[A case of pituitary adenoma progressing to pituitary apoplexy on the occasion of cerebral angiography]

A case of pituitary adenoma which had progressed from subclinical pituitary apoplexy to subacute pituitary apoplexy on the occasion of cerebral angiography is reported. A 29-year-old man, complaining of bitemporal hemianopsia, was admitted to our department. Plain skull X-p revealed enlargement and double floor of the sella turcica. No abnormal calcification was revealed. CT demonstrated an isodensity mass with a diameter of 4 x 4 cm, and with ring enhancement in the suprasellar region. The mass extended from the intrasellar region to the suprasellar region and had a signal of high intensity on T1-weighted images. Endocrinological examination revealed hyperprolactinemia with a serum level of 422 ng/ml and normal reaction of anterior pituitary hormones. On 3rd March, digital subtraction angiography with 5F catheter was performed with the patient under sedation. The contrast medium was ioxaglic acid (Hexabrix 320). A volume of 6 ml with a speed of 4 ml per second was injected for the internal carotid angiogram. A total volume of 60 ml was used. Serum saline with 10 unit per ml of heparin sodium was also used for flushing. During angiography, the patient's blood pressure was 125/60-115/60mm Hg. DSA revealed upward displacement of the proximal portion of the anterior cerebral artery, pocket formation, and staining of the tumor capsule. Six hours later, he complained of retroorbital headache. Next morning, he noticed complete lack of left visual acuity. On 7th March, right visual acuity degenerated to blindness. CT revealed that the mass had increased its density. With bifrontal osteoplastic craniotomy, the tumor with marked intratumoral hemorrhage was resected. Its histology was chromophobe adenoma. The patient's right visual acuity improved rapidly. On the occasion of cerebral angiography, we could observe that subclinical pituitary apoplexy deteriorated to subacute pituitary apoplexy. Rosenbaum postulated that injection of contrast media increased intravascular pressure leading to pituitary apoplexy. At present, we cannot postulate increased intravascular pressure with 5F catheter and DSA. We cannot rule out that, with underlying subclinical pituitary apoplexy, hemorrhagic infarction due to contrast media and the anti-coagulate effect of heparin sodium accelerated the intratumoral bleeding. Subclinical pituitary apoplexy is a vulnerable state because of its aggravation to symptomatic apoplexy under mild stress. We emphasize that an operation should be performed as early as possible in the case of subclinical pituitary apoplexy.

Rapid detection cytomegalovirus pneumonia in recipients of bone marrow transplant: evaluation and comparison of five survey methods for bronchoalveolar lavage fluid

To detect cytomegalovirus-associated interstitial pneumonia (CMV-IP) in recipients of BMT in its earliest stage, five CMV methods were assessed for their usefulness using bronchoalveolar lavage fluid as the test specimen. Of the 43 cases enrolled in the study, PCR was positive in 12 cases, shell vial in eight, culture in eight and cytology in three. There were no positive cases in in situ hybridization. Based on this result, the 43 cases were classified into four groups: Group 1, three cases: positive in PCR, shell vial and cytology; Group 2, five cases: positive in PCR and shell vial; Group 3, four cases: positive only in PCR; and Group 4, 31 cases: negative in all CMV tests. Cases in Group 1 were judged as having the highest risk of overt CMV-IP. They were successfully treated with a combination of ganciclovir and immunoglobulin. Group 2 was diagnosed as having active CMV infection and ganciclovir monotherapy was effective for these patients. Groups 3 and 4 were not given anti-CMV therapy, but they were free from CMV-related manifestations throughout the study. The sensitivity and specificity of each survey method for the detection of Groups 1 and 2 were 1.0 and 0.89 in PCR, 1.0 and 1.0 in shell vial, 0.88 and 1.0 in culture, and 0.38 and 1.0 in cytology. Similarly, the positive and negative predictive values were 0.67 and 1.0 in PCR, 1.0 and 1.0 in shell vial, 1.0 and 0.97 in culture, and 1.0 and 0.88 in cytology. Thus, CMV survey on bronchoalveolar fluid was thought to be useful in detecting post BMT CMV-IP in its earliest stage.

