Endovascular stent graft placement for patients with aortic aneurysm and end-organ dysfunction

Endovascular stent grafts (ESGs) for the treatment of aortic aneurysm is becoming popular because it is less invasiveness for the patient. This new modality seems to be especially useful for treating high risk patients, such as those with end-organ dysfunction. In this study we retrospectively analyzed the results of ESG placement for patients with renal or hepatic dysfunction. From January 1996 to December 1997, six patients with end-organ dysfunction (two with descending thoracic aneurysm and four with abdominal aneurysm) underwent ESG placement. Five of these patients had renal dysfunction, with serum creatinine levels of 2.0 mg/dl or greater, and the remaining patient had hepatic dysfunction with a prothrombin time less than 60%. One of the patients also had severe atherosclerotic disease with a history of multiple brain infarctions. All the patients received custom made endovascular spiral Z stents covered with a woven Dacron (DuPont Co., Wilmington, DE) graft, which was delivered via a femoral artery under local anesthesia. None of the patients showed significant changes in renal or hepatic function after the procedure. None of the five patients with renal dysfunction needed hemodialysis after ESG placement, although the mean preoperative level of serum creatinine and blood urea nitrogen was 3.4 mg/dl and 42.0 mg/ dl, respectively. All the patients left the recovery room on postoperative day 1. These results indicated that endovascular stent graft placement is extremely useful in the treatment of aortic aneurysm patients with end-organ dysfunction.

Effects of injection rates of contrast material on arterial phase hepatic CT

OBJECTIVE

Our goal was to assess the effects of the i.v. injection rate of contrast material on arterial phase hepatic CT.

SUBJECTS AND METHODS

One hundred patients were randomly divided into four groups of 25 with different injection rates of 90 ml of contrast material: 2, 3, 4, or 5 ml/sec. Single-level serial CT was performed at the level of the middle section of the main portal vein before injection and every 2 sec from 12 sec to 60 sec after injection of contrast material. The enhancement value was calculated as the difference in attenuation value between the unenhanced and contrast-enhanced images for the aorta and liver parenchyma. The duration of the arterial phase was defined as the interval beginning when the enhancement value for the aorta reached 100 H and ending when the value for the liver parenchyma reached 20 H.

RESULTS

Faster injection rates increased the maximum enhancement of the aorta. Although faster injection rates decreased the time from injection to the beginning and the end of the arterial phase, faster injection rates did not decrease the duration of the arterial phase itself.

CONCLUSION

A faster injection rate increases arterial enhancement of the liver, and the duration of the arterial phase remains the same as that occurring with a slower injection rate. We hypothesize that faster injection rates can provide better results using CT to reveal hypervascular liver tumors.

[Small cell lung cancer associated with nephrotic syndrome: remission after chemotherapy]

A 66 year-old man was found to have pointed out a 1-cm tumor shadow, on a chest X-ray film when he underwent a gastrectomy because of advanced gastric cancer. Five months after the operation, edema and proteinuria developed, and a chest X-ray film revealed enlargement of the tumor. There was no sign of recurrence of the gastric cancer. Nephrotic syndrome due to IgA-nephropathy and small cell lung cancer was diagnosed. Chemotherapy (carboplatin and etoposide) was effective against both the lung tumor and the nephrotic syndrome. Small cell lung cancer may have been involved in the pathogenesis of the nephrotic syndrome in this patient.

Cationic multilamellar liposome-mediated human interferon-beta gene transfer into cervical cancer cell

Interferons (IFNs) have antineoplastic activity, but it has been reported that treatment with IFN alone is not effective in many cancers. To enhance the effect of growth inhibition on tumor cells by raising the concentration, we attempted the transfection of cervical cancer cells, HeLa cells, with human interferon-beta (HuIFN-beta) cDNA contained in the expression vector pRSV delivered by cationic multilamellar liposomes, which resulted in the secretion of HuIFN-beta into the medium. The concentration of HuIFN-beta in the medium was 22 IU/ml by 72 hours after transfection of 10 ng DNA, and provoked around 45-fold cell growth inhibitory effect compared with that of exogenously added HuIFN-beta (1000 IU/ml). This strong growth inhibition was considered to be due to the action of HuIFN-beta in a paracrine manner, and a notable fraction of the cell death was apoptotic.

[Gd-DTPA enhanced multi-shot echo-planar MRI: improvement of contrast between metastatic liver cancer and liver parenchyma]

In six patients with metastatic liver cancer, spin-echo multi-shot echo-planar MR imaging 8/2000/80/1 (shot/TR/TE/excitation) of the liver was performed before and 30, 60, 90 and 120 sec after the intravenous injection of Gd-DTPA. Signal-to-noise ratios (SNR) of the liver tumor and liver parenchyma were measured in each phase. The contrast-to-noise ratios (CNR) between the tumor and liver parenchyma were also calculated. While the SNR of the tumor did not change after the injection of Gd-DTPA, the SNR of the liver parenchyma decreased and the CNR between the tumor and liver parenchyma increased.

Induction of immune-mediated hearing loss in SCID mice by injection of MRL/lpr mouse spleen cells

Induction of immune-mediated hearing loss in SCID mice by injection of MRL/lpr mouse spleen cells The MRL/lpr mouse, which has a mutation in the Fas gene encoding a cell-surface receptor for apoptosis, shows an accumulation of abnormal immunocompetent cells and SLE-like disease. It has recently been reported that this mouse also manifests sensorineural hearing loss (SHL) with cochlear pathology at 20 weeks of age. We examined the effects of injecting MRL/lpr spleen cells on the development of SHL in severe combined immunodeficient (SCID) mice, which originally develop neither SHL nor cochlear pathology. Immune-mediated SHL and cochlear pathology were, indeed, transferred to the SCID mice by the injection of spleen cells from the MRL/lpr mice. These findings suggest that cell-mediated immunity is involved in the development of SHL and cochlear pathology.

