CT and MR features of primary pulmonary hemangiopericytomas

We investigated the radiological findings of four patients with malignant pulmonary hemangiopericytomas, comparing plain chest radiography, CT, and MR. The radiographic presentation ranged from a small single lesion to a tumor almost completely occupying a hemithorax. Pathognomonic radiological features of malignant pulmonary hemangiopericytomas could not be established, but characteristic features include a large lobulated well-circumscribed mass with an encapsulated appearance, contrast enhancement of the margin, and no signs of surrounding compression atelectasis. The tumors were associated with late onset or a paucity of chest symptoms. Additional information regarding heterogeneity and effects on adjacent structures was provided by MR and was helpful in suggesting the diagnosis of malignant pulmonary hemangiopericytoma.

Posttraumatic bilhemia: conservative management by percutaneous drainage

Posttraumatic bilhemia complicating liver trauma has been managed surgically so far. A case report of a biliary-venous fistula resulting from blunt hepatic trauma managed successfully by percutaneous drainage is presented. A catheter was placed in the right hepatic lobe for reducing intrahepatic pressure. This procedure was followed by a dramatic decrease of bilirubin blood level. This management emphasizes the role of interventional radiology in the treatment of complicated blunt hepatic trauma.

[Pheochromocytoma as dominant manifestation of v. Hippel-Lindau syndrome]

A diagnosis of von Hippel-Lindau syndrome was made in two families originating from the same part of the Black Forest but apparently unrelated. Nine affected persons (seven males and two females) had a total of 17 tumours: retinal angioma (4), haemangioblastoma of the CNS (1), and phaeochromocytoma (12). Three of the affected persons and eight of the tumours (six phaeochromocytomas, two retinal angiomas) were diagnosed by family screening. Phaeochromocytoma was diagnosed in eight persons; in four it was the only symptomatic lesion. After extensive diagnostic tests the phaeochromocytoma was the sole tumour in four. Despite severe symptoms the diagnosis of von Hippel-Lindau syndrome had not been made prior to the screening examinations because either the common aetiology of the tumour was not known or there was insufficient exchange of information between the two families.--It is recommended that in each case of phaeochromocytoma von Hippel-Lindau syndrome should be excluded so that lesions can be discovered early in other organs and in other affected family members. If the syndrome is present, annual examinations are indicated because of asynchronous and multi-focal tumour growth.

Total chemical synthesis, characterization, and immunological properties of an MHC class I model using the TASP concept for protein de novo design

The design, total chemical synthesis, and immunological properties of a four-alpha-helix bundle template-assembled synthetic protein (TASP) mimicking some of the structural features of the major histocompatibility complex (MHC) class I is described. In a first approach, the native sequence 58-74 of the alpha 1 heavy chain domain of HLA-A2 was modeled in order to increase helix stability and amphiphilicity of the 17-mer peptide, preserving the residues for potential T-cell receptor (TcR) binding properties. According to the TASP concept, these helical segments were covalently attached to a cyclic template molecule designed for the induction of a four-helix-bundle topology of the assembled peptide blocks. After extensive HPLC purification, stepwise solid-phase synthesis resulted in a TASP molecule of high chemical purity as demonstrated by analytical HPLC, mass spectrometry, and amino acid analysis. CD spectroscopic investigations are consistent with the onset of a partial alpha-helical conformation in aqueous buffer as well as in TFE. Antibodies raised directly against this four-alpha-helix bundle TASP molecule (without prior conjugation to a carrier molecule) were detected by ELISA. Flow cytometry studies showed that these antibodies recognize the native MHC class I molecule on the surface of HLA-A2-positive cells. The results indicate that the TASP approach represents a versatile tool for mimicking conformational epitopes.

[Digitization of conventional x-ray films]

The diagnostic value of a digitization system for analogue films based on a charge-coupled-device (CCD) scanner with adjustable resolution of 2.5 or 5 lp/mm was assessed. Some 110 skeletal radiographs, 50 contrast studies, including 25 of patients with Crohn's disease, and 70 abdominal plain films before and after successful lithotripsy for renal stones were digitized. Receiver operating characteristic (ROC) studies showed improved detection of cortical and trabecular defects with contrast-optimized digitized films. Edge enhancement algorithms yielded no additional information. Inflammatory lesions of Crohn's disease were detected equally well by conventional films and digitized images. A statistically significant improvement (p less than 0.05) in the recognition of disintegration after lithotripsy was found for the processed digitized images. On the basis of this initial investigation, the digitization system tested appears to be useful for diagnostic purposes, especially when contrast resolution plays an important part, as with stone fragmentation or cortical defects.

