Medial extent of the posterior renal fascia. An anatomic and computed tomography study

To study the medial extent of the posterior renal fascia and the perirenal space, the authors dissected two cadavers and reviewed 50 computed tomographic (CT) abdominal scans. The results demonstrated that the medial extent of the posterior renal fascia depends on the level in a vertical direction and its relationship to the kidney which varies at different levels. At the renal hilus, the fascia inserts posteromedially to the fascia of the quadratus lumborum along its lateral margin; more cranially, the line of insertion is more lateral, onto the diaphragmatic fascia; more caudally, the line of insertion is more medial, inserting onto the anterior surface of the quadratus lumborum. Therefore the posteromedial insertion of the posterior renal fascia extends medially, from the more laterally placed diaphragmatic fascia, to the lateral margin of the quadratus lumborum and then to the anterior surface of the quadratus lumborum, depending on the anatomic level. The clinical implication of these findings are discussed.

Central lesions in chronic inflammatory demyelinating polyneuropathy: an MRI study

To determine the frequency of the possible association between chronic inflammatory demyelinating polyneuropathy (CIDP) and MS, we did magnetic resonance imaging (MRI) of the brain in 19 patients with CIDP. Only 1 patient had clinical signs suggestive of central involvement. Seven of the 19 scans showed 2 or more brain "lesions." In 1 case the cause was an infarct and in 5 cases the patients were over 55 years of age and the lesions were not typical of MS. One 38-year-old patient had 2 small subcortical lesions. Typical MS lesions on MRI are uncommon in CIDP.

Sonographic detection of pneumoperitoneum in patients with acute abdomen

We describe five patients who presented with an acute abdomen in whom pneumoperitoneum was first detected by sonography. All five subsequently were proved to have a perforated viscus. In all cases, the pneumoperitoneum was seen as an echogenic line with a posterior ring-down or reverberation artifact between the anterior abdominal wall and the anterior surface of the liver. The finding was shown best in the right upper quadrant with the patient in the left lateral decubitus position. The echoes caused by the pneumoperitoneum overlapped the echoes of the lung during inspiration, but the echoes were separate during expiration. The probable cause of pneumoperitoneum was determined with sonography in four of the five patients: three had perforation of duodenal ulcer and one had perforation of gastric cancer. The fifth patient had a perforated ileum, which was not evident on the sonogram. Our experience with these patients suggests that the detection of pneumoperitoneum on sonography in patients with an acute abdomen is an important sign of a perforated viscus.

MR imaging after surgery for vertebrobasilar aneurysm

We examined the safety and utility of high-field MR in patients who had surgery for cerebral aneurysms of the vertebrobasilar system. Eighteen posterior (and three coincidental anterior) circulation aneurysms were treated. Twenty-one MR scans were obtained at a mean postoperative interval of 7.2 days. The mean size of the preoperative vertebrobasilar aneurysm was 2.2 cm; six were giant (greater than 2.5 cm) and eight were large (greater than 1.5, less than or equal to 2.5 cm). In 17 patients, Sugita nonmagnetic clips were used. In one other, a Drake tourniquet was used. No ill effects occurred from scanning with a high-field imaging unit at 1.5 T. The MR clip artifact was much less obtrusive than that on CT. In 11 cases, the aneurysm could be partially imaged postoperatively, mainly in very large aneurysms or in those treated by clipping the parent vessel. Of these, two revealed residual lumina on MR and nine looked completely thrombosed. Postoperative angiography showed that in four of the thrombosed-appearing aneurysms a residual lumen with a mean diameter of 1.0 cm had been missed. In the patient imaged after application of a Drake tourniquet, no artifact was seen, and a good assessment of progressive partial thrombosis was obtained. Evolution of the signal intensity of new aneurysm thrombus, in those minimally or not obscured by artifact, coincides with patterns previously described for hemoglobin in intracerebral hematomas. The earliest hyperintensity could be seen in either the periphery or the center of the new thrombus. All 15 patients examined with new postoperative deficits showed appropriate lesions, mainly small brainstem ischemic foci. Postoperative CT (performed in all but four of these patients) missed over 80% of these lesions, mainly owing to artifact from clip or bone. We conclude that MR is better than CT in the postoperative assessment of aneurysm patients, particularly in demonstrating small zones of ischemia. High-field MR scanning is safe if nonmagnetic surgical clips are used. MR is not accurate in assessing residual lumina.