Helical CT angiography of living renal donors: comparison with 3D Fourier transformation phase contrast MRA

PURPOSE

The purpose of this study was to determine whether helical CT angiography (CTA) or MR angiography (MRA) is the optimal method to use as a preoperative examination for anatomic arterial assessment of living renal donors.

METHOD

Eighteen candidates to be renal donors underwent helical CTA, 3D Fourier transformation phase contrast (3D-FT-PC) MRA, and digital subtraction angiography (DSA). The CTA and MRA were interpreted separately by three readers independently, and these results were correlated with the findings of DSA.

RESULTS

DSA showed nine accessory renal arteries and 10 prehilar branches. CTA revealed seven or eight accessory renal arteries. MRA showed six or seven accessory arteries. Of 10 prehilar branches, 7-9 branches were detected with CTA and 5-8 branches with MRA.

CONCLUSION

Helical CTA is superior to 3D-FT-PC MRA for evaluating the arterial anatomy of living renal donors.

Sensitivity in detection of hypervascular hepatocellular carcinoma by helical CT with intra-arterial injection of contrast medium, and by helical CT and MR imaging with intravenous injection of contrast medium

PURPOSE

To determine the effectiveness of i.a. contrast-enhanced helical CT and of i.v. contrast-enhanced helical CT and MR imaging, in detecting hypervascular hepatocellular carcinoma (HCC).

MATERIAL AND METHODS

Fifty patients with 125 hypervascular HCC nodules underwent helical CT both during arterial portography (CTAP) and during hepatic arteriography (CTHA). Helical CT and MR imaging of the entire liver with i.v. administration of contrast medium were also performed. Helical CT images were obtained at 30-33 s (arterial-phase CT) and at 5 min (equilibrium-phase CT) after the initiation of an i.v. bolus injection of contrast medium. After T1- and T2-weighted spin-echo MR imaging, gradient-echo images during breath-holding were obtained prior to and 20 s, 1 min, and 2 min after the bolus administration of 0.1 mmol/kg of gadopentetate dimeglumine (dynamic MR). The sensitivity and positive predictive value of the various techniques were evaluated and compared.

RESULTS

In terms of sensitivity for hypervascular HCC nodules of less than 1 cm in diameter, CTAP (90%) and CTHA (88%) were significantly superior to dynamic MR imaging (44%), arterial-phase CT (39%), spin-echo MR imaging (20%), and equilibrium-phase CT (7%) (p < 0.001). However, there was no significant difference in the techniques with regard to the detection of lesions equal to or more than 2 cm in diameter.

CONCLUSION

For detecting small hypervascular HCCs, helical CT with i.a. contrast enhancement is superior to helical CT and MR imaging with i.v. enhancement.

[Three-dimensional gadolinium-enhanced dynamic MRI of whole liver using spectrally selected enhanced fast gradient recall sequence]

Three-dimensional gadolinium-enhanced dynamic MRI of whole liver using the spectrally selected enhanced fast gradient recall sequence (spec IR-efgre3d) was performed in five patients with HCC. Ten HCC nodules were confirmed by CTA, CTAP and Lipiodol CT, and all of them were detected with dynamic MRI. MIP images reconstructed from 3D gadolinium-enhanced dynamic MR studies clearly showed the main portal vein and its branches in all cases. Portal vein thrombosis was also demonstrated with the MIP images.

[Evaluation of transcatheter hepatic segmental or subsegmental infusion of SMANCS for treatment of hepatocellular carcinoma]

A total of seventeen patients with hepatocellular carcinoma (HCC), nineteen HCCs, who underwent as an initial treatment transcatheter hepatic segmental or subsegmental arterial administration of SMANCS alone for hepatocellular carcinoma (HCC), were studied to evaluate the efficacy and complication of that treatment. The initial treatments provided CR in eight patients (47%), and repeat administrations of SMANCS achieved CR in an additional four patients (24%). The initial treatment provided a dense deposit of Lipiodol in the twelve tumors (63%), in five of which Lipiodol was thereafter washed out in some portions of the tumor. Complete necrosis was obtained in nine (75%) of fourteen hypervascular tumors, and in two (40%) of five intermediately vascular or hypovascular tumors. Segmental or subsegmental administration of SMANCS was well tolerated with self-controlled abdominal pain or fever well responding to medication. Ascites was seen in three cases, and atrophy of the segment infused occurred in five patients. Cholinesterase significantly reduced at one week and one month, then recovered to baseline two to three months after initial treatment. The cumulative survival rates were 77% at 1 year, 66% at 2 years, and 53% at 5 years in the whole patients. The survival rate was 100% at 5 years in the Child A group. In the patients who obtained CR using SMANCS alone, the survival rates were 89% at 1 year, 74% at 2 years and 56% at 5 years. Although this method may transiently deteriorate hepatic function, segmental or subsegmental administration of SMANCS may be an excellent therapeutic method for treatment of HCC and promising for use in properly selected patients.

Preoperative staging of endometrial carcinoma: diagnostic effect of T2-weighted fast spin-echo MR imaging

PURPOSE

To evaluate the usefulness of T2-weighted fast spin-echo magnetic resonance (MR) imaging with a 512 x 256 matrix for assessment of the preoperative stage of endometrial carcinoma.

