[Anatomy and variants of hepatic segments, vessels, and bile ducts]

Knowledge of normal liver anatomy and its variants is indispensable for the radiologist. Accurate assessment of anomalies of the arterial, portal (venous), and biliary system and of liver segments using computed tomography is necessary for consultation with the surgeon and deciding on the therapeutic strategy. The multidetector CT is the most important tool for preoperative evaluation. Alternatively, MRI can be used with special regard to the biliary system (MRCP). This article reviews the most important variants of the liver detected with imaging modalities and their clinical relevance.

Heroin-associated myocardial damages--conventional and immunohistochemical investigations

Well-known complications related to drug abuse are myocardial insufficiency, myocardial infarction, endocarditis, myocarditis, aortic dissection, neurologic damages, ischemic colitis, thrombotic phenomenons, renal infarction and acute liver failure. Furthermore, microfocal fibrosis of the myocardium is found in stimulant abuse. The origin of myocardial fibrosis associated with opiate abuse (endocarditis, myocarditis, embolism) is still unclear. This question shall be investigated using immunohistochemical staining for early diagnosis of myocarditis. A quantification of myocardial interstitial leucocytic infiltrates was accomplished in 21 chronic drug abusers who died of heroin/morphine intoxication and compared to 15 normal subjects who died suddenly due to non-cardiac causes of death without intoxication (e.g. traffic accidents, head trauma). Toxicological investigations were performed and in addition, blood samples were checked to clarify the status of HIV, hepatitis A, B and C in both groups. To verify signs of inflammation, myocardial specimen from different locations were investigated with conventional histological stainings and immunohistochemical techniques for characterization and quantification of interstitial myocardial leucocytes, T-lymphocytes and macrophages. The number of cells were found up to fivefold increased in heroin addicts compared to the control group without reaching the cut-off values for immunohistochemically based diagnosis of myocarditis.

Interleukin-13 acts as an apoptotic effector on lung epithelial cells and induces pro-fibrotic gene expression in lung fibroblasts

BACKGROUND

IL-13 promotes acute allergic asthma and is discussed to play a role in late asthmatic features such as fibrotic processes and airway remodelling. The contributions of IL-13-mediated mechanisms to subepithelial events related to fibrosis are not yet settled.

OBJECTIVE

We investigated the impact of IL-13 on lung epithelial cells as apoptotic effector and on lung fibroblasts as inducer of pro-fibrotic gene expression.

METHODS

Using the two lung epithelial cell lines A549 and BEAS-2B as well as primary lung epithelial cells, we investigated the capability of IL-13 to induce apoptosis by both flow-cytometry and ELISA. The ability of IL-13 to increase the expression of pro-fibrotic genes and to exert influence on the expression of its own receptor was investigated by real-time quantitative PCR measurement of mRNAs encoding collagen I, collagen III, basic fibroblast growth factor (bFGF), alpha-smooth muscle actin (alpha-SMA) and the IL-13 receptor alpha1 (IL-13Ralpha1) chain in human primary lung fibroblasts. The specificity of IL-13-mediated cellular responses was confirmed by means of an inhibitory monoclonal antibody directed to the IL-13 receptor.

RESULTS

IL-13 induces apoptosis in lung epithelial cell lines as well as in primary lung epithelial cells. Furthermore, IL-13 increases the expression of mRNA for alpha-SMA and collagen III, but not for bFGF in human primary lung fibroblasts. The susceptibility of lung fibroblasts to IL-13-induced up-regulation of pro-fibrotic genes is associated with the regulation of IL-13 receptor expression. IL-13-dependent fibrosis-associated effects could be inhibited by antibody-mediated blockade of the IL-13Ralpha1 subunit.

CONCLUSION

Our findings indicate a function of IL-13 as a mediator in fibrotic processes leading to loss of functional airway tissue in asthma. They also highlight the therapeutic potential of specifically targeting the interaction between IL-13 and its receptor.

Energy- and CO2-reduction potentials by anaerobic treatment of wastewater and organic kitchen wastes in consideration of different climatic conditions

The classical municipal wastewater treatment in Germany consists of an aerobic carbon and nitrogen elimination and mostly an anaerobic sludge treatment. Organic kitchen wastes from separate waste collection as well as yard wastes are converted mostly in composting plants to soil conditioner. With these conventional types of treatment, the energy potential in waste and wastewater is lost due to aerobic material conversion. In this article three scenarios for the treatment of municipal wastewater and waste are compared on the subject of energy efficiency and useable potential: Sc1. the classical wastewater treatment and the composting of the organic waste fraction, Sc2. the anaerobic treatment of wastewater combined with deammonification and the digestion of the organic waste fraction, and Sc3. a mutual anaerobic treatment of wastewater and waste as co-digestion with deammonification. The calculation of energy and CO2-balance considers different climatic conditions. In case of using anaerobic treatment, not only the energy balance will be positive, also the CO2-balance is improved by the substitution of fossil fuels with generated biogas.

