Therapeutic efficacy of transcatheter arterial chemoembolization for hepatocellular carcinoma: MRI and pathology

OBJECTIVE

Our goal was to evaluate the usefulness of multisection dynamic MRI with gadopentetate dimeglumine in the assessment of the therapeutic efficacy of transcatheter arterial chemoembolization (TAE) with iodized oil for hepatocellular carcinomas (HCCs).

MATERIALS AND METHODS

Findings on multisection dynamic MRI images were compared with gross appearance and histologic findings in 13 patients with HCCs after TAE with iodized oil. Arterial dominant phase images of the entire liver were obtained 20 s after the start of administration of gadopentetate dimeglumine.

RESULTS

In 3 of the 13 patients, no enhancing areas within the tumors were detected. In the remaining 10 patients, enhancing portions were detected within the tumor on arterial dominant phase images. Histologically, viable tumor cells were present in the rapidly enhancing portions, while necrotic tissues were present in nonenhancing areas, irrespective of the accumulation of iodized oil on CT scans. However, in one patient in whom no enhancing portion was seen in the tumor, a small number of viable tumor cells within the capsule were identified on pathologic examination.

CONCLUSION

Multisection dynamic MRI is helpful for evaluating the therapeutic efficacy of TAE with iodized oil for HCCs by revealing the hemodynamics of the tumor irrespective of accumulation of iodized oil.

Na+/myo-inositol cotransport is regulated by tonicity in cultured rat mesangial cells

Mesangial cells are considered to be faced with osmotic stress under physiological (such as extraglomerular mesangial cells) and pathophysiological (for example, diabetes mellitus) conditions. To see if mesangial cells have an osmoregulatory mechanism, like renal medullary cells, we measured the intracellular contents of organic osmolytes in isotonic and hypertonic conditions. Cultured rat mesangial cells are well tolerant of acute increase in osmolality up to 500 mOsm/kg. The myo-inositol content increased in hypertonic cells more than six-fold the value in isotonic cells. The contents of glycerophosphorylcholine and sorbitol also increased but were less than that of myo-inositol. The Na(+)-dependent myo-inositol uptake in hypertonic cells was a 12-fold uptake in isotonic cells, reaching a maximum 24 hours after the switch to a hypertonic medium. The uptake rate increased as medium osmolality increased from 300 to 500 mOsm/kg. Raffinose is the most effective solute to increase the myo-inositol uptake. NaCl, glucose and mannitol also increased the uptake rate (NaCl > glucose > mannitol). The increased uptake by hypertonicity was the result of an increase in Vmax without change in Km and was dependent on RNA and protein synthesis. These results indicate that mesangial cells respond to extracellular hypertonicity by increasing myo-inositol transport activity and accumulating myo-inositol into the cells, suggesting that myo-inositol functions as an organic osmolyte in mesangial cells.

Elevated serum pepsinogens in chronic renal failure patients

Human pepsinogens, the precursors of pepsin, originating from the stomach mucosa, are classified into two biochemically distinct groups, namely pepsinogen I (PG I) and pepsinogen II (PG II). We studied the serum levels of PG I and II in 51 normal volunteers, 23 chronic glomerulonephritis patients, 21 continuous ambulatory peritoneal dialysis (CAPD) patients and 40 hemodialysis patients. Serum pepsinogen levels were measured with a competitive binding double antibody radioimmunoassay. In the group of chronic glomerulonephritis patients, a positive correlation between the serum creatinine and the pepsinogen levels were found. The serum pepsinogen levels were remarkably elevated in CAPD and hemodialysis patients. The median levels of post-hemodialysis PG I (265.4 +/- 165.2 ng/ml) and PG II (41.7 +/- 38.0 ng/ml) were significantly higher than prehemodialysis values (PG I 207.4 +/- 127.5 ng/ml, PG II 29.0 +/- 16.6 ng/ml). Pepsinogen release by isolated gastric glands of guinea pigs was suppressed by guanidinosuccinic acid and was facilitated by calcium. The data suggest that both removal of guanidinosuccinic acid and infusion of calcium during hemodialysis contribute to the raised serum levels of these pepsinogens after hemodialysis.

