Does an incomplete interlobar fissure influence survival or recurrence in resected non-small-cell lung cancer?

OBJECTIVE

There have been various reports on prognostic factors in non-small-cell lung cancer (NSCLC) under a complete resection, but an incomplete interlobar fissure has not been discussed yet. We attempted to clarify whether this influences survival or recurrence.

PATIENTS AND METHODS

From 1981 to 1994, 239 patients (43%) who had a single lobectomy with mediastinal lymph node dissection were pathologically diagnosed as stage IA/IB or IIA/IIB (excluding T3N0M0). These patients were divided in two groups: patients with a complete interlobar fissure group (group L); and patients with an incomplete one (group NL). Postoperative survivals and cancer-free periods were retrospectively assessed. Patients' characteristics had no statistical difference between groups L and NL by N category.

RESULTS

The 5-year survival was 77.0% in group L-N0, 79.3% in group NL-N0, 48.7% in group L-N1, and 66.2% in group NL-N1. No statistical difference was found between groups L-N0 and NL-N0, L-N1 and NL-N1, L-T1N0 and NL-T1N0, L-T1N1 and NL-T1N1, L-T2N0 and NL-T2N0, and L-T2N1 and NL-T2N1. The 5-year-relapse-free survival was 81.2% in group L-N0, 85.4% in group NL-N0, 69.4% in group L-N1, and 72.2% in group NL-N1. No statistical difference was found between groups L-N0 and NL-N0, L-N1 and NL-N1, L-T1N0 and NL-T1N0, L-T1N1 and NL-T1N1, L-T2N0 and NL-T2N0, and L-T2N1 and NL-T2N1. There was no statistical difference in recurrent sites between groups L-N0 and NL-N0, and L-N1 and NL-N1.

CONCLUSION

We conclude that the incomplete interlobar fissure does not influence the prognosis of resected stage I or II NSCLC (excluding T3N0M0).

Respiratory impedance during positive expiratory airway pressure in patients with chronic obstructive pulmonary disease

The effect of positive airway pressure (5.0 hPa) on airway impedance (Za) and tissue impedance (Zt) during the expiratory phase in chronic obstructive pulmonary disease (COPD) patients was evaluated using random noise oscillation and a body box method. The results were then compared with those obtained from normal subjects. In normal subjects, there was no significant difference between non-expiratory positive pressure (NPEP) and positive expiratory pressure (PEP) for the Zar (real part) and Zai (imaginary part) at 10 Hz (Zar NPEP: 2.14 +/- 0.76, PEP: 1.96 +/- 0.79; Zai NPEP: 1.42 +/- 0.66, PEP: 1.40 +/- 0.70 hPa l-1 s). However, in COPD patients, Zar decreased significantly and the Zai increased significantly during PEP as compared to the values during NPEP (Zar NPEP: 7.10 +/- 1.88, PEP: 5.97 +/- 1.67, P < 0.05; Zai NPEP: -4.10 +/- 2.27, PEP: -2.99 +/- 2.62 hPa l-1 s, P < 0.05). These results suggested that both central and peripheral airway resistance decreased during PEP in COPD patients. Tissue compliance (Ct) calculated from the Zt increased significantly during PEP as compared to during NPEP, in both normal subjects and in COPD patients (normal NPEP: 0.024 +/- 0.004, PEP: 0.021 +/- 0.003, P < 0.05; COPD NPEP: 0.024 +/- 0.004, PEP: 0.014 +/- 0.004 l hPa-1, P < 0.001). This may have been indicative of the stiffened chest wall during PEP.

Age-associated changes in elastin and collagen content and the proportion of types I and III collagen in the lungs of mice

We investigated the effect of aging on the extracellular matrix of the lungs by examining age-associated changes in the elastin and collagen content, and the proportion of types I and III collagen, in the whole lungs of BALB/c and SAMR1 male mice between the ages of 3 and 24 months. The elastin content was determined by the hot alkali method. The hydroxyproline content was measured and assessed to be the collagen content. The relative proportion of types I and III collagen was assessed by cyanogen bromide digestion, followed by separation of the resultant peptides by sodium dodecyl sulfate polyacrylamide gel electrophoresis. The elastin content did not change significantly with age in either strain of mice. The total collagen content of the whole lung was significantly higher at 24 months of age, although there were no significant changes with aging in the hydroxyproline content per dry lung weight nor in the proportion of type III to type I collagen. We conclude that in terms of the extracellular matrix, the lungs of aged mice are not very different in feature from the lungs of younger mice, and this is probably the simple consequence of growth of the lungs of young mice.

