Combined direct and indirect reconstructive vascular surgery on the fronto-parieto-occipital region in moyamoya disease

Between January 1992 and December 1995, eight patients with Moyamoya disease, aged from 2 to 39 years, underwent encephalo-duro-arterio-myo-synangiosis (EDAMS) on the frontal region, superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis combined with encephalo-myo-synangiosis (EMS) on the parietal region and encephaloduro-arterio-synangiosis (EDAS) on the occipital region using the frontal and parietal branch of the STA and the occipital artery, respectively. The development of postoperative collateral formation was assessed by carotid angiography and the improvement of clinical symptoms was evaluated for over 1 year after the bypass surgery. Of the 13 sides which underwent EDAMS and STA-MCA anastomosis with EMS, 11 sides resulted in extensive revascularization on the frontoparietal region and two sides showed localized collaterals, whereas EDAS on the occipital region demonstrated extensive and localized revascularization in each four sides and no evidence of revascularization in two sides among ten sides which underwent the EDAS. The clinical improvement due to the combined reconstructive surgery was very excellent in the reduction of the incidence of transient ischemic attacks (TIA) and reversible ischemic neurologic deficits (RIND).

Three-vessel view of the fetal upper mediastinum: an easy means of detecting abnormalities of the ventricular outflow tracts and great arteries during obstetric screening

The three-vessel view is a transverse view of the fetal upper mediastinum is as simple to obtain as the four-chamber view. It demonstrates the main pulmonary artery, ascending aorta and superior vena cava in cross- or oblique sections. The purposes of this study were to describe the normal anatomy of the three-vessel view and to analyze what anatomical changes would occur in this view when there are lesions of the ventricular outflow tracts and/or great arteries. Sonograms of 29 fetuses with lesions involving the ventricular outflow tracts and/or great arteries were reviewed. Three-vessel views were evaluated in terms of vessel size, number, arrangement and alignment. Twenty-eight of 29 fetuses showed an abnormal three-vessel view that included abnormal vessel size (n = 12), abnormal alignment (n = 8), abnormal arrangement (n = 7) and abnormal vessel number (n = 3). The vessel size was abnormal in obstructive lesions of the right (n = 4) or the left (n = 8) side of the heart. An abnormal alignment was seen in tetralogy of Fallot (n = 6) and double-outlet right ventricle (n = 2) that showed anterior displacement of the aorta. An abnormal arrangement was seen in complete (n = 4) and corrected (n = 1) transposition, double-outlet right ventricle (n = 1) and pulmonary atresia with ventricular septal defect (n = 1). Only two vessels were seen in truncus arteriosus (n = 1). Four vessels were seen in persistent left superior vena cava (n = 2). A fetus with pulmonary atresia and intact ventricular septum showed a normal three-vessel view. In conclusion, most of the lesions involving the ventricular outflow tracts and/or great arteries showed an abnormal three-vessel view.

Caffeine- and inositol 1,4,5-trisphosphate-induced 45Ca2+ releases in the microsomes of tracheal epithelial cells

Major parts of microsomes prepared from the epithelial cells of porcine trachea were tight-sealed vesicles since they showed a saturation of 45Ca2+ uptake and spontaneous releases of stored 45Ca2+ by the treatments of Ca2+-ionophore and Ca2+ channel agonists. In the presence of caffeine (10 mM), the maximal release of microsomal 45Ca2+ was observed at the extramicrosomal Ca2+ concentrations between 0.1 approximately 1 microM and at below or above this range of Ca2+ concentration the releases were decreased, forming a bell-shaped curve. These results indicate that the microsomal 45Ca2+ releases were mediated by ryanodine receptor, a caffeine-sensitive Ca2+ channel. Caffeine (10 mM) released 30.2 +/- 5.9% of microsomal 45Ca2+ while inositol 1,4,5-trisphosphate (InsP3, 10 microM) released 18.4 +/- 3.0% of the stored 45Ca2+. Caffeine-induced and InsP3-induced 45Ca2+ releases were additive, implying that these two types of 45Ca2+ releases are from physically distinct microsomes. Procaine, an antagonist of ryanodine receptor, selectively blocked the effect of caffeine but not the effect of InsP3. The results suggest that the epithelial cells of porcine trachea have caffeine-sensitive Ca2+ store in addition to InsP3-sensitive one.