Differential Inhibition by Ferulic Acid of Nitrate and Ammonium Uptake in Zea mays L

The influence of the allelopathic compound ferulic acid (FA) on nitrogen uptake from solutions containing both NO(3) (-) and NH(4) (+) was examined in 8-day-old nitrogen-depleted corn (Zea mays L.) seedlings. Concurrent effects on uptake of Cl(-) and K(+) also were assessed. The presence of 250 micromolar FA inhibited the initial (0-1 hours) rate of NO(3) (-) uptake and also prevented development of the NO(3) (-)-inducible accelerated rate. The pattern of recovery when FA was removed was interpreted as indicating a rapid relief of FA-restricted NO(3) (-) uptake activity, followed by a reinitiation of the induction of that activity. No inhibition of NO(3) (-) reduction was detected. Ammonium uptake was less sensitive than NO(3) (-) uptake to inhibition by FA. An inhibition of Cl(-) uptake occurred as induction of the NO(3) (-) transport system developed in the absence of FA. Alterations of Cl(-) uptake in the presence of FA were, therefore, a result of a beneficial effect, because NO(3) (-) uptake was restricted, and a direct inhibitory effect. The presence of FA increased the initial net K(+) loss from the roots during exposure to the low K, ammonium nitrate uptake solution and delayed the recovery to positive net uptake, but it did not alter the general pattern of the response. The implications of the observations are discussed for growth of plants under natural conditions and cultural practices that foster periodic accumulation of allelopathic substances.

[Results of surgical therapy of bronchial cancers with reference to adjuvant therapeutic measures in an advanced stage]

The prognosis of bronchial carcinoma especially in advanced tumor stage is poor despite different methods of treatment. The 5-year survival rate after radical operation is about 25-40% for all stages, and between 17-20% in stage III. Without therapy it is 3.5-9.5%. T3-tumors and N2-lymphnodes represent the limit of surgical therapy. From 1980 to 1988 we operated 456 patients because of bronchial carcinoma, 80% men (mean age 59.2 y) and 20% women (mean age 56.9 y). 83.1% had been smokers, 16.9% had been exposed to contaminants. At admission to the hospital 36% were in stage I, 13% in stage II, 47% in stage III, and 4% in stage IV.

HISTOLOGY

squamous cell carcinoma 40.9%, adenocarcinoma 26.1%, large cell carcinoma 21.9%, and small cell carcinoma 11.1%. Looking at all cases we mostly performed a lobectomy, in stage III tumors the most common operation was pneumonectomy. In this group only 57.5% of the patients were resectable. In 77 potentially curative operated patients in stage III with non-small cell carcinoma we performed an adjuvant radio-, chemo- or combined therapy. The cumulative survival rates for all patients in the 1st year were 85% in stage I, 67% in stage II, and 36% in stage III and IV. In the 3rd year 57%, 14% and 10%, and in the 5th year 41%, 7%, and 5%. In stage III the survival rates of the potentially curative operated vs. the exploratively operated patients were in the 1st year 50%/36%, in the 3rd year 16%/10%, and in the 5th year 11%/5%.(ABSTRACT TRUNCATED AT 250 WORDS)

Therapy of invasive aspergillosis with itraconazole: improvement of therapeutic efficacy by early diagnosis

We report on the treatment of invasive aspergillosis with the new triazole antimycotic agent itraconazole. All 11 patients suffered from pulmonary invasive aspergillosis. Two patients also had cerebral aspergillosis; in one of these patients the paranasal sinuses were also invaded. Underlying diseases were acute lymphoblastic leukaemia (n = 3), acute myeloid leukaemia (n = 4); one patient underwent allogeneic bone marrow transplantation before he developed aspergillosis; another was transplanted after successful aspergillosis treatment, liver cirrhosis (n = 1), lung infarction after pulmonary embolism (n = 1), chronic bronchitis after pulmonary tuberculosis (n = 1) and AIDS (n = 1). In five cases initial diagnosis was established by means of mycological methods and clinical signs. In six patients invasive pulmonary aspergillosis was initially diagnosed due to the clinical criteria presented in this paper. Secondary mycological confirmation after onset of therapy was achieved in five out of these six patients. All of the patients initially responded to therapy. One female patient experienced a relapse of aspergillosis and died of cerebral involvement and relapsing leukaemia. Two further patients died due to underlying diseases (pulmonary embolism, relapsing leukaemia). Nine patients (82%) were cured of the mycosis, including the patient with cerebral involvement; two underwent surgical resection of residual pulmonary lesions. Itraconazole is a very effective drug for treatment of invasive aspergillosis. Therapeutic efficacy can be optimized by early diagnosis using clinical criteria and prompt start of treatment.

[Main branch stenosis following aortic valve replacement]

Three patients developed left main stem stenosis within some months after aortic valve replacement. In all of them diagnosis was confirmed by angiography and bypass surgery was performed successfully. Left main stem stenosis is a rare complication of aortic valve replacement and is due to cannulation and perfusion of the coronary arteries. The mechanism is probably injury of the vessel wall due to the perfusion-catheter, followed by intimal hyperplasia. A similar mechanism is assumed for restenosis after transluminal coronary angioplasty.