Cystic lymphangioma of the spleen: MR findings with pathologic correlation

A case of histologically confirmed cystic lymphangioma of the spleen was presented. On MR imaging, the mass was shown to multiloculated hyperintensity areas on T2-weighted images, corresponding to dilated lymphatic spaces. The septa were demonstrated as hypointensity bands, corresponding to abundant fibrous connective tissues. MR findings correlated well with histologic findings. MRI was a useful noninvasive modality for the diagnosis.

Prostate cancer-induced oncogenic hypophosphatemic osteomalacia

A 65-year-old male with prostate carcinoma showed mild hypocalcemia of 7.9 mg/dl, marked hypophosphatemia of 1.7 mg/dl, hyperphosphaturia (tubular reabsorption of phosphorus 43% and tubular threshold for phosphorus of 0.6 mg/dl), low serum 1,25 (OH)2D level of less than 5 pg/ml and osteomalacia indicated by a marked increase of relative osteoid volume and fractional formation rate in the undecalcified section. Oncogenic osteomalacia due to prostatic carcinoma with suppression of 1,25 (OH)2D production and phosphaturia was suggested.

Levels of vitamin K, immunoreactive prothrombin, des-gamma-carboxy prothrombin and gamma-glutamyl carboxylase activity in hepatocellular carcinoma tissue

To clarify the mechanism of production of des-gamma-carboxy (abnormal) prothrombin (DCP) by hepatocellular carcinoma (HCC), we measured the levels of vitamin K, DCP, immunoreactive prothrombin and the activity of gamma-glutamyl carboxylase in liver tissues from HCC patients and in the medium of cultured human hepatoma cells. There was no significant difference in vitamin K (K1, MK-4) contents between HCC and non-HCC cirrhotic liver tissues. The activity of gamma-glutamyl carboxylase per unit amount of endogenous microsomal prothrombin precursor was decreased in HCC tissue compared with non-HCC liver tissue (positive plasma DCP: 335 +/- 72 vs 372 +/- 67, negative plasma DCP: 370 +/- 84 vs 393 +/- 56 nmol/min per mg prothrombin precursor, P > 0.05), although the total incorporation of 14COOH into microsomal precursor protein was higher in the former. By contrast, levels of DCP and immunoreactive prothrombin in HCC tissue were greater (P < 0.05) than those in non-HCC cirrhotic liver tissue. Furthermore, production of large amounts of immunoreactive prothrombin was observed in human hepatoma cells huH-1 and huH-2, which produced large amounts of DCP. These results suggest that there was excessive synthesis of prothrombin precursors by human HCC tissue and hepatoma cell lines huH-1 and huH-2. Thus, excessive synthesis of prothrombin precursors seems to be the main mechanism of DCP production by HCC.

A novel human monoclonal antibody against cervical cancer: its immunoreactivity with normal tube and ovary and with ovarian tumor tissue

1-1-2D, a novel human monoclonal antibody (MAb) raised against cervical cancer, was examined for its immunohistochemical reactivity with ovarian cancer. Six of 10 ovarian cancer cell lines showed positive staining, while 3 of 5 cervical cancer cell lines were positive. Among tumor tissues, 15 of 18 (83%) ovarian serous cystadenocarcinomas and 10 of 12 (83%) ovarian clear cell adenocarcinomas were positive. We also performed immunohistochemical staining of the same cancer specimens with OC 125 and compared their reactivity. The frequency of positivity was similar, but the reactivity of the two MAbs was different. 1-1-2D stained the apical surface of the glandular epithelial cells and secretory products of the gland. On the other hand, OC 125 stained the cytoplasm as well as the plasma membrane of the glandular epithelial cells. These results suggest that 1-1-2D MAb recognizes a different antigen from that recognized by OC 125.

[Applications of mass spectrometry for clinical laboratory test]