Periodontal repair in intrabony defects treated with a calcium carbonate implant and guided tissue regeneration

Clinical outcome following the concurrent use of a porous resorbable calcium carbonate (CC) implant and guided tissue regeneration (GTR) in intrabony periodontal defects was evaluated in a randomized four-treatment parallel arm study. Eighty (80) patients, each contributing one interproximal intrabony defect, were assigned to the four treatments (20 patients per treatment) including the CC implant and GTR (CC + GTR), GTR alone (GTR control), CC implant alone (CC control), and gingival flap surgery alone (GFS control). Fourteen patients treated with CC + GTR, 19 patients treated with the GTR control, 13 patients treated with the CC control, and 18 patients treated with the GFS control completed the study. Clinical healing was evaluated 6 months postsurgery and included changes in probing depth, clinical attachment level, probing bone level, and gingival recession. Postsurgery probing depth reduction was 4.5 +/- 1.7 mm (CC + GTR; P < 0.01), 4.8 +/- 1.8 mm (GTR; P < 0.01), 3.7 +/- 2.2 mm (CC; P < 0.01), and 3.3 +/- 1.6 mm (GFS; P < 0.01). Clinical attachment gain amounted to 3.3 +/- 1.4 mm (CC + GTR; P < 0.01), 4.0 +/- 2.1 mm (GTR; P < 0.01), 3.0 +/- 2.4 mm (CC; P < 0.01), and 2.0 +/- 1.7 mm (GFS; P < 0.01). The CC + GTR and GTR treatments exhibited significantly greater improvements compared to GFS (P < 0.05). Postsurgery probing bone level gain amounted to 4.0 +/- 1.7 mm (CC + GTR; P < 0.01), 4.1 +/- 1.5 mm (GTR; P < 0.01), 4.0 +/- 2.2 mm (CC; P < 0.01), and 0.5 +/- 2.0 mm (GFS; P > 0.05). The CC + GTR, GTR, and CC treatments exhibited significantly greater improvements compared to GFS (P < 0.05). Gingival recession increased significantly compared to presurgery for GTR, CC, and GFS treatments (-0.9 +/- 1.2, -0.7 +/- 0.7, and -1.2 +/- 1.4 mm, respectively; P < 0.01). The results suggest that the concurrent use of a porous resorbable CC implant and GTR has limited adjunctive effect in the treatment of intrabony periodontal defects.

Induction of axon-like processes from axotomized retinal ganglion cells of adult hamsters after intravitreal injection of sciatic nerve exudate

We have shown previously that intravitreous transplantation of a peripheral nerve (PN) graft stimulates a subpopulation of retinal ganglion cells (RGCs) to sprout axon-like processes. The present study examined whether the effect of PN graft was due to diffusible factors released from the graft. Injection of sciatic nerve exudate into vitreous of the eye induced the formation of axon-like processes. Significantly more RGCs with axon-like processes were stained after injection of exudate from the distal stump than the proximal stump of the transected sciatic nerve. Thus, our results showed that trophic factors released from the intravitreous PN can induce the formation of axon-like processes and that more trophic factors are secreted from the distal than the proximal stump of the transected sciatic nerve.

Induction chemotherapy with idarubicin plus N4-behenoyl-1-beta-D-arabinofuranosylcytosine in acute myelogenous leukemia: a newly designed induction regimen--a prospective, cooperative multicenter study

This report describes the results of induction chemotherapy with idarubicin (IDA) plus N4-behenoyl-1-beta-D-arabinofuranosylcytosine (BH-AC), a newly designed induction regimen, in cases of previously untreated acute myelogenous leukemia (AML). The study was conducted by the Multicenter Clinical Study Group of the Korean Biologic Response Modifier Society (KBRMS). From March 1994 through January 1995, 40 patients were treated. The median age was 30 years (range, 15 months to 65 years), with a distribution according to the French-American-British (FAB) classification of one MO, nine MI, 15 M2, six M3, four M4, and five M5 patients. Remission induction therapy consisted of IDA 12 mg/m2 intravenously (i.v.) over 30 minutes daily on days 1 to 3, in combination with BH-AC 300 mg/m2 over 4 hours daily on days 1 to 7 (in patients aged 41 to 65 years, BH-AC dosage was decreased to 200 mg/m2/d). Complete remission (CR) was achieved in 30 patients (75%), 22 by the first induction therapy and eight by the second induction therapy. Ten patients (25%) failed to respond to therapy, six due to resistant disease and four due to death caused by aplasia. The time to CR was 30 days, the median granulocytopenic period was 19 days, and the thrombocytopenic period was 24 days. All nonhematologic side effects such as nausea, vomiting, mucositis, skin eruption, liver and cardiac dysfunction, and neurotoxicity, were transient and tolerable. These data indicate an efficacy comparable to that of other combinations of IDA (or other anthracyclines) with cytosine arabinoside (Ara-C) for remission induction in AML.