[Risks of combined surgical treatment of acquired heart valve defects and coronary heart disease]

In the past years the number of patients with combined treatment of the heart valves and coronary arteries rised as well as the patients age did. In 1980-1987 the rate of patients with aortic valve replacement and simultaneous aorto-coronary bypass was 10.9% in those who underwent aortic valve replacement and 2.9% in those who had aorto-coronary bypass operation. Since 1988 the ratios changed to 18.2% and 4.9%. For the calculation of the operative risk of the combined operative treatment (AVR + CABG, MVR + CABG) we compared these groups with those patients with isolated operations (MVR, AVR, CABG). We studied all patients during 1980 and July 1989. The hospital mortality of combined procedures was significantly increased. The mortality among female patients was higher as compared to the male group. The age of patients treated by the combined procedures was higher as compared to the isolated procedures. The mean age of the patients which died was severely increased as compared to the isolated procedures. However, in the combined procedures this increase was not as pronounced as in the isolated groups. Patients with combined procedures had a higher NYHA class. The risk factors of the combined procedures were comparable to isolated CABG.

[Interstitial cancerous lung diseases. Lymphangiosis carcinomatosa and leukemic pulmonary infiltrates]

The radiological findings in pulmonary lymphangitic carcinomatosis and in leukemic pulmonary infiltrates mirror the tumor-dependent monomorphic interstitial pathology of lung parenchyma. It is a proven fact that pulmonary lymphangitic carcinomatosis is caused by hematogenous tumor embolization to the lungs; pathogenesis by contiguous lymphangitic spread is the exception. High-resolution CT performed as a supplement to the radiological work-up improves the sensitivity for pulmonary infiltrates in general and thus makes the differential diagnosis decided easier. Radiological criteria cannot discriminate the different forms of leukemia. Plain chest X-ray allows the diagnosis of pulmonary involvement in leukemia due to tumorous infiltrates and of tumor- or therapy-induced complications. It is essential that the radiological findings be interpreted with reference to the stage of tumor disease and the clinical parameters to make the radiological differential diagnosis of opportunistic infections more reliable.

Results of surgical repair for 110 thoracic aortic aneurysms

Between 1974 and July 1989 110 operations for thoracic aortic aneurysms in 107 patients (69 males, 38 females) were performed, whose ages ranged from 14 to 74. 37 patients had an aortic valvular disease, 15 had Marfan's syndrome, 28 of these patients had a history of thoracic trauma or of previous aortic or cardiac surgery (14 posttraumatic aneurysms, 9 aneurysms after cardiac surgery, 5 after repair of aortic coarctation), 29 patients had hypertension. 63 patients underwent repair of dissecting aneurysms, 47 of non-dissecting (saccular or fusiform) thoracic aortic aneurysms. 67 repairs were emergency and 43 elective. The hospital mortality for the entire series was 34.5%. The analysis of multiple preoperative and intraoperative variables showed that mortality following thoracic aortic aneurysm repair is higher with increasing age (65.7% mortality for operations between the 60th and 70th year of age, 100% mortality beyond the 70th year of age) and emergency surgery (hospital mortality 52.2% compared with 6.9% for elective operations). A significant increase in mortality was noted related to the aneurysm type (poorer prognosis in DeBakey type I and II), to history of hypertension, to preoperative shock or to perforation of the aneurysm, including haemopericardium or haemothorax.

[Traction injuries of the brachial plexus: radiologic diagnosis using myelo-CT and MR]

The exact radiographic localisation of supraganglionic lesions of the brachial plexus provides important information for the prognosis and clinical management of these injuries. The authors report on the results of enhanced CT scanning and MRI of the cervical spine in five patients with surgically proven root avulsions caused by traction injuries. All lesions were correctly diagnosed by enhanced CT scanning. MRI, by comparison, identified only about 70% of the neural lesions.

The clinical value of percutaneous transluminal angioscopy. Angioscopical findings in primary vascular diagnosis and in interventional radiology

Since the introduction of ultrathin angioendoscopes into clinical application conventional or digital angiography have been controlled by using the same approach like in angiography. In dogs and angiography patients this new angioscopic method for arteries without surgical intervention has been developed. The approach is transfemoral. Endoscopy is combined with angiography, percutaneous transluminal angioplasty (PTA), thrombolysis, thrombus extraction and a new kind of stents and their application. An ultrathin endoscope with an outer diameter of 1.6 mm and working channel of 0.35 mm is used. Guide wires, contrast media and drugs for local thrombolysis can be applied through this channel. The endoscope is placed into the region of interest under fluoroscopic control and view is obtained by using 0.9% NaCl for decreasing blood flow. Endoscopy is documented by video or by a high-speed camera. It was possible to demonstrate the proceedings of dilatation, recanalization, local lysis, stent-application and thrombus-extraction.

Lowering of blood glucose in athymic nude mice and rats, grafted with human lung cancers

Human tumors were transplanted into athymic nude mice. From blood samples in the final stage of their passages we observed that in some of these lines, human lung cancer lines mostly, blood glucose generally decreased with increasing size of the tumor grafts. This observation was the reason for further investigations. Eight out of 13 human lung cancer lines caused a decrease of blood glucose in grafted mice. The extent of decrease was directly correlated with the proliferation of grafts. The results raise hope that the model of human malignant tumors, xenotransplanted and passaged into athymic nude mice, could be helpful in research on IGF and related substances.