Focal periportal sparing in hepatic fatty infiltration: a cause of hepatic pseudomass on US

An unusual pattern of hepatic fatty infiltration was detected sonographically in 31 patients over a 1.5-year period. At appropriate gain settings and time gain compensation, the liver parenchyma demonstrated diffuse increased echogenicity except for a solitary hypoechoic area with relatively distinct margins, usually located in the medial segment of the left hepatic lobe. This hypoechoic periportal focus varied in size between 1.5 and 5 cm and was typically ovoid, but was occasionally spherical or irregular in shape. Eight patients with such foci underwent percutaneous needle biopsy because of concern that there was a space-occupying mass. Microscopic examination of specimens from the hypoechoic periportal region revealed normal hepatic parenchymal cells, while tissue samples from the surrounding liver had high fat levels. In the remaining 23 patients, correlative radiologic studies supported the diagnosis of fatty liver and excluded a central-mass lesion. A localized area of normal hepatic tissue should be considered among the possible diagnoses when a circumscribed hypoechoic periportal area is demonstrated within a fatty liver.

Enzyme activity dot blots: a rapid and convenient assay for acetyltransferase or protein kinase activity immobilized on nitrocellulose

Methods are described for assaying (Tetrahymena) histone acetyltransferase activity and (Drosophila) casein kinase II activity by spotting extracts on nitrocellulose filters. The methods are quantitative over a wide range of enzyme concentrations and are almost as sensitive as liquid assays. Examples are presented for illustrating the use of these methods for enzyme purification, concentration, and desalting, as well as for electrophoretic blotting from agarose gels. A simple method for autoradiographic enhancement of nitrocellulose filters is also described.

Intravascular signal in MR imaging: use of phase display for differentiation of blood-flow signal from intraluminal disease

Intravascular signal from flowing blood is frequently observed on magnetic resonance (MR) images and may be indistinguishable from partial or complete vascular occlusion caused by thrombus or tumor. With a phase-display reconstruction method, qualitative assessment of large-vessel patency within the abdomen was undertaken in 15 healthy subjects and 12 patients with angiographically or surgically documented intravascular thrombus or tumor. Computed tomographic (CT) scans were available in all patients for correlation. MR studies were performed with a multisection spin-echo pulse sequence and two-dimensional Fourier transform spatial encoding. Data acquired from a single sequence was reconstituted in two ways to provide both routine anatomic images and a pictorial representation of large-vessel flow on a phase-sensitive image. With this method, reliable and easy differentiation of intraluminal thrombus and tumor from blood flow signal within large vessels was achieved. Information from these phase-display images compared favorably with findings from angiography and contrast-enhanced CT in the determination of luminal patency and obstruction.

Pediatric neurosonography

Neurosonography is an excellent modality for imaging a wide array of intracranial pathology in the infant and newborn. Neurosonography is also finding increasing use in other accessible regions of the central nervous system, including the adult brain during craniotomy and the spine during laminectomy. Sonography represents the primary modality for the evaluation of the preterm brain. Because of the high incidence of pathology in gestationally immature neonates, screening sonography is required in every infant. The sonographic features of intracranial hemorrhage include areas of increased echogenicity in the region of the germinal matrix, within the ventricles, or in the surrounding cerebral parenchyma. Careful follow-up of these children for sometimes severe posthemorrhagic hydrocephalus is essential. Premature neonates are also at risk for ischemic disease, particularly periventricular leukomalacia, which is accurately diagnosed sonographically and implies a poor prognosis in almost every infant so affected. Cranial sonography is also an excellent method to evaluate abnormalities that are not associated with gestational immaturity. Cranial sonography offers excellent anatomic imaging of the brain when evaluating for congenital anomalies; because sections may be obtained in a multitude of orientations, sonography is actually more versatile than computed tomographic (CT) scans. Cranial sonography is also of use when evaluating children with inflammatory processes such as ventriculitis; sonography is superior to CT scans in identifying intraventricular septae typical of the process. Intrauterine inflammatory processes, however, are frequently associated with intracranial calcifications, CT scans may be more accurate in these cases. CT scans may also be more efficacious in the diagnosis of subdural, epidural, and subarachnoid hemorrhage. Intracranial neoplasms are rare in the younger population and although they are visible with ultrasound, CT scans with contrast are essential in an effort to obtain added information and because of a greater experience using CT scans. Sonography represents an excellent modality with which to evaluate the infant and neonatal brain. In a number of diseases it may be diagnostic alone. The informed clinician, however, should keep in mind those instances where a complimentary modality such as CT scanning can add additional or even essential information.