Effects of polyglactin mesh combined with resorbable calcium carbonate or replamineform hydroxyapatite on periodontal repair in dogs

This study evaluates periodontal repair and biomaterial reaction following implantation of a polyglactin mesh with or without porous resorbable calcium carbonate (RCC) or porous replamineform hydroxyapatite (RHA) in conjunction with reconstructive surgery. Ligature- and surgically-induced interproximal periodontal defects of left and right mandibular premolar teeth in 7 dogs were used. Bilaterally, mesial defects of the 2nd, 3rd and 4th premolar teeth were treated with polyglactin mesh, polyglactin mesh and RHA, or polyglactin mesh and RCC, respectively. The polyglactin mesh, shaped according to the contour of the defect, was adapted to the experimental teeth; its coronal margin positioned immediately apical to the cemento-enamel junction. Gingival flap margins were adapted and sutured to cover the polyglactin mesh completely. Clinical healing was generally uneventful. The dogs were sacrificed to provide block sections for histologic evaluation at 1, 3, 6, 12, 26, 32 and 56 weeks following wound closure. Generally, cementum regeneration was observed beginning at week 6 in all groups. Bone regeneration was observed from week 3 in polyglactin mesh-treated groups, and from week 6 in polyglactin mesh+RCC or polyglactin mesh+RHA treated groups. Bone regeneration appeared enhanced in polyglactin mesh+RCC or polyglactin mesh+RHA treated defects at week 12 and 26, with little difference between the three experimental conditions at week 56. Polyglactin mesh degradation was observed at week 3 and appeared complete at week 12. The RHA did not appear to resorb, while the RCC was gradually replaced by bone from week 3. Within limitations of the study conditions, periodontal regeneration was observed following implantation of a polyglactin mesh with or without RCC or RHA in conjunction with reconstructive surgery. As a conclusion, there seems to be no significant difference in periodontal regeneration after 12 months of healing between the group treated with the membrane only, and the group treated with the membrane and the bone substitution material. Changes in connective fiber orientation over the 1st 12 weeks of healing may suggest that "fibrous encapsulation" observed in earlier studies may only represent a transient stage in periodontal regeneration.

Color Doppler flow imaging of hepatocellular carcinomas. Comparison with metastatic tumors and hemangiomas by three-step grading for color hues

The role of color Doppler imaging was evaluated in differentiating hepatocellular carcinomas (HCCs) from metastases and hemangiomas by the amount of tumoral color signals. Intratumoral and peritumoral color signals were analyzed by a three-step grading system (grade 1 to 3) in 51 patients (32 HCCs, seven metastases, and 12 hemangiomas). Correlation of grading scores for intratumoral and peritumoral color signals was evaluated with the size of the tumors as well. HCCs demonstrated a higher grade of intratumoral color signals than did metastases or hemangiomas in all (p < 0.05) and biopsy-proved lesions (p = 0.0084); there was no significant difference in the degree of peritumoral color signals in all (p > 0.05) or 17 biopsy-proved HCCs (p = 0.2078) from the other tumor groups. In addition, the grade of both intratumoral and peritumoral color signals was not related with the tumor size in all groups (p > 0.05). In conclusion, color Doppler imaging provided a valuable role in the diagnosis of HCCs based on the qualitative analysis of the intratumoral color signals.