Mass spectrometry (MS) has recently played a considerable role in the chemical measurements in clinical laboratories. We have analyzed organic acids for diagnosis of organic acidemias, and tried to report quantitative data measured by GC/MS with 20 kinds of standard compounds of key metabolites labelled with stable isotopes. By ESI/MS/MS acylcarnitine was analyzed accurately and quickly. We found a new acylcarnitine compound in urine from a patient with multiple carboxylase deficiency, which showed m/z 276 ion peak on the spectrum by precursor ion scan of methylated compounds of dried raw urine. This was identified as 3-hydroxyisovalerylcarnitine. By ESI/MS, hemolysate was analyzed and an ion peak of abnormal alpha subunit of hemoglobulin, Hb MBoston, was clearly separated from the normal alpha subunit. Serum transferrin precipitated with anti-transferrin serum was analyzed by MALDI/TOF/MS. The transferrin-antibody complex in the immunoprecipitates was separated into transferrin and IgG in an acidic pH, which is the usual condition of loading on MALDI/TOF/MS. Ions of IgG and other minor components were not superimposed on the transferrin ions. Transferrin isoform with a molecular weight about 2.2kDa smaller than normal transferrin, which is contained in the serum from patients with carbohydrate-deficient glycoprotein syndrome, was identified by this method. The MALDI/TOF/MS analysis of immunoprecipitates may serve as a simple and sensitive method to identify the molecular weight heterogeneity of various biological materials.

[Two siblings with 2,8-dihydroxyadenine urolithiasis]

We treated two children with 2,8-dihydroxyadenine urolithiasis for over 7 years. The male prepositus was admitted to the hospital because of anuria when he was 10 months old. Bilateral urinary stones had caused the anuria. The stones were 2,8-dihydroxyadenine and his APRT activity was low. He has been treated with about 5.0 mg/kg/day of allopurinol without purine diet restriction. His sister, 3 years old at that time, also was found to have a renal stone. She has been treated with about 3.3 mg/kg/day of allopurinol without restricting purine. The allopurinol therapy without purine-restriction resulted in normal growth of both children with neither the recurrence of stone nor renal impairment.

Improved fold width and increased acid secretion after eradication of the organism in Helicobacter pylori associated enlarged fold gastritis

This study examined the effects of eradication of Helicobacter pylori (H pylori) infection on gastric mucosal morphology and acid secretion. Sixteen H pylori positive patients with enlarged gastric body folds were divided into two groups: (a) patients with moderate enlargement (fold width: 6 to 10 mm, n = 8) and (b) patients with severe enlargement (> 10 mm, n = 8). After successful treatment, gastric body fold width was reduced in both groups (p < 0.01) with an associated decrease in inflammatory infiltrates in the body mucosa (p < 0.01 and p < 0.05). Basal acid output and tetragastrin stimulated maximal acid output (mean (SEM)) in all 16 patients significantly increased from 1.1 (0.5) to 2.9 (0.9) mmol/h (p < 0.05) and from 5.4 (1.3) to 18.7 (2.3) mmol/h (p < 0.01), respectively, with a significant decrease in fasting serum gastrin concentrations, from 127.1 (16.1) to 59.6 (3.8) pg/ml (p < 0.01). The increase in acid secretion after eradication of H pylori was more noticeable in the severe group, who had shown lower acid secretion and higher serum gastrin concentrations (p < 0.05) before eradication, than the increase seen in the moderate group. The decreases in ammonia nitrogen content seen after eradication were significant in basal (from 0.91 (0.17) to 0.37 (0.08) mmol/h, p < 0.05) and stimulated gastric secretions (from 1.57 (0.19) to 0.37 (0.13) mmol/h, p < 0.01), although these changes were too small to explain the increases in basal acid output and maximal acid output. These results suggest that inflammation of the gastric body mucosa caused by H pylori infection is associated with enlarged gastric body folds and inhibition of acid secretion in H pylori positive patients with enlarged gastric body folds.

Asynchronous volume changes of the two ventricles after Fontan operation in patients with a biventricular heart

Coordinated contraction of the ventricle is an important determinant of pump function, which seems to be particularly important in Fontan circulation with one pumping ventricle. We analyzed the synchronism of contraction of the two ventricles in 11 patients with a biventricular heart who had undergone Fontan operation. Curves representing ventricular volume changes in a cardiac cycle measured on angiograms were smoothed and divided into 20 segments. We calculated the number of segments of the same directional volume changes (synchronous changes) between the two ventricles (synchronous ratio). We also calculated the total volume of the two ventricles (the two as one whole ventricle) by adding their volumes in each segment and calculated the ratio (stroke volume ratio) of the aortic stroke volume from the whole ventricle to the sum of stroke volumes of the morphological right and left ventricles. If the two ventricles ejected the blood in a completely synchronous manner, these ratios should be 1.0. In seven patients with synchronous ratios of 0.75 or greater and a stroke volume ratio of greater than 0.95, the cardiac index was 3.2 +/- 0.3 l/min/m2, the maximum total volume (corresponding to end-diastolic volume) was 106 +/- 45% normal, and the ejection fraction was 0.44 +/- 0.10. In four patients with ratios of less than 0.70 and 0.95, respectively, the parameters were 2.4 +/- 0.5 (P < 0.05), 193 +/- 92%, and 0.33 +/- 0.08, respectively. The synchronous ratio was inversely correlated with cardiac output. In conclusion, synchronism of the cardiac cycle of the two ventricles affects Fontan circulation in patients with a biventricular heart.

