Supraclavicular lymph node metastases in cervical cancer

PURPOSE OF INVESTIGATION

To evaluate the outcome and prognostic factors of patients with supraclavicular lymph node (SCLN) involvement at primary diagnosis.

METHODS

We reviewed the medical records of cervical cancer patients primarily treated at Chang Gung Memorial Hospital between 1987 and 2005. Thirty-three patients with histologically confirmed SCLN metastasis at primary diagnosis were eligible for analysis. Clinical and pathological features were analyzed for association with outcome.

RESULTS

The 3- and 5-year survival rates of patients with SCLN metastasis were 16.5% and 16.5%, respectively. Multivariate analysis showed the serum level of squamous cell carcinoma antigen (SCC-Ag) < 15 ng/ml at initial diagnosis (p = 0.021) and staging/restaging including [18F] fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) (p = 0.006) to be associated with a better prognosis.

CONCLUSION

Primary SCLN metastasis in cervical cancer is not incurable. The benefit from PET findings might help in selecting appropriate patients for curative primary and/or salvage treatment.

Peritoneal metastasis in primary cervical cancer: a case report

PURPOSE OF INVESTIGATION

Peritoneal metastasis presenting at initial diagnosis of squamous carcinoma of the uterine cervix is extremely rare. However, one such case was treated successfully with curative treatment.

CASE

A 43-year-old woman presented with FIGO Stage IVA cervical carcinoma and underwent concurrent chemoradiation (CCRT) with weekly cisplatin. During CCRT, she suffered from acute lower abdominal pain, high fever, and leukocytosis. Computed tomography (CT) favored a tubo-ovarian abscess, while [18F] fluorodeoxyglucose positron emission tomography (FDG-PET) showed a lesion midway between the umbilicus and symphysis pubis. An exploration by laparoscopy, an omental metastasis adhering to the bladder dome was excised. This patient finished CCRT encompassing the disease extent including the trochar sites and no evidence of disease was noted 50 months after initial diagnosis.

CONCLUSION

Though peritoneal metastasis above the pelvis seems ominous, curative treatment may still be viable in selected patients, even in surgical Stage IVB.

Chemical and microbiological qualities of The East River (Dongjiang) water, with particular reference to drinking water supply in Hong Kong

Currently, about 80% of drinking water in Hong Kong is abstracted from The East River (Dongjiang) that is located in the mainland side of China. Literature records and monitoring results of 2000-2001 confirmed that the lower section of the Dongjiang had been contaminated by organic and inorganic pollutants. Statistical analyses showed that the increases of total cadmium, copper and zinc in the surface layer of sediment of Hong Kong reservoirs from 1994 to 2001 were positively correlated (significant at p<0.05) with those in the surface layer of sediments of the lower Dongjiang. Recent microbiological survey revealed that pathogens such as Salmonella spp., Vibro spp., Giardia lamblia and Cryptosporidium parvum appeared occasionally in water samples of the Dongjiang and Hong Kong reservoirs. While analytical results found that currently most of the heavy metals, trace organics and microbes were removed by the drinking water treatment plants in Hong Kong, the long-term health risk of drinking water contamination should not be overlooked. The Water Supplies Department of Hong Kong is recommended to intensify its water quality monitoring program to cover pathogenic bacteria and parasites in watercourses and reservoirs.

Sarcoidosis of the gingiva--a case report

Involvement of oral tissues by sarcoidosis is uncommon. We present a case of sarcoidosis involving the gingivae of a 60-year-old woman. The patient presents with an 18-month history of localized areas of gingival redness and swelling. She also has a previous history of sarcoidosis.

'Sites' of resistance: alternative websites and state-society relations

Much attention has been focused on Singapore's attempt to use information technology to build a knowledge-based economy. This paper examines the implications of the unintended consequences of the Internet in the restructuring of state and society relations in Singapore. We use the data on Singapore-based and Singapore-related websites to show (a) the diversity of positions expressed by civil society organizations, fringe groups and even mainstream segments of society; (b) the negotiation process between the state and civil society over various rights and how developments in cyber-space have implications for 'reality'; (c) how censorship and content regulation itself is a more complex multi-dimensional process such that while local politics is regulated, the multi-ethnic character of the resident population has led to greater religious tolerance such that religious groups banned in some countries have found a safe haven in Singapore and have used the city-state as a strategic Internet node.

Chemical contamination of the East River (Dongjiang) and its implication on sustainable development in the Pearl River Delta

A recent survey reveals that water quality and river sediments of Dongjiang (the East River) have been mildly contaminated by heavy metals and organic chemicals, such as copper, lead, PCBs, PAHs and HCHs. According to photogrammertic surveys, the sources of contamination are closely related to human activities, such as domestic and industrial discharges, agricultural chemical applications and soil erosion due to deforestation. The level of water and sediment contamination is most serious at the mid-river section near the urban of Weizhou. Due to natural dilution and diffusion, the levels of contamination are slightly decreased at the medium low section of the River near Qiaotou and Matan. Nevertheless, the levels of contamination increase again in the lower river section near Shenzhen, which is a highly developed economic zone. Since Dongjiang is the major source of potable water supply for Hong Kong (nearly 80% of potable water of Hong Kong is abstracted from Dongjiang) and the other parts of the Pearl River Delta (PRD), such organic and inorganic pollution merit concern. Ironically, most of the industrial and commercial activities in the watershed of Dongjiang are business investments of Hong Kong citizens. Cross-border environmental efforts should be enhanced with collaboration of different jurisdictions to achieve targets of regional sustainability.

Organization of ribosomal RNA genes from a Loofah witches' broom phytoplasma

Using the technique of integrative mapping with three vectors carrying chromosomal rDNA sequences, one of two rRNA operons of loofah witches' broom (LfWB) phytoplasma was constructed. This is the first complete rRNA operon of a phytoplasma to be reported. The operon has a context of 5'-16S-23S-5S-3' with a tRNA(Ile) gene in the ITS and tRNA(Val) and tRNA(Asn) genes downstream from the 5S rRNA gene. Although the other operon has not been cloned, the DNA sequence of a PCR-amplified product shows that it has no tRNA(Ile) gene in the ITS region. The complete nucleotide sequences of 16S, 23S, and 5S rDNA are 1538, 2864, and 113 bp, respectively. Five -10-like sequences, but no -35 sequences, were found within a 494-bp leader region. There was a TG dinucleotide two nucleotides upstream from each -10-like sequence. The existence of a TG dinucleotide at this position has been reported to enhance the efficiency of a promoter without a -35 region. The regions immediately flanking the 5' and 3' ends of 16S and 23S rDNA can form long basepaired stems that contain sites for processing by RNase III. No obvious sequence for a rho-dependent or rho-independent termination site was found downstream from the tRNA(Asn) gene. The transcription may stop within a pyrimidine-rich region, as has been reported for several polypeptide-encoding genes and rRNA operons of archaeobacteria. The presence of the tRNA genes downstream from the 5S rRNA gene in the rRNA operon of LfWB phytoplasma further supports the hypothesis that phytoplasmas are phylogenetically closer to acholeplasmas than to mycoplasmas. The phylogenetic relatedness of LfWB phytoplasma to other phytoplasmas is discussed on the basis of the nucleotide sequence of rRNA genes and ITS.