Expression of the major inner capsid protein, VP6, of avian rotavirus in mammalian cells

A gene encoding the major inner capsid protein, VP6, of avian rotavirus was inserted into the eukaryotic expression vector pAX-91 under the control of the SR alpha promoter and was expressed at a high level in simian COS7 cells. The expressed VP6 was indistinguishable in terms of electrophoretic mobility from the corresponding protein synthesized in simian MA104 cells infected with avian rotavirus. Binding assays with a series of monoclonal antibodies (mAbs) that corresponded to four antigenic sites on VP6 of avian rotavirus showed that the antigenic characteristics of the expressed product were identical to those of the native VP6 of avian rotavirus virions. Fiber-like structures that reacted strongly with antiserum against rotavirus were observed in VP6-expressing COS7 cells. Furthermore, an analysis of the tertiary structure of the expressed VP6 protein indicated that it adopts a trimeric configuration, similar to that of the major inner capsid protein of PO-13 virus. From these results, it appears that recombinant VP6 will facilitate studies of the structure and function of authentic VP6, an important protein in avian rotavirus.

[A case of empyema caused by Salmonella enteritidis in a patient with sequela of pulmonary tuberculosis]

A 69-year-old male was admitted to our hospital on Jan. 10, 1995 complaining of bloody sputum, left back pain and fever of 39 degrees C. He had a history of pulmonary tuberculosis 45 years ago. His chest X-ray and CT showed the presence of air-fluid level in the left pleural cavity with thickening and calcification of the pleura. Salmonella Enteritidis was isolated from the sputum, bronchoalveolar lavage fluid and stool. He was diagnosed as suffering from Salmonella-empyema with an internal fistula. Based on the in vitro sensitivity test, sulfamethoxazole/trimethoprim was started. However, the efficacy of the antimicrobia was not sufficient. He then underwent left pleuropneumonectomy. Salmonella was cultured also from the specimen obtained at the operation. His course after operation was uneventful. Thus, although Salmonella Enteritidis is known as a common pathogen of food poisoning, it can cause empyema, especially in a case with an impaired host defence system.

Inflammatory reactions after vascular prosthesis implantation: a comparison of gelatin-sealed and unsealed Dacron prostheses

Despite widespread use of the gelatin-sealed knitted Dacron prosthesis (GDP) in clinical practice owing to its zero porosity, the biological impacts of this graft are still controversial. We conducted a randomized controlled study on 50 patients undergoing abdominal aortic aneurysm repair to evaluate the inflammatory reaction to GDP (n = 25) and unsealed knitted Dacron prostheses (UDP, n = 25). There were no significant differences in the mean age, size of the aneurysm, operative time, blood loss, or transfusion requirements between the GDP and UDP groups. During the first 7 postoperative days (PODs), slight fever and leukocytosis were noticed in both groups. Significant differences in maximum body temperature, leukocyte count, and plasma C-reactive protein concentration were observed between the GDP and UDP groups on POD 14:37.2 +/- 0.5 degrees C vs 36.9 +/- 0.3 degrees C (P = 0.019), 8,151 +/- 1,788/microliters vs 6,914 +/- 1,501/microliters (P = 0.015), and 32.6 +/- 27.5 mg/l vs 19.0 +/- 15.8 mg/l (P = 0.048), respectively. By POD 21, however, there were no detectable differences in these variables. Thus, we concluded that GDP caused an inflammatory reaction in the 2nd week after implantation, but ultimately there were no significant differences from UDP by the 3rd week.

Effects of dietary fiber on prostanoid concentrations in cecal mucosa of rats

Changes were investigated in prostanoid contents in cecal mucosa of rats fed with guar gum, a fiber diet. The rats were divided into 3 groups, the control group fed non-fiber diet and 2 groups fed respectively diets containing 7.5% and 15% of guar gum. Twelve rats in each group were sacrificed 10, 20, and 30 days respectively after initiation of diets, and length and weight of cecum and prostanoid contents in cecal mucosa were determined. The length and weight of cecum increased significantly 10 days after commencement of the fiber diets, and more remarkable changes were observed in the 15% fiber diet group. The ratio of prostaglandin (PG) E2 to PGD2 (PGE2/PGD2) was also increased by the content of guar gum dependently. These results suggest that alteration in prostanoid profiles is implicated in the fiber diet-induced enlargement of large bowels.