Analysis of mutations of neurofibromatosis type 1 gene and N-ras gene in acute myelogenous leukemia

Neurofibromatosis type 1 (NF1) gene is a tumor suppressor gene, and the NF1 gene product, neurofibromin, can downregulate the N-ras gene. Because the N-ras gene is often mutated in acute myelogenous leukemia (AML), we wondered if the NF1 gene might be mutated in those AML samples not having N-ras mutations. We investigated the mutational status of the N-ras gene and the FLR exon of codons 1371-1423 of the open reading frame of the full-length NF1 cDNA, which has a strong homology with the mammalian ras GTPase-activating protein (GAP), especially for a stretch of three consecutive amino acids (F, L, R), by single-strand conformation polymorphism analysis and direct sequencing in samples from patients with AML. Of 48 AML patients, 10 (21%) had point (missense) mutations of the N-ras gene involving codons 12, 13 and 61. However, mutations in the FLR exon of the NF1 gene were not detected in any of the AML samples. We also examined the difference of clinical response to induction therapy between AML patients with and without N-ras mutation. A significantly lower rate of complete remission was noted in individuals with N-ras gene mutations. These results suggest that mutation of the NF1 gene, at least in the FLR exon, is very rare in AML and the NF1 gene probably is not a functional complement of the N-ras gene mutation. The presence of N-ras gene mutation may be associated with a lower clinical response to antileukemic therapy.

Safety of intravitreally injected ciprofloxacin in phakic rabbit eyes

This study was designed to determine the maximal safe drug concentration of intravitreal ciprofloxacin in phakic rabbit eyes. Twenty-two eyes of New Zealand pigmented rabbits received midvitreal ciprofloxacin of 100, 200, 400, 600 or 800 micrograms in BSS Plus, or BSS Plus only. Retinal toxicity was dose-dependent as determined with electroretinography, light microscopy, and transmission electron microscopy. At a dose of greater than 400 micrograms, disorganization of the outer segments was a main pathological finding in transmission electron microscopy. We evaluated retinal function by measuring the electroretinograms for a graded series of flash intensities and by fitting electroretinogram b-wave amplitudes to the Naka-Rushton equation. At a dose of greater than 600 micrograms, Rmax was significantly decreased and log K was significantly increased. N-value tended to decrease. A decrease of b-wave amplitudes caused by retinal toxicity could be detected very sensitively with lower luminance stimuli. Determination of retinal toxicity with lower luminance electroretinography revealed a significant decrease of b-wave amplitudes at a dose of greater than 400 micrograms. We concluded that a safe dose of intravitreal ciprofloxacin in phakic rabbit eyes was 200 micrograms in phakic eyes.

Self-expandable metallic stents in high-risk patients with benign prostatic hyperplasia: long-term follow-up

PURPOSE

To evaluate the long-term clinical utility of self-expandable metallic Z stents in benign prostatic hyperplasia (BPH).

MATERIALS AND METHODS

Under fluoroscopic guidance, 14 multiple-connected Z stents (10 mm in diameter fully expanded, 30-60 mm in length) were placed in 13 patients with bladder obstruction from BPH and high operative risks. The stents were placed in the prostatic urethra with 2-20-mm protrusion into the urinary bladder in six patients (group A) and entirely within the prostatic urethra in seven patients (group B).

RESULTS

Eleven of 13 patients could void immediately, and the other two patients with atonic bladder voided within 8 weeks. Maximum urine flow rates just after stent placement were 8-27 mL/sec. Two patients died of unrelated causes within 2 months. During the follow-up period (mean, 37 months) in the other 11 patients, all patients in group A but none in group B underwent surgery owing to stone formation where the stent protruded into the bladder.

CONCLUSION

Expandable Z stents are effective in patients with BPH but should not protrude into the urinary bladder because of stone formation.

[Occupational medicine services in small enterprises]

The article deals with the materials of International Symposium on Industrial Medicine, which was held in November '93 in Seul (South Korea). Participated by scientists from Finland, China, Hong Kong, Russia, WHO, the Symposium was devoted to 30th Anniversary of Korean Industrial Hygienic Association. The main items discussed were importance of occupational medical control in small enterprises (including also farms, fishing firms and public service offices), as they appear to have unfavourable work conditions (noise, high concentrations of chemicals, heating microclimate). Improved regulation of industrial medicine and developed primary care service were also stressed expedient. Special emphasis involved basic science for industrial hygiene and better professional training.