[High-resolution MR imaging of the mediastinum and hilus of the lung using surface-coils]

High-resolution MR imaging using surface-coils (Helmholtz-coil) was performed on patients with hilar lung cancer and healthy volunteers. We evaluated the clinical usefulness of this technique compared with MR imaging performed with a conventional body-coil. Although the signal-to-noise ratio was slightly decreased, normal anatomic structures, hilar masses, and enlarged lymph nodes were distinctly visualized in comparison with those on MR images obtained with a body-coil. High-resolution MR imaging with the Helmholtz-coil seemed to be useful for the evaluation of mediastinal and hilar disease, and may able to supplant MR imaging with a conventional body-coil in routine examinations.

MR imaging of the uterus: findings from high-resolution multisection dynamic imaging with a surface coil

MR imaging of the female pelvis with a local coil (multiple phased array coils) has been reported. With this method, the signal-to-noise ratio (S/N) is improved so that high-resolution images can be obtained. Dynamic contrast-enhanced MR imaging has been reported to be useful in diagnosing uterine neoplasms. However, dynamic MR imaging is done in only limited imaging planes. When multisection dynamic MR imaging with fast gradient-echo sequences is combined with the use of a local coil, high-resolution images can be obtained throughout the entire uterus during a single breath-hold. This pictorial essay illustrates the appearance of the normal uterus and malignant uterine neoplasms on high-resolution multisection dynamic MR images obtained with a Helmholtz-type surface coil.

Expression of trkC in a mouse osteoblastic cell line and its response to neurotrophin-3

In a cultured osteoblastic cell line, MC3T3-E1 derived from newborn mouse calvaria, the mRNA encoding TRKC, which is the receptor molecule of neurotrophin-3 (NT-3), was detected by the polymerase chain reaction (PCR) method. The mRNAs of the normal type and one alternative form (C14) were highly expressed in the exponential growth phase of MC3T3-E1 cells and decreased as the cells reached the differentiation stage. NT-3, but not nerve growth factor (NGF), stimulated the proliferation of MC3T3-E1 cells in a dose-dependent manner. NT-3 also stimulated calcium incorporation through the surface of MC3T3-E1 cells, indicating the association of NT-3 and its receptor on the cell surface.

Technetium-99m-HMPAO as a marker of chemical and irradiation lung injury: experimental and clinical investigations

We evaluated the ability of 99mTc-hexamethylpropyleneamine oxime (99mTc-HMPAO) to serve as a sensitive marker of lung injury.

METHODS

Two experimental rabbit models of minimal lung injury were designed using injections of a low dose (0.05 ml/kg) of oleic acid or 50 Gy of irradiation. In addition, we clinically investigated whether patients who received chemotherapy (n = 14) or radiotherapy (n = 13) for lung cancer showed high uptake of 99mTc-HMPAO in the lungs.

RESULTS

Despite the minimal endothelial lesions visualized by electron microscopy (edematous changes and blebbing), in both animal models, the lungs showed high uptake of 99mTc-HMPAO, which occurred rapidly within 1 min after injection. Clinically, the mean lung-to-liver ratio of 99mTc-HMPAO activity in the patients who received chemotherapy (0.649 +/- 0.185, p < 0.01) was significantly higher than that of the controls (n = 16; 0.387 +/- 0.108), and all 12 patients who received more than 30 Gy of irradiation showed abnormal uptake in the irradiated lungs, despite the lack of abnormal opacities on chest CT.

CONCLUSION

These findings suggest that 99mTc-HMPAO has the potential to be a sensitive marker of chemical and irradiation lung injury.