The fliU and fliV genes are expressed as a single ORF in Salmonella choleraesuis

A DNA fragment carrying flagellar genes was cloned from Salmonella choleraesuis. Compared to the corresponding DNA fragment of Salmonella muenchen, this fragment contained three ORFs instead of four shown in S. muenchen. The DNA sequence data showed that there was an insertion of nucleotide C in the ORF of the S. choleraesuis fliU gene, which resulted in the disappearance of a termination codon downstream. The recombinant plasmid pFU11 containing the coding region of the fliU gene made by PCR on S. choleraesuis genomic DNA was constructed and expressed in Escherichia coli in the presence of IPTG. As expected, a 45 kDa protein band was observed on a SDS-PAGE gel, in contrast to two with each having about a half of the molecular weight. These results demonstrated that the DNA sequence encoding one protein (FliU) in S. choleraesuis corresponded to the DNA sequence encoding two proteins (FliU and FliV) in S. muenchen. The protein encoded by this single ORF might carry out the functions of two separated proteins by folding in such a way that its conformation could function like two interdependent protein subunits.

Meningococcal disease in South African goldmines--epidemiology and strategies for control

OBJECTIVES

To describe the epidemiology of meningococcal disease in South African goldmines and to suggest strategies for the prevention and control of further outbreaks.

DESIGN

We prospectively investigated a meningococcal outbreak that occurred in 1996 and describe the control measures that were implemented. In addition, we conducted a retrospective analysis of routinely collected data on meningococcal disease in these mines from 1972 to 1996.

SETTING

Four goldmines in Gauteng, employing 30,000 workers who live in hostels.

SUBJECTS

All cases of meningococcal disease at the mine hospital.

RESULTS

Between 1972 and 1976, 588 cases were diagnosed, with peaks in 1972 (203 cases, 727/100,000) and 1975 (147 cases, 564/100,000). Since 1978 less than 5 cases have been reported in most years, but smaller outbreaks occurred in 1990 (30 cases, 89/100,000) and 1996 (14 cases, 50/100,000). The 1996 outbreak (group A, clone I-1) was part of a larger outbreak in Gauteng that originated in Mozambique and began in one mine in July 1996, after which a mass vaccination campaign was implemented. This was followed by a smaller outbreak among non-vaccinated workers at an adjacent mine. Five patients were new recruits.

CONCLUSIONS

Despite a dramatic reduction in meningococcal disease over the last 25 years due mainly to changes in the work force, there are still outbreaks in this community. Those most at risk are young men who are new to the industry. Suggestions for prevention include effective surveillance, routine vaccination of new recruits and a rapid response to outbreaks, with mass vaccination and provision of chemoprophylaxis to close contacts.

Liquid phase parallel synthesis of guanidines

Combinatorial synthesis of N,N'-di(Boc)-Protected guanidines containing piperazine and pyrrolidine scaffolds has been developed. We initiate a preliminary study on the reactivity of several guanylating reagents with soluble polymer-bound diamines in liquid phase. Guanidines are liberated from the polymer support under mild conditions in high yields and high purity by simple precipitation and washings. This combinatorial liquid-phase methodology proves to be a useful tool for constructing guanidine libraries containing diamine scaffolds.

Meningitis in a community with a high prevalence of tuberculosis and HIV infection

OBJECTIVES

To evaluate the spectrum of aetiologies, and distinguishing clinical and laboratory features, of meningeal infection in a community with a high prevalence of tuberculosis (TB) and HIV infection.

SETTING

A hospital serving mineworkers, originating from rural areas of Southern Africa.

DESIGN

Prospective cohort of 60 consecutive lumbar punctures (LPs), performed for suspected meningitis.

MEASUREMENTS

Clinical history and examination; concurrent cerebrospinal fluid (CSF) and blood samples; mortality status six months after entry to study.

RESULTS

38 of 57 patients (66.7%) were HIV-1 positive, 59.5% of whom had a CD4 count <200 cells/mm3. Nine patients had tuberculous meningitis (TBM) and two had tuberculomas; four developed disease while on TB therapy. There was one case of multidrug, and two of isoniazid-resistant TBM. There were nine episodes of cryptococcal meningitis (seven patients), nine of aseptic meningitis, two of neurosyphilis and 20 normal LPs, including four with AIDS dementia complex (ADC). Ten patients with meningococcal infection, part of a larger outbreak, were significantly younger (p=0.004). All patients with tuberculous, cryptococcal (most immune-suppressed p<0.001) and aseptic meningitis were HIV-1 positive. Within six months, 19 patients had died. Death was associated with HIV positivity (p=0.004), low CD4 count (p<0.001) and a diagnosis of cryptococcal meningitis, CNS TB or ADC.

CONCLUSION

HIV has a major impact on the burden of disease and mortality, with a predominance of opportunistic chronic meningitides, despite a meningococcal outbreak, in this community. Of concern is the development of TBM despite therapy, and the emergence of drug-resistant strains.

Favorable scanning electron microscopic findings of stapled saphenous vein-carotid artery anastomoses

BACKGROUND

In the progress toward "off-pump" endoscopic coronary artery surgical procedures, new techniques for coronary artery anastomoses are being developed. One such approach is the use of nonpenetrating titanium clips. We evaluated the quality of anastomoses achieved using this technique in a porcine model of saphenous vein-carotid artery grafting using scanning electron microscopy.

METHODS

Bilateral saphenous vein-carotid artery interposition grafts were implanted in 10 "white race" pigs, using the nonpenetrating clips in one side of the neck and conventional hand suturing on the opposite side. One week after operation, the grafts were harvested.

RESULTS

All grafts were patent 7 days after operation, and 40 anastomoses underwent scanning electron microscopic study. In all samples, the luminal surfaces of both the carotid artery and vein graft were covered by a continuous layer of endothelial cells up to the anastomosis. Anastomotic sites in all clipped samples and most of the sutured anastomoses were completely endothelialized, and anastomotic clefts were indistinguishable. However, in 25% of sutured specimens, the suture material remained clearly visible inside the lumen of the vessel, and the subendothelial matrix remained exposed, with extensive fibrin, red blood cells, and platelet deposition on its surface.

CONCLUSIONS

Because the endothelial coverage consistently appeared to be complete and the subendothelial matrix was not exposed, it is likely that the risk of early anastomotic thrombosis is reduced by using the nonpenetrating titanium clips.

Single-voxel proton MR spectroscopy of nonneoplastic brain lesions suggestive of a neoplasm

BACKGROUND AND PURPOSE

MR spectroscopy is used to characterize biochemical components of normal and abnormal brain tissue. We sought to evaluate common histologic findings in a diverse group of nonneoplastic diseases in patients with in vivo MR spectroscopic profiles suggestive of a CNS neoplasm.

