Human hepatic carbohydrate metabolism. Dynamic observation using 13C MRS without proton decoupling

PURPOSE

Dynamic natural-abundance 13C MR spectroscopy (MRS) studies without proton decoupling were performed in the human liver using commercial 1.5 T MR equipment.

MATERIAL AND METHODS

A single tuned custom-made circular surface coil with an OD of 20 cm operating at 16.04 MHz was used for the 13C study. Seventy-five grams of glucose dissolved in water was administered for the natural-abundance 13C-MRS dynamic study which lasted for approximately 40 to 60 min. Data acquisition was broken into 20-min and 1.7-min blocks. Localized proton shimming with a whole-body coil was performed with sufficient volume to include the observing area of the surface coil; the line width of the water signal was less than 20 Hz.

RESULTS AND CONCLUSION

The glucose and glycogen spectra were clearly visible at 80 to 120 ppm after oral administration of the glucose solution. These data demonstrate that dynamic hepatic carbohydrate metabolism can be observed with commercially available MR equipment. Given that the human hepatic glycogen pool reaches maximum level within less than 10 min, this technique should provide a direct diagnosis of hepatic carbohydrate metabolic disorders.

[No association between IgG anti-GTla antibody and bulbar palsy in Guillain-Barré and Fisher's syndromes]

Pharyngeal-cervical-brachial weakness (PCB) is a rare variant of Guillain-Barré syndrome (GBS) and shows a regional muscle weakness, specially in oropharynx. Mizoguchi et al. (1994) reported a GBS patient with PCB-like symptoms who had serum IgG anti-GTla antibodies in the acute phase of illness. We therefore assumed that bulbar palsy was associated with anti-GTla antibodies and made serological study in patients with GBS or Fisher's syndrome. The frequency of positive IgG anti-GTla antibody was significantly higher in patients with bulbar palsy than those without bulbar palsy. Most of the patients with IgG anti-GTla antibodies, however, had also anti-GQlb antibodies in their sera and anti-GTla antibodies were more closely associated with ophthalmoplegia than with bulbar palsy. These findings do not support that IgG anti-GTla antibodies play an important role in the pathogenesis of bulbar palsy in GBS.

The measurement of blood flow parameters with deuterium stable isotope MR imaging

METHODS

Because there are no radioactive hydrogen isotopes which can be used for clinical examinations, deuterium as a non-radioactive, freely diffusible tracer has some advantages compared with the radioactive tracers in the measurement of blood flow parameters. A non-invasive technique to estimate the mean tissue blood flow parameter in vivo was developed by using deuterium nuclear magnetic resonance (NMR) imaging in rat. We obtained the NMR signal changes from deuterium NMR images in nine male Wister rats after intravenous injection of D2O and applied exponential curve fitting analyses to calculate blood flow parameters of the brain, heart and skeletal muscle.

RESULTS

While fitting the reducing of the monoexponential function yielded a blood flow parameter of 27.9 +/- 1.6 ml/min/100 g tissue weight for the brain and 46.7 +/- 3.7 ml/min/100 g tissue weight for the heart, fitting the early reducing of the signal intensity of the biexponential function yielded a blood flow parameter of 95.6 +/- 10.9 ml/min/100 g tissue weight for the brain and 108.0 +/- 13.1 ml/min/100 g tissue weight for the heart. The mean muscle blood flow parameter determined by the monoexponential uptake function was 43.8 +/- 7.3 ml/min/100 g tissue weight.

CONCLUSIONS

The blood flow parameter measurement by means of an imaging coil for deuterium is less invasive and reflects the mean tissue blood flow parameter for the entire tissue sample more homogeneously than spectroscopic monitoring.

A case of lymphoid interstitial pneumonia in a 3-month-old boy not associated with HIV infection: immunohistochemistry of lung biopsy specimens and serum transforming growth factor-beta 1 assay

The case of a 3-month-old boy with lymphoid interstitial pneumonia (LIP) is reported. He had cough and tachypnea, his weight gain was poor and a chest radiograph showed microgranular shadows in almost all lung areas. Histological investigations revealed severe cellular infiltration by a variety of lymphoid and plasma cells with lymphoid follicle formation in the alveolar walls and also around the bronchioles. Foamy macrophages, a few lymphocytes and exudate filled the alveolar spaces. Epithelial cells lining the air spaces expressed human leukocyte antigen (HLA)-DR. Lymphocytes and macrophages in the alveolar spaces expressed transforming growth factor (TGF)-beta strongly. Serum TGF-beta 1 concentrations were measured eight times during the course of his illness. They exceeded the upper end of the normal range in four samples and were within it in the others. These results suggested that dysfunction of the immune system, especially abnormal expression of HLA-DR in non-immune cells and exaggerated production of TGF-beta played important roles in the pathogenesis of LIP in this patient.