Expression of vascular endothelial growth factor in normal pituitary cells and pituitary adenomas producing adrenocorticotropic hormone

Vascular endothelial growth factor (VEGF) induces endothelial cell proliferation and an increase in capillary permeability. Because the anterior pituitary gland and pituitary adenomas are highly vascular, expression of VEGF was examined immunohistochemically. Some normal pituitary cells stained positively for VEGF, and restaining for ACTH, prolactin, TSH, LH, FSH, and S-100 protein after VEGF staining revealed that almost all cells staining positively for ACTH also stained for VEGF. Only adenomas staining positively for ACTH stained for VEGF. These results suggest that VEGF is produced by normal pituitary cells and adenomas producing ACTH.

A polydiagnostic study of depressive disorders according to DSM-IV and 23 classical diagnostic systems

The classification of mood disorders is one of the most highly debated topics in modern psychiatry. The introduction of DSM-III (and its followers) has set a new standard in this controversy but little empirical evidence is available as to how the various classical diagnostic categories of mood disorders by Kraepelin, Schneider, Leonhard, Hamilton, Kielholz, Winokur and others compare with this new standard. The Intensive Prospective Study arm of the Group for Longitudinal Affective Disorders Study has studied a broad spectrum of mood disorders in 23 participating centres from all over Japan with a polydiagnostic semistructured interview called Comprehensive Assessment List of Affective disorders. In this paper we examined how the various classical diagnostic systems of depressive disorders correspond to the DSM-IV diagnoses, and found the following: (1) The classical 'neurotic' or 'psychogenic' depressions are diagnosed as major depression and not as dysthymia in DSM-IV; although dysthymia was dubbed as 'depressive neurosis' in DSM-III, its criteria were not true to the traditional usage of the term. Viewed from the other side of the coin, DSM-IV can be said to stand in the unitary tradition. (2) Some of the classical diagnostic categories such as Schneider's depressive psychopathy and Klein's acute dysphoria as well as modern ones such as Akiskal's subaffective dysthymia and Angst's recurrent brief depression were rarely seen in traditional psychiatric treatment settings. (3) Comparisons of the unique diagnostic systems such as those by Leonhard, Winokur and Berner warrant further studies on their validity.

Distal axonopathy does not occur without neurofilament accumulation in gamma-diketone neuropathy: comparative studies of normal and neurofilament-deficient quail

The neurotoxic effects caused by chronic exposure to 2,5-hexanedione (2,5-HD) were investigated in normal and neurofilament (NF)-deficient quail (Quv strain). These quail were given 175 mg/kg per day of 2,5-HD intraperitoneally for 24 weeks. Five of nine normal quail showed clumsy gait. They had NF-rich axonal swellings in the distal parts of the peripheral nerves, ventral and lateral funiculus of the cervical cord, and cerebellar peduncles. Axonal degeneration consisting of accumulation of mitochondria, vesicles, microtubules and dense bodies was found distal to the axonal swellings. Testicular atrophy appeared in two normal quail. In contrast, four of nine Quv quail showed systemic tonic convulsion, and died of respiratory paralysis within 6 days. No significant changes in the nervous system or testis of these four dead Quv quail. The five other Quv quail survived and did not show any neurological signs. Again, no significant changes were detected in the nervous system or testis of the surviving Quv quail. The present study revealed that distal axonal degeneration did not occur without NF accumulation. These results suggest that NF accumulation is an essential factor in the development of distal axonopathy in gamma-diketone neuropathy.

Fibromyxoma of the rib: report of a case

We present herein the case of a 36-year-old man with fibromyxoma of the rib. At the age of 33 years, an abnormal shadow of the chest was found on a radiographic examination, subsequent to which the mass grew slowly into the intrathorax, and he was referred to our hospital. An X-ray film and computed tomography scan on admission showed an extrapleural mass, 7 x 5 cm in diameter, in the left sixth rib with no evidence of destruction, cortical expansion, or rupture. The patient underwent peripheral osteotomy of the sixth rib, which was resected with a 3-cm margin around the mass. Microscopically, a diagnosis of fibromyxoma was confirmed. To the best of our knowledge, this is the first reported case of fibromyxoma originating in a rib.