Spontaneous proliferation of and cytokine production by T cells adherent to human endothelial cells in patients with human T-lymphotropic virus type I-associated myelopathy

We previously reported increased adherence of T cells to human endothelial cells (EC) in patients with HTLV-I-associated myelopathy (HAM). To define the immunological function of EC-adherent T cells from HAM patients, we investigated the degree of spontaneous proliferation and the production of inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-alpha), interferon-gamma (IFN-gamma) and granulocyte-macrophage colony stimulating factor (GM-CSF). Both the degree of spontaneous proliferation and the production of TNF-alpha, IFN-gamma, and GM-CSF by EC-adherent T cells of HAM patients were significantly increased, compared to anti-HTLV-I seronegative controls. Furthermore, in HAM patients, spontaneous proliferation and production of inflammatory cytokines by EC-adherent T cells were significantly higher than that of EC-non-adherent T cells. Conversely, those functions of EC-non-adherent T cells were significantly lower than that of unseparated cells, which were T cells before application to EC. We demonstrated that EC-adherent T cells were qualitatively and quantitatively more hyperactive than those of anti-HTLV-I seronegative controls and the population of activated T cells of HAM patients was concentrated in EC-adherent T cells rather than in EC-non-adherent T cells. Our results suggest that EC-adherent T cells in the peripheral blood of HAM are intimately involved in the immunopathogenesis of HAM.

[Rapidly progressive T-cell angiocentric lymphoma with CD56+ phenotype involving bilateral orbits and skin in a patient with anti-HTLV-I antibody]

A 57-year-old woman was admitted to our hospital complaining of left exophthalmos in July, 1991. Biopsy specimen of a tumor in the left orbit suggested an inflammatory pseudotumor. The orbit was irradiated and the exophthalmos disappeared. During admission, an erythema was noted on her anterior chest wall. After discharge, right exophthalmos and generalized skin eruptions developed. The skin eruption on her anterior chest wall was histopathologically diagnosed as angiocentric lymphoma and she was readmitted. Since her serum was positive for anti-HTLV-I antibody, adult T-cell leukemia/lymphoma was suspected. Chemotherapy yielded limited relief of the right exophthalmos and transient fading of the skin eruptions. She died due to progression of the disease. Close examination of the skin eruption on the calf revealed that the lymphoma cells were CD56-positive immunohistochemically and electron microscopy revealed that they had large membrane-bound granules. Rearrangement of the T-cell receptor beta chain gene was observed. Incorporation of HTLV-I proviral DNA was not observed. Re-examination of the left orbital tumor confirmed the infiltration of these lymphoma cells. This is a rare case of T-cell lymphoma with NK cell phenotype involving orbits and skin, and showing a rapid clinical course.

Prevention of water immersion stress-induced gastric lesions through the enhancement of nitric oxide synthase activity in rats

BACKGROUND

Gastric mucosal microcirculation is an important factor in the protection of gastric mucosa, and nitric oxide (NO) plays a crucial role in the regulation of regional blood flow. This study was designed to evaluate the effect of cetraxate, an anti-ulcer drug, on water immersion stress-induced gastric lesions in relation to the changes in NO synthase activity.

METHODS

Gastric lesions were induced in rats by water immersion stress. The effects of cetraxate on NO synthase activity with or without stress was determined enzymatically. Changes in gastric mucosal prostaglandin (PG) contents with or without stress were also determined using high-performance liquid chromatography. Gastric mucosal blood flow was measured by hydrogen gas clearance technique.

RESULTS

Water immersion stress-induced gastric lesions. Cetraxate significantly mitigated the lesions but N(G)-monomethyl-L-arginine (L-NMMA), a specific inhibitor of NO synthase, exacerbated the lesions. The favourable effect of cetraxate was remarkably diminished by administration of L-NMMA. NO synthase activity decreased significantly by 6 h after stress. Cetraxate treatment increased NO synthase activity throughout the experiment in rats with or without stress treatment. Water immersion stress decreased all PGs detected, i.e. 6-keto-PGF1alpha, PGF2alpha, PGE2 and PGD2. Cetraxate prevented stress-induced decreases in PG contents. L-NMMA showed no significant effect on PG contents. Cetraxate increased gastric mucosal blood flow significantly and L-NMMA cancelled out cetraxate-induced increase in blood flow.

