[Multiple nodular pulmonary amyloidosis with multiple bullae]

We report a case of multiple nodular amyloidosis accompanied by multiple emphysematous bullae. The patient was a 72-year-old nonsmoking woman who presented with chronic cough and had a history of pneumothorax. Chest computed tomography disclosed multiple nodules up to 1 cm in diameter, and multiple small emphysematous bullae predominantly distributed in the middle and lower lung fields. Left lung biopsy was performed under thoracoscopy. The nodules were histopathologically diagnosed as amyloidoma. The mechanism of the accompanying bullae formation was also considered.

The 11 A resolution projection map of Na+/K+-ATPase calculated by application of single particle analysis to two-dimensional crystal images

Two-dimensional (2D) crystals of Na+/K+-ATPase were vitrified and observed with an electron cryo-microscope that allowed specimen observation at liquid helium temperature. Images showing 19 A spots on the optical diffraction patterns were digitized and processed by a crystallographic method. After optimization of parameters for the image processing, the locally averaged images revealed that each 2D crystal contained heterogeneous molecules. Single particle analysis was therefore applied to the 2D crystal images to select homogeneous molecule images, and averaging the selected images significantly improved map quality. Five major peak densities were clearly resolved in the new projection map, while two were found previously.

Evaluation of dural sinus invasion and extension of extra-axial intracranial tumors. The advantages of a high-resolution postcontrast 3-D gradient-echo technique

OBJECTIVE

To assess the usefulness of a postcontrast 3-D Fourier transform (3DFT) gradient-echo (GRE) technique in dural sinus invasion and extension of extraaxial intracranial tumors in comparison with a conventional spin-echo (SE) technique.

MATERIAL AND METHODS

Fourteen consecutive patients with 15 extra-axial tumors in contiguity with the dural sinus, including 14 meningiomas and 1 adenoid cystic carcinoma, underwent postcontrast T1-weighted SE and GRE MR studies. Detectability of dural sinus invasion and extension was evaluated using two sequences by two neuroradiologists in a blinded manner and compared with surgical results. Quantitative analysis was also performed to calculate the contrast-to-noise ratio (CNR) between lesion and dural sinus on SE and GRE images. The data were analyzed statistically using a matched paired t-test.

RESULTS

In the qualitative evaluation, the detectability of dural sinus invasion in 3DFT-GRE images was superior to that using SE images. The mean CNR for all lesions was 3.86 on SE images and 5.63 on 3DFT-GRE images (p = 0.03).

CONCLUSION

For evaluation of dural sinus invasion and the extension of extra-axial tumors, postcontrast 3DFT-GRE MR images were superior to conventional SE images.

Microsatellite instability in squamous cell carcinomas and dysplasias of the esophagus

Microsatellite instability (MSI) caused by the defective functions of mismatch repair genes plays an important role in the carcinogenesis of gastrointestinal tumors. However, little is known about the role of MSI in esophageal carcinogenesis. In the present study, we conducted microsatellite assays on 41 esophageal carcinomas and also on 44 dysplasias of the esophagus with 7 separate microsatellite loci. MSI was detected in 17 cases (42%) among 41 esophageal carcinomas. MSI negative cases revealed greater lymph node metastasis, metastasis at a more advanced stage, a higher recurrence level and a poorer prognosis (statistically not significant). In the analysis of dysplasias, MSI was detected in 26 lesions (59%) among 44 lesions. Interestingly, MSI was detected in 21 lesions (78%) from the mutator phenotype dysplasias, but detected in only 5 lesions (29%) from the non-mutator phenotype cases. Although the significance of MSI in esophageal carcinoma was not clear, these results indicate that MSI occurs in the early stage of esophageal carcinogenesis.

An evaluation of three-dimensional ultrasonography for the measurement of gallbladder volume

OBJECTIVE

Various three-dimensional ultrasonography systems have been developed. We estimated the accuracy of a three-dimensional ultrasonography system for measuring gallbladder volume and compared the results to the sum-of-cylinders method.

