Sydenham's chorea: MRI and proton spectroscopy

We present the MRI and proton spectroscopy findings in a child with clinical diagnosis of Sydenham's chorea. MRI showed high signal in the caudate nuclei and putamina on T2-weighted images. We believe that the spectra showed an abnormality in the number and/or function of neurons, lipids from cellular breakdown (cytolytic effect of antibodies), aminoacids (related to the presence of antibodies in the neostriatum), and sugars (also related to the presence of antibodies). The spectroscopy features correlate well with the histopathology and biochemistry of this rare disorder.

[Factors that affect DNA content analysis by flow cytometry]

DNA ploidy and cell cycle analysis by flow cytometry is used to obtain additional information about the diagnosis and prognosis of different types of cancer. However, there are several disagreements among authors about the tissue source (fresh-frozen or paraffin embedded), cellular dissociation methods (mechanical, enzymatic or other), use of different dyes, lasers, analysis software with different mathematical models and interpretation of results. A discussion about the different aspects that affect the study of DNA ploidy and cell cycle and a consensus in publications is mandatory. A strict control of analysis processes and data interpretation is also necessary.

Early abnormalities related to postinfarction Wallerian degeneration: evaluation with MR diffusion-weighted imaging

PURPOSE

Wallerian degeneration (WD) is most commonly seen after cerebral infarctions and results in persistent neurological deficits. MRI may detect changes related to WD as early as 4 weeks after the insult. We sought to determine if MR diffusion-weighted imaging (DWI) detects changes of WD during the acute period that follows a cerebral infarction.

METHOD

Eleven patients with cerebral infarctions underwent DWI within 72 h of the onset of symptoms. DWI was performed using a high diffusion gradient strength (B = 1,000) in a single axis and trace imaging. We reviewed all images with special attention to the signal intensity in the location of the corticospinal tracts.

RESULTS

Ten patients harbored 11 middle cerebral artery (MCA) infarcts, and one patient had an anterior cerebral artery (ACA) infarction. Only one patient with an MCA infarct showed a subtle abnormality in the ipsilateral corticospinal tract. The patient with the ACA infarct showed an abnormality in the region of the corticopontine tract.

CONCLUSION

As used in this study, DWI depicted presumed early WD in only 20% of instances.

Dietary fish oil reduces cholesterol and arachidonic acid levels in chick plasma and very low density lipoprotein

The mechanisms involved in the hypolipidemic effects of fish oil have not been clearly established. This study shows that supplementation of 10% menhaden oil to the chick diet for 7 days produced a significant hypocholesterolemia and hypotriglyceridemia. Fatty acid composition of chick plasma drastically changed by the same dietary manipulation. Percentages of 20:5 and 22:6 n-3 fatty acids strongly increased, while percentages of 20:4 n-6, 18:2 n-6, and 18:1 n-9 significantly decreased. Changes observed in the relative percentages were parallel to those obtained in the amount of each fatty acid. Ratio of n-3/n-6 clearly decreased in plasma by fish oil feeding. Total cholesterol and triacylglycerol contents decreased in high density lipoprotein (HDL) but did not change in low density lipoprotein (LDL). All chemical constituents of very low density lipoprotein (VLDL) significantly decreased after the first week of menhaden oil supplementation to the diet. Similar modifications in fatty acid composition of the three lipoprotein fractions were also found. Our results suggest that the hypocholesterolemic effects of fish oil may be mediated by the depletion in VLDL synthesis and secretion into the chick plasma. On the other hand, the strong decrease found in the arachidonic acid (AA) content of chick plasma and lipoproteins may contribute to the beneficial effects of fish oil consumption by lowering the production of its derived eicosanoids.

Normal canals at the fundus of the internal auditory canal: CT evaluation

PURPOSE

Knowledge of the normal anatomy of the four bony canals located at the fundus of the internal auditory canal (IAC) is necessary during evaluation of temporal bone trauma, congenital anomalies affecting the individual nerves, and some neuro-otologic surgeries. The purpose of this work was therefore to characterize the normal appearance of the four bony canals and to measure their dimensions.

