Herpes simplex virus type 2 infections presenting as brainstem encephalitis and recurrent myelitis

We describe here 3 patients with central nervous system infection caused by herpes simplex virus type 2 (HSV-2); one patient with brainstem encephalitis and two with recurrent transverse thoracic myelitis. All three patients showed increased IgG antibodies to HSV in the cerebrospinal fluid (CSF). HSV-2 DNA was demonstrated in the CSF by polymerase chain reaction (PCR) amplification. Upon treatment with acyclovir, one patient with myelitis partially recovered and the others completely recovered. It is important to recognize the wide spectrum of clinical manifestations of HSV-2 infection in the central nervous system (CNS).

[Pharmacokinetics of balofloxacin in the intraocular tissues of pigmented rabbits]

We performed the pharmacokinetics of balofloxacin in plasma and intraocular tissues in pigmented rabbits upon its oral administration. The penetrations of balofloxacin into plasma and aqueous humor of the anterior chamber reached their peaks of 6.46 micrograms/ml and 0.70 microgram/ml, respectively, and the ratio of drug concentration in aqueous humor to that of plasma was 0.12 at 1 hour after an oral administration of 20 mg/kg. Concentrations in plasma and aqueous humor of the anterior chamber reached 0.27 microgram/ml and 0.18 microgram/ml, respectively, at The T 1/2 (alpha) and T 1/2 (beta) of the drug in aqueous humor were longer than those in plasma The T 1/2 (alpha) and T 1/2 (beta) of the drug in aqueous humor were longer than those in plasma at a dose of 20 mg/kg. The concentrations in iris and ciliary body were much higher than in any other intraocular tissue in 24 hours after single administration of 20 mg/kg, and those concentrations remained at high levels for a long time.

The direct effect of injectable cyclosporine and its vehicle, cremophor, on endothelial vascular cell adhesion molecule-1 expression. Ricinoleic acid inhibits coronary artery endothelial activation

As in humans, rabbit coronary artery endothelium basally expresses vascular cell adhesion molecule-1 (VCAM-1). Treatment with parenteral cyclosporine (CsA) to prevent graft rejection in rabbits receiving heterotopic heart transplantation reduced VCAM-1 expression in coronary arteries not only in transplanted, but also in native rabbit hearts. To explore the mechanism of this effect, we co-incubated cultured human saphenous vein endothelial cells for 24 hr with CsA or its vehicle (containing polyoxyethylated castor oil, or Cremophor, and ethanol), at concentrations compatible with those achievable in plasma during administration of parenteral preparations of CsA. Cells were then stimulated with TNF alpha or IL-4 to induce VCAM-1 expression, assessed by a cell-surface enzyme immunoassay. Both CsA and vehicle inhibited IL-4-stimulated VCAM-1 expression in a dose-dependent manner (from [OD mU, mean +/- SEM] 230 +/- 5 to 165 +/- 3 for CsA 50 ng/ml, and to 181 +/- 6 for the corresponding vehicle concentration; P < 0.05 for both comparisons). To investigate whether this vehicle effect also occurs in vivo, we treated 9 New Zealand White rabbits with saline (n = 3), CsA (10 mg/kg/day, n = 3), or vehicle at corresponding doses (n = 3) for 6 weeks. Profiles of coronary arteries (> or = 48 for each group) were semiquantitatively scored (0-5) for VCAM-1 in immunostained heart cross-sections. Administration of both CsA and vehicle significantly reduced VCAM-1 expression compared with saline. Two vehicle components, ethanol and ricinoleic acid, were further evaluated directly on endothelial cells in vitro. While ethanol was ineffective, the monounsaturated fatty acid ricinoleic acid inhibited IL-4-stimulated VCAM-1 expression in a dose-dependent manner (IC50 between 10 and 100 microM). Thus, a fatty acid component of CsA vehicle exerts direct endothelial effects, potentially limiting arterial leukocyte recruitment during parenteral CsA treatment. This observation reveals a novel mechanism for CsA as an inhibitor of leukocyte-endothelial interactions, and furnishes a new potential rationale for the therapeutic action of unsaturated fatty acids in graft coronary disease.

Acute rejection accelerates graft coronary disease in transplanted rabbit hearts

BACKGROUND

The relation between episodes of acute rejection and the development of graft coronary arteriosclerosis remains controversial. We examined the hypothesis that acute rejection episodes accelerate graft coronary arteriosclerosis lesion formation in rabbit allografts.