Neuropathologic correlates of leuko-araiosis

We describe the pathologic findings in 17 persons with dementia, 12 of whom exhibited leuko-araiosis on computed tomographic scan. The presence of white matter pallor was confirmed on autopsy in 11 of these 12 cases, 9 with Alzheimer's disease and 2 with multi-infarct dementia. Two further patients, 1 with Alzheimer's disease and 1 with multi-infarct dementia, proved to have white matter changes on pathologic examination. White matter pallor coexisted with cerebral amyloid angiopathy in the brains of the patients with Alzheimer's disease. The presence of severe white matter pallor in patients with Alzheimer's disease correlated with early death, while the presence of cortical scars was associated with prolonged survival. Because early death in patients with Alzheimer's disease has been linked with severe pathologic and chemical changes, the presence of white matter pallor may be further evidence of a particularly severe process in patients with early onset of Alzheimer's disease.

Oncogene expressions detected by in situ hybridization of squamous metaplasia, dysplasia and primary lung cancer in human

In order to elucidate the dynamic changes of oncogene expression in the sequential cascade of squamous metaplasia, dysplasia, and squamous cell carcinoma of the bronchial epithelium, hybridization in situ was employed with a biotinylated oncogene probe. The expression of c-myc was localized exclusively in nuclei. While normal bronchial epithelium revealed no discernible clumps of c-myc grains, except occasional grains less than 3 per cell, squamous metaplasia showed increased number of grains and a few clusters of c-myc grains. In dysplasia, c-myc expression was more intensive than in squamous metaplasia. Approximately, 1/3 to 2/3 of tumor cell populations of squamous cell carcinomas of the lung revealed tremendously increased c-myc expression. In addition clumpy grains of c-myc in squamous cell carcinoma appeared more frequently than in squamous metaplasia or dysplasia. The c-myc expression was found to vary between different samples and within each cancer, and not all cancer cells expressed c-myc. These data indicate that c-myc oncogene plays it's role on reprogramming for growth control of cell populations particularly in multistage carcinogenesis and progression of lung cancer. These dynamic alterations of c-myc expression suggest that neoplastic transformation may occur conceivably at the dysplastic phase eventually resulting in carcinoma in situ. This means, in turn, squamous dysplasia is a putative precancerous lesion of the human lung.

Pigmented cells of the stria vascularis and spiral ligament of the chinchilla

This study was designed to investigate the cellular distribution and ultrastructure of melanin pigment in the stria vascularis and spiral ligament of the chinchilla cochlea. Typical dendritic melanocytes containing homogeneously distributed eumelanin granules were observed in the spiral ligament. In the stria vascularis melanin was found to occur in three types of cells (heavily pigmented cells that appear to be melanocytes, intermediate cells and basal cells). The melanocyte-like cells contain pigment globules composed of melanin granules, granular matrix and occasional lipid droplets in a configuration similar to that of neuromelanin. These cells are morphologically distinct from intermediate cells which contain sparsely distributed, small, dense granules apparently composed of melanin. The intermediate cells show a positive DOPA reaction and portions of the intermediate cell GERL system display intense acid phosphatase reactivity. The basal cells of the chinchilla stria were also found to contain occasional clusters of melanin granules. It is hypothesized that the basal cells may acquire melanin by donation from the other pigmented cells of the lateral cochlear wall.

Platelet monoamine oxidase in Parkinson patients: effect of L-deprenyl therapy

Platelet MAO activity was measured in 79 Parkinson patients (56 males and 23 females) before and during L-deprenyl therapy. Baseline platelet MAO activity was higher in females than in males with no age dependent differences. During chronic L-deprenyl therapy, MAO activity was inhibited greater than 98%. Four hours after the oral administration of the first 5 mg dose of L-deprenyl, platelet MAO activity was inhibited by 86%. By 24 hours, greater than 98% inhibition was achieved and this degree of inhibition was maintained during continuous L-deprenyl administration. Following oral administration of 10 mg L-deprenyl once a day versus 5 mg L-deprenyl twice a day, the time course of platelet MAO inhibition was similar. Five days after the termination of chronic L-deprenyl therapy, platelet MAO activity was still inhibited by 96%. MAO activity returned to normal by 2 weeks after stopping L-deprenyl. Platelet MAO activity is a useful method of monitoring bioavailability, compliance, dose-response relationship and optimal dosage schedules for L-deprenyl in Parkinson patients.