METHOD

A retrospective study was performed using CT studies of the temporal bones in 50 patients to identify and characterize the bony canals for the labyrinthine segment of the facial nerve (BCFN), superior vestibular nerve (BCSVN), cochlear nerve (BCNC), and the inferior vestibular nerve (singular canal; SC) located at the fundus of the IAC. All the patients underwent high resolution temporal bone CT for evaluation of uncomplicated inflammatory (n = 49) and neoplastic (n = 1) diseases involving the temporal bone. CT studies were done using 1-mm-thick contiguous sections in axial and coronal planes. Measurements of the canals were performed by one radiologist. No patient had a prior history of trauma, vertigo, and sensorineural hearing loss or facial nerve paralysis.

RESULTS

The BCFN, BCSVN, and BCNC were identified in all studies, whereas the SC was seen in 93% of studies. The BCFN, BCSVN, and BCNC arise from the fundus of the IAC, whereas the SC arises medial to the fundus. Mean +/- SD measurements (in mm) of the length and width were as follows: BCFN = 2.92+/-0.48 and 0.91+/-0.28; BCSVN = 2.36+/-0.53 and 0.89+/-0.28; BCNC = 0.93+/-0.21 and 2.13+/-0.44; and SC = 3.22+/-0.73 and 0.50+/-0.14.

CONCLUSION

These small canals are routinely visualized on thin section (1 mm) CT of the temporal bone and should not be confused with fractures. This study provides baseline measurements that may be used to evaluate congenital anomalies of these canals. These data may also be helpful in the presurgical evaluation of patients undergoing singular neurectomies for benign positional vertigo.

Identification of polar toxicants in industrial wastewaters using toxicity-based fractionation with liquid chromatography/mass spectrometry

An efficient and novel method for the identification of toxic compounds in industrial wastewater was developed. In the first step, the samples collected were tested for toxicity using the recently developed ToxAlert 10 system based upon luminescence inhibition of freeze-dried Vibrio fischeri. In the second step, sequential solid-phase extraction (SSPE) and liquid chromatography/mass spectrometry (LC/MS) for compound identification were employed to isolate and identify compounds in the waters. Average recoveries ranging from 72 to 95% were obtained using the SSPE methodology for ubiquitous analytes such as poly(ethylene glycol)s, nonylphenol and alcohol polyethoxylates, phenols, linear alkylbenzenesulfonates, and benzene- and naphthalenesulfonates. In the third step, all the extracts obtained after SSPE followed by LC/MS identification were tested again with the ToxAlert system. The procedure was applied to influent and effluent samples of a sewage treatment plant (STP) and to a raw tannery effluent that constitutes the main type of influent in the receiving waters of the STP. This method has shown that, despite the complexity of the untreated tannery wastewaters with an average total organic carbon (TOC) value of 1960 mg of C/L, the biological treatment of the STP eliminates compounds that inhibit luminiscence of V. fischeri. In the final step, the chemical toxicity of the tentatively identified chemicals was tested to identify the toxicants in the waters. Comparison of the toxicities of the sample, the extracts, and individual components has shown that diverse classes of pollutants were responsible for toxicity, as all fractions of toxic samples gave significant bioluminescence inhibition values. Toxicity of the two intermediate-polarity SSPE fractions was attributed to alcohol ethoxylates, nonylphenol ethoxylates, bis(2-ethylhexyl)phthalate, and linear alkylbenzenesulfonates. In the most nonpolar and most polar fractions, identification of the compounds responsible for toxicity was unclear. By the toxicity-based fractionation, followed by LC/MS methodology, it was feasible to identify between 1.4 and 7.5% of the TOC, thus expanding the number of toxicants identified in these complex wastewaters as compared to those identified by conventional gas chromatography/mass spectrometric (GC/MS) methods. When artificial water samples were reconstituted using similar concentrations of the chemicals detected in the wastewaters, nonsynergetic toxicity effects were observed for all analytes with the exception of 2,6-naphthalenedisulfonate (2,6-NPS), which promoted the bioluminescence inhibition. The toxicity-directed identification was successful for the STP's samples and showed 1400 times higher toxicity for the raw tannery wastewaters as compared to the mixed industrial and domestic wastewaters by applying the Weibull model.