METHODS AND RESULTS

A control group (n = 5) received cyclosporine 5 mg.kg-1.d-1 for 6 weeks after heterotopic heart transplantation. In a rejection group (n = 5), cyclosporine was omitted for 4 days at 1 and 4 weeks after transplantation. We studied cross sections of grafted hearts at 6 weeks and evaluated myocardial rejection grade, incidence, and severity and cell composition of intimal lesions in multiple coronary artery profiles. Episodic withdrawal of cyclosporine augmented myocardial rejection (International Society for Heart and Lung Transplantation grades 0, 0, 0, 0, and 1A in the control group to grades 1A, 1B, 2, 3A, and 3B in the rejection group). Episodes of acute rejection significantly increased the incidence (7.8 +/- 2.7% to 49.7 +/- 1.9%) and severity (from grade 0.10 +/- 0.04 to 0.79 +/- 0.24) of intimal thickening in graft coronary arteries. Most intimal lesions consisted of smooth muscle cells and contained various degrees of T-lymphocyte infiltration but sparse macrophages.

CONCLUSIONS

In this experimental model, episodes of acute rejection precipitated by cyclosporine withdrawal accelerated the development of graft vascular lesion formation. Activation of vascular cells and leukocyte recruitment during acute rejection may thus contribute to the pathogenesis of graft arteriosclerosis.

The association of complement activation at a low temperature with hepatitis C virus infection in comparison with cryoglobulin

Complement activation at a low temperature in vitro and cryoglobulinaemia are associated with hepatitis C virus (HCV) infection. The frequency of HCV antibody positivity determined in serum specimens that showed the cold-dependent activation of complement was 100%, whereas it was 48% among sera with cryoglobulin. On the other hand, the frequency of cold activation among HCV-infected sera was 41%, and that of cryoglobulin 48%. Cold activation was not found in any HCV- sera studied, whereas cryoglobulin was found at a frequency of 14% in HCV- sera. Cold activation was also absent among hepatitis B virus (HBV) S antigen or antibody-positive sera, except a few that were both HBV+ and HCV+. Rheumatoid factor was also frequently detected in sera with cold activation or cryoglobulin. Cold activation and cryoglobulin may be generated by common mechanisms in which a low avidity, low temperature-preferring antibody may function. In sera with cold activation, fine particles of immune complexes, which do not form precipitates, may activate the complement system. HCV is a unique virus that coexists with antibody in the serum, therefore the avidity of the antibody for the virus antigen may be low, and occasionally react only at a low temperature. This may be why the in vitro phenomenon related to immune complexes occurs specifically in HCV-infected sera.

Validity and reliability of the Japanese version of the Stress and Coping Inventory

We examined the validity and reliability of the Japanese version of the Stress and Coping Inventory (SCI) among 170 Japanese college students and 234 healthy subjects. The validity and reliability of this version of the SCI in the college student group were supported by significant test-retest correlations, relatively high internal consistency coefficients, and adequate correlations with the Coping Inventory for Stressful Situations (CISS). AS for the healthy subject group, the reliability was supported by relatively high internal consistency coefficients, although further analyses, such as test-retest, are required. The Japanese version of the SCI appears to be suitable for use among college students.

[Evaluation of the polymerase chain reaction for diagnosis of tuberculous meningitis]

Since Shankar et al used polymerase chain reaction (PCR) for detection of Mycobacterium tuberculosis (M. tuberculosis) in cerebrospinal fluid (CSF), there have been numerous reports on PCR assay for diagnosis of tuberculosis meningitis (TBM). The PCR assay have been recognized to be a rapid method for diagnosis of TBM, however there are problems of PCR sensitivity when dealing with CSF samples containing small amount of M. tuberculosis DNA. Comparing direct PCR with nested PCR, we studied on the evaluation of PCR for diagnosis of TBM. In present study the nested PCR were positive in all CSF specimens from 4 patients with TBM, but we could not detect M. tuberculosis DNA by only the direct PCR. Because nested PCR amplification improved the sensitivity and specificity, the nested PCR assay will be necessary for rapid diagnosis of TBM on the clinical laboratory.

