inhibitory molecules such as tumor necrosis factor alpha, macrophage inflammatory protein 1 alpha, transforming growth factor beta, and IFN-gamma. Treatment of murine bone marrow cells with the cytotoxic agent 5-fluorouracil (5-FU) results in the release of a nondialyzable inhibitor of progenitor (colony-forming unit-granulocyte macrophage; CFU-GM) proliferation. When murine bone marrow cells were treated with 5-FU plus LSF, release of this inhibitor of CFU-GM proliferation was blocked. Neutralizing antibody and Western blot analysis indicated that the inhibitor was TGF-beta. We tested the effect of LSF (100 mg/kg i.p., b.i.d.) on multilineage regeneration after high-dose 5-FU or thiotepa treatment in BALB/c mice. In 4 of 5 experiments, LSF significantly accelerated neutrophil recovery (P < or = 0.05, Wilcoxon paired-signed test). In addition, platelet, reticulocyte, and CFU-GM regeneration were significantly accelerated in mice treated with LSF compared to control mice (P < or = 0.05). LSF had no significant effects on the ability of 5-FU to kill hematopoietic progenitor cells, nor did LSF stimulate or inhibit proliferation of CFU-GM. LSF had no effect on chemotherapy-induced killing of tumor cells in vitro, nor on the antitumor activity of 5-FU or thiotepa in BALB/c mice implanted with P388 leukemia cells. Inhibition of hematopoietic inhibitor release may accelerate multilineage recovery after cytotoxic therapy and, as such, may represent an alternative or additional therapy to the use of positively acting lineage specific colony-stimulating factors.