Efficient formation of influenza virus-like particles: dependence on the expression levels of viral proteins

It has previously been demonstrated in this laboratory that an influenza virus-like chloramphenicol acetyltransferase (CAT) RNA could be expressed in COS-1 cells that synthesized all ten influenza A virus-encoded proteins from recombinant plasmids. It was also shown that supernatant fluids harvested from these cultures contained virus-like particles (VLPs) that could deliver an enclosed CAT RNA to MDCK cells. Here, it is shown that the levels of expression of the reporter gene in the COS-1 and/or MDCK cells can be altered drastically by modifying the concentrations of the recombinant plasmids transfected in the COS-1 cells. Thus, it was observed that overexpression of NS2 reduced CAT expression in COS-1 cells, whereas overexpression of M2 and NS1 proteins dramatically decreased transmission of the CAT RNA to the MDCK cultures. These results are discussed with reference to the roles of these proteins during virus replication. From these experiments, a ratio of transfected plasmids was found that increased the efficiency of the previously described system by 50-100-fold. Under these optimized conditions, it was demonstrated that VLPs can be formed in the absence of neuraminidase expression and that these VLPs remained aggregated to each other and to cell membranes. Moreover, it is shown that CAT RNA transmission was dependent on specific interactions of the ribonucleoprotein complex with other viral structural polypeptides. These data demonstrate the usefulness of this encapsidation-packaging system for the study of different aspects of the influenza virus life-cycle.

Thallium-201 single-photon emission CT versus CT for the detection of recurrent squamous cell carcinoma of the head and neck

BACKGROUND AND PURPOSE

Thallium-201 single-photon emission computed tomography (SPECT) can be used to detect primary squamous cell carcinoma (SCCA) of the head and neck. Nevertheless, there have very few studies performed to evaluate the ability of thallium-201 to depict recurrent SCCA. The purpose of this study was to compare the ability of thallium-201 SPECT with CT to enable detection of recurrent SCCA of the upper aerodigestive tract.

METHODS

Thirty-three patients with a history of previously treated SCCA of the extracranial head and neck underwent thallium-201 SPECT imaging and contrast-enhanced CT. A neuroradiologist and nuclear medicine physician with knowledge of the primary site evaluated all thallium-201 studies for abnormal radiotracer uptake at the primary site. These results were correlated with histologic findings and clinical follow-up in all patients. All patients were followed up for a minimum of 2 years after completion of treatment. The McNemar test was used to determine statistical significance.

RESULTS

The diagnostic accuracy of thallium-201 SPECT was as follows: sensitivity, 88%; specificity, 94%; positive predictive value, 93%; and negative predictive value, 89%. The diagnostic accuracy of CT was as follows: sensitivity, 100%; specificity, 24%; positive predictive value, 55%; and negative predictive value, 100%. The diagnostic accuracy of thallium was superior to CT (P = .01).

CONCLUSION

Thallium-201 SPECT is superior to CT for differentiating recurrent tumor from post-treatment changes and may complement CT in the evaluation of previously treated SCCA of the extracranial head and neck.

Diffusion-weighted MR imaging of global cerebral anoxia

BACKGROUND AND PURPOSE

Diffuse cerebral anoxia is a devastating event, and its acute findings, as revealed by conventional MR imaging and CT scanning, may be subtle. We analyzed diffusion-weighted and conventional MR images of patients with diffuse cerebral anoxia to determine their usefulness in establishing the diagnosis during the acute period and in determining the age of insult.

METHODS

We reviewed 11 MR imaging studies of 10 patients who had experienced prolonged cardiac arrest. All of the patients underwent echo-planar diffusion-weighted imaging with low- and high-strength B values and multiplanar unenhanced MR imaging. We considered bright areas on the high-strength diffusion-weighted images to be abnormal when compared with low-strength images. Special attention was given to the cortex, basal ganglia, thalami, hippocampi, cerebellum, and white matter. Conventional MR studies also were reviewed, and abnormalities noted. The medical records of all of the patients were reviewed.

RESULTS

Four patients who underwent imaging during the acute period (<24 hours) had bright basal ganglia (n = 2), bright cerebellum (n = 3), and bright cortex (n = 1) shown on their diffusion-weighted images. For these patients, conventional MR images showed questionable increased T2-weighted signal intensity in the basal ganglia (n = 1), and the results of two studies were judged to be normal. During the early subacute period (24 hours-13 days), four patients were studied, and were determined to have an abnormal cortex (n = 3) and basal ganglia (n = 2). For two of these patients, conventional MR images showed similar abnormalities, and the results of one study were normal. For two patients who underwent imaging during the late subacute period (14-20 days), diffusion-weighted images showed abnormalities mostly confined to white matter. Two patients who underwent imaging during the chronic phase (>21 days) had normal results of their diffusion-weighted imaging and one had evidence of laminar necrosis revealed by conventional MR imaging.