Combination assay of urinary beta-core fragment of human chorionic gonadotropin with serum tumor markers in gynecologic cancers

Ectopic production of the immunoreactive beta-subunit of human chorionic gonadotropin (IR-hCG beta) by gynecologic malignancies has been well recognized, but IR-hCG beta has not yet been established as a clinically useful tumor marker, except for germ cell tumors. We measured the concentrations of IR-hCG beta-related molecules, intact hCG, free hCG beta, and beta-CF, in the sera and urine of patients with various gynecologic cancers (cervical, endometrial, and ovarian cancers) to assess their clinical usefulness as a tumor marker in comparison with serum tumor markers such as CEA, SCC, CA125, and CA19-9. The highest incidence of IR-hCG beta was obtained in the assay for beta-CF in the urine, with positive rates of 47.7% (94 of 197) for cervical, 37.8% (14 of 37) for endometrial, and 84.4% (38 of 45) for ovarian cancers with a cut-off value of 0.2 ng/mg of creatinine. In cervical cancer, there was no significant correlation between the concentrations of urinary beta-CF and serum SCC, and 57.9% (114 of 197) of the patients were detected by the combination assay of these tumor markers. Serial determination in 22 cervical cancer patients with elevated urinary beta-CF level prior to therapy showed that its level decreased after successful treatment, but 4 of 5 patients with persistent or recurrent disease had elevated levels of urinary beta-CF. All of the ovarian cancer patients examined were detected by the combination assay of urinary beta-CF and serum CA125. The levels of urinary beta-CF showed little correlation with those of the serum tumor markers, indicating the usefulness of the combination assay of urinary beta-CF with serum tumor markers for detecting cervical and ovarian cancers.

Chemical stability of polyacrylamide-coating on fused silica capillary

The chemical stability of polyacrylamide coatings on a fused silica capillary for capillary electrophoresis was investigated with respect to temperature of capillary and pH as well as salt concentration of running buffer solution by evaluating their effects on electroosmotic mobility. The capillary covalently bonded to linear polyacrylamide through Si-C linkage was stable in buffer solutions of pH 2.3-8.0 at 30 degrees C for 30 days, whereas the capillary bonded through Si-O-Si-C linkage was damaged at pH above 4.6. The electroosmotic mobility observed in both capillaries increased with increasing temperature, though the degree of increase was smaller in the Si-C linked capillary than in the Si-O-Si-C linked capillary. The increase in the buffer concentration resulted in increased electroosmotic mobility in the Si-O-Si-C linked capillary, but no effect was observed for the Si-C linked capillary.

Experimental study of intraoperative local chemotherapy with fibrin glue containing nitrosourea for malignant gliomas

BACKGROUND

Local control of the tumor bed after removal of a tumor is one of the most important points in the treatment of malignant gliomas. This study was designed to examine whether fibrin glue is useful as a vehicle for sustained release of intraoperative local chemotherapy with nitrosourea (ACNU).

METHODS

The growth-inhibiting activity of ACNU on C6 glioma cells and ACNU released into 5-mL supernatant saline from fibrin glue containing 5 mg/mL (10 mg) of ACNU was measured in vitro. C6 tumor inoculated in rat brains was covered with fibrin glue containing either 2 mg/mL or 5 mg/mL of ACNU for 5 days, and the histologic changes were examined.

RESULTS

ACNU inhibited the growth of C6 glioma cells in a dose-dependent manner, and the drug concentration required for 50% inhibition of cell growth (IC50) was about 4 micrograms/mL with 1 hour of treatment. Although about 50% of all ACNU included in the fibrin glue was released in the first hour, an effective concentration over the value of IC50 was sustained even after 12 hours. A histologic examination showed tumor cells damaged within a depth of about 2-3 mm from the tumor surface covered with fibrin glue containing ACNU.

CONCLUSIONS

Fibrin glue may be useful as a vehicle for sustained-release chemotherapy, and intraoperative local chemotherapy with fibrin glue containing anticancer agents such as nitrosourea may be helpful in the local control of malignant gliomas.