Pancreatic necrosis: CT manifestations

Pancreatic necrosis is a potential sequela of acute pancreatitis, which pathologically represents a collection of devitalized tissue. Appropriate therapeutic planning requires definition of this irreversibly damaged gland, the presence of which is not consistently diagnosed on the basis of clinical and laboratory data. Over an 18-month period, 22 patients with pancreatic necrosis were studied by one or more computed tomographic (CT) examinations. Retrospective analysis showed the findings to vary with the developmental stage of the necrotizing process. During the acute phase, there was considerable morphologic overlap of necrosis and pancreatic phlegmon. Typical findings were seen in the subacute and chronic stages and included diffuse enlargement of the gland with largely decreased central density. A thick, smooth surrounding rim produced a characteristic saclike configuration. CT-guided aspiration for culture material was performed in four patients with suspected superinfection. Negative gram stain and culture results in two patients allowed surgery to be performed on a more elective basis.

Drainage of pelvic abscesses through the greater sciatic foramen

A computed tomographic (CT) guided transgluteal approach through the greater sciatic foramen was used to drain pelvic abscesses and fluid collections in 21 patients. Ideal catheter placement should traverse the lower portion of the greater sciatic foramen at the level of the sacrospinous ligament. This avoids the vascular and neural elements that are located slightly cephalad at the level of the piriformis muscle. Percutaneous drainage through this approach was successful in avoiding surgery in 17 patients (81%). Pain was the most common complication and was generally associated with a more cephalad approach, transgressing the piriformis and the sacral plexus. CT-guided percutaneous drainage of pelvic abscesses through the greater sciatic foramen should be used when the more standard transperitoneal approach is not possible.

Corn mitochondrial protein synthesis in response to heat shock

Corn (Zea mays L., W23(N), OH43(N), and reciprocal single cross hybrid) seedling mitochondria respond to a 10 degrees C temperature shift (27-37 degrees C) by incorporating a greater amount of [(35)S]methionine into acid-insoluble material than mitochondria incubated at the original growing temperature (27 degrees C). This increase is in part manifested in the enhanced synthesis of a 52 kilodaltons protein. At both temperatures mitochondria of two inbreds and their reciprocal hybrids synthesize normal (N) cytoplasm proteins sensitive to chloramphenicol and insensitive to cyclohexamide treatment. The 52 kilodaltons protein is found in the supernatants of pelleted (15,000g, 5 min) mitochondria after heat shock. The role of this protein in the heat shock response is discussed in light of the implication of mitochondria as the primary cellular target to temperature stress.

Surface coil MR imaging of abdominal viscera. Part III. The pancreas

Eight healthy volunteers and 11 patients with pancreatic abnormalities were studied using a conventional body coil and a prototype magnetic resonance (MR) surface coil. Final pathologic diagnoses included carcinoma of the head (six), body (one), and tail of the pancreas (two) and chronic pancreatitis (two). In surface coil images of the volunteers, the body and tail of the pancreas was visualized in all cases but one, and the pancreatic duct was seen in five of eight cases. In-plane spatial resolution of 0.9 X 0.9 mm and 5-mm section thickness was obtained. At the same time, pancreatic surface coil images had a twofold improvement in the signal-to-noise ratio (SNR) compared with body coil images. T1-weighted spin-echo images gave greater SNR, reduced motion artifacts, provided superior anatomic detail, and offered more diagnostic information than comparable T2-weighted images. Significant abnormalities detected only by surface coil imaging included a small tumor surrounded by reactive edema and periglandular tumor invasion. This study demonstrates that surface coil imaging of the pancreas not only is feasible but provides an improved method for examining the pancreas by MR.

Surface coil MR imaging of abdominal viscera. Part I. Theory, technique, and initial results

Prototype surface coil magnetic resonance (MR) images were obtained from phantoms and 42 subjects at 0.6 T to assess the feasibility of imaging relatively deep abdominal structures. Surface coil images demonstrated a two- to fourfold improvement in signal-to-noise ratio (SNR) when compared with whole-body coil images with the same resolution elements. This improvement in SNR allowed us to obtain images with thinner sections, higher in-plane resolution, or, alternatively, a decrease in image time. Compared with body images, surface coil images demonstrated greater anatomic detail and reduction in motion artifacts. Despite the limited field of view in very large patients, the use of surface coils improves the diagnostic capability of MR imaging of the abdomen.