Loculated fluid collections in hepatic fissures and recesses: CT appearance and potential pitfalls

The peritoneum invaginates into the liver parenchyma normally, as a normal anatomic variation, or pathologically and then fissures and furrows are formed. There are four normal fissures: fissures for the ligamentum teres, ligamentum venosum, and gallbladder and the transverse fissure. Fissures caused by normal anatomic variations include accessory fissures and furrows created by diaphragmatic indentation. Pathologic fissures occur secondary to traumatic or iatrogenic causes or as a result of liver cirrhosis. When ascites, hemoperitoneum, or infected ascites is loculated in the fissures or recesses, it may be mistaken for a liver cyst, intrahepatic hematoma, or liver abscess. When peritoneally disseminated tumor cells are implanted into these spaces, they may mimic intrahepatic focal lesions. Because the clinical consequences for these entities are very different, exact localization of the lesions may be crucial in the diagnosis and management of the lesions. Complete understanding of the liver surface anatomy and awareness of these situations may prevent a misdiagnosis of a focal intrahepatic abnormality.

In vitro MR imaging of the resected stomach with a 4.7-T superconducting magnet

PURPOSE

To study the effects of formalin fixation, signal intensity characteristics of the stomach-wall layers, and findings suggestive of cancerous invasion to the stomach wall in vitro with magnetic resonance (MR) imaging in humans.

MATERIALS AND METHODS

MR images of nine specimens of stomach cancer and 29 normal specimens were obtained at 4.7 T; 26 of the normal specimens were fixed in 10% formalin for 2 hours to 187 days before imaging. The field gradient was 10 G/cm; the spatial resolution, 0.1 mm.

RESULTS

The mucosal, submucosal, and proper-muscle layers were clearly identifiable. The submucosa of the fresh specimens had the lowest signal intensity of all specimens on both T1- and T2-weighted images (P < .01). No statistical correlation existed between signal intensity and duration of fixation. Tumor invasion was detected in seven of eight specimens with mucosal invasion, all eight specimens with submucosal invasion, and three of six specimens with muscle invasion.

CONCLUSION

In vitro MR imaging enabled differentiation of all three layers of the stomach wall, detection of the cancer, and measurement of the depth of invasion.

Clinical value of DMSA planar and single photon emission computed tomography as an initial diagnostic tool in adult women with recurrent acute pyelonephritis

Routine DMSA scintigraphy, ultrasound (US) of the kidney, intravenous pyelography (IVP) and voiding cystoureterography (VCU) were performed in 27 consecutive adult women with recurrent acute pyelonephritis (APN) during a 12-month follow-up. Both planar and single photon emission computed tomography (SPECT) images were obtained for DMSA scan. DMSA scans were repeated in those patients with abnormal initial scan. DMSA-SPECT showed normal findings in 2, single renal cortical detect (RCD) in 9 and multiple RCD in 16 (including nonvisualization in 2). Of the 11 kidneys with normal findings or single RCD on DMSA-SPECT, only 1 (9%) showed vesicoureteral reflux (VUR) on VCU (grade I). A large proportion of those with multiple RCDs showed abnormal findings on IVP (44%, 7/16), US (38%, 6/16) or VCU (31%, 5/16); 63% in any of these three studies. 5 of 6 patients with VUR had multiple RCDs on DMSA-SPECT, and 3 of these 5 showed no abnormality on IVP or US. 7 patients who needed other managements besides initial standard antibiotic treatment had multiple RCDs on DMSA-SPECT. 15 normal women were also studied and showed normal DMSA-SPECT, US and IVP, in all cases. Follow-up DMSA-SPECT was done in 16 patients (7 with single RCD, 9 with multiple RCD). All 7 patients with single RCD showed improvement, in those with multiple RCDs improvement was observed in 2, no change in 7 on follow-up studies. We conclude: (1) DMSA-SPECT is a useful initial diagnostic tool in adult women with recurrent APN to identify patients who need more extensive radiological studies.(ABSTRACT TRUNCATED AT 250 WORDS)

CT of carcinoma of the pancreas: different mode of spread according to lesion site

Thirty-seven patients were evaluated on computed tomography concerning the different modes of spread (peripancreatic vascular invasion and peritoneal implanting) in the pancreatic carcinoma arising in the four anatomic segments. Each was graded from 0 to 3. The median diameter of the adenocarcinomas was 4.5 cm. It was found that high propensity for vascular invasion occurred in the carcinomas of the body and neck, probably due to the anatomical proximity of the these structures, and the high incidence of intraperitoneal seeding in the carcinomas of the tail was found probably because of its intraperitoneal location.