Neurotoxic effects of 2,5-hexanedione on normal and neurofilament-deficient quail

The neurotoxic effects of 2,5-hexanedione (2,5-HD) were investigated using neurofilament (NF)-deficient (Quv) Japanese quail in comparison with normal Japanese quail. Both Quv and normal Japanese quail were inoculated intraperitoneally with 350 mg/kg/day 2,5-HD for 6 consecutive wk. The results of 2,5-HD exposure differed substantially between the 2 strains of Japanese quail. The 2,5-HD-exposed normal quail showed leg paralysis about 4 wk after initiation of dosing. Some treated normal quail fell into dysstasia and died of nutritional disturbances. Histologically, 2,5-HD-treated normal quail had NF-rich axonal swellings and degeneration in the distal parts of the peripheral nerves, spinal cord, and cerebellar peduncles. In contrast, 2,5-HD-injected Quv quail showed tonic convulsion, ataxia gait, severe quivering, and excitation about 2-3 days after administration. Some treated Quv birds died immediately after systemic tonic convulsion, probably because of asphyxia. Although all treated Quv quail showed neurologic signs, there were no recognizable 2,5-HD-induced lesions in the nervous system. After about 4-6 wk of dosing, 2,5-HD induced distal axonopathy in normal quail and acute neurotoxicity in Quv quail.

Ultrafast FLAIR imaging with single-shot echo-planar technique in evaluation of intracranial lesions

We evaluated the detection of the brain lesions with single-shot echo-planar FLAIR imaging (EP-FLAIR) relative to fast spin-echo FLAIR imaging (fast-FLAIR). In 30 patients with variety of intracranial lesions, a prospective comparison of EP-FLAIR and fast-FLAIR was performed. Data acquisition time per image was 0.1 s with EP-FLAIR. Quantitative and qualitative criteria as well as lesion detectability were evaluated. EP-FLAIR provided almost same tissue contrast and CSF suppression as fast-FLAIR did. In the quantitative analysis, contrast and contrast-to-noise ratio (C/N) of EP-FLAIR were comparable to those of fast-FLAIR, and there was no significant difference between them. The increased magnetic susceptibility effect was useful in screening for subtle hemorrhage. However, EP-FLAIR was degraded by susceptibility artifacts at the skull base and posterior to the frontal sinuses. Motion artifacts were not encountered owing to the very short imaging time, and EP-FLAIR was particularly useful in screening for the lesions in uncoorporative patients.

Stages III and IV squamous cell carcinoma of the mouth: three-year experience with superselective intraarterial chemotherapy using cisplatin prior to definitive treatment

PURPOSE

This study was designed to assess the 3-year experience with superselective intraarterial chemotherapy prior to definitive treatment for stages III and IV squamous cell carcinomas of the mouth.

METHODS

Twenty-two patients prospectively received superselective intraarterial chemotherapy using relatively low-dose cisplatin via a transfemoral approach. The locations of the tumors were the tongue (n = 12), gingiva (n = 5), buccal mucosa (n = 2), hard palate (n = 1), floor of the mouth (n = 1), and lip (n = 1). After intraarterial chemotherapy, 21 patients underwent surgery (n = 14), radiation therapy (n = 6), or both (n = 1). The survival rate of 25 patients who underwent surgery with/without radiation therapy until 1992 at Kumamoto University Hospital was also evaluated as a historical control. The survival curve was calculated with the Kaplan-Meier method, and the statistical difference between survival curves was determined with the generalized Wilcoxon test.

RESULTS

The overall response rate was 95% [complete response (tumor completely resolved), 24%; partial response (tumor reduction > or = 50%), 71%]. Fifty-two intraarterial infusions were performed without any catheter-related complications. Mild and transient local toxicity such as edema or mucositis of the infused area was relatively common. One patient died of renal failure from cisplatin. After a median follow-up of 20 months (range 2-41 months), the estimated 3-year survival rate for patients who underwent intraarterial chemotherapy plus surgery was 91%. The survival of the patients who underwent intraarterial chemotherapy plus surgery tended to be longer than that of the historical control.

CONCLUSIONS

Early tumor reduction without delay of subsequent treatments can be obtained by intraarterial chemotherapy while minimizing complications and possibly improving survival. Further investigations of long-term survival with larger series need to be performed.

