Localized gallbladder carcinoma: sonographic findings

Our study of color (seven cases) and contrast (three cases) Doppler results of seven cases with gallbladder carcinoma localized in the gallbladder wall (TNM stage T1) showed that the presence or absence of blood flow signals distinguishes gallbladder carcinoma in stage T1b (muscular involvement) from tumefactive biliary sludge and that injection of contrast medium markedly increased diagnostic confidence. Thus, when color Doppler sonography is ambiguous, contrast-enhanced Doppler sonography is the next line of investigation. However, actual color Doppler sonography is still not fully capable of displaying fine blood flow signals from gallbladder carcinoma in stage T1a (mucosal involvement), and greater Doppler sensitivity is mandatory for this purpose.

Duodenal carcinoma: sonographic findings

BACKGROUND

Duodenal carcinoma is a relatively rare tumor and its sonographic (US) findings have rarely been reported.

METHODS

We reviewed the clinical data and US results of 15 patients with histologically proven duodenal carcinoma to pinpoint the contribution of US to the diagnosis.

RESULTS

US was useful for not only detecting the duodenal carcinoma (13 of 15, 86.7%), which altered the endoscopic procedure in nine patients, but also for evaluating vascular involvement (marked portal invasion in four cases and inferior vena cava invasion in two cases). Four of the eight carcinomas arising from the second or third portion showed this vascular invasion.

CONCLUSION

After reviewing the clinical data and US results of 15 cases of duodenal carcinoma, we found that US was useful for detecting duodenal carcinoma and determining vascular invasion. Thus, US contributed significantly to alter the endoscopic procedure and patient management.

Peripheral bone metastasis from hepatocellular carcinoma: sonographic findings

BACKGROUND AND METHODS

We reviewed medical and radiologic records of five patients with bone metastasis from hepatocellular carcinoma (HCC) to evaluate the role of sonography (US) in the diagnosis of this bone metastasis.

RESULTS

The metastatic lesions were clearly visualized by US as expansive, homogeneous, soft tissue masses with bony destruction, and color Doppler US showed fine vessels within the lesions. After treatment, US showed a decrease in tumor size with an increase in echogenicity and a decrease in blood flow. Hepatic US at the time of bone metastasis showed a portal tumor thrombus in all cases.

CONCLUSION

When US detects a portal venous tumor thrombus in HCC patients, attention should be directed not only to the liver but also to bone to improve patient care. US is useful not only in detecting the metastatic lesion but also in evaluating the treatment effect.

Splenic lymphoma: differentiation from splenic cyst with ultrasonography

BACKGROUND AND METHODS

Lymphoma can be nearly anechoic and mimic a cyst on ultrasonography (US). To investigate whether this phenomenon occurs at the level of the spleen, we analyzed the US findings of 38 cases of splenic lymphoma and 16 cases of splenic cyst.

RESULTS

(1) With regard to shape, echogenicity of the lesion, and mode of posterior echo, there was no difference between splenic lymphomas and splenic cysts. However, the boundaries of the lesions were indistinct in splenic lymphomas and distinct in splenic cysts. (2) Blood flow signals and vascular penetration were seen exclusively in splenic lymphomas.

CONCLUSION

The mode of boundary echo (distinct or indistinct) distinguishes splenic lymphomas from splenic cysts. Color Doppler US increases the diagnostic confidence of US.

Liver tumors in fatty liver: difficulty in ultrasonographic interpretation

BACKGROUND

Fatty liver and liver tumors are very frequent diseases. Sonography (US) currently is the initial diagnostic tool for hepatic exploration. However, there is a marked paucity of US findings of tumors in fatty liver.

METHODS

We studied the US findings of 41 lesions (31 patients) with this combination, with special attention paid to internal echoes, marginal echoes, and especially the mode of back echoes, and compared them with the US results of 64 lesions (38 patients) without fatty liver.

RESULTS

Comparing the group having liver tumor without fatty liver with the group having liver tumor with fatty liver showed that (a) the number of hypoechoic lesions increased (29 of 41, 70.7%, vs. 16 of 64, 25.0.%), (2) the tumor margin appeared indistinct (32 of 41, 78.0%, vs. nine of 64, 14.1%), and (c) the lesions showing posterior echo enhancement increased (34 of 41, 82.9%, vs. eight of 64, 12.5%).