Surface coil MR imaging of abdominal viscera. Part II. The adrenal glands

Magnetic resonance (MR) imaging of the adrenal glands with a prototype surface coil was compared with conventional body coil images in five healthy volunteers and 15 patients with adrenal disease. The spectrum of abnormalities included five nonfunctioning cortical adenomas, of which two were in hyperplastic glands, four adrenal metastases, three pheochromocytomas, a functioning adenoma, a myelolipoma, and a partially calcified, cystic adrenal mass. In both body and surface coil images, anatomic detail was superior on T1-weighted images compared with T2-weighted images obtained with identical imaging time because of decreased motion artifact and superior contrast. In the T1-weighted studies, high-resolution surface coil images showed a threefold improvement in signal-to-noise ratio (SNR) over body coil images, which was manifest by better intrinsic resolution of small adrenal lesions and clearer definition of the extrinsic relationships of large masses to nearby organs. In addition, inferior vena caval invasion by two right adrenal metastases was better demonstrated using the surface coil than body coil MR or computed tomography (CT). Limitations of surface coil imaging include restriction in the field of view to a single gland and additional time required for patient positioning. Since the sensitivity of surface coils diminishes with depth, gains in SNR were limited in large patients with deeper adrenal glands. Despite these limitations, dramatic improvements in SNR and anatomic resolution indicate that surface coil MR imaging will be competitive with CT for examining the adrenal glands.

Reversal of lower esophageal sphincter hypotension and esophageal aperistalsis after treatment for hypothyroidism

A 65-year-old woman suffered from both chronic gastroesophageal reflux, which was complicated by columnar metaplasia (Barrett's epithelium), and profound hypothyroidism. An esophageal motility tracing showed absence of peristalsis in the lower esophagus and the lower esophageal sphincter (LES) could not be identified. Thyroid replacement therapy, in conjunction with antacid and cimetidine treatment, was associated not only with improvement in the gastroesophageal reflux symptoms, but also with a return of esophageal peristalsis and LES pressure to normal. To support our clinical observations, we rendered four cats hypothyroid with 131I and documented a fall in LES pressure. We propose that abnormal smooth-muscle function of the esophagus may be another manifestation of the gastrointestinal motility disturbances which are associated with hypothyroidism.

Use and Modifications in Group Psychotherapy with Chronic Schizophrenic Outpatients

The authors have presented a framework for group psychotherapy with chronic schizophrenic outpatients which is based on belief that these patients can engage in moderately intensive insight-oriented therapy. The functional deficits and the interpersonal needs of these patients have been identified, and a strategy of intervention has been developed to ameliorate these deficits and facilitate gratification of these needs. Modifications in traditional group approaches are necessary for these groups to be a success. These include alterations in: 1) the group contract, 2) role and tasks of the therapists, and 3) use of special techniques. The authors believe that use of these techniques, informed by genuine interest in and empathy for these patients, will lead to a successful group experience for all.

Use of ergonovine to identify esophageal spasm in patients with chest pain

We administered intravenous ergonovine maleate to 14 patients with chest pain resembling angina pectoris and to four healthy volunteers. Five of the patients experienced their typical chest pain after ergonovine, and manometric signs of esophageal spasm also developed. The remaining nine patients and the four volunteers did not experience chest pain, but all subjects except one had some symptomatic response to ergonovine, including chest warmth or heaviness, headache, mild choking sensation, facial numbness, flushing, or nausea. Two of the nine patients and one of the four volunteers developed manometric signs of esophageal spasm after ergonovine but experienced no chest pain. Intravenous ergonovine may be useful to identify esophageal spasm in selected patients with chest pain who have normal coronary arteries or in whom coronary artery disease is insufficient to explain symptoms. However, we believe that the potential risks of ergonovine do not justify its routine use as a provocative agent for esophageal spasm.

The type material of the International Reference Centre for Avian Haematozoa

The type, paratype, and reference material of avian hematozoa in the reference collection of the International Reference Centre for Avian Haematozoa is listed. This material includes one species of Atoxoplasma, 41 species of Haemoproteus, one species of Hepatozoon, two species of Lankesterella, 15 species of Leucocytozoon, 31 species of Plamodium, one species of Spirogregarina, and three species of Trypanosoma.