METHODS

During a 2-year period, 241 patients with suspected neoplastic CNS lesions detected on MR images were studied with MR spectroscopy. Of these, five patients with a nonneoplastic diagnosis were identified retrospectively; a sixth patient without tissue diagnosis was added. MR spectroscopic findings consistent with a neoplasm included elevated choline and decreased N-acetylaspartate and creatine, with or without detectable mobile lipid and lactate peaks.

RESULTS

The histologic specimens in all five patients for whom tissue diagnoses were available showed significant WBC infiltrates, with both interstitial and perivascular accumulations of lymphocytes, macrophages, histiocytes, and (in one case) plasma cells. Reactive astrogliosis was also prominent in most tissue samples. This cellular immune response was an integral component of the underlying disorder in these patients, including fulminant demyelination in two patients, human herpesvirus 6 encephalitis in one patient, organizing hematoma from a small arteriovenous malformation in one patient, and inflammatory pseudotumor in one patient. Although no histologic data were available in the sixth patient, neoplasm was considered unlikely on the basis of ongoing clinical and neuroradiologic improvement without specific therapy.

CONCLUSION

Nonneoplastic disease processes in the CNS may elicit a reactive proliferation of cellular elements of the immune system and of glial tissue that is associated with MR spectroscopic profiles indistinguishable from CNS neoplasms with current in vivo MR spectroscopic techniques. Such false-positive findings substantiate the need for histologic examination of tissue as the standard of reference for the diagnosis of intracranial mass lesions.

Fulminant progression of demyelinating disease after valproate-induced encephalopathy

We report the clinical, radiologic, and pathologic features of a patient who had fulminant demyelinating disease and who experienced acute progression of his disease after an episode of valproate-induced hyperammonemic encephalopathy. The role hyperammonemia played in the progression of the demyelination is uncertain. This case raises concern of a possible risk with the use of valproic acid in the subset of patients with fulminant demyelinating disease.

Contrast media of high and low molecular weights in the detection of recurrent herniated disks

PURPOSE

Our goal was to compare contrast enhancement of recurrent herniated disk fragments and scar after intravenous injection of a new high-molecular-weight contrast medium, Gadomer 17 (gadomer), with that after injection of a low-molecular-weight contrast medium, (gadopentetate dimeglumine).

METHODS

Recurrent herniated disks were modeled in dogs by placing a fragment of intervertebral disk cartilage in the epidural space at laminectomy. MR imaging was performed with one of the contrast media at 20 and 50 days and with the other medium at 22 and 52 days. The changes in signal intensity from baseline in the disk fragment and in the adjacent scar tissue was measured at 2, 22, and 45 minutes. Differences were tested for significance with a student t-test.

RESULTS

At 50 days after surgery, signal intensity in the intervertebral disk fragment increased by an average of 0.52 at 2 minutes after injection of gadomer and by an average of 0.90 after injection of gadopentetate. For scar, the increases in signal intensity were 1.41 (gadomer) and 1.62 (gadopentetate). At 22 and 45 minutes after injection, the signal intensity change in the disk fragment continued to be significantly greater after gadopentetate than after gadomer injection. In comparison with the changes at 50 days, both scar and disk fragment tended to show greater signal intensity changes at 20 days. Signal intensity changes in the disk fragments were significantly less after gadomer than after gadopentetate. Signal intensity changes in scar were slightly less with gadomer than with gadopentetate.

CONCLUSION

Greater contrast is achieved between scar and recurrent herniated disk with a higher-molecular-weight contrast medium than with one of lower molecular weight. The difference between the high- and low-molecular-weight contrast media increases with maturation of the scar tissue.

CuTira brachytherapy: a new combination of radioactive copper isotopes and the hypoxic cytotoxin, tirapazamine, for targeted tumor therapy

We previously showed a significant enhancement of tirapazamine-induced cytotoxicity and DNA damage after binding with copper. This result suggests that conjugates of tirapazamine with radioactive copper, i.e., 64Cu and 67Cu, may offer potential for targeted therapy of a wide range of advanced stage tumors including a possible treatment for patients with solitary hepatocellular carcinoma by intrahepatic arterial infusion. Major supporting considerations include: (a) tirapazamine having a high selective toxicity against hypoxic cells; (b) the nature of radioactive decay of these copper isotopes and obtainable high specific activity; and (c) simple procedure for the production of copper-tirapazamine complex.

Bilateral choroidal metastases as the initial presentation of a small breast carcinoma: a case report

Most ocular tumors metastasize from systemic origins in breast carcinoma in females, and bronchial carcinoma in males. Here, we report a case of choroidal carcinoma metastasis from the breast with visual problems being the only initial manifestations. In this case, both eyes were involved at almost the same time, with initial manifestation of blurred vision which progressed to complete visual loss. At first, the patient was diagnosed with malignant melanoma, and enucleation of the right eye was performed in another hospital. However, the tumor had already metastasized rapidly to numerous organs, including the lungs, brain and bone, although it had not affected the liver. Clinical presentations were, therefore, not compatible with those of malignant melanoma, which has usually been reported to metastasize to the liver. Persistent hypercalcemia and raised carcinoembryonic antigen (CEA) concentrations prompted investigations into the possibility of systemic malignancy. A very small breast nodule was finally located by thorough physical examination, and a lumpectomy was performed. A detailed review of the histopathology showed the tumors from the breast and the right eye to have the same origin. Simultaneous bilateral choroidal metastases from other malignancies is not uncommon; however, it is quite rare for breast carcinoma to present with visual problems as a first manifestation. Detailed history taking and physical examination are therefore essential when searching for a primary tumor, so that appropriate therapy can be given earlier.

Epstein-Barr virus LMP1 modulates the malignant potential of gastric carcinoma cells involving apoptosis

About 10% of gastric carcinomas including lymphoepithelioma-like carcinoma and adenocarcinoma are associated with Epstein-Barr virus (EBV) infection. In EBV-associated gastric carcinomas, the tumor cells express Epstein-Barr nuclear antigen 1 (EBNA-1) but not EBNA-2, -3A, -3B, or -3C, leader protein, or latent membrane proteins (LMPs) because of gene methylation. Only a few exceptional cases have LMP1 expression in tumor cells as demonstrated by immunohistochemical studies. To elucidate the biological effects of LMP1 and the significance of its restricted expression in EBV-associated gastric carcinomas, the LMP1 gene was transferred into EBV-negative gastric carcinoma cell lines (SCM1 and TMC1) and into EBV-negative nasopharyngeal carcinoma (NPC) cells (HONE-1) as a control. The biological effects of LMP1 in gastric carcinoma cells were monitored in vitro and in vivo. These results showed that the consequence of LMP1 expression is a growth enhancement in NPC cells, but it is a growth suppression in gastric carcinoma cells. The LMP1-expressing gastric carcinoma cells had a reduced growth rate, colony-forming efficiency, mean colony size, and tumorigenicity and a lower malignant cytological grade. The reduced growth rate, colony-forming efficiency, and mean colony size were partially reversible in vitro with treatment with LMP1 antisense oligonucleotide. In addition, enhanced apoptosis was found in the LMP1-expressing gastric carcinoma cells. This suggests that LMP1 may negatively modulate the malignant potential of gastric carcinoma cells via an enhancement of apoptosis. We concluded that the restriction of LMP1 expression in EBV-associated gastric carcinomas may lead to a growth advantage for tumor cells by avoiding LMP1 apoptotic effects and immunologically mediated elimination.