Interleukin-1 alpha and interleukin-1 beta periapical exudates of infected root canals: correlations with the clinical findings of the involved teeth

This study quantified the concentrations of interleukin-1 alpha (IL-1 alpha) and interleukin-1 beta (IL-1 beta) in the periapical exudates obtained from 69 single-rooted teeth using enzyme-linked immunosorbent assays, and examined their correlation with clinical findings of the involved teeth. Changes in the levels of these factors during root canal treatment were also investigated. The average levels of IL-1 beta (6.57 ng/ml) in periapical exudates were twice that of IL-1 alpha (3.25 ng/ml). The exudates containing pus showed significantly higher IL-1 alpha levels than those from the canals without pus (p < 0.01). The exudates from the canals with small radiolucent areas contained significantly higher IL-1 alpha levels than those from the canals with large radiolucent areas (p < 0.05). The tendency for there to be an increase in the levels of IL-1 alpha and a decrease in the levels of IL-1 beta was observed following root canal treatment. These observations suggest that IL-1 alpha and IL-1 beta are involved in the immunopathogenesis of periapical lesions and that IL-1 alpha and IL-1 beta may play different roles in the healing process of periapical lesions during root canal treatment.

[Blood flow pattern in pulmonary atelectasis with color Doppler flow imaging]

Blood flow pattern in the lesion was evaluated in 4 patients with pulmonary atelectasis by color Doppler flow imaging synchronized electrocardiography. The pulsatile signal and triphasic signal were detected, whereas the continuous signal was not. It seemed that in pulmonary atelectasis the pulsatile signal was the blood flow signal in the pulmonary artery and the triphasic signal was the blood flow signal in the pulmonary vein.

Iron ion induces mitochondrial DNA damage in HTC rat hepatoma cell culture--role of antioxidants in mitochondrial DNA protection from oxidative stresses

The mitochondrial DNA (mtDNA) is exposed to the reactive oxygen species generated in the mitochondrial electron transfer system. While mitochondrial superoxide dismutase (Mn-SOD) scavenges superoxide anions to prevent damage of mtDNA, excess amount of reactive oxygen generated by quinone compounds impairs the mtDNA, in which involvement of iron ion-catalyzed reactions is suggested. In this communication, we report that the mtDNA in HTC rat hepatoma cells was markedly damaged in the presence of either ferrous (Fe2+) or ferric (Fe3+) iron in the culture medium. The mtDNA of HTC cells was damaged in the presence of 100 microM of iron ions in the culture medium within 3 h. There was no significant difference in the potency of Fe2+ and Fe3+. Deferoxamine, a Fe(3+)-specific chelating reagent, blocked the iron ion-induced mtDNA damage completely. The mtDNA in rat hepatocyte primary culture was, on the other hand, not damaged by either Fe2+ or Fe3+. To understand the difference between iron ion-induced damage of mtDNA in HTC cells and in the primary hepatocytes, the Mn-SOD activity and lipid-soluble antioxidant contents were compared. The Mn-SOD activity in HTC cells was markedly lower (< 0.02 U/mg cell protein) than that in rat hepatocyte primary cell cultures (1.5 U/mg cell protein). Immunoreactive Mn-SOD content in HTC cells was also lower (21 ng/mg cell protein) than in the primary cultures (99 ng/mg cell protein). HTC cells contain much smaller amounts (3-11% of that of normal rat hepatocytes) of alpha-tocopherol and coenzyme Q homologs (CoQn). These results suggest that reactive oxygen species produced by iron ion impaired mtDNA of HTC cells, in which antioxidant activity was markedly decreased.

Monoclonal antibodies recognizing 2-oxo acid dehydrogenase components in granular structures in neurons

Monoclonal antibodies (MAbs) were raised against the hippocampal homogenate of young rats and classified into three types by immunohistochemical analysis: (1) MAbs specific for a granular structure observed within neurons, (2) MAbs specific for neuronal cell surface and cell body, and (3) MAbs specific for both neurons and astroglial cells. One MAb (2D11-7) specifically reacted with granular structures observed in neurons. A specific protein antigen was purified from rat homogenate by immunoadsorbent assay with MAb 2D11-7. Amino acid sequencing followed by lysyl endopeptidase digestion of the proteins in the eluate demonstrated that the antigens recognized by MAb 2D11-7 were E2 components of the 2-oxoglutarate dehydrogenase complex and pyruvate dehydrogenase complex. The cell specificity and age dependency of these proteins are also discussed.