CONCLUSION

During the acute period, high-strength diffusion-weighted images showed the abnormal basal ganglia, cerebellum, and cortex to a better extent than did conventional MR images. During the early subacute period, gray matter abnormalities were seen on diffusion-weighted images. During the late subacute period, diffusion-weighted images showed mostly white matter abnormalities. During the chronic stage, the results of diffusion-weighted imaging were normal. Our findings suggest that diffusion-weighted images are helpful for evaluating and dating diffuse cerebral anoxia, and therefore aid in the determination of prognosis and management of these patients.

Midline spinal cord hamartomas: MR imaging features of two patients

Congenital midline spinal hamartomas are relatively rare. Patients harboring this anomaly are generally asymptomatic, but present with an overlying skin anomaly. MR imaging depicts a mass that is isointense with the spinal cord on all sequences, and may show a dermal sinus tract that tethers the cord at the level of the lesion. We report the MR features of congenital midline spinal hamartoma in two children.

Juvenile retinoschisis: imaging findings

We present the CT and B-scan sonographic findings in an infant with juvenile retinoschisis, a rare hereditary eye disease, which usually follows an X-linked recessive inheritance pattern.

Increase in alfalfa nodulation, nitrogen fixation, and plant growth by specific DNA amplification in Sinorhizobium meliloti

To improve symbiotic nitrogen fixation on alfalfa plants, Sinorhizobium meliloti strains containing different average copy numbers of a symbiotic DNA region were constructed by specific DNA amplification (SDA). A DNA fragment containing a regulatory gene (nodD1), the common nodulation genes (nodABC), and an operon essential for nitrogen fixation (nifN) from the nod regulon region of the symbiotic plasmid pSyma of S. meliloti was cloned into a plasmid unable to replicate in this organism. The plasmid then was integrated into the homologous DNA region of S. meliloti strains 41 and 1021, which resulted in a duplication of the symbiotic region. Sinorhizobium derivatives carrying further amplification were selected by growing the bacteria in increased concentrations of an antibiotic marker present in the integrated vector. Derivatives of strain 41 containing averages of 3 and 6 copies and a derivative of strain 1021 containing an average of 2.5 copies of the symbiotic region were obtained. In addition, the same region was introduced into both strains as a multicopy plasmid, yielding derivatives with an average of seven copies per cell. Nodulation, nitrogenase activity, plant nitrogen content, and plant growth were analyzed in alfalfa plants inoculated with the different strains. The copy number of the symbiotic region was critical in determining the plant phenotype. In the case of the strains with a moderate increase in copy number, symbiotic properties were improved significantly. The inoculation of alfalfa with these strains resulted in an enhancement of plant growth.

Evaluation of CSF leaks: high-resolution CT compared with contrast-enhanced CT and radionuclide cisternography

BACKGROUND AND PURPOSE

Radiologic evaluation of CSF leaks is a diagnostic challenge that often involves multiple imaging studies with the associated expense and patient discomfort. We evaluated the use of screening noncontrast high-resolution CT in identifying the presence and site of CSF rhinorrhea and otorrhea and compared it with contrast-enhanced CT cisternography and radionuclide cisternography.

METHODS

We retrospectively reviewed the imaging studies and medical records of all patients who were evaluated for CSF leak during a 7-year period. Forty-two patients with rhinorrhea and/or otorrhea underwent high-resolution CT of the face or temporal bone and then had CT cisternography and radionuclide cisternography via lumbar puncture. The results of the three studies were compared and correlated with the surgical findings in 21 patients.

RESULTS

High-resolution CT showed bone defects in 30 of 42 patients (71%) with CSF leak. High-resolution, radionuclide cisternography and CT cisternography did not show bone defects or CSF leak for 12 patients (29%) who had clinical evidence of CSF leak. Among the 30 patients with bone defects, 20 (66%) had positive results of their radionuclide cisternography and/or CT cisternography. For the 21 patients who underwent surgical exploration and repair, intraoperative findings correlated with the defects revealed by high-resolution CT in all cases. High-resolution CT identified significantly more patients with CSF leak than did radionuclide cisternography and CT cisternography, with a moderate degree of agreement.