CONCLUSIONS

The pharmacological efficacy of anti-ulcer drugs such as cetraxate might be attributable to the enhancement of NO synthase activity resulting in an increase in gastric mucosal blood flow.

The distribution of G and P types within isolates of bovine rotavirus in Japan

Various combinations of G type and P type were observed in 76 bovine rotavirus (BRV) strains isolated from 235 diarrheal calves in three prefectures of Japan in 1992-1994. The most prevalent combination was G6:P5 (46/76, 60.5%), followed by G10:P11 (13/76, 17.1%), G6:P11 (7/76, 9.2%) and G10:P5 (5/76, 6.6%). No G6:P1 strain of BRV was recognized from the isolates in the present study, though this type of BRV is well known as a suitable vaccine strain against BRV infection.

The effects of ketamine on renal sympathetic nerve activity and phrenic nerve activity in rabbits (with vagotomy) with and without afferent inputs from peripheral receptors

One reason for the reported conflicting results of the effect of ketamine on hemodynamics and respiration may be variations in afferent inputs from peripheral receptors to the central nervous system. In order to evaluate unmasked direct effects of ketamine on sympathetic nerve and phrenic nerve outflow, totally deafferented (involving vagus, sinus nerve, aortic depressor nerve) rabbits (n = 18), rabbits with vagotomy (n = 21), and neuraxis-intact rabbits (n = 6) were used in this study. The animals were anesthetized with urethane and mechanically ventilated. Ketamine 0.5, 1, or 2 mg/kg was injected intravenously and mean arterial pressure (MAP), heart rate (HR), and integrated renal sympathetic nerve and phrenic nerve activity (IRSNA, IPNA) were recorded before, and 1, 2, 3, 5, and 10 min after injection. MAP and IRSNA were significantly decreased, even by the smallest dose of ketamine, in the totally deafferented group. IPNA was decreased by the largest dose of ketamine only in the totally deafferented group. On the other hand, spontaneous respiratory frequency was decreased in the totally deafferented and vagotomy groups, but more so in the totally deafferented group. In the neuraxis-intact group, the only significant change with the largest dose of ketamine, 2 mg/kg was a slight increase in HR. We conclude that ketamine can suppress vasomotor and respiratory centers directly, and that the suppression is counterbalanced by afferent inputs from peripheral receptors.

Idiopathic portal hypertension associated with high serum titer of autoantibodies and liver dysfunction

Idiopathic portal hypertension (IPH) is a condition marked by unexplained portal hypertension. Although a number of immunological abnormalities occur in patients with IPH, liver function is usually normal. We experienced an unusual case of IPH in a 49-year-old woman, who had pronounced splenomegaly. Laboratory data revealed pancytopenia, hypergammaglobulinemia, and liver dysfunction. Antinuclear antibodies were positive, with high titer at 1280 dilutions of sera. LE cell phenomena were also positive. Histological examination of biopsied liver showed only mild changes, but portal venous pressure was markedly elevated, at 38 cm H2O. This case was thus characterized by both a high serum titer of autoantibodies and liver dysfunction.

The role of complement in the acute inflammatory process in the skin and in host-parasite interaction in hamsters inoculated with Leishmania (Leishmania) chagasi

Tecidual reaction at the inoculation site of L. (L.)chagasi promastigotes in hamsters depleted and non-depleted of complement was studied within 2, 6, 12, 24, 48 and 72 hours of infection. The inflammatory reaction was characterized by early predominance of polymorphonuclear cells (PMN) at 2, 6 and 12 hours of infection, mixed infiltrate of PMN and mononuclear cells (MN) at 24 hours, followed by predominance of MN at 48 and 72 hours after infection. The group depleted of complement showed a higher number of PMN at 2 hours and lower numbers of MN at 72 hours after infection (P < 0.0001). In the depleted group the phagocytosis by PMN was lower at 2 and 24 hours and by MN was lower at 24, 48 and 72 hours after infection. Electron microscopy showed extracellular intact and degenerated parasites, and lysed intracellular parasites, in PMN; and, rarely, preserved intracellular parasites in MN at 2, 6 and 12 hours after infection. The groups examined at 24, 48 and 72 hours of infection showed only cellular and parasite debris in mononuclear inflammatory cells. C3b deposits were detected by immunofluorescence in the interstitium and in the cytoplasm of inflammatory cells in non-depleted group at 2, 6 and 12 hours of infection. No immunoglobulin was detected in either group. Visceralization was detected 240 days after infection. The complement system has an important role in the inflammatory reaction and phagocytosis. The ultrastructural findings showed that the escape of the parasite probably occurs soon after inoculation.