MATERIALS AND METHODS

Twenty-eight women with histopathologically proved endometrial carcinoma underwent preoperative T2-weighted fast spin-echo, dynamic T1-weighted fast spin-echo, and postcontrast T1-weighted spin-echo MR imaging with a phased-array surface coil. The uterine long-axis planes in each sequence were reviewed at separate sessions by three radiologists blinded to the histopathologic data.

RESULTS

For the diagnosis of myometrial invasion, no statistically significant differences were found among T2-weighted imaging, dynamic imaging, and postcontrast T1-weighted imaging. For the diagnosis of deep myometrial invasion, T2-weighted and dynamic images showed higher specificity than postcontrast T1-weighted images (T2-weighted, 89%; dynamic, 88%; and postcontrast T1-weighted, 80%). For cervical invasion, T2-weighted and dynamic images showed larger areas under receiver operating characteristic curves than did postcontrast T1-weighted images (T2-weighted, 0.78; dynamic, 0.71; and postcontrast T1-weighted, 0.67).

CONCLUSION

T2-weighted imaging is useful for identifying the stage of endometrial carcinoma.

[Energy expenditure in patients with pulmonary emphysema]

We evaluated resting energy expenditure (REE) using canopy mode indirect calorimetry in 21 ambulatory, clinically stable outpatients with pulmonary emphysema (age: 69.3 +/- 8.4, %IBW: 79.3 +/- 12.5, FEV1: 0.98 +/- 0.36) and compared it with that of a 14 age-matched healthy controls (age: 71.1 +/- 6.0, %IBW: 94.5 +/- 13.4). We also compared REE in malnourished patients (%IBW < 90; 73.0 +/- 7.6, N = 14) and normonourished patients (%IBW > or = 90; 92.0 +/- 5.6, N = 7). We examined the relation ship between %REE (REE/REEpred. x 100) and measurements of lung function tests in 21 emphysema patients using single regression analysis. The REE of the patient group was significantly higher than that of the control group (%REE; 115.9 +/- 12.0 vs 86.5 +/- 8.7, p < 0.01). The REE of the malnourished patient subgroup was significantly higher than that of the normonourished patient subgroup (%REE; 121.9 +/- 7.9 vs 109.9 +/- 9.2, p < 0.01). There were no significant differences in FEV1(L), RV/TLC(%), TLC(pred.%) or DLco/VA (pred.%) between the two patient subgroups. The REE of the normonourished subgroup was significantly higher than that of control group (%REE; 109.1 +/- 9.2 vs 86.5 +/- 8.7, p < 0.01). There were significant relations hips among %REE and FEV1, %FVC, FEV1% G, %DLco/VA and RV/TLC (p < .05). These findings suggest that elevated REE may have a significant relation ship with abnormal lung function, and that elevated REE may be a cause of malnutrition in clinically stable patients with pulmonary emphysema.

[Cdk inhibiting proteins]

Mammalian cell growth is governed by a number of extracellular signals, among which anti-proliferative stimuli arrest cells in G1 phase of the cell cycle by increasing the activity of a group of polypeptides called cdk inhibitors (cdk inhibiting proteins). So far seven members of cdk inhibiting proteins have been isolated and characterized. They mostly locate in the nucleus and inhibit G1 cyclin/cdk activities by directly binding to them, thereby interfering with phosphorylation of key substrates to exit G1 including retinoblastoma proteins among them. Some of the cdk inhibiting protein genes are frequently deleted or mutated in tumor cells, and certain oncoproteins encoded by transforming viruses target cdk inhibiting proteins, suggesting that cdk inhibiting proteins function as tumor suppressors. It is important to investigate signaling pathways and regulatory mechanisms involving cdk inhibiting proteins not only to better understand cellular proliferation, cell cycle regulation, or cancer development, but also to search for new target molecules for chemotherapy.

CT, MR imaging and muscle biopsy in severe crush injury

PURPOSE

We reviewed CT and MR findings in crush injuries in muscles and compared them with findings at muscle biopsy.

MATERIAL AND METHODS

CT and MR examinations were made of the lower extremities in 6 adult patients whose muscles were crushed in the big earthquake in Kobe, Japan, on 17 January 1995. All CT examinations were performed twice and within 60 days of the earthquake. In 5 of the 6 patients, biopsies were taken of the injured muscle after the CT and MR examinations.

RESULTS

At CT investigation, the images in 5 patients showed calcification in the muscles, and the crushed muscle appeared atrophic. In 3 of these 5, the degree of calcification decreased with time. At MR investigation, T1-weighted images of the crushed muscle showed isointensity in 4 of the 6 patients and high intensity in the remaining 2. T2-weighted images of the crushed muscle showed inhomogeneous high intensity in all patients. After Gd injection, all the crushed muscles were enhanced, either slightly or markedly. At muscle biopsy, in 5 of the 6 cases, the findings showed calcification in the muscle cells and the total destruction of the normal muscle structure.

CONCLUSION

CT and MR findings in crush injury correlated well with the findings at histopathology.

[A case of Mycobacterium intracellulare infection associated with sinobronchial syndrome]

The patient was 71-year-old male with a history of sinobronchial syndrome since 8 years ago. He has been suffering from cough, sputum and upper abdominal discomfort since January 1994. He was diagnosed as an early gastric cancer by endoscopy, and his chest X-ray film showed an infiltrative shadow in the right upper lung field. A smear of the sputum specimen was positive for acid fast bacilli, which were later identified as Mycobacterium intracellulare. In this case, before the Mycobacterium intracellulare infection, it was confirmed that his mucociliary transport was severely impaired by using aerosol inhalation cine-scintigraphy. This case suggests that an impairment of the local defence mechanisms may play an important role in the pathogenesis of Mycobacterium intracellulare infection.