METHODS

In an in vitro study, 10 balloons of various shapes, sized 5-68 mL were scanned by real-time ultrasonography. In an in vivo study, we evaluated the gallbladder emptying of 14 healthy male volunteers after ingestion of two raw egg yolks. In both studies, volume measurement was performed by the three-dimensional ultrasonography method and the sum-of-cylinders method.

RESULTS

With the three-dimensional ultrasonography method, the mean difference between the measured volume and the true volume and the limits of agreement were smaller than those of the sum-of-cylinders method. Gallbladder volumes did not differ significantly with both ultrasound methods.

CONCLUSION

The three-dimensional ultrasonography method accurately determined gallbladder volumes.

The structure of aquaporin-1 at 4.5-A resolution reveals short alpha-helices in the center of the monomer

Aquaporin-1 is a water channel found in mammalian red blood cells that is responsible for high water permeability of its membrane. Our electron crystallographic analysis of the three-dimensional structure of aquaporin-1 at 4.5-A resolution confirms the previous finding that each subunit consists of a right-handed bundle of six highly tilted transmembrane helices that surround a central X-shaped structure. In our new potential map, the rod-like densities for the transmembrane helices show helically arranged protrusions, indicating the positions of side chains. Thus, in addition to the six transmembrane helices, observation of helically arranged side-chain densities allowed the identification of two short alpha-helices representing the two branches of the central X-shaped structure that extend to the extracellular and cytoplasmic membrane surfaces. The other two branches are believed to be loops connecting the short alpha-helix to a neighboring transmembrane helix. A pore found close to the center of the aquaporin-1 monomer is suggested to be the course of water flow with implications for the water selectivity.

Adenocarcinoma of the gastroesophageal junction in Japan: relevance of Siewert's classification applied to 177 cases resected at a single institution

BACKGROUND

There had been a lack of international consensus about the definition of cancer of the gastric cardia until Siewert's classification was approved at a consensus conference during the second International Gastric Cancer Congress held in 1997.

STUDY DESIGN

A review of the prospective gastric cancer database at Aichi Cancer Center from 1983 to 1992 identified 1,913 gastric carcinoma patients who underwent gastrectomy. These patients were classified retrospectively according to the Siewert classification, and 177 patients who fell into one of the three types form the basis of this study. Survival analyses were performed after stratifying patients by clinicopathologic variables.

RESULTS

There were 33 patients with type II and 144 with type III, although none had type I, a type frequently observed in the west. No evidence of a change in the frequency of types II or III cancers (approximately 9.3% overall) among gastric carcinoma patients was observed over the 10-year period. Clinical staging of gastric carcinoma by the TNM classification was found to reflect accurately the prognosis of these patients. There were no longterm survivors among the few patients with metastasis to the perigastric nodes of the distal stomach.

CONCLUSIONS

A striking difference in the distribution of types of adenocarcinoma of the gastroesophageal junction was observed in Japan compared with previously reported western data. A subgroup of carcinoma of the proximal stomach identified as types II and III may not require proximal gastrectomy from the viewpoint of sufficient lymphadenectomy.

3D TOF turbo MR angiography for intracranial arteries: phantom and clinical studies

This work investigated whether turbo magnetic resonance angiography (MRA) can replace conventional MRA in screening examination of intracranial arteries. A phantom was used to evaluate the effect of the zero-filling interpolation (ZFI) technique on spatial resolution and partial volume effect. Thirty-one consecutive patients underwent both turbo MRA with a slice thickness of 0.7 mm (data were measured as 1.33 mm sections) and conventional MRA with 1.0 mm sections. In the phantom studies, ZFI did not improve the spatial resolution, but the partial volume effect was somewhat reduced. In the clinical evaluation, turbo MRA showed better signal-to-noise and contrast-to-noise ratios of the intracranial major vessels than conventional MRA. The lesions included cerebral aneurysms less than 3 mm in diameter, occlusive vascular disease, arteriovenous malformations, and arteriovenous fistulas. These were all depicted on both turbo MRA and conventional MRA. Turbo MRA is a useful screening procedure because of its capability of delineating lesions in approximately half the usual imaging time. J. Magn. Reson. Imaging 1999;10:939-944.