Cytochrome oxidase in Alzheimer's disease: biochemical, histochemical, and immunohistochemical analyses of the visual and other systems

Defects in oxidative metabolism have been implicated in Alzheimer's disease (AD). The present study evaluated the level of cytochrome oxidase (C.O.), an indicator of neuronal oxidative capacity, in various brain regions of post-mortem AD and control patients. We found a statistically significant reduction in C.O. levels in all cortical areas examined, including the primary and secondary visual cortices. In addition, all layers of the dorsal lateral geniculate nucleus and sublaminae of the primary visual cortex in AD cases examined suffered a reduction in their relative C.O. activity and protein amount. Our results suggest a generalized suppression of oxidative metabolism throughout the cortex, as well as in a major subcortical visual center in AD. Such hypometabolism may form the basis for not only deficits in higher cortical functions, but also a variety of visual dysfunctions known to occur in AD.

Malignant lymphomas of sinonasal region, including cases of polymorphic reticulosis: a retrospective clinicopathologic analysis of 34 cases

BACKGROUND

Lymphomas occurring in nasal cavities and paranasal sinuses are uncommon neoplasms in Western, but are reported to be higher in Oriental, countries. A retrospective study was performed to analyze the clinical and pathological characteristics of sinonasal lymphomas/polymorphic reticulosis at Taichung Veterans General Hospital during a 14-year period.

METHODS

At Taichung Veterans General Hospital, 37 patients with sinonasal lymphomas (including three patients with polymorphic reticulosis) were seen from November 1982 through September 1996. Excluding three patients without sufficient data, a total of 34 patients with their clinical records were reviewed. Clinical information regarding characteristics of the tumors, histological studies, treatment modalities and follow-up was collected for analysis.

RESULTS

The 34 patients who underwent review showed a male-to-female ratio of 2.1:1. Median age was 60 years (range 13-83 years). The most common symptoms were nasal obstruction, nasal discharge/rhinorrhea and epistaxis. Median duration of symptoms at the time of diagnosis was two months. The most frequently involved sites were nasal cavities (right more than left side). There were 31 non-Hodgkin's lymphomas and three polymorphic reticuloses. The pathological classifications revealed 13 diffuse large cell lymphomas, 14 diffuse mixed small and large cell lymphomas and four pleomorphic T-cell lymphomas. Of the 21 adequately staged patients, 13 patients were in stage I; four, stage II; two, stage III and two, stage IV. The immunophenotypic study was performed in 20 patients. Eighteen (90%) of them were T-cell lymphomas and only two cases (10%) derived from B-cell. Though approach to therapy and follow-up periods varied during the time period covered by this study, the differences in survival according to treatment modalities were not statistically significant. The follow-up period ranged from 9 days to 130 months. The mean survival was 84.2 months. The overall five-year survival rate was 63%.

CONCLUSIONS

The majority of the cases here were T-cell lymphomas. Most histologic grading by Working formulation belonged to the intermediate grade. Optimal treatment for such a group of patients still has no consensus, but adequate local control is important. If diagnosed and treated early, primary sinonasal lymphomas can be associated with a favorable outcome even with local treatment alone.

Analysis of bcl-2 expression in normal, inflamed, dysplastic nasopharyngeal epithelia, and nasopharyngeal carcinoma: association with p53 expression

To further characterize bcl-2 expression in nasopharyngeal carcinoma (NPC), the authors analyzed bcl-2 expression immunohistochemically in biopsy specimens from 101 cases of NPC, of which 65 had the component of normal nasopharyngeal epithelium (NPE), 24 with dysplastic lesions adjacent to carcinoma, and 14 with both primary and metastatic lesions. An additional 25 nasopharyngeal biopsies of NPE from patients with chronic inflammation of nasopharynx were also included. The percentage of detectable bcl-2 expression shown in NPC (80%) and adjacent dysplastic lesions (71%) was significantly higher than in adjacent NPE (37%) and NPE from patients with chronic inflammation of the nasopharynx (30%) (P < .05). In both normal and inflamed NPE, the detectable bcl-2 expression was restricted to the basal cells; however, in dysplastic lesions, the bcl-2 staining distribution was increased with the dysplastic cell layers, and in entire layers of epithelium in severe dysplasia or carcinoma in situ. In addition, the staining intensity of bcl-2 in carcinomas and adjacent dysplastic lesions was generally stronger than that of adjacent NPE. These observations suggest that the expression of bcl-2 in dysplasia and carcinoma is enhanced relative to that of adjacent NPE. Enhanced bcl-2 expression to prevent apoptosis seems to occur from the early stages and may play an important role in the carcinogenesis of NPC. Furthermore, up to 77% of NPC with the coexpression of bcl-2 and p53 was observed and suggested that the association of bcl-2 and p53 expression seems to occur from the early stages of the development of NPC. The overexpression of p53 protein in NPC suggests that the mutation of p53 gene or altered function of wild-type p53 protein may contribute to the pathogenesis. It is conceivable that the presence of both enhanced bcl-2 expression and altered p53 functions may play a crucial synergistic effect in the carcinogenesis of NPC.

Effect of degeneration of the intervertebral disk on the process of diffusion

PURPOSE

To test the hypothesis that diffusion of contrast medium into the intervertebral disk is affected by the integrity of the nucleus pulposus and annulus fibrosus.

METHODS

In canine intervertebral disks, defects were made in the annulus fibrosus and nuclear material was removed from the disk with a nucleotome. MR imaging was performed with intravenous contrast medium at 15, 30, 60, and 90 days after the procedure. The diffusion of contrast medium in the intervertebral disk was studied by visual inspection and by measuring changes in signal intensity. The intervertebral disk were classified at each MR study as normal or abnormal on the basis of the signal intensity on T2-weighted images.

RESULTS

In untreated disks after intravenous injection of contrast medium, a band of increased signal intensity was observed near the endplates that became wider with time and approached the center of the disk. In six of the 12 treated disks, the band of increased signal intensity was visibly diminished or less discrete compared with that in the control disks. Weeks later, these treated disks showed diminished signal intensity on T2-weighted images and bulging of the annulus fibrosus.

CONCLUSIONS

Intervertebral disks with defects in the annulus fibrosus and reduced cartilage content were characterized by abnormal diffusion of contrast medium into the disk, and changes characteristic of early disk degeneration were detected subsequently.