Combined hepatocellular and cholangiocellular carcinoma

A patient with combined hepatocellular carcinoma (HCC) and cholangiocellular carcinoma (CCC) underwent partial hepatectomy, and the correlation between the pathological and radiological findings was examined retrospectively. The tumor showed hypoattenuation and hypoenhancement relative to the surrounding liver parenchyma on noncontrast and postcontrast CT, respectively. Both the HCC and CCC components of the tumor showed hypointensity and heterogeneous hyperintensity on T1- and T2-weighted spin echo images, respectively. While the HCC component of the tumor showed hyperenhancement relative to the liver parenchyma on arterial phase images of dynamic MR imaging, the CCC component showed hypoenhancement. When components with different degrees of vascularity are seen in a hepatic tumor, combined HCC and CCC should be considered.

Helical CT during arterial portography and hepatic arteriography for detecting hypervascular hepatocellular carcinoma

OBJECTIVE

We assessed whether helical CT hepatic arteriography (CTHA) improves detection of hypervascular hepatocellular carcinoma (HCC) when used in conjunction with helical CT obtained during arterial portography (CTAP).

SUBJECTS AND METHODS

One hundred two patients with 254 hypervascular HCC nodules underwent both CTHA and CTAP. CTHA and CTAP were separately interpreted for detection of hypervascular HCC nodules by three observers who were unaware of tumor burden in the liver, lodized oil CT performed 1 week and 1 month after transcatheter arterial chemoembolization with iodized oil was the gold standard. Sensitivity and positive predictive value for CTHA alone, CTAP alone, and CTAP and CTHA combined were calculated and compared using the McNemar test.

RESULTS

We found no significant difference between the sensitivity of CTAP (85%) and CTHA (87%) for revealing hypervascular HCC nodules. The combination of CTAP and CTHA showed significantly higher sensitivity than either CTAP or CTHA alone for revealing HCC nodules smaller than 20 mm in diameter (p < .01).

CONCLUSION

The combination of CTHA and CTAP is recommended to improve the detection sensitivity of small hypervascular HCC nodules.

[Trial of a detachable Y-shaped tube with two valves for serial examinations of CT arterial portography and CT hepatic arteriography]

In five patients with hepatocellular carcinoma, CT arterial portography (CTAP) and CT hepatic arteriography (CTHA) were performed serially by using a newly developed detachable Y-shaped tube with two valves that could be attached to a conventional angiographic sheath. Two catheters could be inserted into the conventional angiographic sheath without blood backflow by using the Y-shaped tube. One catheter could be easily and safety placed on the common or proper hepatic artery, and the other on the superior mesenteric artery. This detachable Y-shaped tube with two valves could make it easy to perform serial CTAP and CTHA examinations.

[Cytokine producing ability of peripheral blood mononuclear cells in the clinical course of pulmonary tuberculosis]

Interferon-gamma (IFN-gamma) and interleukin-10 (IL-10)-producing ability of peripheral blood plastic-dish adherent cells and non-adherent cells obtained from patients with active pulmonary tuberculosis (N = 17) and healthy controls (N = 14) upon stimulation with purified protein derivatives (PPD) were assessed. Adherent cells and non-adherent cells were obtained two times from each patient with active pulmonary tuberculosis without any underlying diseases, on admission before the initiation of administering anti-tuberculous drugs and 2 months later from the negative conversion of Mycobacterium tuberculosis in sputum culture. ELISA was performed to measure IFN-gamma and IL-10 levels in culture media of adherent cells and non-adherent cells stimulated with PPD. IFN-gamma levels produced by non-adherent cells on admission were significantly higher than that of healthy controls (p < 0.001). Elevated IFN-gamma levels on admission was reduced after treatment for tuberculosis (p < 0.03), but still remained higher than that in healthy controls. IL-10 levels of non-adherent cells of patients were lower than those of healthy controls, although the difference was not significant. IL-10 levels produced by non-adherent cells on admission correlated with the time needed for negative conversion of bacilli in sputum culture (p < 0.05). IL-10 level produced by adherent cells from nutritionally normal patients were significantly higher than that of healthy controls (p < 0.05), and elevated IL-10 level was significantly reduced after therapy (p < 0.05). In the normonourished patients, the time needed for negative conversion of the bacilli in sputum culture of patients kept higher level of IL-10 of non-adherent cells (N = 5) was significantly longer than that of patients reduced IL-10 level after therapy. These results suggest that IL-10 produced by monocytes may diminish the TH1 responses of patients with pulmonary tuberculosis.

Superparamagnetic iron oxide enhanced magnetic resonance imaging of rat liver with hepatocellular carcinoma and benign hyperplastic nodule

RATIONALE AND OBJECTIVES

The authors assess the potential of a new superparamagnetic iron oxide (SPIO) in grading hepatocellular carcinoma (HCC) histologically and in differentiating HCC from benign hyperplastic nodule (HPN).

METHODS

Nine Wistar rats (with poorly to moderately differentiated HCC, well-differentiated HCC, and HPN) received drinking water containing N-nitrosomorpholine, and were examined by magnetic resonance imaging (4.7 tesla). Spin-echo images (repetition time/echo time, 600/24.5 mseconds) were obtained before and 15 minutes after intravenous administration of 10 mumol Fe/kg of SH U 555A.