Peritoneal washing cytology: prognostic value of positive findings in patients with gastric carcinoma undergoing a potentially curative resection

BACKGROUND AND OBJECTIVES

Free cancer cells in the abdominal cavity exfoliated from a tumor are considered to be responsible for peritoneal dissemination, the most frequent pattern of failure in gastric carcinoma patients treated with curative surgery.

METHODS

A prospective survival analysis was performed with 91 gastric carcinoma patients treated by potentially curative resection. Cytology was performed for all the patients. The method of Kaplan and Meier was used to construct curves with diagnosis of peritoneal dissemination and cancer death as the end points. Multivariate analysis by Cox's proportional hazards model was performed to identify independent prognostic factors of significance.

RESULTS

Patients with a positive cytology result were confirmed to have a greater risk for recurrence in the pattern of peritoneal carcinomatosis and hence a significantly inferior prognosis. Positive cytology was the only significant independent prognostic factor among the curatively resected patients with advanced gastric carcinoma.

CONCLUSIONS

Peritoneal lavage cytology should be employed for all advanced cancer undergoing potentially curative resection for added accuracy in the stage classification. The results should also reflect the eligibility of the patients for future clinical trials involving perioperative intraperitoneal chemotherapy.

The duality of fish gonadotropin receptors: cloning and functional characterization of a second gonadotropin receptor cDNA expressed in the ovary and testis of amago salmon (Oncorhynchus rhodurus)

We previously isolated a cDNA encoding a gonadotropin receptor (sGTH-R) from amago salmon (Oncorhynchus rhodurus) ovarian follicles. In the present study, we cloned a second gonadotropin receptor (sGTH-RI) from the same RNA preparations. Overall sequence homology between sGTH-RI and sGTH-R is 44%. The highest homology occurs with mammalian FSH receptors (49%). Functional characterization examined in COS-7 cells transiently transfected with sGTH-RI showed the largest increase in cAMP production when exposed to salmon GTH I. These results provide the first evidence in any ectothermic vertebrate, the amago salmon, of the duality of gonadotropin receptors.

Effects of recombinant bovine granulocyte-macrophage colony-stimulating factor on bovine peripheral blood neutrophil functions in vitro and in vivo

Effects of recombinant bovine granulocyte-macrophage colony-stimulating factor (rboGM-CSF) on bactericidal activity of bovine peripheral blood neutrophils in vitro and in vivo were studied. In in vitro experiment, bovine blood neutrophils were cultured for 9 hr in media containing 0.005, 0.05 or 0.5 microg/ml of rboGM-CSF. Neutrophils treated with rboGM-CSF showed significantly higher luminol-dependent chemiluminescence (LDCL) than control cells. In in vivo experiment, neutrophils isolated from cows injected 5.0 microg/kg of rboGM-CSF showed significantly higher Nitrobluetetrazolium (NBT) reduction value than that from control cows 24 hr post injection. Total leukocyte counts of cows injected rboGM-CSF sharply decreased 6 hr post injection and recovered to normal level 2 days post injection. Body temperature of these cows rose 6 hr post injection and back to normal level at 24 hr post injection. It was suggested that rboGM-CSF enhanced bactericidal activity of bovine neutrophils both in vitro and in vivo.

Time course of the effects of temocapril on cardiovascular structure and function in patients with essential hypertension

To investigate the time course of cardiovascular structural changes in patients with essential hypertension after angiotensin-converting enzyme (ACE) inhibition, we determined left ventricular structure, minimal vascular resistance in the forearm as an index of resistance vessel structure and stiffness beta of carotid artery in 15 essential hypertensive subjects during a placebo period and after 2, 6, and 12 months of temocapril treatment. Blood pressure decreased within 2 weeks, and the antihypertensive effects were noted throughout the 12-month administration period. Left ventricular mass index decreased significantly after 2 months (120+/-12 to 106+/-9 g/m2; p < 0.01) and was normalized after 12 months (88+/-6 g/m2). Postischemic minimal vascular resistance in the forearm decreased gradually from 2.1+/-0.5 to 1.6+/-0.4 PRU at month 12 of temocapril treatment. In contrast, increased stiffness index beta of carotid artery was not altered during a 1-year treatment period (11.4+/-4.9 to 11.6+/-3.8 at month 12 of treatment). These data indicated that the regression of structural changes of left ventricle and arterioles occurred gradually and progressively for 1-year treatment with ACE inhibition, but large arteries were not affected.