Tuberculous epididymitis and epididymo-orchitis: sonographic findings

The findings at scrotal sonography in 10 patients with tuberculous epididymitis and in 2 with nontuberculous epididymitis are presented. In 6 patients with tuberculous epididymitis the testes were also involved (epididymo-orchitis). The most notable sonographic findings of tuberculous epididymitis were an enlarged epididymis, predominantly in the tail portion, and marked heterogeneity of the echo texture of the involved epididymis. Sonographic findings of associated testicular involvement consisted of a diffusely enlarged hypoechoic testis or ill defined focal intratesticular hypoechoic areas, or an irregular margin between the testis and epididymis. The sonographic findings encountered in patients with tuberculous epididymitis appear to be different from those encountered in nontuberculous epididymitis. Sonography might prove helpful in aiding the clinical distinction between these 2 forms of epididymitis and in demonstrating associated testicular involvement in tuberculous epididymitis.

Primary breast lymphoma

We report the case of a 20-year-old female with lymphoma of the breast. Mammography showed an asymmetric pattern of confluent densities without any discrete mass. Sonography revealed diffuse heterogenous echoic mass intermingled with low-and medium level echoes. We present the clinical, radiographic and histologic features of primary breast lymphoma with a brief review of the literatures.

Therapeutic percutaneous aspiration of hepatic abscesses: effectiveness in 25 patients

OBJECTIVE

The objective of this study was to evaluate the effectiveness of sonographically guided needle aspiration and systemic antibiotic therapy for the treatment of hepatic abscesses.

SUBJECTS AND METHODS

From June 1989 to September 1991, sonographically guided needle aspiration and systemic antibiotics were used to treat 25 consecutive patients with 25 hepatic abscesses. Among 36 patients with hepatic abscesses who were admitted to the hospital during that time, six had antibiotic therapy only; of these, three had microabscesses, two had abscesses less than 3.0 cm in diameter, and one refused needle aspiration. Four patients had surgical external drainage (three had cholelithiasis in addition to hepatic abscesses, and one did not respond to needle aspiration). Two patients treated in 1989 had drainage via an indwelling catheter, which was the preferred method at that time. The remaining 24 patients and one patient who had needle aspiration followed by surgical drainage made up the study group. Seventeen of the hepatic abscesses were caused by pyogenic organisms, six by amoeba, and two by unknown organisms. Eighteen abscesses (72%) were aspirated once, four (16%) were aspirated twice in 8 days, two (8%) were aspirated three times in 14 days, and one (4%) was aspirated four times in 10 days. Persistent fever, pain and tenderness in the right upper quadrant, and leukocytosis were the indications for multiple aspirations. Follow-up sonography was performed to evaluate the outcome of treatment.

RESULTS

In 16 cases (64%), the abscesses disappeared within a mean of 84 days. In eight cases (32%) with only partial follow-up, the patients were asymptomatic at the time of discharge and the abscesses were markedly smaller on the last follow-up sonograms (mean, 43 days). One patient (4%) did not respond to aspiration and had surgical drainage. The length of hospitalization varied from 5 to 42 days (mean, 22 days). In patients who became afebrile during the treatment, the fever had lasted from 0 to 10 days (mean, 3 days). Only one patient had a complication of the procedure, a pleural effusion that was treated conservatively.

CONCLUSION

Our results show that sonographically guided needle aspiration combined with antibiotic therapy is effective as the initial treatment for hepatic abscesses.