RESULTS

Poorly to moderately differentiated and well-differentiated HCC showed no significant change in signal-to-noise ratio (SNR) 15 minutes after contrast, whereas HPN showed a significant decrease in SNR. The contrast-to-noise ratio (CNR) between each kind of tumor and adjacent liver parenchyma showed a significant increase at 15 minutes after contrast.

CONCLUSIONS

The SPIO discussed in this article may help to differentiate HCC from HPN, but it remains difficult to grade hepatocellular carcinoma histologically.

Hepatocellular carcinoma patients showing long-term complete responses to chemoembolization

The objective was to evaluate hepatocellular carcinoma (HCC) patients showing a long-term complete response (CR) to chemoembolization. We defined the criteria of CR as normalized tumor marker, no enhanced tumor in diagnostic images, and no tumor cells found at autopsy. Five HCC patients showing long-term CR to chemoembolization were evaluated. The CR period ranged from 3.5 to 7 years (mean, 5.7 years). The survival period ranged from 3.5 to 9 years (mean, 6.7 years). Four cases (80%) were stage IV according to the TNM classification due to a portal tumor thrombus. The liver function was rated as Child's A in four cases (80%). Long-term CR to chemoembolization can be achieved even in some advanced HCC cases with a tumor thrombus. We speculate that the good antitumor effect is brought about by the stagnation of both the arterial and portal blood flows to the HCC. Good liver function is also considered to be an important factor for long-term CR and a long survival period. If the liver function is good, advanced HCC with a portal tumor thrombus should be treated aggressively with chemoembolization.

Effect of histamine on intracellular Ca2+ concentration in guinea pig isolated vestibular hair cells

The present study examined the effects of histamine in the guinea pig isolated vestibular hair cells (VHCs) by measuring the dynamic changes of intracellular free calcium ion ([Ca2+]i) concentration using calcium sensitive dye Fura-2. The histamine-induced calcium response in VHCs was markedly increased at the concentration of 10 microM histamine in the presence of extracellular Ca2+, while in the absence of extracellular Ca2+, a slow increase of [Ca2+]i was evident. Receptor specificity of the response to histamine was examined: promethazine (H1 receptor antagonist), cimetidine (H2 receptor antagonist) and thioperamide (H3 receptor antagonist) completely blocked the histamine-induced calcium response at the concentrations of 2.5 microM, 1.0 microM and 1.0 nM, respectively. The responses were mediated by H1, H2 and H3 receptors and resulted in a rise of [Ca2+]i due to an influx of Ca2+ from the extracellular space and a release from intracellular stores. Our preliminary data suggest that under immuno-pathological conditions of the inner ear, histamine released from the mast cells distributed in the endolymphatic sac may act through receptors located on the vestibular hair cell membrane and may regulate the cell function and the signal transduction in the vestibular nerve-hair cell afferent system.

[Preliminary evaluation of the apparent diffusion coefficient of the kidney with a spiral IVIM sequence]

We examined the usefulness of the spiral intravoxel incoherent motion (IVIM) sequence in measuring the apparent diffusion coefficient (ADC) of the kidneys. Five volunteers and five patients with chronic renal failure underwent diffusion-sensitive magnetic resonance imaging of the kidneys with the spiral IVIM sequence. The ADC values in patients with chronic renal failure were significantly lower than those in the renal cortex of volunteers. The mean value of ADC in patients with chronic renal failure was lower than that in volunteers, although there was no statistically significant difference. In volunteers, the ADC of the renal cortex was significantly higher than that of the renal medulla. The phantom study indicated that the accuracy of ADC depended on the signal to noise ratio. A spiral IVIM sequence with a high enough signal to noise ratio may be useful in evaluating renal function especially that of the cortex.

Anionic sites of charge barrier in the guinea pig crista ampullaris

In present studies we obtained anionic sites in the epithelial and capillary basement membranes in the dark cell area of the crista ampullaris in the guinea pig. The immersion method with cationic tracer polyethyleneimine (PEI) was applied. Electronmicroscopically, the arrangement of PEI particles was observed as two strata along the basement membrane. The number of particles could be counted and compared in each portion. The control test with protamine sulfate showed that the number of PEI particles decreased in both the epithelium and capillaries of the dark cell area. In the experiment using furosemide, the stria vascularis and the dark cells had changed, with pathological findings of interstitial edema and PEI particles reduced in number. It is suggested that the PEI particles reflect different conditions of charge in the basement membrane, which influences the production or absorption of the inner ear fluid.

[Clinical benefit of nutritional assessment and support in patients with chronic obstructive pulmonary disease]

Weight loss is common in patients with chronic obstructive pulmonary disease (COPD). Comprehensive nutritional assessment was conducted in two large groups of patients with COPD who were enrolled in the Respiratory Failure Research Program sponsored by the Japanese Ministry of Health and Welfare and the Kinki COPD Research Group. The incidences of mild malnutrition (%IBW < 90%) were 74% and 62%, respectively. The incidences of hypoalbuminemia were low: 10.0% and 6.5%, respectively. The incidence of imbalance in plasma amino acids, which was defined as an abnormally low BCAA/AAA ratio, was as high as 93% in patients with COPD and chronic respiratory failure. The %IBW was significantly related to the FEV1 and to the DLco/VA. The moderately-malnourished subpopulation was characterized by a greater degree of hyperinflation and hypercapnea: the measured resting energy expenditure (REE) was significantly higher than the values in age-matched healthy controls. REE/REEpred was significantly and inversely related to BCAA/AAA and to Pimax. REE was inversely related to FEV1%. REE in the subgroup with severe hyperinflation was significantly higher than REE in those with milder hyperinflation. Among patients with an FEV1% of less than 50%, mortality tended to be higher in those with lower body weight, and this relationship was stronger in patients with an FEV1% of more than 50%. When patients were given a BCAA-enriched enteral formula in addition to their usual diet for 3 months, there was a significant increase in body weight, transferrin level, and Pimax.