Experimental cholesteatoma. Epidermal ingrowth through tympanic membrane following middle ear application of propylene glycol

This study was designed to investigate morphological changes in the tympanic membrane (TM) associated with cholesteatoma formation in experimental animals following application of propylene glycol to the middle ear. A 50% solution of propylene glycol was applied bilaterally to the middle ear cavities of 30 young-adult chinchillas. The animals were sacrificed for light and electron microscopic study at intervals of 2 days to 6 weeks after a single application of 0.2 ml of the propylene glycol solution. At 2 days there was complete destruction of the epidermal and mucosal layers of the TM. The denuded lateral surface rapidly became re-epithelialized by hyperplastic epidermal cells and by 2-3 weeks, keratinizing epidermis penetrated damaged areas of the fibrous layer of the lamina propria to reach the medial surface of the TM. These epidermal cells proliferated in the middle ear cavity, forming cholesteatomas. Our observations indicate that invasion of the intact, but structurally altered, tympanic membrane by hyperplastic epidermis is a primary mechanism of cholesteatoma formation in the animal model.

Biliary cystadenoma and cystadenocarcinoma: CT and sonographic findings

Eight women (ages 18-65 years; mean, 47 years) with biliary cystadenoma (n = 3) or cystadenocarcinoma (n = 5) were examined with computed tomography and sonography. The appearance of the tumors varied from unilocular cystic masses to multilocular cystic masses with multiple satellite tumors, although the majority (n = 6) of tumors were single, multilocular, and cystic. Cystic areas showed attenuation numbers under +30 HU. Papillary excrescences, nodular thickening of internal septa, and mural nodules, which showed contrast enhancement, were seen in one case of cystadenoma and all five cases of cystadenocarcinoma. One cystadenoma and one cystadenocarcinoma contained calcifications. Three cases showed connection to the intrahepatic bile ducts. Biliary cystadenoma and cystadenocarcinoma should be the primary diagnostic consideration when one detects in a middle-aged woman a well-encapsulated, multilocular cystic mass connected to the biliary system or prolapsing into the bile duct.

Clonorchiasis: sonographic findings in 59 proved cases

Clonorchiasis is a parasitic disease of the bile ducts that occurs in endemic areas after ingestion of the raw flesh of freshwater fish. We analyzed the sonographic findings in 59 patients with clonorchiasis, suspected prospectively from sonographic findings and proved subsequently by demonstration of eggs in their stools. Diffuse dilatation of the small intrahepatic bile ducts with no or minimal dilatation of the large intra- and extrahepatic ducts was observed in all cases. The extrahepatic ducts were patent throughout in all except one case. This characteristic finding reflects diffuse intrahepatic bile duct obstruction and resultant proximal dilatation caused by an adult worm or aggregates of worms, as worms reside diffusely in the medium and small intrahepatic bile ducts. Cholangitis and multifocal periductal fibrosis with proximal dilatation may play an additional role. Increased echogenicity of the intrahepatic bile duct wall was present in 39 cases (66%), reflecting cholangitis and periductal fibrosis. In 17 cases (29%), floating or dependent, discrete, nonshadowing, intraluminal, echogenic foci caused by adult worms in the bile were demonstrated in the gallbladder. These echogenic foci were distinguished from stones because they were fusiform, weak in echogenicity, and floated with a change in position. Clonorchiasis should be considered when sonography discloses the characteristic pattern of bile duct dilatation with increased wall echogenicity and nonshadowing, discrete, echogenic foci in the gallbladder lumen.

Normative arm and calf blood pressure values in the newborn

Indirect BP measurement was obtained in the right upper arm in 219 healthy newborn infants with the Dinamap monitor and was compared with values obtained from the calf to establish normative BP values and to help establish a diagnosis of hypertension and coarctation of the aorta in the newborn. There were 174 Mexican-Americans (79.5%), 33 whites (15.0%), and 12 blacks (5.5%). The width of the BP cuff was selected to be 0.4 to 0.5 times the circumference of the extremities. Three supine position readings of BPs and heart rate were obtained from each site and were averaged for statistical analyses. Mean arm BP values (+/- SD) of the neonate less than 36 hours of age were 62.6 +/- 6.9/38.9 +/- 5.7 mm Hg (48.0 +/- 6.2 mm Hg). Neonates older than 36 hours had slightly but significantly (P less than .05) greater values (4 to 6 mm Hg) than did infants younger than 36 hours of age. Active neonates had values 6 to 10 mm Hg greater than quiet neonates (P less than .05). BP values in the calf obtained with the same-sized cuff were almost identical with those obtained from the arm. Differences in consecutively obtained arm and calf BPs (arm values minus calf values) were 1.1 +/- 7.7 mm Hg systolic, -0.01 +/- 6.2 mm Hg diastolic, and 0.9 +/- 6.9 mm Hg mean pressures. Mean heart rate (+/- SD) of neonates less than 36 hours of age was 129.4 +/- 13.2 beats per minute and that of neonates older than 36 hours of age was 139.4 +/- 14.1 beats per minute.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of three embolic agents in pig rete