Blood parasites of some Jamaican birds

The prevalence of avian hematozoa in 1791 birds of 80 species and 22 families from Jamaica was determined. Species of Haemoproteus were the most common hematozoan encountered. Species of Leucocytozoon were diagnosed only in three over-wintering North American migrants and the genus was absent in native Jamaican birds. The low prevalence of infection (7.4%) of blood parasites in Jamaican birds was closely similar to that seen in Neotropical birds and far below that noted for the Nearctic avifauna of the same families. Prevalence in adult and young birds was virtually identical; transmission occurred primarily during the period February-April.

Distribution of the hematozoa of Neotropical birds

The literature pertaining to the prevalence of avian hematozoa in the Neotropics, together with unpublished records from the files of the International Reference Centre for Avian Haematozoa, has been examined with respect to the distribution of parasite genera by host family and region. The blood parasites of 35555 birds of 955 species (80 families) occurring in the Neotropics formed the basis for the comparisons. Only 3743 (10.5%) individuals harbored one or more species of hematozoa. Haemoproteus was the most commonly observed form exhibiting a 7.4% prevalence, followed by Plasmodium (1.9%), microfilaria (1.2%), Trypanosoma (0.6%), and Leucocytozoon (0.2%). Hematozoan prevalence varied markedly from region to region and among families. In comparison with a similar review of Nearctic avian hematozoan distribution, the Neotropics demonstrated a much lower prevalence and a near absence of Leucocytozoon.

Blood parasites of some birds from Senegal

A total of 809 birds from Senegal, including 43 species and 21 families, were examined for hematozoans; 93 birds (11.5%) harbored blood parasites, with only 7 (7.5%) harboring mixed infections. Species of Haemoproteus occurred in 81.7% of the infected birds while species of Plasmodium. Trypanosoma, microfilaria and Leucocytozoon were encountered less frequently. The majority of the sample was composed of species of ploceids and estrildidis and blood parasites were most prevalent in the colonial-nesting ploceids. Prevalence of blood parasites in Senegal was low in comparison to that seen in birds from other parts of Africa.

Additional observations on the blood parasites of Ugandan birds

One thousand and seventy-six birds of 26 families and 127 species were examined for hemoprotozoa; 404 birds (37%) of 41 species representing 17 families harbored one or more blood parasites. Most parasites were species of Haemoproteus which represented 95% of all parasitic infections detected. Prevalence of blood parasites in birds collected from four areas over a period of six years was relatively stable.

Predictive value of early developmental examination

A developmental examination was carried out on 168 children at intervals over a 3-year period. The results suggest that developmental screening of this type is effective in picking out the "poor performers" who might well benefit from preschool education and extra health visitor supervision. On the other hand, the test given to children under the age of one year failed to pick out 2 children who were found to be moderately handicapped at the time of the 3-year examination. The study under-lined some of the problems of universal screening which require further research, and the need to assess the results of developmental screening clinic.

Distribution of the avian hematozoa of North America

The literature pertaining to the prevalence of avian hematozoa in North America, north of Mexico, together with unpublished records from the files of the International Reference Centre for Avian Malaria Parasites, have been collated and analyzed with respect to the distribution of parasite genera by region, host family, and vertical stratification of nesting sites. The blood parasites of 57 026 birds of 388 species (representing 55 families) breeding in North America are the basis of this analysis. A total of 21 048 (36.9%) birds harbored one or more species of Haemoproteus (19.5%), Leucocytozoon (17.7%), Trypanosoma (3.9%), Plasmodium (3.8%), microfilariae (3.1%), and Haemogregarina/Lankesterella (0.6%). The continent was arbitrarily divided into seven regions along a topographic basis. Overall hematozoan prevalence varied markedly from region to region, as did the relative frequencies of the different genera. Overall hematozoan prevalence also varied markedly from avian family to family, as did the relative frequencies of the different genera. Nine families had prevalences of 50% or more, while 16 families had prevalences of 5% or less; sea- and shore-birds were nearly hematozoan-free. Prevalence of blood parasites is correlated with the vertical stratification of nesting sites when considered on a localized geographic basis but no correlation exists when the results are pooled from the continent.