Effect of liver intoxication by carbon tetrachloride on hepatic local disposition of oxacillin using moment characteristics as index

The effect of liver intoxication by carbon tetrachloride (CCl4) on the hepatic local disposition using oxacillin as a test drug and bovine serum albumin (BSA) as a reference substance was evaluated by single-pass bolus input method in the isolated perfused rat liver. Oxacillin and BSA were introduced into the liver from the portal vein, and the outflow concentration-time profiles of oxacillin and BSA from the rat liver into the hepatic vein were kinetically assessed by moment analysis. Liver damage was monitored by plasma SGOT, plasma SGPT, and bile flow rate. Hepatic recovery ratio FH of oxacillin increased from 50% to 80%, with an increase in liver intoxication by CCl4; whereas FH of BSA was naturally 100%. Mean transit time tH of oxacillin increased from 6 to 12 sec, with an increase in liver intoxication; whereas tH of BSA increased from 7 to 10 sec. The relative variance sigma 2/tH2 of oxacillin increased from 0.2 to 0.7, with an increase in liver intoxication; whereas sigma 2/tH2 of BSA took the value of approximately 0.4, independent of liver damage. In the relationship between the dispersion model and moments, it was shown that the blood space VB increased from 15 to 20%, the index for distribution (1 + k') of oxacillin from 1.0 to 1.5, the efficiency number RN of oxacillin decreased from 0.7 to 0.3 with the increase in liver damage, and the extent of eddy mixing was predicted to be unaffected by liver damage. The intensive increases in tH and sigma 2/tH2 of oxacillin with the liver intoxication by CCl4 were explained by increases in the extent of distribution and nonequilibrium distribution, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of organic modifier concentrations on electrokinetic migrations in micellar electrokinetic chromatography

The effect of low concentrations of organic modifiers on the electroosmotic mobility, mueo, and electrophoretic mobility of the micelle, muep, mc, in micellar electrokinetic chromatography (MEKC) with sodium dodecyl sulfate (SDS) solutions was investigated. The results showed that mueo was mainly influenced by the viscosity of the running solution. A linear relationship between mueo and the concentration of the organic modifier was found in MEKC. A newly defined parameter, the mobility ratio, Rm, mc, which is the ratio of the electrophoretic mobility of the micelle to the electroosmotic mobility, and which characterizes the surface charge density of the micelle in MEKC system with organic modifiers, was introduced. A linear relationship between Rm, mc and the organic modifier concentration was observed. The parameter Rm, mc was found to be useful to investigate the changes in the micellar phase with the addition of organic modifier. The measured muep, mc values showed different and interesting characteristics among different organic modifiers.

Simultaneous bilateral hypertensive intracerebral hemorrhages--two case reports

A 65-year-old male and an 80-year-old female presented with unusual simultaneous bilateral hypertensive intracerebral hemorrhages in the putamina and thalami, respectively. The hematomas were demonstrated by computed tomography performed within a few hours of onset. The patients underwent conservative therapy. The male patient died 4 days after the onset and the female finally became vegetative. The majority of patients with bilateral intracerebral hemorrhages generally have a poor outcome due to the development of severe disturbed consciousness, tetraparesis, and pseudobulbar palsy, even if the hematomas are not so large. The indication of surgery for this type of hemorrhage may be confined to patients with small hematomas who can be expected to have a good functional outcome after removal of the larger hematoma.

The relation between an esophageal cancer and associated cancers in adjacent organs

BACKGROUND

The relation between esophageal cancers and head and neck tumors was studied in order to improve the treatment results in patients with multiple cancers.

METHODS

We reviewed the records of 3,375 patients with an indexed squamous cell carcinoma of the head and neck treated at our institution between 1960 and 1994; and 81 patients were found to have an associated esophageal carcinoma. Similarly, the records of 434 patients with an indexed esophageal cancer were reviewed; and 54 patients had cancers in other organs or in the residual esophagus. A total of 135 esophageal cancers with 154 synchronous or metachronous cancers were entered into the analysis.

RESULTS

The risk of developing esophageal cancer was ten times higher in male patients with head and neck cancer than in female patients. Synchronous or metachronous esophageal cancer associated with head and neck cancer was most frequently seen with pharyngeal cancer (28/360 = 7.8%), followed by in the oral cavity (47/2148 = 2.2%).

CONCLUSIONS

Better knowledge of the relation between an esophageal cancer and a head and neck cancer may lead to the early detection of subsequent small, potentially curable neoplasms sited in either the esophagus or the head and neck region.