[Cytomegalovirus retinitis and Pneumocystis carinii choroidopathy in a patient with AIDS]

A case of Pneumocystis carinii (P. carinii) choroidopathy is reported. The patient was a 17-year-old man with acquired immunodeficiency syndrome (AIDS) who developed bilateral, multifocal, yellow-white, round, flat choroidal lesions ranging in size from 1/8 to 1/6 of the disc diameter while undergoing treatment for cytomegalovirus retinitis. He had had P. carinii pneumonia 43 months previously, and received inhaled pentamidine as suppressive therapy. Over a 4-week period of observation, the choroidal lesions appeared to enlarge slowly and increased in number in the posterior pole, with no clinical evidence of intraocular inflammation and retinal involvement. He was diagnosed as having P. carinii choroidopathy and treated with intravenous pentamidine. Three months after systemic pentamidine therapy was begun the choroidal lesions disappeared. Despite the fact that P. carinii choroidopathy is a rare opportunistic ocular infection, ophthalmic manifestations may be an important initial marker of extrapulmonary disseminated infection in some patients. Therefore we recommend ophthalmologic examinations in patients with AIDS who receive long-term aerosolized pentamidine prophylaxis for pneumonia.

t(7;11) and trilineage myelodysplasia in acute myelomonocytic leukemia

A 48-year-old Japanese man was admitted to our hospital because of general fatigue, nasal bleeding, and petechiae on his extremities. He was diagnosed with acute myelomonocytic leukemia with trilineage myelodysplasia (T-MDS). Chromosomal analysis of bone marrow cells revealed t(7;11)(p15;p15), which has been rarely reported but known to be characteristic of Japanese patients. Although t(7;11)(p15;p15) has been reported mainly in acute myelogenous leukemia (AML), it can be occasionally found in so-called stem cell diseases such as chronic myelogenous leukemia or chronic myeloproliferative disorders. Therefore, t(7;11)(p15;p15) might affect trilineage progenitors or stem cells as well as myeloid lineage cells, subsequently resulting in AML with T-MDS, as in our case reported here.

Characterization of T cells transmigrating through human endothelial cells in patients with HTLV-I-associated myelopathy

We investigated the surface markers as well as the expression of beta 2-integrin (LFA-1 beta/CD 18), in T cells migrating through human umbilical vein endothelial cells (EC) in patients with HTLV-I-associated myelopathy (HAM). No significant differences were found in the percentages of both HLA-DR+ T cells and total CD4+ cells and in the expression of beta 2-integrin between the EC-transmigrated and the EC adherent T cells. However, the percentages of HLA-DR+CD4+ cells in the transmigrated cells were significantly higher than those in the adherent cells. These results suggest that activated or HLA-DR+CD4+ T cells play an important role as the first trigger in the immunopathogenesis of HAM.

Hepatocyte growth factor levels in bone marrow plasma of patients with leukaemia and its gene expression in leukaemic blast cells

Hepatocyte growth factor (HGF) has been known as a multiple function factor, which also stimulates early haematopoiesis. In this study, we found that HGF was expressed at both the RNA and protein levels in acute myeloid leukaemia (AML) and chronic myeloid leukaemia (CML). In patients with AML (n = 20) and CML (n = 5), bone marrow plasma HGF concentrations were 20.44 +/- 6.26 (mean +/- s.e.) ng ml-1 and 7.17 +/- 0.53 ng ml-1 respectively. These were significantly higher (P < 0.01) than the value for normal subjects (n = 26): mean 0.92 +/- 0.09 ng ml-1. Constitutive HGF production was observed in freshly prepared leukaemic blast cells from three patients with high HGF levels of bone marrow plasma. Expression of HGF mRNA was correlated with bone marrow plasma HGF levels. After complete remission was obtained in six patients, bone marrow plasma HGF levels were significantly decreased. In contrast, the HGF mRNA was less abundantly expressed in acute lymphoid leukaemia (ALL). In patients with ALL (n = 5), bone marrow plasma HGF concentration (0.69 +/- 0.14 ng ml-1) remained low within the value for normal subjects. These results suggest that some populations of myeloid lineage cells have the ability to produce HGF.