Spontaneous remission in acute myelogenous leukemia: a case report

A 62-year-old woman with hypocellular acute myelogenous leukemia experienced spontaneous remission after repeated episodes of severe infections. Transient surge of profuse blasts in the peripheral blood was observed prior to the occurrence of spontaneous remission. The duration of the spontaneous remission was relatively short, and the disease relapsed five months later. A second complete remission was achieved after chemotherapy with low-dose cytosine arabinoside. The patient finally died of relapsed leukemia after a second remission of three year duration. Possible mechanisms implicated in the occurrence of spontaneous remission in this patient are discussed.

Anatomic relationship of the oculomotor nuclear complex and medial longitudinal fasciculus in the midbrain

PURPOSE

To compare the MR characteristics of the oculomotor nucleus with its appearance on anatomic images.

METHODS

Specimens of cadaveric brains were imaged in a 3.0-T MR imager equipped with a 3.0-cm solenoid coil. The specimens were sectioned, stained, and examined histologically. On anatomic sections, the oculomotor nuclei, medial longitudinal fasciculus, red nuclei, and oculomotor nerve were identified. The MR images were then compared with the anatomic sections.

RESULTS

The oculomotor nuclei, medial longitudinal fasciculus, red nuclei, and oculomotor nerve could be identified on MR images by their size, shape, signal intensity, and location.

CONCLUSION

MR images show the anatomic relationship of the oculomotor nerve complex, medial longitudinal fasciculus, and related structures in the brain stem.

Enhanced malignant progression of nasopharyngeal carcinoma cells mediated by the expression of Epstein-Barr nuclear antigen 1 in vivo

Nasopharyngeal carcinoma (NPC) is consistently associated with Epstein-Barr virus (EBV) and mostly classified as poorly differentiated squamous cell carcinoma or undifferentiated carcinoma with early metastasis and a rapidly progressive clinical course. The EBV-encoded latent proteins, Epstein-Barr nuclear antigen 1 (EBNA 1) and latent membrane proteins (LMPs), may be expressed in NPC, but their biological effects are poorly understood. EBNA 1 may predispose B lymphocytes to lymphomagenesis in transgenic mice, but its biological effects in NPC are still unknown. This study investigated the biological effects of EBNA 1 by expressing it in an EBV-negative NPC cell line (HONE-1), which was then inoculated into both nude and severe combined immunodeficiency mice. The EBNA 1 caused HONE-1 cells to grow in a less differentiated pattern and to progress more rapidly, as well as increasing their tumourigenicity and metastatic capability. These data suggest that EBNA 1 may play a critical role in the progressive evolution of NPC.

Correlative MR-anatomic study of the median nerve

OBJECTIVE

The purpose of our study was to evaluate the effectiveness of MR imaging for showing the intrinsic anatomy of a peripheral nerve. Cadaver wrist specimens that included the median nerve were imaged with MR imaging at 3 T, then sectioned, stained, and inspected grossly and microscopically. The size, shape, and signal intensity of the sheath and axonal structures in the median nerve were identified in MR images by comparison with anatomic sections.

CONCLUSION

This study suggests that MR imaging with sufficiently high-resolution techniques shows the internal structure of peripheral nerves. These results suggest that MR imaging may be a means to distinguish neuritis, tumor, degeneration, or fatty proliferation in a peripheral nerve and to evaluate the nerve before microsurgical anastomosis.

Tirapazamine (SR 4233) interrupts cell cycle progression and induces apoptosis

Tirapazamine (Tira), a bioreductive agent, is highly toxic to cells under low oxygen conditions. Since active investigations of this agent are focusing on its potential as an adjunct of radiotherapy to improve overall effects on radioresistant hypoxic tumor cells, understanding its toxic mechanisms under aerobic conditions is important to the clinical application of this agent. Tira-treated V79 Chinese hamster cells were tested for cytotoxicity by colony assay and growth inhibition by the MTT assay. The survival of V79 cells after being exposed to 100 microM of Tira for 2 h was about 78% of untreated controls. The mitotic cell counts of V79 cells approached zero after 4 h treatment of Tira at 100 microM or 3 h at 300 microM. The fragmentation pattern of DNA isolated from cells 2 h after 300 microM Tira treatment showed characteristics of apoptotic cells. The induction of apoptosis by Tira was also detected by flow cytometric analysis and microscopic observation. These effects of Tira may be part of underlying toxic mechanisms to cells (including normal cells) under aerobic conditions.

Tumor necrosis factor-alpha suppresses the regrowth of fractionated irradiated endothelial cells in vitro

Cytokines from two sources may affect endothelial cells (ECs) in tumor therapy: endogenously from cells in tumors and exogenously from therapeutic applications. These cytokines could modulate the influence of other therapy on tumor ECs. We use the colorimetric MTT method to assess the growth of irradiated ECs isolated from bovine pulmonary artery (CPAEC) and human umbilical cord vein (HUVEC) treated by cytokines. CPAECs given a single radiation dose of 2.5 to 15 Gy showed a small reduction in viable cells 2 to 3 days post-treatment. Neither tumor necrosis factor-alpha (TNF), interleukin-1 alpha (IL-1), nor interferon-gamma (INF) altered the growth of CPAECs treated by single radiation doses. HUVECs irradiated by a single dose of 12 Gy showed continuous reduction in viable cell numbers while those treated by 3 fractions of 4 Gy in 3 days or 6 fractions of 2 Gy in 3 days began to regrow 7 to 8 days after irradiation. Addition of TNF during the fractionated irradiation period limits the regrowth of HUVECs. Addition of IL-1 does not have the same effect. We have also tested the combined effect of another EC active agent flavone acetic acid (FAA), which has also been shown to stimulate the expression of TNF, with radiation, FAA (200 micrograms/ml) has a greater inhibitory effect on the growth and regrowth of fractionatedly irradiated HUVECs than TNF. These data suggest that TNF or FAA should be explored along with radiotherapy for their anti-tumor effect.

Clinical, physiologic, and pathologic evidence for vagus dysfunction in a case of traumatic brain injury

A trauma victim with locked-in syndrome demonstrated severely decreased bowel sounds, intact response to suppository, and elevated, but unchanging pulse. Absent cardiac response to tracheal suctioning, high gastric residual volumes, and pulmonary edema in response to a urecholine challenge demonstrated dysfunction in the automatic system. Symptoms persisted for 2 1/2 years until death. At autopsy, asymmetric bilateral involvement of the dorsal motor nucleus of the vagus and of the nerve tract in the medulla were demonstrated. In contrast, a control subject with locked-in syndrome caused by a stroke did not demonstrate these phenomena. In trauma patients with delayed gastric emptying, measurement of the heart rate response to deep suctioning may lead to the diagnosis of this vagus dysfunction syndrome.

Ionic versus nonionic paramagnetic contrast media in differentiating between scar and herniated disk

PURPOSE

To compare the MR contrast enhancement produced by ionic and nonionic paramagnetic contrast media in herniated disk fragments with that in epidural scar tissue.

METHODS

A recurrent herniated disk was modeled in canines by using laminectomy to place a fragment of disk cartilage in the epidural space. The dogs were studied 88 and 90 days after laminectomy with MR imaging enhanced with an ionic or a nonionic paramagnetic contrast medium. Contrast enhancement of the epidural scar tissue and the epidural disk fragment was measured at 2, 22, and 45 minutes after the injection.