Hepatic arterial color Doppler signals in Caroli's disease

Three siblings with congenital dilatation of the intrahepatic bile ducts (Caroli's disease) are presented. Bile duct pathology was associated with congenital hepatic fibrosis and polycystic renal disease in all three patients. On color Doppler imaging (CD imaging), multiple small color Doppler signals were observed in the vascular radicles within the dilated bile ducts or in the center of the lumen apart from the vascular radicles, as well as in other well-known sonographic findings such as bile duct dilatations and bilary calculi. Doppler frequency spectral analysis confirmed all these color signals as arterial in origin in all patients, revealing pulsatile wave patterns. In spite of the fact that portal venous radicles have been well described on conventional sonograms or computed tomography (CT), continuous wave patterns of venous flow on spectral analysis were not detected in all patients. Identification of such less emphasized arterial flow may add another clue in the diagnosis and pathogenesis of this rare disease entity. In conclusion, color Doppler signals of arterial wave pattern within the dilated bile ducts are another helpful diagnostic criteria in previously reported sonographic findings, and these color signals are easily depicted on sonograms with color mapping.

Degradation of hydrogen sulfide by Xanthomonas sp. strain DY44 isolated from peat

Xanthomonas sp. strain DY44, capable of degrading H2S, was isolated from dimethyl disulfide-acclimated peat. This bacterium removed H2S either as a single gas or in the presence of the sulfur-containing compounds methanethiol, dimethyl sulfide, and dimethyl disulfide. The maximum specific H2S removal rate, obtained in the late stationary phase, was 3.92 mmol g of dry cells-1 h-1 (6.7 x 10(-16) mol cell-1 h-1) at pH 7 and 30 degrees C through a batch experiment in a basal mineral medium. Since Xanthomonas sp. strain DY44 exhibited no autotrophic growth with H2S, the H2S removal was judged not to be a consequence of chemolithotrophic activity. By using X-ray photoelectron spectroscopy, the metabolic product of H2S oxidation was determined to be polysulfide, which has properties very similar to those of elemental sulfur. Autoclaved cells (120 degrees C, 20 min) did not show H2S degradation, but cells killed by gamma-irradiation and cell extracts both oxidized H2S, suggesting the existence of a heat-labile intracellular enzymatic system for H2S oxidation. When Xanthomonas sp. strain DY44 was inoculated into fibrous peat, this strain degraded H2S without lag time, suggesting that it will be a good candidate for maintaining high H2S removability in the treatment of exhaust gases.

Biological deodorization of dimethyl sulfide using different fabrics as the carriers of microorganisms

Biological deodorization of dimethyl sulfide (DMS) was studied using nine unwoven fabrics as the carriers of microorganisms in a laboratory-scale deodorizing system. The activated carbon fabric FN-200CF-15 was the best packing material compared with other packing materials used, on the basis of removal rate. The maximum removal rate (Vm), evaluated by using Michaelis-Menten equation, was 2.28 g-S.kg-dry fab.-1.day-1 in this fabric biofilter. The critical load of DMS in this fabric biofilter was dependent on space velocity (SV), determined as 0.78 and 0.66 g-S.kg-dry fab.-1 at SV 100 and 150 h-1, respectively. Strain IM1 isolated from the carbon fabric FN-200CF-15 biofilter in modified Waksman (MW) medium successfully degraded DMS as well as hydrogen sulfide (H2S), methanethiol (MT), and dimethyl disulfide (DMDS) in batch test. The DMS removal rates (g-S.cell-1.h-1) by this strain measured in batch culture and calculated in FN-200CF-15 biofilter by the cell numbers appeared in MW medium were found almost equal, indicating that strain IM1 may be the dominant microorganism in this biofilter.

Extracorporeal shockwave lithotripsy of primary intrahepatic stones

Extracorporeal shockwave lithothripsy (ESWL) was performed in intrahepatic stone patients (n = 18) by Dornier MPL 9,000 with ultrasound guidance. The patients had T-tube (n = 9) or percutaneous transhepatic biliary drainage tube (n = 9). Average treatment session was four and shock-wave numbers were in the range of 3,064 to 12,000 (average 6,288 shocks). Intrahepatic stones were removed completely in 16 patients over a 3 month period by ESWL and combined stone extraction maneuver such as cholangioscopic or interventional radiologic method. Extracorporeal shockwave lithothripsy was very helpful in facilitating extraction of stones in unfavorable locations or located above the severe stricture. In summary, extracorporeal shockwave lithotripsy, followed by percutaneous stone extraction, will provide an improvement in the success rate and duration of treatment required for complete removal of primary hepatolithiasis.