Multiple pulmonary nodules in association with pyoderma gangrenosum

This report describes a patient with extensive pyoderma gangrenosum in whom there were co-existent lung abnormalities. The patient's X-ray showed peripherally sited multiple pulmonary lesions bilaterally. A lung biopsy showed chronic non-specific inflammatory changes with neutrophil and lymphocyte infiltration which were similar to the skin lesions. This case was diagnosed as multiple aseptic nodules in pyoderma gangrenosum. The pulmonary infiltrative shadows were controlled only with prednisolone treatment. Steroid therapy is considered to be the first choice to control pulmonary lesions of this disease.

Coexpression of multiple Sertoli cell and Leydig cell marker genes in the spontaneous testicular tumor of F344 rat: evidence for phenotypical bifurcation of the interstitial cell tumor

The development of testicular tumor has been frequently observed in some laboratory rat strains. In the present study, we have further characterized the testicular tumor that spontaneously develops in the F344 rat (F344/Jcl). Tumor cells first appeared in the interstitium and developed into multifocal nodular lesions. In the later stage, the whole testes were occupied by tumor cells that consisted of three different types of cells in morphological appearance: large clear type, small eosinophilic type and intermediate type. To determine the character of these cells, we examined the expression of marker genes for Sertoli cells (e.g., transferrin) and Leydig cells (e.g., 3 beta-hydroxysteroid dehydrogenase 1 (3 beta-HSD 1)). Transferrin and 3 beta-HSD 1 mRNAs were found in all 8 tumor samples analyzed by northern blotting. By in situ hybridization, we observed a substantial amount of 3 beta-HSD 1 mRNA and little or no transferrin mRNA in the large clear cells. In contrast, the small eosinophilic cells showed little or no 3 beta-HSD 1 mRNA and a large amount of transferrin mRNA, suggesting that the tumor was a mixture of at least two types of cells. Other Sertoli cell marker genes, such as cyclic protein 2 and sulfated glycoprotein 2, were expressed in all 8 tumors analyzed, and testin and steel factor (SLF), the c-kit receptor ligand, were also expressed in some of the tumors (testin, 75%; SLF, 25%), while other Leydig cell markers, LH receptor and c-kit, were expressed in 87% and 80% of the tumors, respectively. These results indicate that the spontaneous testicular tumor of F344 rat is of interstitium origin, showing phenotypical bifurcation possibly via transdifferentiation.

Relationship between levels of soluble interleukin-2 receptors and the types and activity of vitiligo

Levels of serum-soluble interleukin-2 receptors (serum sIL-2R) are thought to indicate the activation of immunocompetent cells, mainly lymphocytes. Elevated levels of serum sIL-2R have been observed in various infectious and autoimmune diseases and also after organ transplantation. It has been hypothesized that autoimmune mechanisms are involved in the pathogenesis of vitiligo. Therefore, we studied serum sIL-2R levels in relation to disease types and activity of vitiligo. We used sera separated from venous blood samples from 12 patients with dermatomally distributed type B vitiligo, 17 patients with non-dermatomally distributed type A vitiligo during the active stage, 9 patients with type A vitiligo during the inactive stage, and 12 normal control subjects. Serum sIL-2R levels were similar in type B vitiligo patients and the controls but were significantly elevated in patients with active type A vitiligo compared with controls and inactive type A vitiligo patients. It is suggested that the immune system is activated in patients with type A vitiligo during the active stage and that autoimmune mechanisms may play a role only in type A vitiligo.

[Association of IgA anti-GM1 antibody with antecedent diarrhea in patients with Guillain-Barré syndrome]

IgA has an important role in the gastrointestinal immune system. We investigated IgA anti-GM1 antibodies in Guillain-Barré syndrome (GBS) subsequent to diarrhea. IgA anti-GM1 antibodies were detected more often in GBS patients with a history of antecedent diarrhea than in those without that. Between the GBS patients with a history of prior symptoms of upper respiratory tract infections and those without that, we found no difference of the frequency of increased IgA anti-GM1 antibody titers. Six GBS patients who had antecedent symptoms of upper respiratory tract infections had IgA anti-GM1 antibodies. However, 5 patients of them also had a history of antecedent diarrhea. Our findings show that IgA anti-GM1 antibodies are associated with GBS following diarrhea.