[Atypical mycobacteriosis (Mycobacterium xenopi) with "initial aggravation"]

A 66-year-old man was admitted to Nara Medical University Hospital because of sputum production and fevre. A chest X-ray film obtained on admission revealed many cysts and an infiltrative shadow in the right upper lung field. The patient was treated with antimycobacterial drugs (isoniazid 400 mg, streptomycin 0.75 g, and rifampicin 450 mg) because acid-fast bacilli were detected in his sputum. Although the symptoms and laboratory data improved, a new infiltrative shadow developed in the right lower lung field two months after the start of treatment. Transbronchial biopsy specimens showed intraluminal organizing exudate and alveolitis. The new lesion resolved when treated with the same antimycobacterial drugs. Mycobacterium xenopi was cultured from the sputum 80 days later. This is the third reported case of atypical mycobacteriosis (non-tuberculous mycobacteriosis) due to M. xenopi in Japan with the "initial aggravation" seen in some patients with typical pulmonary tuberculosis.

Clinical value of CA125, CA19-9, CEA, CA72-4, and TPA in borderline ovarian tumor

Five tumor markers were analyzed clinically in 101 patients with borderline ovarian tumors who were treated by the Tokai Ovarian Tumor Study Group, an association comprising Nagoya University and its affiliated hospital, between January 1986 and December 1994. The positive rate of CA125 was 68.2% in serous tumor and 51.9% in mucinous tumor. The positive rate of CA19-9 was 51.5% in serous tumor and 44.7% in mucinous tumor. The positive rates and mean serum levels of CA125 in serous and mucinous tumor by stage had rising tendencies with an increase in each stage. The mean serum levels of CA19-9 in serous and mucinous tumor by stage had rising tendencies with an increase in each stage. CA125 and CA19-9 were useful for screening of borderline ovarian tumors. The positive rates of CEA and TPA in mucinous tumor were 32.5 and 27.3%, respectively, although none of the patients with serous tumor were positive in CEA and TPA. The positive rates and mean serum levels of CEA in mucinous tumor by stage had rising tendencies with an increase in each stage. The positive rate of CA72-4 was significantly lower than that of CA125 (P < 0.05).

[Investigation of soluble tumor necrosis factor receptor in patients with active tuberculosis]

It is assumed that soluble tumor necrosis factor receptor I and II (sTNF-RI, II) play important roles in the regulation of tumor necrosis factor alpha (TNF-alpha) activity. We measured the levels of circulating sTNF-R in patients with active pulmonary tuberculosis (n = 31) and the correlation between TNF-alpha and sTNF-R in serum level was investigated. We also compared sTNF-R levels before and after the treatment in 7 cases. Significant increase of circulating sTNF-R were found in patients with tuberculosis compared with the normal controls (n = 28) (p < 0.01). Moreover, significant positive correlations were found between TNF-alpha and sTNF-R I and II (r = 0.520, r = 0.553) in serum comparing sTNF-R levels before and after the treatment for patients with tuberculosis, significant fall was found in sTNF-R I, but not in sTNF-R II. As a result, it is suggested that sTNF-R regulates TNF-alpha activity in patients with tuberculosis, and that sTNF-R I levels could be used as one of the indices to evaluate the clinical activity of tuberculosis.

CT and MR imaging of abdominal liposarcoma

OBJECTIVE

CT and MR images were reviewed to correlate the histologic subtypes of abdominal liposarcoma with the radiologic findings.

SUBJECTS AND METHODS

Ten patients with liposarcoma who underwent CT or MR imaging before surgery were included in this study. CT and MR imaging findings for these patients were compared retrospectively with histologic findings.

RESULTS

Major histologic subtypes found in our group of patients were five well-differentiated, three myxoid, one pleomorphic, and one round-cell liposarcomas. The well-differentiated subtype consisted of lipoma-like and/or sclerosing components. The predominant attenuation and signal intensity characteristics of the lipoma-like components on CT and MR images resembled those of fat, whereas the predominant attenuation and signal intensity characteristics of the sclerosing components resembled those of muscle. The myxoid subtype showed, on unenhanced images, predominant attenuation and signal intensity characteristics that resembled those of water; on contrast-enhanced images, this subtype showed gradual reticular enhancement. The appearance of the round-cell and pleomorphic subtypes was that of heterogeneous, nonfatty tumors. Their characteristics were indistinguishable from those of other malignant soft-tissue masses.

CONCLUSION

Each histologic subtype of abdominal liposarcoma showed different CT attenuation or MR imaging signal intensity characteristics. A clear understanding of these findings should prove helpful in the diagnosis of liposarcoma.

3DFT-flash MR imaging of pancreatic cancer with gadopentetate dimeglumine

PURPOSE

We evaluated the usefulness of dynamic 3-dimensional Fourier transformation (3DFT) fast low angle shot (FLASH) MR imaging using gadopentetate dimeglumine (Gd-DTPA) to assess the extent of pancreatic cancer.

MATERIAL AND METHODS

Breath-hold 3DFT-FLASH MR images (20/4; 25 degrees flip angle; 7 partitions; 3-5-mm slice thickness) were obtained before the ++administration of 0.1 mmol/kg of Gd-DTPA, just after (early phase), and 1 and 2 min (late phases) after in 14 patients with pancreatic cancer. All patients underwent surgical removal or laparotomy. We compared the findings of T1-, T2-, and postcontrast T1-weighted spin-echo (conventional SE) and 3DFT-FLASH imaging with histologic or surgical findings.