Improvement of regional myocardial and coronary blood flow reserve in a patient treated with enhanced external counterpulsation: evaluation by nitrogen-13 ammonia PET

Enhanced external counterpulsation (EECP) is a noninvasive treatment for chronic stable angina, which works by recruiting and developing the coronary collateral vessels. Coronary perfusion and coronary flow reserve (CFR) were evaluated by nitrogen-13 (13N) ammonia positron emission tomography (PET) in a patient who had undergone EECP. The patient, who had 3-vessel coronary artery disease, required a percutaneous transluminal coronary angioplasty (PTCA) for the right coronary artery. The PTCA was successful, but 6 months later he again felt chest oppression. The coronary angiography showed re-stenosis at the PTCA site, and other progressive coronary stenosis. The patient was again treated with EECP for 35 h. The 13N-ammonia PET was performed both at baseline and during dipyridamole provocation, before and after EECP treatment. Coronary perfusion of each myocardial wall increased at the baseline (anterior: 0.52-0.75; septal: 0.48-0.66; lateral: 0.61-0.68; inferior: 0.46-0.57 ml min(-1) g(-1), and the CFRs in the septal and inferior walls (septal: 2.07-2.15; inferior: 1.99-2.06) also increased after the treatment. Thus, the EECP treatment improved both coronary perfusion at baseline and CFR, which suggests that it may be one of the choices for treatment of angina.

Optimized scanning conditions of high resolution CT in the follow-up of pulmonary emphysema

PURPOSE

To address the optimal scanning condition of high resolution computerized tomography from the perspective of minimizing exposed dose.

METHOD

The influence of the electric current, the slice number, and the slice thickness on precise percent ratio of the low attenuation area to whole lung field (LAA%) of chronic obstructive pulmonary disease patients was examined. The standard conditions were 250 mA, 3 slices, 2 mm slice thickness, and a varied parameter.

RESULTS

In cases showing an LAA% less than 30, LAA% obtained by < or =150 mA were significantly larger than those by 250 mA. The mean LAA% with 3 and 10 slices were well correlated and the correlation with lung function was similar. The correlation of LAA% with lung function was approximately the same between the 2 and 5 mm slice thicknesses.

CONCLUSION

The electrical current must be > or =200 mA, and 3 slices and 2 mm slice thickness are appropriate.

Comparison of low attenuation areas on computed tomographic scans between inner and outer segments of the lung in patients with chronic obstructive pulmonary disease: incidence and contribution to lung function

BACKGROUND

The low attenuation areas on computed tomographic (CT) scans have been reported to represent emphysematous changes of the lung. However, the regional distribution of emphysema between the inner and outer segments of the lung has not been adequately studied. In this study the regional distribution of low attenuation areas has been compared by quantitative CT analysis and the contribution of the regional distribution to pulmonary function tests evaluated in patients with chronic obstructive pulmonary disease (COPD).

METHODS

Chest CT images and the results of pulmonary function tests were obtained from 73 patients with COPD. The lung images were divided into inner and outer segments in the upper (cranial), middle, and lower (caudal) sections. The percentage ratio of low attenuation area to corresponding lung area (LAA%) was then calculated. The LAA% of each segment was also compared with the results of pulmonary function tests.

RESULTS

The mean (SD) LAA% of the inner segment was 39.1 (18.5) compared with 28.1 (13.2) for the outer segment (p<0.0001). Linear and multiple regression analyses revealed that airflow limitation is closely correlated with the inner segment LAA% of the lower lung. In contrast, the carbon monoxide transfer factor is closely correlated with the inner segment LAA% of the upper lung.

CONCLUSION

Low attenuation areas on CT scans are more often found in the inner segment of the lung than in the outer segment, and the contribution of the inner segment to pulmonary function tests may be greater than the outer segment.

The projection structure of the membrane protein microsomal glutathione transferase at 3 A resolution as determined from two-dimensional hexagonal crystals

The formation of two-dimensional crystals of the membrane-bound enzyme microsomal glutathione transferase is sensitive to fractional changes in the lipid-to-protein ratio. Variation of this parameter results in crystal polymorphism. The projection structure of a p6 crystal form of the enzyme has been determined by the use of electron crystallography. The unit cell at 3 A resolution is comprised of two trimers. The hexagonal p6 and the orthorhombic p21212 crystal types have common elements in the packing arrangement which imply dominant crystal contacts. An overall structural similarity between the protein molecules in the two crystal forms is suggested by the projection maps. Furthermore, a comparison of the p6 and p21212 projection maps identifies additional corresponding protein densities which could not be assigned to the microsomal glutathione transferase trimer previously. Surprisingly, an ambiguity of the rotational orientation was found for trimers interspersed at certain positions within the crystal lattice.