[Measurement of cerebral blood flow using phase-contrast MRI]

The development of phase-contrast magnetic resonance imaging(P-C MRI) provides a noninvasive method for measurement of volumetric blood flow(VFR). The VFR of the left and right internal carotid arteries and basilar artery were measured using P-C MRI, and total cerebral blood flow(tCBF) was calculated by summing up the VFR values in three vessels. We investigated the changes in these blood flows as influenced from age, head size, height, weight, body surface area and handedness. Moreover, regional CBF(rCBF) was measured by combining with the single photon emission computed tomography(SPECT) of 123I. The blood flows were 142 +/- 58 mL/ min(mean +/- SD) in the basilar artery, 229 +/- 86 mL/min in the left, 223 +/- 58 mL/min in the right internal carotid artery, and tCBF was 617 +/- 128 mL/min(Ref. Magn Resn Imaging 14:P. 1143, 1996). Significant increases were observed in head-size-related change of VFR in the basilar artery and height-related change of tCBF. The value of rCBF was easily acquired in combination with SPECT. Phase-contrast MRI is useful for a noninvasive and rapid analysis of cerebral VFR and has potential for clinical use.

[Metabolic imaging of human brain tumors: H-1 chemical shift imaging and PET]

Positron Emission Tomography(PET) and Proton Chemical Shift Imaging(1H-CSI) has provided a cerebral metabolism. The glucose analog fluorine-18 fluorodeoxy-glucose(FDG) and amino acid analog 11C-L-methionine is the most commonly used PET tumor tracer. This time we compare with 1H-CSI and PET in gliomas and metastatic brain tumor with computer-assisted fusion images. We experienced some cases of the brain tumor. One case is metastatic brain tumor after radiation therapy, localized in right parietal hemisphere, with hemorrhage, and slightly accumulated Gd-DTPA in tumors. 11C-methionine PET demonstrates defects in tumors, but slight accumulated surrounding tumors. Accumulation of PET lesion is not elevated choline in CSI, but lactate is accumulated in tumors. Choline signal elevation seen in brain neoprasms, associated with increased cellular proliferation. Accumulation of PET and another accumulation of lactate in tumor are not demonstrate recurrence. Fusion image of PET and CSI is useful in understanding metabolism of brain tumor.

[Relationship between cholinergic symptoms caused by distigmine and the activities of serum AChE and BChE]

Distigmine is widely used for the treatment of dysuria, which is caused by various types of psychotropic medications. Distigmine, however, is also known to induce adverse cholinergic effects, such as diarrhea and salivation, with a decreased level of serum cholinesterase. We evaluated the possibility of using serum acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) as specific clinical markers for the adverse cholinergic effects of distigmine. Of the twelve patients treated with distigmine for dysuria caused by psychotropic drugs six patients presented both adverse cholinergic effects and decreased levels of serum AChE and BChE. The other six presented neither of these changes. This study suggests that the values of serum AChE and BChE may be useful markers for the manifestation of adverse cholinergic effects caused by distigmine.

[Ventricular septal perforation due to coronary artery spasm--a case report]

A 70-year-old female was referred due to chest pain and cardiogenic shock. Echocardiogram showed ventricular septal perforation (VSP) with large left to right shunt. ECG indicated ischemia on the left anterior descending region. Instantaneous coronary angiogram was done under the support of IABP. Neither obstructive nor stenotic lesions were found in the coronary arteries. Coronary artery spasm was a likely cause of VSP. The patient underwent emergency surgery within 12 hours from the onset. The VSP, 2 cm in diameter, was located on the postero-apical portion of the ventricular septum. The defect was closed by endocardial patch method using an equine pericardium. Postoperative course was uneventful, and the patient was transferred 3 weeks after the operation.

Quantitative analysis of interferon alpha/beta receptor mRNA in the liver of patients with chronic hepatitis C: correlation with serum hepatitis C virus-RNA levels and response to treatment with interferon

We analysed the expression of interferon (IFN) alpha/beta receptor mRNA in the liver of patients with chronic hepatitis C and examined the relationship between the expression of this receptor gene and the level of hepatitis C virus (HCV)-RNA as well as the response to 16 weeks of 6 x 10(6) units IFN. The mean level of IFN alpha/beta receptor mRNA in patients with chronic HCV infection (expressed as delta cycle; 10.8 +/- 1.9 (mean +/- SD); n = 39) was significantly higher than that of control subjects (9.4 +/- 0.5; n = 6; P < 0.01). There was a significant negative correlation between the level of IFN alpha/beta receptor mRNA and serum HCV-RNA in 39 patients with chronic hepatitis C (R = -0.546; P < 0.01). The mean level of IFN alpha/beta receptor mRNA in six patients who showed a complete response to IFN therapy (12.3 +/- 1.6) was higher than that of 15 patients who failed to respond to therapy (10.1 +/- 1.5; P < 0.01). Our results are consistent with the suggestion that the anti-viral activity of IFN depends on the level of the IFN alpha/beta receptor on hepatocytes in patients with chronic hepatitis C.