CONCLUSION

Noncontrast high-resolution CT showed a defect in 70% of the patients with CSF leak. No radionuclide cisternography or CT cisternography study produced positive results without previous visualization of a defect on high-resolution CT. CT cisternography and radionuclide cisternography may be reserved for patients in whom initial high-resolution CT does not identify a bone defect or for patients with multiple fractures or postoperative defects.

Imaging features of intraventricular melanoma

We present the MR imaging findings in a patient with symptoms of increased intracranial pressure and a mass in the left lateral ventricle. The mass showed increased signal intensity on T1-weighted images and low signal intensity on T2-weighted images. The histologic diagnosis was that of melanoma, and detailed physical and funduscopic examinations disclosed no evidence of a primary lesion. We believe that the mass was a primary intraventricular melanoma, possibly arising from the choroid plexus, and we discuss the mechanisms that may be responsible for its occurrence in this location.

Differential effects of dietary fat on chick plasma and liver composition and HMG-CoA reductase activity

The comparative effects of diet supplementation with 10% saturated fat rich in 12:0 and 14:0 fatty acids (coconut oil), without and with 1% added cholesterol, and with 10% unsaturated fat rich in n-3 polyunsaturated fatty acids (menhaden oil) on cholesterol metabolism in neonatal chicks were examined to clarify the different mechanisms of their hyper- and hypolipidemic action. Supplementation of coconut oil produced a significant hypercholesterolemia after 7 days of treatment, with a similar increase in the amount of both free and esterified cholesterol. Supplementation of coconut oil plus cholesterol produced a higher increase of plasma cholesterol levels (approximately two to three times higher than those found with standard diet). However, supplementation of menhaden oil induced a significant decrease in total cholesterol after only 2 weeks of treatment. Levels of plasma triglycerides did not change by coconut oil addition to the diet, but a significant increase was observed after coconut oil plus cholesterol feeding. Menhaden oil produced a transient decrease in plasma triglycerides. Hepatic 3-hydroxy-3-methylglutaryl-CoA reductase activity did not change with coconut oil treatment. However, both coconut oil plus cholesterol and menhaden oil supplemented diets drastically decreased reductase activity after 1 week of dietary manipulation. These results show that different nutrients with the same inhibitory effect on reductase activity produced opposite effects on plasma cholesterol content, suggesting the existence of important differences in the regulatory mechanisms implied in cholesterol biosynthesis and its accumulation in plasma.

Leukoencephalopathy complicating an Ommaya reservoir and chemotherapy

We describe the imaging findings in an unusual case of biopsy-proven, methotrexate-induced leukoencephalopathy complicating a malfunctioning Ommaya reservoir in a patient with lymphoma.

Tumor volume: an independent predictor of outcome for laryngeal cancer

PURPOSE

Other studies have shown a relationship between the volume of laryngeal tumors and local control when treated with radiation therapy. Our purpose was to determine the relationship between tumor volume, clinical staging, and several histologic abnormalities to local control in patients treated with initial surgery.

METHOD

Tumor volume was calculated from pretreatment CT scans in 52 patients with squamous cell carcinoma treated surgically. The presence of perineural and lymphatic spread as well as cartilage and vessel invasion were obtained from histology. All cases had at least a 2 year clinical follow-up after initial surgery. Statistical analysis consisted of Mantel-Haneszel chi2-tests and Fisher exact test.

RESULTS

Local control rate was 92%. Tumor volume and cartilage invasion were associated with local control (p < 0.05). Local control rate for tumors with volumes of < 16 cm3 was 98% compared with 40% for tumors with volumes of > 16 cm3 (p < 0.05). Evidence of cartilage invasion was associated with increased likelihood of local recurrence. There was no significant association between local control and perineural, vascular, or lymphatic tumor spread. We found a marginally significant association between clinical T-stage and local control (p = 0.05).

CONCLUSION

Pretreatment CT volumes are useful in predicting local control in laryngeal carcinoma treated with surgery. Of the histologic features studied, only cartilage invasion was significant in predicting tumor control.