CONCLUSION

Liver tumors in fatty liver are expected to show unusual patterns on US, so we should consider this difficulty when interpreting these US findings and we should not make a conclusion without including other imaging modalities.

Determination of serotonin in microdialysis samples from rat brain by microbore column liquid chromatography with post-column derivatization and fluorescence detection

The present paper describes a new method for on-line determination of 5-HT in brain microdialysates from awake rats by microbore column liquid chromatography with post-column derivatization and fluorescence detection. The derivatization reagent contained 1 mM benzylamine and 0.5 mM potassium hexacyanoferrate (III), both dissolved in a mixture of acetonitrile and 25 mM borate buffer (pH 11.0) (1:1, v/v). The limit of detection (S/N=3) for 5-HT was 0.5 fmol/20 microl. The samples were injected every 20 min onto a microbore column packed with C18 silica gel. The method exhibits an excellent stability over the periods of at least 12-24 h. The basal levels of 5-HT from 25 awake rats were 7.10+/-1.06 fmol/20 microl in the dorsal hippocampus and 4.64+/-0.91 fmol/20 microl (mean+/-SD) in the striatum. The 5-HT release increased to about 1500% during the perfusion with 100 mM K(+) containing Ringer solution or it was reduced to 60 or 40% during the perfusion with 1 microM tetrodotoxin or calcium free Ringer, respectively. The new method can be used to monitor extracellular 5-HT following acute systemic drug administration.

X-Ray Telescope Onboard Astro-E. II. Ground-Based X-Ray Characterization

X-ray characterization measurements of the x-ray telescope (XRT) onboard the Astro-E satellite were carried out at the Institute of Space and Astronautical Science (Japan) x-ray beam facility by means of a raster scan with a narrow x-ray pencil beam. The on-axis half-power diameter (HPD) was evaluated to be 1.8?-2.2?, irrespective of the x-ray energy. The on-axis effective areas of the XRTs for x-ray imaging spectrometers (XISs) were approximately 440, 320, 240, and 170 cm(2) at energies of 1.49, 4.51, 8.04, and 9.44 keV, respectively. Those of the x-ray spectrometer (XRS) were larger by 5-10%. The replication method introduced for reflector production significantly improved the imaging capability of the Advanced Satellite for Cosmology and Astrophyics (ASCA) XRT, whose HPD is ~3.6?. The increase in the effective area by a factor of 1.5-2.5, depending upon the x-ray energy, compared with that of the ASCA, was brought about by mechanical scale up and longer focal lengths. The off-axis HPDs were almost the same as those obtained on the optical axis. The field of view is defined as the off-axis angle at which the effective area becomes half of the on-axis value. The diameter of the field of view was ~19? at 1.49 keV, decreasing with increasing x-ray energy, and became ~13? at 9.44 keV. The intensity of stray light and the distribution of this kind of light on the focal plane were measured at the large off-axis angles 30? and 60?. In the entire XIS field of view (25.4 mm x 25.4 mm), the intensity of the stray light caused by a pointlike x-ray source became at most 1% of the same pointlike source that was on the optical axis.

Mycotic abdominal aneurysm: report of a case with emphasis on the presence of gas echoes

Mycotic abdominal aneurysm is a relatively rare disease and its sonographic (US) findings have rarely been reported. We present a case of mycotic aneurysm of the common iliac artery in which the initial US showed a slightly wall-thickened abdominal aorta with gas echoes in the wall, a second US 6 days later showed a rapid increase in aortic size, and an emergent surgical intervention showed a mycotic aneurysm. This interesting observation suggested that the presence of gas echoes is a useful US finding indicating the beginning of a mycotic aneurysm and, when encountering this US finding, that emergent treatment should be considered to prevent delay in patient management.

Anti-AIDS agents. 46. Anti-HIV activity of harman, an anti-HIV principle from Symplocos setchuensis, and its derivatives

Matairesinol (1) and harman (5), identified from Symplocos setchuensis, were found to inhibit HIV replication in H9 lymphocyte cells. Anti-HIV evaluation of 28 derivatives of 5 revealed that compound 19 showed potent activity with EC(50) and therapeutic index values of 0.037 microM and 210, respectively.

Choledochal cyst due to anomalous pancreatobiliary junction in the adult: sonographic findings

BACKGROUND

Adult cases of choledochal cyst due to anomalous pancreaticobiliary duct junction have been rarely reported. At present, sonography (US) is the first tool for diagnosing biliary disorders. The aim of this study was to reevaluate the US findings of choledochal cysts due to anomalous pancreaticobiliary duct junction in adults.