RESULTS

Contrast enhancement was consistently and significantly higher in scar tissue than in disk fragments, although the difference decreased between 2 and 45 minutes after administration of contrast medium. Enhancement of disk fragments was less with the ionic than with the nonionic contrast medium. Contrast between the disk fragments and scar was also greater with the ionic than with the nonionic medium.

CONCLUSIONS

The contrast between recurrent disk fragments and scar tissue is affected by the timing of the scan and the choice of contrast medium. Scans obtained immediately after the injection of contrast medium show more contrast between disk fragment and scar than do delayed scans. Recurrent herniated disk fragments are more effectively shown by ionic than by nonionic media.

Multiplanar MR and anatomic study of the mandibular canal

PURPOSE

To evaluate the MR appearance of the mandibular canal and its contents.

METHODS

Cadaveric mandibles were imaged at 1.5 T and 3 T, then sectioned with a cryomicrotome. The size, shape, signal intensity, and pattern of structures in the mandibular canal were identified on MR images by comparing them with corresponding anatomic sections.

RESULTS

The inferior alveolar nerve and connective tissue were identified on the 1.5-T and 3-T images in the mandibular canal. Within the nerve the axon bundles were distinguished from the nerve sheath on the 3-T images.

CONCLUSION

This study suggests that MR images can show excellent anatomic detail in the mandibular canal.

MR appearance of the internal architecture of Ammon's horn

PURPOSE

To determine whether the four subdivisions of Ammon's horn and six layers of CA1 seen histologically can be demonstrated with MR imaging.

METHODS

Specimens of cadaver brains were imaged in a 3.0-T MR imager with a 3.0-cm solenoid coil. The specimens were sectioned, stained, and examined histologically. On anatomic sections, the four subdivisions of Ammon's horn and six layers of CA1 were identified. The MR images were then compared with the anatomic sections.

RESULTS

Using geographic characteristics, we identified the four subdivisions of Ammon's horn. In CA1, the six layers could be identified by variations in signal intensity, width, and location.

CONCLUSION

This study suggests that, with MR imaging of sufficiently high resolution, the internal architecture of Ammon's horn may be identified.

Quantitative evaluation of thallium-201 uptake in predicting chemotherapeutic response of osteosarcoma

Thallium-201 has been shown to be useful in predicting tumour viability in patients undergoing neoadjuvant chemotherapy for osteogenic sarcoma. Early studies relied upon qualitative assessment of analog images to obtain predictive results. Recently, the lesion to normal tissue uptake ratio of 201Tl has been used in evaluating bone and soft tissue sarcomas. This study attempts to quantitate changes in tumour to normal tissue ratio following chemotherapy. Eight consecutive patients with classical osteosarcoma received standard preoperative chemotherapy with a combination of cisplatin, adriamycin and high-dose methotrexate. 201Tl gamma scintigraphic images were obtained both before and after chemotherapy. The average counts taken over the tumour divided by that from the contralateral normal tissue area yielded a tumour-to-normal tissue (T/N) ratio. The percentage change in the T/N ratio before and after preoperative chemotherapy was correlated with the percentage of tumour necrosis from pathological section. The median post-chemotherapy T/N ratio was 1.85 (range 0.5-7.7). The median percentage change in T/N ratio after chemotherapy was -58% (range +26% to -83%). The median percentage of necrosis from pathological section was 80% (range 0%-95%). There was a good correlation between the percentage of tumour necrosis and the percentage change in T/N ratio (rank correlation coefficient r = 0.84, P = 0.0085). Quantitative assessment of changes in 201Tl uptake by osteosarcoma correlates well with tumour necrosis after preoperative chemotherapy. This method may be used to predict response to chemotherapy at an earlier stage, enabling the clinician to consider alternative chemotherapeutic regimens or salvage surgery.

Assessment of p53 expression in nasopharyngeal carcinoma

We analyzed the expression of the p53 protein by immunohistochemical methods from 101 patients with nasopharyngeal carcinoma (NPC): 24 with NPC and dysplastic lesions adjacent to carcinoma and 14 with primary and metastatic specimens. Ninety-six of 101 lesions (95%) had detectable p53 protein in the nuclei of tumor cells, indicating that overexpression of the p53 protein might be closely associated with NPC. Among 24 patients who had NPC and dysplastic lesions adjacent to carcinoma, 19 of the dysplastic lesions (79.2%) and 22 of the carcinomas (91.7%) showed positive staining for the p53 protein. In dysplastic epithelia p53 antigenicity was generally in a basal location. The significant association of p53 expression in NPC and dysplastic lesions adjacent to carcinoma (P < .0001, Fisher's exact probability test) suggests that p53 overexpression seems to occur at an early stage in the development of NPC. p53 expression in NPC does not correlate with histological grading, degree of lymphocytic infiltration between tumor cells, clinical stage, sex, or age (P > .05, chi-squared test). A comparison of p53 expression between primary and metastatic NPC was performed in 14 lesions. Although the p53 protein was consistently expressed in primary and metastatic tumor cells, there was no significant difference in p53 expression in both distinct but related lesions (P > .05, paired t-test). Our results suggest that the association of overexpression of the p53 protein in NPC may not be indicative of a mutant type p53 protein.

Contrast enhancement in spinal nerve roots: an experimental study

PURPOSE

To examine histopathologically the endothelium of contrast-enhancing spinal nerve roots.

METHODS

In five adult baboons, chronic compression of the left S-1 spinal nerve root sufficient to produce a change in the evoked potential was produced by means of a suture tied around the nerve. The animals were studied with MR at 8 and 16 days after nerve compression and then killed for histopathologic and electron microscopic studies. Histopathologic changes in the nerve roots demonstrating contrast enhancement were described.

RESULTS

In all compressed spinal nerves, contrast enhancement was observed. Histopathologically, wallerian degeneration of the root and inflammation and disruption of the endothelium of capillaries in the spinal nerve were evident.

CONCLUSIONS

Degenerative changes in the nerve root and the capillary endothelium of a lumbar spinal nerve are associated with contrast enhancement.

Destructive hostility: the Jeffrey Dahmer case. A psychiatric and forensic study of a serial killer

We were involved as forensic experts in the case of the serial killer Jeffrey Dahmer. We discuss the scene and victim autopsy findings, with a brief consideration of the basic emotion of hostility. These findings support the thesis that at the basis of this serial killer's behavior were primary unconscious feelings of hate that he had channeled into a sadistic programmed destruction of 17 young men. The interview of the serial killer, the photographic scene documentation, and the autopsy findings stress the ambivalent homosexuality of the killer, his sexual sadism, his obsessive fetishism, and his possible cannibalism and necrophilia.

Gadolinium-enhancement characteristics of magnetic resonance imaging in distinguishing herniated intervertebral disc versus scar in dogs

STUDY DESIGN

This study is an experimental investigation on the gadolinium contrast magnetic resonance imaging (MRI) in distinguishing sequestered disc fragment versus scar in dogs. The conspicousness of the disc fragment and signal intensities of the disc fragment and laminectomy scar were evaluated using gadolinium-enhanced MRI and histology.