Gualamycin, a novel acaricide produced by Streptomyces sp. NK11687. II. Structural elucidation

A novel acaricide, gualamycin was isolated from the culture broth of Streptomyces sp. NK11687. The structure of gualamycin was determined to be (2R,3S,4S)-2-O-[4-O-(2-amino-2-deoxy-beta-D-gulopyranosyl)-alpha-D - galactopyranosyl]-2,3,4-trihydroxy-4-[(2S,3S,4S,5S)-3,4-dihydroxy-5-hydr oxy - methylpyrrolidin-2-yl] butanoic acid by FAB-MS, 1H and 13C NMR, COSY, HMQC, HMBC, IR, X-ray crystallographic analyses and synthetic studies.

Development of the blood-retinal barrier in vitro: formation of tight junctions as revealed by occludin and ZO-1 correlates with the barrier function of chick retinal pigment epithelial cells

To elucidate the molecular mechanisms of the blood-retinal barrier (BRB), we examined chick retinal tissues histochemically using antibodies against tight junction proteins such as ZO-1, 7H6 antigen, and occludin. Retinal pigment epithelial (RPE) cells in situ in chickens and late chick embryos expressed all of the tight junctional proteins examined, showing that tight junctions seal the cell borders of chick RPE cells in vivo. On the other hand, RPE cells isolated from late chick embryos and transferred in vitro did not express occludin, ZO-1 and 7H6 antigen. The effects of differentiation-inducing agents, such as retinoic acid, dexamethasone and dimethyl sulfoxide (DMSO) were tested. Only DMSO induced an increase in transepithelial electrical resistance (TER) in a time-dependent manner. Under supplementation with DMSO, immunofluorescently demonstrable occludin and ZO-1 were induced progressively at cell borders in parallel with the increase in TER that occurred with decreases in inulin and dextran permeability. Electron microscopically tight junction-like junctional apparatus were induced in RPE cells. These results indicated that tight junctions of RPE cells play an important role in the formation of the BRB.

Gualamycin, a novel acaricide produced by Streptomyces sp. NK11687. I. Taxonomy, production, isolation, and preliminary characterization

A novel acaricide, gualamycin, was isolated from the culture broth of Streptomyces sp. NK11687. It was purified from the filtrate by column chromatographies. Gualamycin showed 100% acaricidal activity at 250 micrograms/ml against sensitive and resistant mites to Dicofol.

Effect of temperature in perfusate on local hepatic disposition of BOF-4272, a new xanthine oxidase inhibitor

The effect of temperature on the local hepatic disposition of BOF-4272 [(+/-)-8-(3-methoxy-4-phenylsulfinyl-phenyl)pyrazolo[1,5-a]-1,3,5- triazine-4-olate], a new drug used to treat hyperuricemia, was investigated by means of a perfusion experiment following the pulse input into the portal vein of rat, in which the temperature of the perfusate was changed from 37 degrees C down to 4 degrees C. The same perfusion experiment was also attempted using bovine serum albumin (BSA) as a reference substance to compare with the hepatic disposition of BOF-4272. The elution time profiles of BOF-4272 and BSA from the liver into the hepatic vein were evaluated by moment analysis. The recovery ratio (FH) and the mean transit time (tH) of BOF-4272 were 22.8 +/- 3.3% and 0.111 +/- 0.008 min at 37 degrees C, respectively. Both FH and tH significantly increased with the decrease in the temperature of the perfusate, 3 times and 2 times greater at 4 degrees C than at 37 degrees C, respectively. The FH and tH of BSA were 98.3 +/- 4.5% and 0.129 +/- 0.013 min at 37 degrees C, respectively. These parameters of BSA were independent of temperature, while those of BOF-4272 showed a definite dependency on temperature. A new estimation method for the elimination rate constant (kc) and the partition ratio (k') in the dispersion model was developed by rearranging the theoretical equations of FH and tH. The index for the elimination (ke) of BOF-4272 decreased with the decrease in temperature, while the index for the distribution (k') increased with the decrease in temperature. This result shows that the metabolism (or the biliary excretion) decreased and the distribution increased with a decrease in temperature, indicating that the hepatic metabolizing pathway which is presumably temperature-dependent is blocked, and the blocked portion of BOF-4272 thus returns back to the perfusate at the low temperature.