METHODS

We reviewed the clinical manifestations and US findings of 12 such adult cases confirmed by endoscopic retrograde cholangiopancreatic ductography (ERCP). Patients were assigned to three groups: (a) associated with biliary carcinoma (two cases), (b) associated with choledocholithiasis (one case), and (c) not associated with other abdominal diseases (nine cases).

RESULTS

Patients in group c were asymptomatic, and the lesions were detected incidentally detected by US. In contrast, patients in group a sought medical care because of symptoms such as jaundice and those in group b sought medical attention because of abdominal pain. The diameter of a dilated bile duct on US was considerably less than that of ERCP (ERCP: 26-58 mm, mean = 37.6 mm; US: 13-32 mm, mean = 21.8 mm). Its diameter changed significantly under probe compression when the dilated bile duct took a purely cystic form but changed very little when it took a tubular form.

CONCLUSION

Unlike cases in children, adult cases of choledochal cyst are generally asymptomatic. Careful US observation of the bile duct is thus expected to detect asymptomatic adult choledochal cysts cases. Cyst diameter can change significantly under probe compression, so it is important not to compress the bile duct during routine US examination.

Macronodular deformity of the spleen

BACKGROUND AND METHODS

Macronodular splenic deformity without a focal lesion has rarely been reported. We present three such cases and discuss the possible pathomechanism.

RESULTS

There was one case of macronodular deformity of unknown cause. In this case, the liver was elongated anteriorly over the dome of the spleen, and the markedly deformed spleen mimicked a round lesion in the left lobe of the liver. Color Doppler ultrasonography showed the major intra- and perisplenic vessels to be patent. There were two cases of macronodular deformity associated with extended portal thrombosis. In both cases, portal thrombosis extended throughout the intrahepatic and extrahepatic portal systems, and this portal flow disturbance was presumed to be the cause of the splenic deformity.

CONCLUSION

Although very rare, thrombosis should be sought throughout the portal system when ultrasonography shows a markedly deformed spleen. Marked splenic deformity, especially in cases with an elongated liver, may mimic a liver tumor. A good understanding of its sonographic appearance may help sonographers prevent a hazardous misdiagnosis.

Characterization of RGS5 in regulation of G protein-coupled receptor signaling

RGS proteins (regulators of G protein signaling) serve as GTPase-activating proteins (GAPs) for G alpha subunits and negatively regulate G protein-coupled receptor signaling. In this study, we characterized biochemical properties of RGS5 and its N terminal (1-33)-deleted mutant (deltaN-RGS5). RGS5 bound to G alpha(i1), G alpha(i2), G alpha(i3), G alpha(o) and G alpha(q) but not to G alpha(s) and G alpha13 in the presence of GDP/AIF4-, and accelerated the catalytic rate of GTP hydrolysis of G alpha(i3) subunit. When expressed in 293T cells stably expressing angiotensin (Ang) AT1a receptors (AT1a-293T cells), RGS5 suppressed Ang II- and endothelin (ET)-1-induced intracellular Ca2+ transients. The effect of RGS5 was concentration-dependent, and the slope of the concentration-response relationship showed that a 10-fold increase in amounts of RGS5 induced about 20-25% reduction of the Ca2+ signaling. Furthermore, a comparison study of three sets of 293T cells with different expression levels of AT1a receptors showed that RGS5 inhibited Ang II-induced responses more effectively in 293T cells with the lower density of AT1a receptors, suggesting that the degree of inhibition by RGS proteins reflects the ratio of amounts of RGS proteins to those of activated G alpha subunits after receptor stimulation by agonists. When expressed in AT1a-293T cells, deltaN-RGS5 was localized almost exclusively in the cytosolic fraction, and exerted the inhibitory effects as potently as RGS5 which was present in both membrane and cytosolic fractions. Studies on relationship between subcellular localization and inhibitory effects of RGS5 and deltaN-RGS5 revealed that the N terminal (1-33) of RGS5 plays a role in targeting this protein to membranes, and that the N terminal region of RGS5 is not essential for exerting activities.