OBJECTIVES

This study investigated the effects of timing of gadolinium injections, gadolinium doses, and aging of scar or disc on the enhancement characteristics and conspicuousness of disc fragment in MRI.

SUMMARY OF BACKGROUND DATA

Contrast-enhanced MRI has been frequently used as a procedure to evaluate patients with suspected recurrent herniated discs. In contrast-enhanced MRI, the postoperative scar tissue enhances to a greater extent than disc fragments. Previous reports suggest different contrast enhancement characteristics of scar depending on doses, timing of gadolinium, or maturity of scar. There are different compounds of gadolinium agents and different doses are becoming available. There is no previous report on the evaluation of gadolinium enhancement characteristics in dogs with concurrent herniated disc and scar.

METHODS

Six conditioned Beagle dogs underwent hemilaminectomies and discectomies at the L3-L4 level. An autogenous disc fragment was obtained from the intervertebral disc of the tail. This disc fragment was placed anterolateral to the thecal sac, simulating a sequestered disc herniation. Three control animals underwent hemilaminectomies and discectomies alone. Each dog underwent MRI on a 1.5 Tesla scanner (3.0 mm slice in sagittal and axial projections with TR 500, TE 30 msec and high dose 0.3 mmol/kg of gadoteridol). Images were obtained at 15 days, 30 days, 60 days, and 90 days after surgery. At each imaging session, contrast enhancement was measured at 2 minutes, 25 minutes, and 45 minutes after gadolinium injection for kinematic analysis. Two animals at a time were killed on 30 days, 60 days, and 90 days postoperatively. Magnetic resonance imaging was done with conventional low dose 0.1 mmol/kg of gadopentetate at 15 days and before death.

RESULTS

Results revealed that the difference of enhancement between disc and the scar and therefore conspicuousness of disc fragment was greater on 2-23-minute images as compared with 45- minute images, and the distinction decreased with aging of the scar. The high dose contrast-enhanced MRI increased signal intensities for both disc and scar. Conspicuousness of disc fragment seemed to be better with the high-dose gadolinium compound.

CONCLUSIONS

In conclusion, contrast enhancement characteristics in MRI may depend on the timing of MRI after gadolinium injection, doses of gadolinium, and aging of scar or disc.

Utility of high-dose contrast enhancement for detecting recurrent herniated intervertebral disks

PURPOSE

To study the utility of high-dose contrast enhancement in the detection of recurrent herniated disk fragments.

METHODS

Recurrent herniated disks were modeled in nine dogs by placing a fragment of normal autologous disk tissue in the epidural space at laminectomy. MR was performed at 30, 60, and 90 days with 0.3 mmol/kg of gadoteridol and repeated 24 hours later with 0.1 mmol/kg of gadopentetate dimeglumine. Contrast enhancement in the disk and scar tissue was measured and conspicuousness of the disk fragments assessed.

RESULTS

In 70% of the animals, disk fragments were more conspicuous with the larger dose of contrast medium than with the smaller dose. In 30% of animals the conspicuousness was approximately equal. Contrast between disk fragment and scar decreased with time elapsed since surgery, with time elapsed since contrast-medium injection, and with decreasing dose of contrast medium.

CONCLUSION

In the experimental model, increased conspicuousness of disk fragments was achieved with the larger dose of contrast medium. A clinical study is needed to confirm that a contrast-medium dose of 0.3 mmol/kg improves detection of recurrent herniated disks over a dose of 0.1 mmol/kg.

Selective internal radiation therapy with intra-arterial iodine-131-Lipiodol in inoperable hepatocellular carcinoma

From August 1990 to June 1993, 26 patients with inoperable hepatocellular carcinoma were treated with intra-arterial iodine-131-Lipiodol (131I-L).

METHODS

Iodine-131-Lipiodol was given through either an implantable arterial port (9 patients) or during hepatic angiography (17 patients). All 26 patients had multiple lesions, 3 had involved resection margin after surgical resection and 1 had diffuse infiltrative lesions. The median size of the largest tumor among 22 patients with a measurable lesion was 4.5 cm (2-9.5 cm). The end points are tumor response in terms of tumor size, change in serum alpha-fetoprotein level, toxicity of treatment and overall survival.

RESULTS

Twenty-three patients received a single treatment of 1.11-2.22 GBq (30-60 mCi)131I-L. Three patients received 2.22-4.44 GBq (60-120 mCi)131I-L in three fractions. Considering both radiological regression and reduction in serum alpha-fetoprotein level as objective response criteria, the overall response rate was 52% (13 out of 25 patients with evaluable disease). Ten out of 15 patients who had raised alpha-fetoprotein levels had more than 50% reduction and 8 patients had more than 90% reduction in alpha-fetoprotein level. Since analysis, 19 patients have died and 7 remain alive, giving a minimum median survival of 6 mo (range 1.2-16.6 mo), with 4 surviving more than 1 yr calculated from the day of treatment. There was only one patient who had late deterioration of liver function compatible with radiation hepatitis. There was no bone marrow toxicity documented in any patients.

CONCLUSION

Treatment with intra-arterial 131I-L was well tolerated in patients with inoperable hepatocellular carcinoma and produced an objective response of 52% with median survival of 6 mo. A fractionated dose of 131I-L was feasible and the radiation dose could be escalated safely.

Imaging white matter tracts and nuclei of the hypothalamus: an MR-anatomic comparative study

PURPOSE

To evaluate the MR appearance of the hypothalamus and its associated white matter tracts.

METHODS

Coronal and sagittal spin-echo images were obtained in cadaver brains. Gross and histologic sections were made of the cadaver brains. The size, shape, signal intensity, course, and pattern of structures in the hypothalamic region were identified in MR images by comparison with the anatomic sections.

RESULTS

The mamillary bodies, paraventricular zone of hypothalamic nuclei, postcommissural fornix, mammillothalamic fasciculus, and anterior commissure were identified on the MR images.

CONCLUSION

This study suggests that, with MR imaging of sufficiently high resolution, some of the tracts and nuclei in the hypothalamus may be identified.

A complex response element in intron 1 of the androgen-regulated 20-kDa protein gene displays cell type-dependent androgen receptor specificity

The androgen-regulated 20-kDa protein gene consists of four exons that code for a major secretory protein of rat ventral prostate. Analysis of its potential cis-acting transcriptional regulatory elements revealed that a large intron 1 region (In-1) had stronger androgen response element (ARE) activity than did the 5'-flanking DNA. In cotransfected CV1 cells, In-1 and its most active subfragment In-1c functioned as AREs but not glucocorticoid response elements (GRE). Nevertheless several ARE/GRE-like partial palindromic sequences are present in In-1c, and it bound both androgen receptors and glucocorticoid receptors in mobility shift assays. A cluster of three ARE/GRE-like sequences contained within a 39-base pair sequence of In-1c had both ARE and GRE activities when analyzed as an isolated oligonucleotide, suggesting that other elements within In-1c determined its ARE specificity. In addition to ARE/GRE-like sequences, In-1c contains putative response elements for the transcription factors AP1, CREB, AP2, OCT-1, C/EBP, and a number of inverted and direct repeats. The ARE specificity of In-1c observed in CV1 cells was diminished in PC3 and HeLa cells transiently cotransfected with an androgen receptor or glucocorticoid receptor expression vector together with an In-1c reporter vector; however, the ARE activity of In-1c was greater than its GRE activity in these cell lines. Interestingly, a 131-base pair subfragment of In-1c retained ARE specificity in all three cell lines.