Lewis Y antigen expression in hepatocellular carcinoma. An immunohistochemical study

BACKGROUND

The altered expression of the Lewis blood group-related antigens during malignant transformation can be used clinically as a tumor marker or as a prognostic indicator. The Lewis Y (LeY) antigen, which is one of the Type 2 human blood group-related antigens, also is thought to behave as an oncodevelopmental cancer-associated antigen. In this study, the authors examined the association between human LeY antigen expression and the clinicopathologic features of HCC, including its proliferative activity.

METHODS

Forty-six histologically confirmed cases of HCC were studied retrospectively. Liver biopsy specimens from the main tumor of each case were obtained under ultrasonic guidance before treatment was initiated. The formalin fixed, paraffin embedded serial sections were immunostained using a modification of the avidin-biotin-peroxidase complex method, with a primary monoclonal antibody (MoAb) directed against the LeY antigen (BM-1/JIMRO). The relationship between LeY antigen expression and the HCC's proliferative activity was analyzed similarly by immunohistochemical methods using a primary MoAb directed against the Ki-67 antigen (MIB 1). In addition, to clarify the relationship between LeY antigen expression and the histologic heterogeneity within HCC, seven cases of surgically resected HCC also were immunostained.

RESULTS

The LeY antigen was detected on the membrane and in the cytoplasm of the cancer cells. Of the 46 HCC cases, 20 (43.5%) expressed the LeY antigen in the tumor cells. There was no correlation between LeY antigen expression and the maximum tumor dimension or the Stage. However, the incidence of LeY antigen-positive cases in poorly differentiated HCCs was found to be significantly higher than that in well or moderately differentiated HCCs (P < 0.01). In resected HCC cases, LeY antigen expression within HCC nodules was frequently greater in the less differentiated tumor than in adjacent differentiated tumor. Moreover, the incidence of LeY antigen expression in alpha-fetoprotein (AFP)-positive (AFP > or = 200 ng/ml) HCC cases was significantly higher than that in AFP-negative (AFP < 200 ng/ml) HCC cases (P < 0.05). Furthermore, the mean value of the Ki-67 labeling index in LeY antigen-positive HCC cases (25.2 +/- 11.3%) was significantly higher than that in LeY antigen-negative HCC cases (9.4 +/- 4.1%) (P < 0.001).

CONCLUSIONS

These results suggest that LeY antigen expression correlated closely to the dedifferentiation and proliferative activity of HCC.

Determination of the new fluoroquinolone balofloxacin and its metabolites in biological fluids by high performance liquid chromatography

A sensitive high performance liquid chromatographic method for the determination in biological fluids of 1-cyclopropyl-6-fluoro-1,4- dihydro-8-methoxy-7-(3-methylaminopiperidin-1-yl)-4-oxoquinoline-3 -carboxylic acid dihydrate (CAS 127294-70-6, balofloxacin, Q-35), a new fluoroquinolone, as well as its metabolites, has been developed. Balofloxacin and its metabolite, N-desmethyl balofloxacin, were separated and determined by reversed-phase column with fluorescence detection. Balofloxacin glucuronide was determined as balofloxacin after alkali hydrolysis. This method exhibited good precision and accuracy. Furthermore, it is a simple method and requires only a small amount of samples, and therefore should be useful for pharmacokinetic studies in animals and humans.

Transesophageal echocardiography combined with magnetic resonance imaging for detecting venous anomalies in dextrocardia. A case report

A fifty-six-year-old woman was admitted to Osaka Rosai hospital because of dyspnea, chills, and fatigue. The patient was diagnosed by transthoracic echocardiography as having congestive heart failure due to severe biatrioventricular valve regurgitation, and cardiac surgery was proposed. Preoperative transesophageal echocardiography (TEE) revealed a dilatation of the coronary sinus (CS), a right-sided hemiazygos vein (R-AZ), and another great vessel lying between the CS and the R-AZ. Magnetic resonance imaging (MRI) was also performed, and this showed a persistent right superior vena cava (PRSVC) entering the left atrium via the dilatated CS. However, the site of connection between the R-AZ and the PRSVC could not be detected by MRI because of inadequate slice acquisition. Each method has its limitations, particularly with regard to visualizing the extracardiac vascular system. Therefore, the authors demonstrated that the combination of TEE and MRI might be more useful than each alone, and the combination is as a valuable method as digital subtraction angiography for the diagnosis of extracardiac venous anomalies.