Pulmonary small cell carcinoma associated with sarcoid reactions: report of a case

A 45-year-old male was admitted to our hospital for investigation of a nodular shadow in segment 5 of the right lung on a chest computed tomogram. A right middle lobectomy with mediastinal lymph node dissection was performed under a diagnosis of lung cancer, and histologic examination confirmed small cell carcinoma. There were sarcoid reactions in the resected lymph nodes and the lung parenchyma, but no signs of systemic sarcoidosis were evident. Sarcoid reactions are rarely observed in the regional lymph nodes draining malignant tumors. Moreover, while they are most common in squamous cell carcinoma of the lung, they extremely rare in small cell carcinoma. To our knowledge, this is only the third report of this unusual entity in the English and Japanese literature.

Usefulness of diffusion-weighted MRI with echo-planar technique in the evaluation of cellularity in gliomas

The purpose of this study was to evaluate the utility of diffusion-weighted magnetic resonance imaging (MRI) with echo-planar imaging (EPI) technique in depicting the tumor cellularity and grading of gliomas. Twenty consecutive patients (13 men and 7 women, ranging in age from 13 to 69 years) with histologically proven gliomas were examined using a 1.5 T superconducting imager. Tumor cellularity, analyzed with National Institutes of Health Image 1.60 software on a Macintosh computer, was compared with the minimum apparent diffusion coefficient (ADC) and the signal intensity on the T2-weighted images. The relationship of the minimum ADC to the tumor grade was also evaluated. Tumor cellularity correlated well with the minimum ADC value of the gliomas (P = 0.007), but not with the signal intensity on the T2-weighted images. The minimum ADC of the high-grade gliomas was significantly higher than that of the low-grade gliomas. Diffusion-weighted MRI with EPI is a useful technique for assessing the tumor cellularity and grading of gliomas. This information is not obtained with conventional MRI and is useful for the diagnosis and characterization of gliomas.

Lung carcinoma in patients age younger than 30 years

BACKGROUND

To the authors' knowledge, no study regarding lung carcinoma patients age <30 years has been published. Therefore, this study was undertaken to define the characteristics of lung carcinoma patients age <30 years.

METHODS

Information regarding 26 patients with primary lung carcinoma who were age <30 years was obtained from 10 medical institutions and reviewed retrospectively. For comparison, 304 patients age > or = 30 years who were admitted to the First Department of Internal Medicine at Toyama Medical and Pharmaceutical University between 1980-1996 were studied.

RESULTS

Among the characteristics observed in the group of lung carcinoma patients age <30 years was a high incidence of female gender, no history of smoking, so-called "low grade malignancy," American Joint Committee on Cancer Stage I disease, and previous surgical resection. In addition, a low incidence of squamous cell carcinoma was noted, and a more favorable prognosis was observed.

CONCLUSIONS

The current study noted clinical features that could be defined clearly in lung carcinoma patients age <30 years.

Bronchoscopic removal of bronchial foreign bodies through the laryngeal mask airway in pediatric patients

The laryngeal mask airway was used to perform fiberoptic removal of bronchial foreign bodies (peanuts) in two pediatric patients. Laryngeal mask airway offers easy access to the airway, safe respiratory management and direct visualization of the airway during bronchoscopic procedures. Laryngeal mask airway allows the use of larger bronchoscopes than can usually be used for children when bronchoscopy is performed through an endotracheal tube. In each case, the peanuts were removed safely and easily using a Fogarty catheter through the fiberoptic bronchoscope. These cases suggest that laryngeal mask airway is useful in maintaining a secure airway during the removal of bronchial foreign bodies in children.

Social Support Questionnaire among psychiatric patients with various diagnoses and normal controls

BACKGROUND

Several studies have pointed to the importance of social support in influencing the onset and course of a psychiatric disorder such as schizophrenia or depression. However, only a few have studied it across groups of patients with various psychiatric diagnoses employing a standardized assessment procedure.

METHOD

We administered the Social Support Questionnaire (SSQ); a measure of social support recommended by two recent reviews on the subject, to 1,369 psychiatric outpatients visiting the 23 psychiatric hospitals and clinics all over Japan and to 178 healthy controls recruited from among employees at a general hospital.