RESULTS

Dynamic MR images could delineate the pancreatic tumors more clearly than the conventional SE images, and were useful for diagnosing vessel invasion. The contrast-to-noise ratio between the pancreatic cancer and the surrounding pancreatic parenchyma was significantly higher with the dynamic 3DFT-FLASH image than with the conventional SE images (p<0.01).

CONCLUSION

Dynamic 3DFT-FLASH MR imaging with Gd-DTPA is useful in delineating and evaluating the extent of pancreatic cancer.

Investigation of the local provocation test to PPP and IgA nephritis

We examined 24 cases with pustulosis palmaris et plantaris (PPP) and 13 cases with IgA nephritis. The provocation test was performed in 11 cases with PPP and 7 cases with IgA nephritis. According to Nosaka's criteria, as variables for assessing the provocation test, changes in WBC (white blood cell count), BT (temperature), ESR (erythrocyte sedimentation rate) and skin eruption or urinary findings (hematuria and proteinuria) were estimated. Analysis of the provocation test proved positive in 3 of 11 cases (27%) with PPP and in 5 of 7 cases (71%) with IgA nephritis. Improvement of PPP was found in 12 of 14 cases (86%) with tonsillectomy and in 5 of 10 cases (50%) without tonsillectomy. However, there was no significant relation between prognosis and results of provocation tests. Improvement of IgA nephritis was found in 6 of 10 cases (60%) with tonsillectomy and none of 3 cases (0%)) without tonsillectomy. Furthermore, the cases with positive reaction by the provocation test showed better prognosis than those with negative reaction. Our results suggest that in patients with IgA nephritis, the efficacy of tonsillectomy is better in patients with a positive reaction to the provocation test than in those with a negative reaction. However, this phenomenon was not observed in the patients with PPP. Improvement of symptoms in the patients undergoing tonsillectomy was found in the early time period after surgery as compared with that in the patients with conservative treatment.

[A new embolic material: super absorbent polymer (SAP) microsphere and its embolic effects]

SAP-Microsphere (sodium acrylic acid-vinyl alcohol copolymer) has the ability to absorb fluids within a few minutes and increase its diameter. Its diameter can also be calibrated. The diameters in ionic contrast material and human serum are 2.1 and 3.5 times larger, respectively, than the original size. It can pass through a microcatheter with an ionic contrast material, and swells at the occluding point into the desired size. It can be recognized under fluoroscopy due to its absorption of contrast material. A total of 10 rabbit kidney embolizations were done followed by resection in 1-14 weeks. Recanalization was absent in all cases. No adhesion to the perirenal tissue was found. Limited reactive change in endothelial cells was found at one week. No changes in the smooth muscle layer were found at any time during the study. Limited infiltration of neutrophil cells was found in perivascular tissue within a period of one week. SAP-Microspheres maintained their spherical shape during a 14-week period. Extensive fibrosis and calcification were found after 4 weeks. SAP-Microspheres are promising as an embolic agent to obtain satisfactory results of embolization therapy.

Intramural invasion of gastric cancer: evaluation by CT with water-filling method

OBJECTIVE

Our goal was to clarify the ability of CT to evaluate intramural invasion of gastric cancer.

MATERIALS AND METHODS

We reviewed bolus-enhanced CT images performed with orally administered 400-600 ml of water in 59 early gastric cancers and 22 advanced gastric cancers mimicking early gastric cancers macroscopically.

RESULTS

CT was able to reveal 49% of early gastric cancers and 68% of advanced gastric cancers mimicking early cancers. Twenty-seven gastric tumors were detected in two or three layered structure of wall. Morphologic features of early gastric cancers are strong enhancement without wall thickening and thickened inner layer with normal middle and outer layers. Morphologic features of early advanced gastric cancers are a thickened wall with disappeared middle and outer layers and transmural enhancement with wall thickening. If one of these features was used to predict whether the tumor was early or early advanced gastric cancer in detected cases, specificity was 93-100%, sensitivity was 7-72%, and positive predictive value was 80-100%.

CONCLUSION

We evaluated whether the wall pattern of gastric tumors on CT can provide useful information about intramural invasion.

[Pulmonary infection due to Mycobacterium szulgai associated with multiple bullous disease of the lung]

A 46-years-old male was admitted to our hospital because of productive cough and infiltrates on the chest roentogenogram. The patient had a history of left upper bullectomy ten years prior to the admission. The CT scan of the chest on admission showed infiltrats with cavitation in the left apex and multiple bullae in almost whole lung. Microscopical examination of smears of sputum and bronchoalveolar lavage fluid revealed acid-fast bacilli. They were identified as Mycobacterium szulgai by DNA-DNA hybridization method. The patient was treated with isoniazid, streptomycin and rifampicin. After treatment for about a month, the culture of sputum converted to negative for M. szulgai. After about three months hospitalization, the infiltrates decreased and the cavity wall became thin, and no recurrence sign has been observed after the discharge. There are a few case reports of pulmonary infection due to M. szulgai associated with bullous disease of the lung in Japan.