Absence of myocardial ischemia during sudden controlled occlusion of coronary arteries in patients with well-developed collateral vessels

OBJECTIVE

To determine whether the presence of well-developed collateral vessels (visualized by baseline angiography) prevents myocardial ischemia associated with electrocardiographic ST-segment deviation or anginal pain during subsequent coronary balloon occlusion.

METHODS

Study patients with stable effort angina but without complete coronary obstruction were divided into two groups on the basis of whether myocardial ischemia was observed during the first minute of coronary balloon occlusion in order to compare the degrees of collateral development at baseline. Patients in group A (n = 47) had electrocardiographic ischemic ST-segment deviations or angina, or both, during balloon inflation, whereas patients in group B (n = 13) had neither.

RESULTS

The incidences both of poor anterograde perfusion with TIMI grade 1 or 2 (77 versus 38%, P < 0.05) and of well-developed collateral vessels (Rentrop grade 3) in the perfusion territory of the target vessel for coronary angioplasty (77 versus 15%, P < 0.01) were higher for patients in group B than they were for those in group A. The incidence of no myocardial ischemia during balloon inflation among the patients with well-developed collateral vessels was higher than that among those without (59 versus 7%, P < 0.01). The prediction of the absence of myocardial ischemia during balloon inflation according to whether well-developed collateral vessels were present had the sensitivity 77% (10 of 13) and the specificity 93% (40 of 43) for the study patients.

CONCLUSION

Absence of myocardial ischemia (revealed by electrocardiographic changes or angina during transient coronary balloon occlusion) was associated with presence of well-developed collateral vessels (Rentrop grade 3; visualized by baseline angiography), suggesting that the patients with well-developed collateral vessels have a low risk of developing acute myocardial infarction or hemodynamic instability upon abrupt closure of the culprit coronary artery.

Peritoneal washing cytology: prognostic value of positive findings in patients with gastric carcinoma undergoing a potentially curative resection

BACKGROUND AND OBJECTIVES

Free cancer cells in the abdominal cavity exfoliated from a tumor are considered to be responsible for peritoneal dissemination, the most frequent pattern of failure in gastric carcinoma patients treated with curative surgery.

METHODS

A prospective survival analysis was performed with 91 gastric carcinoma patients treated by potentially curative resection. Cytology was performed for all the patients. The method of Kaplan and Meier was used to construct curves with diagnosis of peritoneal dissemination and cancer death as the end points. Multivariate analysis by Cox's proportional hazards model was performed to identify independent prognostic factors of significance.

RESULTS

Patients with a positive cytology result were confirmed to have a greater risk for recurrence in the pattern of peritoneal carcinomatosis and hence a significantly inferior prognosis. Positive cytology was the only significant independent prognostic factor among the curatively resected patients with advanced gastric carcinoma.

CONCLUSIONS

Peritoneal lavage cytology should be employed for all advanced cancer undergoing potentially curative resection for added accuracy in the stage classification. The results should also reflect the eligibility of the patients for future clinical trials involving perioperative intraperitoneal chemotherapy.

Cloning, functional characterization, and expression of a gonadotropin receptor cDNA in the ovary and testis of amago salmon (Oncorhynchus rhodurus)

A gonadotropin receptor was cloned from amago salmon (Oncorhynchus rhodurus) ovarian follicles. This receptor (sGTH-R) belongs to the glycoprotein hormone receptor family with a large extracellular and seven-transmembrane domains. Its sequence homology is highest with mammalian LH receptors. Phylogenetic analysis reveals that sGTH-R is grouped with mammalian and chicken FSH and LH receptors, but not with mammalian TSH receptors. sGTH-R is expressed dominantly in the ovary and testis. Functional characterization examined with transiently transfected mammalian cells revealed increased intracellular cAMP level when exposed to mammalian and fish gonadotropins; the most potent hormone was salmon GTH II. These results indicate that the cloned cDNA encodes a functional amago salmon GTH receptor protein.