[Late phase reaction in atopic dermatitis--immunological parameters and immunohistological analysis]

We studied the correlation between late phase reaction (LPR) and laboratory data in atopic dermatitis (AD) and evaluated the pathological findings in LPR. We studied the correlation between LPR and the severity of AD, total IgE, specific IgE, total IgG4, specific IgG4 and eosinophils. There were correlations between immediate reaction (IR) and some laboratory data, but not between LPR and laboratory data. Pathological findings at 15 min 24 hrs and 48 hrs after dermal injection showed edema at 15 min, followed by epidermal eczematous changes in almost all cases at 24 hrs, edema and degeneration of dermal endothelial cells and surrounding connective tissue, and leukocytoclasia in half of the cases and deposition of C3 and IgG in parts. We found CD4+ cells in all layers of dermis, a greater ratio of EG2+ cells in deeper layers of dermis as time passed, and decrease of CD23+ cells after 24 hrs throughout the dermis. These changes were found in cases of IR-LPR+, too. It appears that the mechanism of LPR is complex and that IR is not indispensable, for LPR and that infiltration of CD4+ and EG2+ cells throughout all layers of dermis are important, and these condition were related to subsequent reactions.

A patient with acromegaly who showed remarkable improvement of hyperglycemia after treatment with octreotide

A case with diabetes mellitus associated with growth hormone (GH)-producing pituitary adenoma is described. A 56-year-old woman who had been treated for diabetes mellitus for 3 years, was admitted for the treatment of hyperglycemia. She showed a few acromegalic features and her plasma GH level was 146 +/- 16 ng/ml. After improvement of plasma glucose level by insulin injection, octreotide therapy (100 micrograms/8 hours) was started. Seven days after the initiation of octreotide therapy, the fasting plasma glucose level was almost normalized without insulin injection. After the octreotide treatment, urinary C-peptide excretion was significantly decreased and the plasma GH level became within normal range. In this case, octreotide appears to have improved the insulin sensitivity by reducing the plasma GH level.

Interleukin-6 secreting phaeochromocytoma associated with clinical markers of inflammation

Phaeochromocytomas have been shown to produce not only catecholamines but other neuropeptides and hormones, with a variety of clinical manifestations. We report a 70-year-old female patient with phaeochromocytoma exhibiting sustained hypertension, low-grade fever, thrombocytosis, and elevated levels of plasma fibrinogen and C-reactive protein. Serum interleukin (IL)-6 levels were significantly elevated, whereas serum IL-1 alpha and IL-1 beta were not detectable. After surgical removal of the tumour, hypertension and low-grade fever disappeared, and the laboratory finding including serum IL-6 concentrations became normal. Immunohistochemical study of the tumour showed positive staining for IL-6. Culture of the resected tumour revealed the production of large amounts of IL-6. It is suggested that IL-6 secreted by the tumour was responsible for some of the clinical manifestations in this patient.

[Diagnostic criteria for Non-ABCDE hepatitis]

Hepatitis viruses A, B, C, D and E are all well-characterized, molecularly defined agents with unequivocal disease association. Usual diagnosis for these virus infections are established by serological markers which are specific antigens or antibodies for these virus infections. But serological diagnosis occasionally shows pseudonegative results because this method is indirect diagnosis. In contrast, molecular diagnosis catches directly components of viral structure. Molecular diagnosis is also able to show the appearance and disappearance of these hepatitis viruses. Diagnostic criteria for Non-ABCDE hepatitis is the exclusion of hepatitis viruses A, B, C, D and E infections by using not only serological diagnosis but also molecular diagnosis.

[Abdominal aortic aneurysm and annuloaortic ectasia in siblings with Marfan syndrome]

A combination of annuloaortic ectasia (AAE) and abdominal aortic aneurysm (AAA) appeared in siblings with Marfan syndrome is presented. The patients were a 53-year-old female and her younger brother. The brother died of arrhythmia twenty years before while waiting for surgical repair of AAE. His AAA and Marfan syndrome were ascertained at autopsy. The female patient received surgical repair for AAA and AAE subsequently. Pathologic study of the resected aneurysm revealed cystic medial necrosis. A combination of AAE and AAA developed in two members of a family with Marfan syndrome is extremely rare.