[Studies on mucociliary transport in patients with pulmonary atypical mycobacteriosis--by aerosol inhalation cine-scintigraphy]

Mucociliary transport (MCT) was studied in 22 patients with atypical mycobacteriosis (Group I : 16 with M. avium-intracellulare complex (MAC), Group II : 6 with M. kansasii) by aerosol inhalation cine-scintigraphy. In most of the patients, the MCT was abnormally slow both in the main bronchus and in the trachea, while in healthy controls the transport of the inhaled aerosol in the bronchus and the trachea were rapid and smooth. In both groups, the tracheal MCT was impaired in two thirds of the patients, while the MCT in the main bronchus was impaired in all except one in Group I and in two-thirds in Group II. The results indicate that the grade of bronchial impairment was higher in MAC than in M. kansasii infections. In atypical mycobacteriosis, especially in MAC infections, such impairment of MCT could be closely related to the disruption of local defence mechanisms in the airways.

Portal vein thrombosis associated with active ulcerative colitis: percutaneous transhepatic recanalization

A patient with severe ulcerative colitis developed portal vein thrombosis. Intraportal infusion of plasminogen activators through a percutaneous transhepatic catheter produced an effective thrombolysis without increasing rectal bleeding. This is the first report in which portal vein thrombosis associated with active ulcerative colitis was treated successfully.

[Studies on production of interleukin-1 beta (IL-1 beta) and granulocyte. Macrophage-colony stimulating factor (GM-CSF) by peripheral blood monocytes from patients with Mycobacterium avium-intracellulare complex (MAC) infection]

Production of Interleukin-1 beta (IL-1 beta) and granulocyte macrophage-colony stimulating factor (GM-CSF) by peripheral blood monocytes (PBMs) from patients with Mycobacterium avium-intracellulare complex (MAC) infection was assessed and the relationship with their clinical course was analyzed. PBMs were obtained from MAC-infected patients in their active stage as well as in the inactive stage and the healthy controls. Spontaneous release of IL-1 beta by PBMs from patients in the active stage was higher than those by the cells in the inactive stage or the healthy controls. On the other hand, spontaneous GM-CSF release by PBMs from patients in the active stage was higher than the healthy controls. When PBMs were stimulated with MAC-derived purified protein derivatives (PPD-B), increased production of both IL-1 beta and GM-CSF were obtained for PBMs in their active stage. While these enhanced production upon stimulation with PPD-B related to the persistent infection with MAC, the increased IL-1 beta production correlated with the exhausted nutritional state. Both IL-1 beta and GM-CSF produced by PBMs seemed to be closely related with the clinical course of human MAC infection.

Evidence of cellular supplies to the endolymphatic sac from the systemic circulation

Donor T lymphocytes injected into the host systemic circulation were observed to infiltrate into the host endolymphatic sac in mice. These findings suggest that the endolymphatic sac, a major immune organ in the inner ear, is supplied with immunocompetent cells from the systemic circulation. This concept is consistent with clinical reports that inner ear disorders accompany certain systemic autoimmune diseases. Bone marrow transplantation to replace autoreactive immunocompetent cells with normal cells should be considered as a potential therapy for inner ear autoimmune diseases and an alternative to conventional treatments.

[Production of tumor necrosis factor alpha and interleukin-6 by peripheral monocytes from patients with atypical mycobacteriosis--relationship to clinical activity]

The production of tumor necrosis factor alpha (TNF alpha) and of interleukin-6 (IL-6) by peripheral blood monocytes (PBMs) from patients infected with Mycobacterium avium intracellular complex (MAC) were assessed. Spontaneous release of both TNF alpha and IL-6 were greater during the active stage than during the inactive stage and in healthy controls. When the cells were stimulated with MAC-derived purified protein derivative B (PPD-B). TNF alpha production by PBMs in the active stage increased and IL-6 production by cells in both the active and inactive stages decreased. Moreover, the in vitro increase in TNF alpha production after stimulation in the active stage seemed to be related to the persistent MAC infection, which resulted in an exhaustion of nutrition. These results suggest that the ability of PBMs to produce TNF alpha and IL-6 in vitro is closely related to the clinical stage of MAC infection.

[Spinal anesthesia for patients with progressive muscular dystrophy]

Spinal anesthesia was applied on 8 occasions to 7 patients with progressive muscular dystrophy (PMD) undergoing orthopedic lower limb surgery. No postoperative complication occurred in all patients. During the operations, however, two patients were subjected to high spinal anesthesia, which caused ventilatory suppression in one patient and bronchial asthma attack in another. Both respiratory complications were easily managed by ventilatory assistance with endotracheal intubation or by administration of bronchodilator, respectively. High spinal anesthesia should be avoided in applying spinal anesthesia to patients with PMD.

Transarterial embolization of an extrahepatic portal vein aneurysm with arterioportal fistula

We successfully performed transcatheter arterial embolization of an extrahepatic arterioportal fistula with a portal vein aneurysm. The fistula was considered secondary to cholecystectomy for cholecystolithiasis 5 years earlier. After occlusion of the fistula with platinum coils, the aneurysmal cavity thrombosed.

Cervical invasion of endometrial carcinoma--evaluation by parasagittal MR imaging

Twenty-seven consecutive patients were examined by T2-(1,800/70 ms) and postcontrast T1-weighted (600/15) spin echo (SE) or dynamic (200/15) SE MR imaging to determine the usefulness of parasagittal MR imaging in assessing cervical invasion of endometrial carcinoma. The images were obtained in a direction parallel to the longitudinal axis of the uterus (parasagittal). The cervical epithelium, being hyperintense on the late phase dynamic and postcontrast T1-weighted SE images, had disappeared partially or totally in all 4 patients with cervical invasion. The enhanced cervical epithelium was completely seen in one patient with the tumor protruding into the cervical canal in a polyp-like form without cervical epithelial invasion. The same was also seen in the 22 patients with the tumor remaining in the corpus cavity. The enhanced parasagittal MR images facilitated the evaluation of the extent of the endometrial carcinoma.