X-ray telescope onboard Astro-E: optical design and fabrication of thin foil mirrors

X-ray telescopes (XRT's) of nested thin foil mirrors are developed for Astro-E, the fifth Japanese x-ray astronomy satellite. Although the launch was not successful, the design concept, fabrication, and alignment procedure are summarized. The main purpose of the Astro-E XRT is to collect hard x rays up to 10 keV with high efficiency and to provide medium spatial resolution in limited weight and volume. Compared with the previous mission, Advanced Satellite for Cosmology and Astrophysics (ASCA), a slightly longer focal length of 4.5-4.75 m and a larger diameter of 40 cm yields an effective area of 1750 cm2 at 8 keV with five telescopes. The image quality is also improved to 2-arc min half-power diameter by introduction of a replication process. Platinum is used instead of gold for the reflectors of one of the five telescopes to enhance the high-energy response. The fabrication and alignment procedure is also summarized. Several methods for improvement are suggested for the reflight Astro-E II mission and for other future missions. Preflight calibration results will be described in a forthcoming second paper, and a detailed study of images will be presented in a third paper.

[Dynamic MR imaging of liver lesions with superparamagnetic iron oxide (SH-U-555A)]

Dynamic MRI with SH-U-555 (SPIO) was evaluated. Dynamic MRI was performed for 17 patients with 22 lesions. Dynamic study with T2*-weighted imaging (T2* dynamic) and T1-weighted imaging (T1 dynamic) were performed in 8 cases (10 lesions) and 9 cases (12 lesions), respectively. T2* dynamic MR images were obtained before and 30, 90, 180, 270, 360, and 450 seconds and 31 minutes after the intravenous injection of SPIO, and T1 dynamic MR images were obtained before and 0, 40, 80, 120, 180, 240, 300, 360, 420, and 480 seconds and 28 minutes after the injection of SPIO. The signal intensity of each lesion was measured before and after the injection of SPIO. The enhancement ratio of the lesions was calculated and evaluated. The enhancement ratio of hypervascular lesions decreased rapidly in the first phase of T2* dynamic MRI, while that of hypovascular lesions decreased gradually. The enhancement ratio of hypervascular lesions increased in the first phase of T1 dynamic MRI and decreased gradually, while that of hypovascular lesions lacked the increase in the first phase, in contrast to hypervascular lesions. However, the changing of signal intensity could not be recognized on images with T2* dynamic and T1 dynamic study. In conclusion, quantitative analysis using the enhancement ratio made it possible to anticipate lesion vascularity.

Pancreatic uncinate carcinoma: sonographic findings

BACKGROUND

Pancreatic carcinoma arising from the uncinate process (pancreatic uncinate carcinoma) is relatively rare. We wished to define its clinical manifestations and sonographic findings.

METHODS

Clinical and sonographic data of eight cases were reviewed.

RESULTS

The common bile duct and the pancreatic duct were not dilated until a very late stage. The lesion mimicked a mesenteric tumor in two cases. The superior mesenteric vessels were compressed anteriorly. Computed tomography was useful, not only for confirming the pancreatic uncinate origin of the lesion but also for determining precisely the mode of mesenteric vascular involvement.

CONCLUSION

Knowledge of these unusual sonographic findings can determine the diagnostic strategy in pancreatic uncinate carcinoma.

Pancreatic metastasis: sonographic findings

BACKGROUND

Pancreatic metastasis is a relatively rare pathologic condition. Its ultrasound (US) findings have been infrequently reported, and there has been no previous report describing its color Doppler findings.

METHODS

We reviewed the US findings of 13 such cases.

RESULTS

The pancreatic metastasis consisted of a single hypoechoic nodule in four cases and multiple hypoechoic nodules in nine cases. US showed a slight dilatation of the main pancreatic duct in two cases of pancreatitis, and a marked biliary dilatation in one case of jaundice. The US results prompted introduction of appropriate treatment in these cases. Color Doppler US was useful for confirming the absence of flow abnormalities in the arterial and portal systems around the pancreas. In a patients with renal carcinoma metastasis, it showed many fine blood flow signals in the metastatic lesions.

CONCLUSION

The role of US in the diagnosis of pancreatic metastasis consists of associated complications such as biliary dilatation or pancreatitis and detection of isolated lesions. Additional information provided by color Doppler US may increase diagnostic confidence.