Evaluation of the diagnostic value of the measurement of (1-->3)-beta-D-glucan in patients with pulmonary aspergillosis

The value of the measurement of (1-->3)-beta-D-glucan, a major and common cell wall constituent of fungi, for diagnosing pulmonary aspergillosis was assessed in comparison with that of conventional examinations. The concentrations of (1-->3)-beta-D-glucan in sera was elevated in 7 out of 8 patients with active aspergillosis, but not in cases without active diseases, except for one sample. Further, the concentrations well reflected the activity of the aspergillosis in each case. Regarding conventional examinations, with the immunodiffusion test it was difficult to detect the present activity of the disease. The radioallergosorbent test was useful for diagnosing bronchopulmonary aspergillosis, but not for other types of aspergillosis. The Aspergillus-specific component, galactomannan, was insensitive and the enzyme-linked immunosorbent assay gave highly variable results. Thus, although the assessment of the specificity of the assay is still necessary, compared with other tests, the assay of (1-->3)-beta-D-glucan has the advantage of diagnosing pulmonary aspergillosis and also of assessing the disease activity.

[Study of medical economy in home parenteral nutrition]

The authors studied the relation between home parenteral nutrition (HPN) and medical economy. The items of study are 1) cost benefit of HPN compared with TPN, 2) hospital intention to promote HPN, 3) economical demerits for outpatients receiving HPN.

RESULTS

1) HPN had the advantage of cost benefit compared with TPN in reimbursement; however, hospitals did not have such an intention. 2) It is necessary for advanced home care to improve reimbursement in the health insurance system; and in the existing situation, hospitals do not profit from HPN. 3) Home care companies are unprofitable because of nursing visits and reimbursement issues which do not ease legal restrictions. 4) HPN in the present situation depends on the ability of patients to pay and the ability of care givers to provide care.

[A case of one stage-repair of interrupted aortic arch and ventricular septal defect in neonate using a separated cardiopulmonary bypass]

We report a case of one stage-repair of interrupted aortic arch and ventricular septal defect in neonate. The operation was performed at the age of 14 days. After a median sternotomy incision, a separated cardiopulmonary bypass was commenced through the ductus and a 4 mm EPTFE graft which was anastomoted to the right subclavian artery. Cerebral circulation was maintained through the graft during reconstruction of the aortic arch. Our method is useful regarding that brain damage can be avoided which may be induced by total circulatory arrest.

Antigenic and genetic analyses of the hemagglutinin of influenza viruses isolated from pigs in 1993

Three strains of influenza A virus (H3N2) were isolated from pigs in Hokkaido, Japan in 1993. The hemagglutinin (HA) antigen of the three isolates was related to that of recent H3N2 viruses of human origin. The reactivity patterns of two of the isolates (A/sw/Obihiro/1/93 and A/sw/Obihiro/2/93) with monoclonal antibodies to the hemagglutinin of A/Bangkok/1/79 strain were similar to that of the human H3N2 strain isolated in Hokkaido in 1988, while that of the other one (A/sw/Obihiro/3/93) was similar to human H3N2 strains of 1993. In the phylogenetic analysis based on the nucleotide sequences of the HA1 regions, the HA genes of the two isolates were shown to be closely related to those of human H3N2 viruses isolated between 1986 and 1988. The remaining one isolate was shown to be closely related to those of current human H3N2 viruses. We have also found serological evidence that the A/sw/Obihiro/1/93 virus is circulating extensively in Obihiro swine. It is clear from these findings that pigs were infected with the recent H3N2 influenza virus during the human epidemic and that the virus has been maintained in pigs for at least five years.