RESULTS

The original two-factor structure of the SSQ was confirmed and internal consistency reliability for the Number and Satisfaction subscales was satisfactory, with Cronbach's alphas above 0.85. When the SSQ scores were compared between psychiatric patients and healthy controls, it was found that the psychiatric patients in general reported significantly lower Number as well as Satisfaction scores than the healthy controls. When individual diagnostic categories were considered, almost all the diagnostic groups reported significantly lower Number scores, but only the patients with anxiety disorder, mood disorder, schizophrenia, and V codes reported significantly lower Satisfaction scores than the healthy controls. Compared with patients with other diagnoses, the schizophrenic patients stood out as reporting significantly lower Number and Satisfaction scores.

CONCLUSION

The findings demonstrated the internal consistency reliability, factor validity, and construct validity of the SSQ among psychiatric as well as normal populations, and exemplified the feasibility of applying the SSQ as a standard measure of social support among psychiatric patients.

Reproductive factors related to the risk of colorectal cancer by subsite: a case-control analysis

The authors hypothesized that reproductive factors of colorectal cancer, which are probably mediated by endogenous hormones, would differ according to colonic subsite. Information on reproductive factors was obtained from 372 female colorectal cancer cases (113 proximal colon, 126 distal colon, 133 rectum) and 31,061 cancer-free controls at the Aichi Cancer Center Hospital, Japan, between 1988 and 1995. Multiple logistic analysis showed that late age at interview, family history of colorectal cancer among first-degree relatives, menstrual regularity, late age at menopause, late age at first pregnancy and late age at first full-term pregnancy were significantly associated with the risk of colorectal cancer. None of the risk factors were significantly dissociated between colon and rectal cancer. In polytomous logistic regression analysis, particularly noteworthy was the fact that the odds ratios for age at menarche (P-value for heterogeneity of odds ratios = 0.010), age at first pregnancy (P = 0.016) and age at first full-term pregnancy (P = 0.028) were significantly higher for distal than for proximal colon cancer. This study supports the hypotheses that there might be an association between reproductive factors and risk of colon cancer, and that the carcinogenesis of colon cancer, by subsite, might show aetiologic distinctions.

Ras proteins induce senescence by altering the intracellular levels of reactive oxygen species

Human diploid fibroblasts eventually lose the capacity to replicate in culture and enter a viable but nonproliferative state of senescence. Recently, it has been demonstrated that retroviral-mediated gene transfer into primary fibroblasts of an activated ras gene (V12ras) rapidly accelerates development of the senescent phenotype. Using this in vitro system, we have sought to define the mediators of Ras-induced senescence. We demonstrate that expression of V12Ras results in an increase in intracellular and in particular, mitochondrial reactive oxygen species. The ability of V12Ras to induce growth arrest and senescence is shown to be partially inhibited by coexpression of an activated rac1 gene. A more dramatic rescue of V12Ras-expressing cells is demonstrated when the cells are placed in a low oxygen environment, a condition in which reactive oxygen species production is inhibited. In addition, in a 1% oxygen environment, Ras is unable to trigger an increase in the level of the cyclin-dependent kinase inhibitor p21 or to activate the senescent program. Under normoxic (20% O2) conditions, the V12Ras senescent phenotype is demonstrated to be unaffected by scavengers of superoxide but rescued by scavengers of hydrogen peroxide. These results suggest that in normal diploid cells, Ras proteins regulate oxidant production and that a rise in intracellular H2O2 represents a critical signal mediating replicative senescence.

Collagen-phagocytosing ability of periodontal osteoblasts at the bone surface

The collagen-phagocytosing activity of osteoblasts at the alveolar bone-ligament interface of rat mandibular first molars was investigated both histologically and histochemically. Alveolar bones of male Wistar rats (6 months old) were used in this study. Collagen-containing phagosomes appeared in cuboidal osteoblasts aligned on the bone surface. The 5.7% of the osteoblasts exhibiting alkaline phosphatase activity revealed collagen-containing phagosomes, and the collagen fibrils within the phagosomes were at various stages of degradation. In addition, acid phosphatase activity and the immunocytochemical distribution of cathepsin B were found in these collagen-containing phagosomes at similar locations. The presence of both enzymes in the phagosomes suggests that an intracellular degradation of collagen occurs. Therefore, in addition to the osteoblastic functions of synthesizing and secreting bone matrices, osteoblasts are also capable of phagocytosis and the intracellular disintegration of collagen. Our findings suggest that osteoblasts at the alveolar bone-periodontal ligament interface have a collagen-phagocytosing ability and play an important role in the physiological remodeling and metabolic breakdown of collagen fibrils of periodontal ligament without osteoclastic bone remodeling.