Liquid chromatographic determination of ornithine and lysine based on intramolecular excimer-forming fluorescence derivatization

A highly sensitive and selective fluorometric determination method for ornithine and lysine has been developed. This method is based on an intramolecular excimer-forming fluorescence derivatization with a pyrene reagent, 4-(1-pyrene)butyric acid N-hydroxysuccinimide ester (PSE), followed by reversed-phase liquid chromatography (LC). The analytes, containing two amino moieties in a molecule, were converted to the corresponding dipyrene-labeled derivatives by reaction with PSE. The derivatives afforded intramolecular excimer fluorescence (450-550 nm) which can clearly be discriminated from the normal fluorescence (370-420 nm) emitted from PSE and monopyrene-labeled derivatives of monoamines. The structures of the derivatives and the emission of excimer fluorescence were confirmed by LC with mass spectrometry and with three-dimensional fluorescence detection system, respectively. The PSE derivatives of ornithine and lysine could be separated by reversed-phase LC on ODS column with isocratic elution. The detection limits (signal-to-noise ratio = 3) for ornithine and lysine were 3.5 and 3.7 fmol, respectively, for a 20-microl injection. Furthermore, this method had enough selectivity and sensitivity for the determination of ornithine and lysine in normal human urine.

Liver tumors in children and young patients: sonographic and color Doppler findings

BACKGROUND

Liver tumors are a relatively rare pathologic condition in children and young patients. The aim of the present study was to categorize the sonographic (US) and color Doppler results of liver tumors in these patients.

METHODS

We retrospectively reviewed the US findings of 23 such cases: malignant tumor (13 cases)-hepatoblastoma (four cases), hepatocellular carcinoma (HCC; four cases), and hepatic metastasis (five cases); benign tumor (10 cases)-hepatocellular adenoma (four cases), focal nodular hyperplasia (two cases), mesenchymal hamartoma (two cases), cystadenoma (one case), and hemangioendothelioma (one case).

RESULTS

There was no specific US findings for each tumor type. HCC usually developed on a normal liver and was imaged as multiple nodules. Color Doppler US helped in differentiating multiple metastatic nodules (hypovascular) from multiple HCC nodules (hypervascular). Presence of intratumoral cystic areas was usually suggestive of benign tumors. Follow-up US was useful for detecting small nodules in high-risk groups (congenital biliary atresia, glycogen storage disease). Color Doppler US helped in diagnosing portal thrombus or intratumoral shunt.

CONCLUSION

Although there were no highly specific findings, US and color Doppler results contributed, to a certain degree, to the diagnosis of liver tumors in children and young adults by showing intratumoral cystic areas or vascularity.

Macronodular hepatic deformity on normal liver

BACKGROUND AND METHODS

Macronodular hepatic deformity on normal liver is very rare. We present nine such cases and try to define the characteristic clinical and ultrasound (US) findings.

RESULTS

In the left lobe, the lateral segment was replaced by multiple nodules and the medial segment was very atrophied and irregularly shaped. Compared with the left lobe, the right lobe showed very few abnormalities except for segment 6, which showed a macronodular deformity. These nodules, regardless of diameter or lobe, showed a relatively homogeneous internal structure and were isoechoic relative to the surrounding hepatic parenchyma. These multinodular changes on US corresponded to multiple regenerative nodules identified at laparoscopic evaluation. On color Doppler US and angiography, the major intrahepatic vessels were patent in all cases.

CONCLUSION

Although relatively rare, the macronodular hepatic deformity on normal liver collected in our series showed a characteristic appearance by US. A good understanding of its characteristics may help sonographers in differentiating it from other, more common hepatic deformities.

Total reconstruction of the alar cartilages with a partially split septal cartilage graft

The alar cartilage is a unique structure that supports the tip of the nose, keeps the external valve open, and plays an important role in tip aesthetics. Very often the plastic surgeon needs to reconstruct this cartilage, as in secondary rhinoplasties when the lower lateral cartilage is overresected. Many authors have described cartilage grafts taken from the ear and septum, mounted and stitched in various manners, with some very good results. In patients with thin skin, though, any irregularity or distortion in the grafts becomes visible after a short time postoperatively. The authors present an alternative to reconstructing alar cartilage symmetrically using one graft. This graft is obtained by shaping septal cartilage in an "L" form, with a 135-deg angle (instead of a 90-deg angle) between its legs, and then splitting the smaller leg, obtaining a strut from the longer leg and two "lateral crura" from the shorter leg.