Serum levels of endogenous and exogenous granulocyte colony-stimulating factor after autologous blood stem cell transplantation

Although the administration of recombinant human granulocyte colony-stimulating factor (rhG-CSF) enhances myeloid engraftment and reduces infectious morbidity after autologous and allogeneic bone marrow transplantations, the effect of rhG-CSF on neutrophil recovery in autologous blood stem cell transplantation (ABSCT) is controversial. We previously demonstrated that a low dose, delivered subcutaneously, of rhG-CSF (50 micrograms/m2) accelerates neutrophil recovery in ABSCT, but the optimal dosage of rhG-CSF is not known. To elucidate the effect of rhG-CSF on neutrophil recovery, we determined serum levels of endogenous and exogenously administered G-CSF in 24 patients receiving ABSCT. Of these, five received bolus subcutaneous injection of 50 micrograms/m2 rhG-CSF, 10 received 150 micrograms/m2, and nine received no rhG-CSF. Endogenous G-CSF levels rose immediately after ABSCT, and an inverse correlation was found between the serum level of G-CSF and the absolute neutrophil count (r = -0.73, p < 0.01). The pre-dose level in patients receiving rhG-CSF rose gradually, reaching a maximum between days 3 and 6. The level gradually decreased as the neutrophil count began to rise, even through administration of the same dose of rhG-CSF continued. Pharmacokinetic data showed that the half-life of elimination of G-CSF (t1/2) exceeded 15 hours during severe neutropenia but decreased during the recovery of neutrophils. These observations suggest that neutrophils provide a negative feedback mechanism for clearing G-CSF from the circulation. Pre-dose levels of G-CSF in patients receiving 50 micrograms/m2 rhG-CSF reached 10 ng/mL, equivalent to the concentrations used in clonogenic assay in vitro to stimulate myeloid progenitor cells.

[A surgically treated case of ventrally exophytic pontine glioma]

A surgically treated case of ventrally exophytic pontine glioma is reported. A 49-year-old woman, complaining of dysarthria, dysphagia and gait disturbance, was admitted to our department. Her past history included bronchial asthma. Plain skull x-p and tomography revealed destruction of the dorsum sellae and upper clivus. CT demonstrated an enhanced oval mass at the ventral side of the upper brainstem. The mass was severely compressing the brainstem dorsally. MRI revealed a low-intensity band between the tumor and the brainstem. Dynamic MRI demonstrated a pattern of rapid increasing and slow reduction. Cerebral angiogram demonstrated a paradoxical sign that pontine branches were located anterior to the basilar artery. The finding demonstrated that the tumor was an intraaxial mass. The first operation was performed by the orbitofrontomalar approach. On the trans-sylvian route, the tumor was removed partially with CUSA and neuronavigation system. Its histology was astrocytoma grade III. Radiation therapy was added. The patient's symptoms aggravated again. On the second operation, the transtemporal route with tentorial resection was chosen. Under a wide visual field, intracapsular subtotal resection of the tumor was performed. Interferon therapy was added. She was discharged to her home with no neurological deficits. Ventrally exophytic pontine glioma is very rare. Low-intensity band of MRI, a sign of extraaxial mass, was visualised in our case. On the other hand, cerebral angiogram demonstrated a paradoxical sign. This sign suggested that the tumor originated from the brainstem. With update skull base surgery and neuronavigation system, surgical therapy of ventrally exophytic pontine glioma is safe and effective.

Hemodynamics of small hepatocellular carcinomas (5 cm or less in diameter): cases with discrepant findings between dynamic MR images and hepatic arteriograms

BACKGROUND

The degrees and patterns of contrast enhancement of small hepatocellular carcinomas (HCCs) on dynamic magnetic resonance (MR) images were compared with those on hepatic arteriograms in 61 patients.

METHODS

Dynamic MR imaging was performed within 1 week before hepatic angiography prior to treatment, 3-4 weeks after treatment, and then once every 1-3 months if necessary. Hepatic arteriography was carried out with a coaxial microcatheter inserted into the proper hepatic artery or its distal branches.

RESULTS

In 58 of 61 cases, the degrees of contrast enhancement of the tumor in dynamic MR imaging were roughly consistent with those in hepatic arteriography before treatment. In the remaining three cases, however, the tumors were depicted as hyperintense in the arterial dominant phase of the dynamic MR imaging, whereas the tumors were not detected by hepatic arteriography. The tumor detectability is 97% by dynamic MR imaging and 92% by hepatic arteriography. Furthermore, when an HCC nodule was not clearly enhanced by hepatic arteriography after treatment, it was possible by dynamic MR imaging to obtain accurate information on whether the HCC nodule had parasitic arteries.

CONCLUSIONS

Dynamic MR imaging was superior to hepatic angiography in contrast resolution. It was therefore considered to be useful in assessing the degrees and patterns of contrast enhancement of small HCCs before and after treatment.