High-resolution contrast-enhanced, susceptibility-weighted MR imaging at 3T in patients with brain tumors: correlation with positron-emission tomography and histopathologic findings

BACKGROUND AND PURPOSE

The purpose of this work was to demonstrate susceptibility effects (SusE) in various types of brain tumors with 3T high-resolution (HR)-contrast-enhanced (CE)-susceptibility-weighted (SW)-MR imaging and to correlate SusE with positron-emission tomography (PET) and histopathology.

MATERIALS AND METHODS

Eighteen patients with brain tumors, scheduled for biopsy or tumor extirpation, underwent high-field (3T) MR imaging. In all of the patients, an axial T1-spin-echo (SE) sequence and an HR-SW imaging sequence before and after IV application of a standard dose of contrast agent (MultiHance) was obtained. Seven patients preoperatively underwent PET. The frequency and formation of intralesional SusE in all of the images were evaluated and correlated with tumor grade as determined by PET and histopathology. Direct correlation of SusE and histopathologic specimens was performed in 6 patients. Contrast enhancement of the lesions was assessed in both sequences.

RESULTS

High-grade lesions demonstrated either high or medium frequency of SusE in 90% of the patients. Low-grade lesions demonstrated low frequency of SusE or no SusE. Correlation between intralesional frequency of SusE and histopathologic, as well as PET, tumor grading was statistically significant. Contrast enhancement was equally visible in both SW and SE sequences. Side-to-side comparison of tumor areas with high frequency of SusE and histopathology revealed that intralesional SusE reflected conglomerates of increased tumor microvascularity.

CONCLUSIONS

3T HR-CE-SW-MR imaging shows both intratumoral SusE not visible with standard MR imaging and contrast enhancement visible with standard MR imaging. Because frequency of intratumoral SusE correlates with tumor grade as determined by PET and histopathology, this novel technique is a promising tool for noninvasive differentiation of low-grade from high-grade brain tumors and for determination of an optimal area of biopsy for accurate tumor grading.

[O-Twist Marker for marking breast cancer under neoadjuvant chemotherapy--first results]

PURPOSE

Evaluation of ultrasound-guided percutaneous marking of breast cancer using an "O-Twist Marker" (BARD GmbH, Karlsruhe, Germany) in patients undergoing neoadjuvant chemotherapy. In the event of complete remission, the lesion of interest can be missed after completion of therapy. In these cases marking of the tumor site is essential.

MATERIALS AND METHODS

We monitored patients with breast cancer proven by biopsy who were undergoing neoadjuvant chemotherapy with ultrasound. In cases in which the follow-up ultrasound examination after the second chemotherapy cycle showed a significant tumor mass reduction (> 30 %), we pinpointed the lesion with an ultrasound-guided "O-Twist Marker". The position of the marker was documented by ultrasound and mammography. Between January and November 2006, we marked 7 patients.

RESULTS

The visibility of the marker was excellent on mammography, but only moderate on ultrasound. The marker did not cause any imaging interference. The instrument was easy to operate. We did not detect any migration of the marker. In 3/7 patients it would have been possible to locate the remaining tumor tissue after the completion of neoadjuvant chemotherapy without the marking. In 4/7 cases the clip was very useful or even essential for preoperative site determination.

CONCLUSION

The use of "O-Twist Marker" is a reliable and effective technique for locating breast cancer sites in remission during neoadjuvant chemotherapy. The visibility of the marker on ultrasound should be improved. In 57 % of the cases tumor marking was advantageous for surgical procedures.

[Late secondary syphilis with ulceration of the tongue during HIV coinfection: case report]

With the continuing rise of syphilis incidence, late stages and atypical courses with HIV-coinfection can be expected. A 45 year old HIV infected male presented with an unusual manifestation of late secondary syphilis on the tongue, which was first diagnosed as a squamous cell carcinoma but cleared after therapy with penicillin. He also exhibited psoriasiform and annular lesions on the trunk and hyperkeratotic papules on the palms of the hand and soles of the feet. A TPHA test was negative due to a prozone phenomenon. With this case, we would like to emphasize the formerly well known relationship between the lesions of tertiary syphilis on the tongue and development of secondary carcinoma.