Accurate frequency control of a mode-locked laser diode by reference-light injection

Injection locking is employed to narrow the spectrum linewidth of individual modes of an active mode-locked laser diode (ML-LD). The multiple modes of the injection-locked ML-LD lie over 3.0 THz with 25-GHz spacing at 30 dB down; their linewidth and stability, ~25 MHz, are nearly the same as those of the master laser. We also demonstrate the accurate frequency measurement of laser diodes stabilized to molecular (H(13)C (15)N ,(13)C(2)H (2)) absorption lines by use of the injection-locked ML-LD.

Bilateral adrenal lymphoma with neoplastic angioendotheliosis

We report a case of bilateral lymphoma of the adrenal glands. A 61-year-old man was admitted to our hospital in clinical shock with anuria. Endocrine examination indicated a diagnosis of Addison's disease. Large tumors were found bilaterally in the suprarenal area, and a needle biopsy was performed, and the diagnosis was malignant lymphoma. Treatment with chemotherapy achieved a moderate response. He was discharged, but died 1 month later. On autopsy, microscopic examination showed extensive intravascular infiltration of lymphoma cells. We considered this to be a case of bilateral adrenal lymphoma with neoplastic angioendotheliosis.

Comparison between magnetization transfer contrast and fast spin-echo MR imaging of degenerative disease of the cervical spine at 0.3 T

We compared magnetization transfer contrast (MTC) with gradient recalled echo (GRE) magnetic resonance imaging (MRI) and fast spin-echo (FSE) MRI of the degenerative cervical spine at 0.3 T. Fifty patients with suspected degenerative disease of the cervical spine were prospectively evaluated. Multislice sagittal and axial images of the cervical spine were obtained using MTC GRE sequence [repetition time (TR)/echo time (TE)/flip angle = 750/23/25 degrees] and FSE sequence with peripheral gating (TR/effective TE = 2000-4000/120). Quantitatively, FSE showed higher signal-to-noise ratio and superior disk contrast between normal and degenerative disks, while MTC images showed superior contrast-to-noise ratio for the cerebrospinal fluid (CSF) versus cord and superior CSF homogeneity. In qualitative analysis, similar results were obtained. In conclusion, FSE and MTC GRE sequences are MRI techniques of imaging the cervical spine that have different characteristics and supplement each other in the diagnostic imaging of degenerative disease of the cervical spine.

Localization and clinical significance of thyrotropin receptor mRNA expression in orbital fat and eye muscle tissues from patients with thyroid-associated ophthalmopathy

We have studied the cellular localization of thyrotropin receptor (TSH-R) mRNA in orbital fat and extraocular muscle tissues from patients with thyroid-associated ophthalmopathy (TAO) using Northern blot, reverse transcriptase polymerase chain reaction (RT-PCR), and in situ hybridization, and we correlated the findings with clinical estimates of ophthalmopathy. Although we failed to detect TSH-R mRNA in orbital tissues by Northern blot, TSH-R cDNA was amplified in orbital fat tissue from 13 of 25 patients with TAO and from 2 of 4 control subjects, in eye muscle tissue from 2 out of 7 patients with TAO, and in cultured orbital fibroblasts and subcutaneous fibroblasts from TAO patients. In situ hybridization showed that TSH-R mRNA was detected in cultured orbital fibroblasts as well as skin fibroblasts obtained from the patient. Furthermore, the expression of TSH-R mRNA in orbital fat tissue from patients with TAO significantly correlated with the orbital fat volume and the severity of ophthalmopathy, especially the extent of eye muscle dysfunction. These results suggest that the expression of TSH-R in the orbit, especially fibroblasts, may play a role in the pathogenesis and clinical manifestations of the ophthalmopathy in patients with TAO, although a secondary effect, involving fibroblasts in TAO is also possible.

Evaluation of blood flow patterns of true and false lumens in dissecting aneurysms using MR phase-contrast techniques

The magnetic resonance phase-contrast technique for the measurement of flow velocity and volume in true and false lumens was studied in six patients with chronic dissecting aneurysms. Phase-contrast images were obtained at a level perpendicular to the dissecting aneurysms of the descending aorta. As the maximum diameter of aneurysms increased, the ratio of the cross-sectional area of the false to the true lumen increased and the peak average velocity in the true lumen during systole was decreased. This technique proved invaluable for determining prognosis and operability for this condition.

Unusual pulmonary metastasis of neuroblastoma: a case report

A case of unusual pulmonary metastasis of neuroblastoma in an 8-year-old girl is presented. Nodular opacities mimicking pulmonary tuberculosis first appeared in lung apices on chest radiographs. They subsequently developed into extensive consolidations with mediastinal involvement. Metastasis of neuroblastoma was confirmed at autopsy.