Cytotoxicity and manganese superoxide dismutase induction by tumor necrosis factor-alpha and ionizing radiation in MCF-7 human breast carcinoma cells

Both tumor necrosis factor-alpha (TNF) and ionizing radiation cause active-oxygen radical-mediated cell injuries and cell death. Thus cells treated by both TNF and radiation may suffer greater injuries than cells treated by either agent alone. On the other hand, TNF or radiation treatment can stimulate the expression of a mitochondrial superoxide scavenging enzyme, manganese superoxide dismutase (MnSOD), which can lower the cytotoxic effects of both agents. Thus, the induction of MnSOD by radiation may interfere with the cytotoxic action of TNF and vice versa. We used a human breast tumor cell line, MCF-7, to determine the interaction of TNF and radiation on cytotoxicity and MnSOD expression. TNF was found to be more effective as a cytotoxic agent when used before than after radiation treatment. These observations suggest that radiation induced-MnSOD was more effective in reducing the cytotoxic effect of TNF whereas TNF induction of MnSOD was less effective in counteracting the radiation action. Our results not only underscore the different effects of the treatment order of TNF and radiation, but also point to potential implication in the radiotherapy of breast tumors.

Combined treatments of heat, radiation, or cytokines with flavone acetic acid on the growth of cultured endothelial cells

The antitumour effects of flavone acetic acid (FAA) against a broad spectrum of established experimental tumours has been demonstrated. Damage to the vasculature, which rapidly disrupts blood flow and induces haemorrhagic necrosis, is believed to be a major mechanism contributing to the observed antitumour effects. Despite these established observations, FAA has shown little effect against human tumours. However, other applications of FAA, for examples, for an extended period of treatments or in combination with other antitumour modalities, have not been sufficiently explored. In order to test the direct effects of FAA on vasculature, endothelial cells isolated from human umbilical vein (HUVEC) and bovine pulmonary artery (CPAEC) were used in this study. FAA at the concentrations of 50 to 200 micrograms/ml causes reduction in cell number (from 20 to > 30% of the cells) of HUVEC as measured by MTT assay after 1, 3, and 5 h of treatment at 37 degrees C. FAA did not produce significant effects on similarly treated human squamous cell carcinoma, cell line UM-SCC-2. After 1 h treatment of FAA at 300 micrograms/ml, a large number of HUVECs failed to react with an actin stain, NBD-phallacidin. The growth of HUVECs and CPAEC in the presence of FAA for 1-3 days was progressively reduced. The number of HUVEC treated for 3 days at the concentrations of 100, 200, and 300 micrograms/ml were reduced by 75-86% in comparison with the control culture. The experiments with CPAEC showed similar results. The inhibition of the growth of endothelial cells by FAA was enhanced when it combines with tumour necrosis factor-alpha but not with interleukin-1, interferon-gamma, heat, or radiation. We observed that FAA can initiate both immediate effects and growth inhibition on cultured endothelial cells. These results support the notion that FAA rapidly induces vasculature damage. Furthermore, cytokines such as tumour necrosis factor-alpha can enhance the toxicity of FAA on endothelial cells.

The etiology of focal spinal arachnoiditis. An experimental study

Focal arachnoiditis and back pain have been attributed to potentially irritating substances leaking into the spinal canal from the lumbar intervertebral disc or facet joints. Through experimentation this hypothesis was tested: the nucleus pulposus (escaping from the intervertebral disc), lactic acid (from anaerobic glycolysis in the disc), chondroitin sulfate (a component of glycosaminoglycans in the disc), or synovial fluid (from degenerating facet joints) causes inflammation in the meninges if it contacts the dura mater. The test and control substances were injected into the epidural space of monkeys. Twelve weeks later the animals were killed; the dural sac was exposed by total lumbar laminectomy, grossly inspected, and then removed, fixed, sectioned, stained, and examined microscopically. Nucleus pulposus produced significant fibrosus in the arachnoid and epidural spaces; the other substances did not cause fibrosus or inflammation. The study suggests that leakage of nucleus pulposus into the epidural space causes an inflammatory response in the arachnoid and epidural spaces.

Vascularized iliac crest grafts: evaluation of viability status with marrow scintigraphy

Forty-three vascularized iliac crest grafts in the femoral neck region in 38 patients were assessed with marrow scintigraphy. Twenty grafting procedures had been performed for treatment of fractures, 16 for nontraumatic osteonecrosis, and seven for focal bone lesions. Scintiscans were obtained preoperatively and in the early and late postoperative period. Anterior images of the hips were obtained 30 minutes after intravenous injection of 4 mCi (148 MBq) of technetium-99m tin colloid by using a gamma camera with a low-energy, general-purpose collimator. The viable graft was detected as an area of tracer uptake corresponding to the configuration of the graft on radiographs. Marrow scintigraphy at 12 weeks showed that 24 grafts were viable, 11 were nonviable, and eight were indeterminate. Early and late results concurred in 36 of 43 (84%) grafts. Nonviable grafts occurred most frequently in fractures in the elderly. In seven patients who subsequently required total hip replacement, six grafts were nonviable while one was indeterminate at 12 weeks. Results indicate that marrow scintigraphy is useful in the treatment of patients with vascularized iliac crest bone grafts.

MR contrast enhancement: an experimental study in postlaminectomy epidural fibrosis

PURPOSE

To measure the effect of contrast medium dose, time elapsed since injection, and maturity of epidural scar tissue on the enhancement of scar tissue in MR imaging.

METHODS

We imaged 12 beagle dogs with MR at 10 to 60 days after lumbar laminectomy, and at necropsy we obtained exactly correlating histologic sections. Contrast enhancement of scar tissue at 2, 15, 40, and 60 minutes after 0.1 and 0.3 mmol of paramagnetic contrast medium per kilogram was measured. Contrast enhancement was analyzed with respect to the dose of contrast medium, the time of imaging, and the maturity of scar tissue.

RESULTS

Epidural scar tissue enhanced more intensely at 2 and at 15 minutes than at 40 or at 60 minutes. Consistently greater enhancement was observed with the dose of 0.3 mmol/kg than with the dose of 0.1 mmol/kg. Regions of loosely organized scar tissue enhanced less intensely and less quickly than did more organized scar tissue.

CONCLUSION

Contrast enhancement in scar tissue can be heightened by increasing the dose of contrast medium from 0.1 to 0.3 mmol/kg and by obtaining images within 15 minutes of injection.