[Mode of onset and two years outcome of a broad spectrum of affective disorders]

In recent years emphasis has tended to be placed on assessing and diagnosing low-grade affective disorders. If mild affective symptoms are also considered a broad spectrum of affective disorders, this spectrum can be seen, not only in the manifestation of major symptoms of such illnesses as manic-depressive illness, but also in symptoms of various mental disorders. The present study was undertaken to analyze the clinical features of a broad spectrum of affective disorders in a prospective follow-up study. Ninety mentally ill patients who visited our outpatient clinic were followed for 2 years, to investigate the mode of onset, the course and outcome of their disorders. Using a semistructured interview method specially developed for this survey, these patients were divided into a broad spectrum of affective disorder group and the other groups. Forty-nine patients were allocated to a spectrum of affective disorder group characterized by four-day (or longer) persistence of at least one of the following symptoms, depressed mood, loss of interest or elevated, expansive, or irritable mood. Of the forty-nine patients there were only two patients with manic symptoms. And the forty-seven patients with depressive symptoms were compared with the other groups as a main subject. The other groups were composed of eighteen patients with psychotic symptoms (the psychotic group) and 23 patients with neurotic symptoms (the neurotic group). The psychotic and neurotic groups did not satisfy the criteria shown above. There was no significant differences in male-to-female ratio or age between these three groups. When the mode of onset of symptoms were compared, the percentage of cases in whom symptoms could be identified early (within 10 days after onset) was 64.4% in the depressive group, 41.2% in the psychotic group and 30.4% in the neurotic group. The percentage of cases who remitted 2 years later was 70.2%, 38.9%, 45.5% in the depressive group, psychotic and neurotic groups, respectively. The GAS score (mean +/- SD), assessed 2 years later, was 76.2 +/- 12.5, 62.8 +/- 11.7, 78.2 +/- 9.9 points for these three groups, respectively. These results suggest that a broad spectrum of depressive disorders develops more acutely and patients with this spectrum are more likely to recover from symptoms and in function. Thus, the course of disorders was more favorable in the depressive group than in the psychotic group or the neurotic group.

The prognostic significance of p53, p21 (Waf1/Cip1), and cyclin D1 protein expression in esophageal cancer patients

Recently, various cell cycle regulators have been studied as biological markers of malignant potential. These regulators might influence survival rates and the effects of adjuvant therapies. In this study, we analyzed the expression of p53, p21(Waf1/Cip1), and cyclin D1 in 64 esophageal cancer patients and their relation to clinicopathologic parameters and patient survival. For p53, p21, and cyclin D1 oncoprotein expression, we defined positive cases as those with over 10% of examined cells stained. Positive rates were 48.4%, 42.2%, and 43.8% for p53, p21, and cyclin D1, respectively. In a multivariate analysis, tumor depth, chemotherapy, and p21 expression were determined to be significant prognostic factors. Five-year survival rates of p53-negative/p21-positive and p53-positive/p21-negative patients were 53.0% and 28.5%, respectively, and were not significantly different. These results suggest that, of various cell cycle regulators, p21 might be a good predictor of prognosis for esophageal cancer patients.

Brain lesions: when should fluid-attenuated inversion-recovery sequences be used in MR evaluation?

PURPOSE

To compare qualitatively and quantitatively the contrast of brain lesions detected with fluid-attenuated inversion-recovery (FLAIR) and intermediate-weighted sequences at magnetic resonance (MR) imaging.

MATERIALS AND METHODS

In this prospective study, 47 patients suspected of having a brain lesion underwent MR imaging with FLAIR, intermediate-weighted, and T2-weighted sequences. Qualitative assessment was performed of lesion conspicuity, detection, overall image artifact, and additional clinical information. Contrast and contrast-to-noise ratio (CNR) were calculated between lesions and the normal brain or cerebrospinal fluid (CSF).