Myocardial metabolism of 123I-BMIPP in a canine model with ischemia: implications of perfusion-metabolism mismatch on SPECT images in patients with ischemic heart disease

123I-(rho-iodophenyl)-3-R,S-methylpentadecanoic acid (BMIPP) is a fatty acid analog for SPECT imaging. This radiopharmaceutical possesses the unique property, that is, perfusion-metabolism mismatch on SPECT images in patients with ischemic heart disease. However, the reason of this mechanism remains unclear.

METHODS

Using open-chest dogs under anesthesia, we made a system to release all the blood of the great cardiac vein outside without recirculation, if necessary. Left anterior descending artery (LAD) was occluded for 30 min after reperfusion. After the injection of BMIPP into LAD, blood samplings from the cardiac vein and abdominal aorta (6 dogs) or serial biopsy specimens from the LAD region (5 dogs) were performed, and then compared with the normal control. The catabolites of BMIPP, including backdiffusion of nonmetabolized BMIPP, were evaluated with high-performance liquid chromatography (HPLC) in the efflux study. Thin-layer chromatography (TLC) technique was introduced in the tissue analytical study.

RESULTS

Although the rapid extraction of BMIPP from the plasma into the myocardium and the subsequent retention were unchanged, the early washout (8 min) of radioactivity significantly increased (51% +/- 12% to 65% +/- 7%; P < 0.05) with ischemia. The metabolites from the myocardium consisted of backdiffusion of nonmetabolized BMIPP, alpha, intermediate, and full oxidation metabolites. Among these metabolites, backdiffusion of nonmetabolized BMIPP in blood significantly increased (27.9% +/- 7.7% to 42.3% +/- 8.1%; P < 0.05), especially in the early phase with ischemia. In tissue, the radioactivity was concentrated in the triglyceride pool even in the early phase, and in addition, BMIPP and alpha-oxidized metabolite significantly decreased in the early phase with ischemia (t = 1 min after BMIPP injection, 25.9% +/- 8.6% to 14.5% +/- 2.1%, P < 0.01; t = 2 min, 8.9% +/- 5.0% to 4.5% +/- 1.7%, P < 0.05).

CONCLUSION

These results show that backdiffusion of nonmetabolized BMIPP from the myocardium increased and BMIPP (long-chain fatty acids) in tissue decreased with ischemia, suggesting backdiffusion of nonmetabolized BMIPP might play an important role in myocardial perfusion-metabolism mismatch on SPECT images in patients with ischemic heart disease.

Perfusion-sensitive MRI of cerebral lymphomas: a preliminary report

PURPOSE

To date, there have been no systematic reports examining cerebral lymphomas with perfusion-sensitive MRI. We sought to determine the characteristics of perfusion-sensitive MRI of these tumors.

METHOD

Five primary and three secondary cerebral lymphomas were analyzed. None of the patients had a history of AIDS. Various areas of relative cerebral blood volume (rCBV) within tumor were analyzed, and maximum CBV ratios (CBV[tumor/contralateral]) were identified for evaluation.

RESULTS

In three primary and three secondary cerebral lymphomas, maximum CBV ratios were <2.5 (mean 1.50). In others, maximum CBV ratios were markedly higher than those of the white matter (5.38 and 5.42). Mean maximum rCBV ratios of primary and secondary cerebral lymphomas were 2.93 and 1.43, respectively. There was no significant difference between the two groups.

CONCLUSION

Cerebral lymphomas had a tendency to have low rCBV values. This information may be helpful in diagnosing these tumors.

Meningioma followed up for radiological findings before and after radiosurgery: case report

The present paper reports on serial image changes before and after radiosurgery regarding a falx meningioma incidentally discovered in a 79-year-old female. The tumor doubling time during the 3-year observation period before radiosurgery was 469 days. Following radiosurgery using a gamma knife, tumour volume temporarily increased, but then reduced to 55% in 22 months. No symptoms or signs are observable at present, when the patient is 84 years old. These findings suggest that in treating elderly patients with meningioma diagnosed by imaging, radiosurgery should be the first method considered. Also presented are changes in image findings over time.