In ongoing research into potential embolic agents, three substances were evaluated for their effectiveness in occluding the pig rete. Selective injection of these agents produced varying degrees of occlusion, with the most effective a microfibrillar collagen hemostat in a 33% ethanol solution. Angiostat, a collagen particulate, did not produce rete occlusion, and all pigs injected with it developed adverse effects, including coma and apnea. Tisseel, a tissue sealant, produced partial rete occlusion, but was uniformly difficult to manage through long catheters, and its use was discontinued. Microfibrillar collagen hemostat with ethanol appears to have the greatest potential as an embolic agent in low-flow structures.

In vivo DNA loops in araCBAD: size limits and helical repeat

Formation of a DNA loop by AraC proteins bound at the araI and araO2 sites, whose center-to-center distance is 211 base pairs, is necessary for repression of the araBAD promoter, PBAD, of Escherichia coli. To determine the upper and lower size limits of the loop, we constructed PBAD-reporter gene fusion plasmids with various spacings between araI and araO2 and measured their levels of expression. Spacings larger than about 500 base pairs resulted in elimination of detectable repression. No lower limit to spacing was found, suggesting that AraC protein itself possesses significant flexibility and its bending substantially aids formation of small loops. As the spacing between araI and araO2 varied, the activity of PBAD oscillated with an 11.1-base-pair periodicity, implying that the in vivo helical repeat of this DNA is 11.1 base pairs per turn.

Falx ossification--MR visualization

While falx calcification is rarely demonstrated using magnetic resonance, falx ossification, when seen, is characteristic. On magnetic resonance images, falx ossification exhibits a typical appearance consisting of a central marrow-containing portion with signal intensity similar to fat, surrounded by low signal intensity representing cortical bone. Falx ossification was seen in 0.7% of patients and should not be confused with a falx lipoma, a rare congenital entity.

Oncogene expression detected by in situ hybridization in human primary lung cancer

By means of in situ hybridization using biotinylated oncogene probes and the immunohistochemical reaction of avidin-biotin complex-alkaline phosphatase with substrate, we investigated expression of c-myc oncogene in the formalin-fixed, paraffin-embedded tissue sections from seven patients with squamous cell carcinoma (six cases) and small cell carcinoma (one case) of primary lung origin. The expression of c-myc oncogene was greatly enhanced in all cases studied, with individual and cell-to-cell variation. In contrast, all of the specimens incubated with deoxyribonuclease after the standard pretreatment with ribonuclease T1 were negative for the expression of c-myc oncogene. The in situ hybridization permits estimation of a heterogeneous amplification of c-myc oncogene that may be related to secondary alterations occurring during the progression of the malignant lung tumors.

Effects of otic drops on chinchilla tympanic membrane

Experimental studies have shown that if antibiotic otic drops reach the middle ear cavity they produce severe inflammation. However, the effects of these preparations on the tympanic membrane have not been thoroughly investigated. This study was designed to assess morphological changes in the chinchilla tympanic membrane two to 21 days after a single 0.2-mL application of an antibiotic otic preparation (Cortisporin Otic Suspension) to the middle ear cavity. At two days, the epidermal and the mucosal layers were destroyed. By four days, reepithelialization had occurred and all layers of the tympanic membrane subsequently became markedly hyperplastic. Disruption of the fibrous layer, invasion of keratinizing epidermis to the medial surface, and perforation were observed at three weeks. These findings indicate that tympanic membrane damage is a potentially significant aspect of the ototoxic properties of topical otic preparations.

Superior aspect of the perirenal space: anatomy and pathological correlation

To study the anatomy of the superior aspect of the perirenal space, we analysed 50 computed tomographic (CT) scans with reference to the anatomy of Gerota's fascia, and dissected five cadavers laying special emphasis on the ascent of Gerota's fascia. We also reviewed 10 scans of patients with a large lesion in the right upper abdomen regarding localisation of the lesion. We conclude that Gerota's fascia does not cover the upper portion of the kidney and adrenal gland so that the superior aspect of the perirenal space is open towards the upper abdominal extraperitoneal space. Thus, a large lesion arising from the right adrenal gland or kidney easily invaginates the liver through the bare area mimicking a hepatic lesion, and vice versa. This explains the difficulty in localising a large lesion in the right upper abdomen.