RESULTS

FLAIR images were equal to intermediate-weighted images for overall lesion conspicuity and detection but were associated more often with image artifacts. Lesion-to-background contrast was significantly higher on FLAIR than on intermediate-weighted images. FLAIR images failed to demonstrate multiple sclerosis (MS) plaques located in the basal ganglia and brain stem.

CONCLUSION

Although FLAIR images provided additional information in some cases, they did not have distinct advantages over intermediate-weighted images. When cases of MS are evaluated, intermediate-weighted images are preferable to FLAIR images. Except in cases of MS, either FLAIR or intermediate-weighted sequences should be added to T2-weighted sequences at MR imaging.

p53, p21(Waf1/Cip1) and cyclin D1 protein expression and prognosis in esophageal cancer

Recently, various cell cycle regulators have been investigated as biological markers of malignant potential. These regulators might influence the survival rate and the effect of adjuvant therapies. In this study, we analyzed p53, p21(Waf1/Cip1) and cyclin D1 expression in 64 esophageal cancer patients and the relationship between clinicopathologic parameters and patient survival. The positive expression rate was 48.4%, 42.2% and 43.8% in the p53, p21 and cyclin D1 groups respectively. Multivariant analysis revealed that tumor depth, chemotherapy, p53, p21 and cyclin D1 expression showed significant values. p53- and cyclin D1-negative patients had a worse prognosis. p21-positive patients had a better prognosis. In stage 0, I and II patients, there was a significant difference between p53-positive and -negative, p21-positive and -negative, and cyclin D1-positive and -negative groups. In stage III and IV patients, there was no significant difference between any two groups. However, a significant difference was seen in the p21 group: among patients who received adjuvant chemotherapy, the p21-positive group had a 5-year survival rate of 50% compared with 13.4% in the p21-negative group (not significant).

Complexity of terminal airspace geometry assessed by lung computed tomography in normal subjects and patients with chronic obstructive pulmonary disease

Increases in the low attenuation areas (LAA) of chest x-ray computed tomography images in patients with chronic obstructive pulmonary disease (COPD) have been reported to reflect the development of pathological emphysema. We examined the statistical properties of LAA clusters in COPD patients and in healthy subjects. In COPD patients, the percentage of the lung field occupied by LAAs (LAA%) ranged from 2.6 to 67.6. In contrast, LAA% was always <30% in healthy subjects. The cumulative size distribution of the LAA clusters followed a power law characterized by an exponent D. We show that D is a measure of the complexity of the terminal airspace geometry. The COPD patients with normal LAA% had significantly smaller D values than the healthy subjects, and the D values did not correlate with pulmonary function tests except for the diffusing capacity of the lung. We interpret these results by using a large elastic spring network model and find that the neighboring smaller LAA clusters tend to coalesce and form larger clusters as the weak elastic fibers separating them break under tension. This process leaves LAA% unchanged whereas it decreases the number of small clusters and increases the number of large clusters, which results in a reduction in D similar to that observed in early emphysema patients. These findings suggest that D is a sensitive and powerful parameter for the detection of the terminal airspace enlargement that occurs in early emphysema.

Anomalous systemic arterial supply to normal basal segments of the left lower lobe

BACKGROUND

Anomalous arterial supply to the normal basal segments of the lower lobe without sequestration is a rare congenital abnormality, and whether it belongs to the broad spectrum of sequestration disorders remains controversial.

METHODS

The cases of all 4 patients who were treated surgically by us were reviewed together with 8 previously reported cases.

RESULTS

The anomalous artery originated from the descending thoracic aorta, distributed to the basal segments of the left lower lobe, and drained to a normal inferior pulmonary vein in each case. The anomalous artery was thick and elastic walled. From the review of all 12 cases, male gender, left side, descending thoracic aorta as the aberrant arterial origin, absence of pulmonary blood flow to the basal segments, and normal pulmonary venous drainage were predominant. Despite some differences, the findings seemed closely related to intralobar sequestration. Surgical treatments were lung resection, anastomosis, and ligation of the anomalous artery.

CONCLUSIONS

This anomaly is probably one type of sequestration complex. Both aortic and pulmonary arterial angiographic studies are needed to plan the definitive surgical procedure.