Results of postoperative radiotherapy for clinical stage Ib uterine cervical carcinoma with evidence of microscopic involvement of surgical margin, parametrium and/or lymph node metastasis

From January 1979 to September 1985, a total of 125 patients preoperatively staged as International Federation of Gynecology and Obstetrics (FIGO) Ib uterine cervical carcinoma were proven to have either microscopic involvement of the surgical margin, parametrium and/or regional lymph node metastasis histopathologically after radical hysterectomy and pelvic lymphadenectomy. All of these patients were treated postoperatively with radiotherapy because of the above indications. Based on indications of postoperative radiotherapy, patients were divided into 3 major subgroups according to the microscopic involvement: group A patients (50) with microscopic evidence of regional lymph node metastasis only; group B patients (59) with microscopic evidence of parametrial involvement; and group C patients (16) with microscopic infiltration of the surgical margin involving the vaginal cuff. All patients were treated with external irradiation using a Cobalt-60 teletherapy machine. The overall actuarial 5-year survival rate was 62% with a 77% 5-year survival rate for group A, a 50% rate for group B and a 75% rate for group C. Further analysis of the prognostic factors revealed that those with regional lymph node involvement of 4 or less had a better chance of survival than those with lymph node involvement of more than 4. Also those with poorly differentiated squamous cell carcinoma had a lower 5-year survival rate than those with moderately or well-differentiated squamous cell carcinoma. Univariate analysis revealed that hemoglobin values, age, and the time interval from surgery to radiotherapy were not significant prognostic factors.

Novel enzymic hydrolytic dehalogenation of a chlorinated aromatic

Microbial enzyme systems may be used in the biodegradation of persistent environmental pollutants. The three polypeptide components of one such system, the 4-chlorobenzoate dehalogenase system, have been isolated, and the chemical steps of the 4-hydroxybenzoate-forming reaction that they catalyze have been identified. The genes contained within a 4.5-kilobase Pseudomonas sp. strain CBS3 chromosomal DNA fragment that encode dehalogenase activity were selectively expressed in transformed Escherichia coli. Oligonucleotide sequencing revealed a stretch of homology between the 57-kilodalton (kD) polypeptide and several magnesium adenosine triphosphate (MgATP)-cleaving enzymes that allowed MgATP and coenzyme A (CoA) to be identified as the dehalogenase cosubstrate and cofactor, respectively. The dehalogenase activity arises from two components, a 4-chlorobenzoate:CoA ligase-dehalogenase (an alpha beta dimer of the 57- and 30-kD polypeptides) and a thioesterase (the 16-kD polypeptide).

The role of contrast-enhanced MR imaging in the diagnosis of neurocysticercosis

Pre- and postcontrast MR images of 17 patients with the diagnosis of neurocysticercosis were reviewed to evaluate the role of gadopentetate dimeglumine in MR imaging of this disease. The MR images, which were obtained on either a 0.5-T or 2.0-T superconducting system, revealed a total of 92 cysticerci in 17 patients. On contrast-enhanced T1-weighted images, 23 parenchymal cysticerci showed contrast enhancement. Ring-shaped enhancement was seen in only 6% (3/54) of cysticerci with intensity paralleling the CSF, while it was noted in 67% (16/24) of the cysticerci with intensity higher than CSF. Nodular enhancement was seen in granulomatous lesions with surrounding edema (29%, 4/14). Of 18 cysticerci with surrounding edema, 17 showed contrast enhancement. Basal meningeal enhancement, indicating meningitis, was observed in three patients. The results indicate that contrast enhancement usually occurs in patients in whom precontrast MR findings have shown active inflammatory reaction in the degenerating stage of the worm. Thus, postcontrast imaging is useful in a limited number of patients with neurocysticercosis; it should be used selectively in those whose clinical or precontrast MR studies show meningitis, granulomatous lesions, or cysts with surrounding edema.

Sinonasal psammomatoid ossifying fibromas: CT and MR manifestations

Five cases of pathologically proved psammomatoid ossifying fibromas of the sinonasal area are presented. All five cases were examined by CT and in three cases MR imaging was performed before and after injection of gadopentetate dimeglumine. The lesions were located in the sphenoethmoidal area and extended over the nasal cavity or orbit in four cases. In one case, the lesion occurred at the perpendicular plate of the ethmoid bone with preservation of the ethmoidal sinus. On CT, all the lesions were expansile and circumscribed by a thick bony wall. Internal septations of bone density (four cases) or enhancing soft-tissue density (one case) were seen and internal content was low in density in all but one from which blood was aspirated. On MR, the bony walls were isointense with gray matter on T1-weighted images and were seen as areas of low intensity on T2-weighted images. The lesions significantly enhanced after injection of contrast material. A well-circumscribed multiloculated expansile mass with a thick wall of bone density on CT scans and enhancement of this area on postcontrast MR images is strongly suggestive of psammomatoid ossifying fibroma.

Radiotherapy for postoperative recurrent uterine cervical carcinoma

From January 1980 to December 1985, a total of 110 patients with postoperative recurrent uterine cervical carcinoma were treated with radiotherapy. The mean age was 53 years. Ten patients were excluded due to incomplete treatment. The population was grouped according to the classification by Ciatto et al. into patients with central recurrence (n = 48), with peripheral limited recurrence (n = 43), and with peripheral massive recurrence (n = 9). The midpelvic dose given to patients with central recurrence was 40 to 45 Gy, followed by a boost given either by perineal teletherapy with 30 Gy or brachytherapy with 30 Gy at 0.5 cm. beneath the vaginal mucosa. For the peripheral group, the midpelvic dose was 50 Gy followed by a boost of 10 Gy through reduced portals. Further boost to the vaginal mucosa was given by either of the two methods mentioned above. The overall 5-year survival rate was 28%. In the group with central recurrence, it was 42% and in the group with peripheral recurrence 15%. Sixteen patients had persistent local tumor and 15 patients developed distant metastasis. Complications noted were proctitis (5%), cystitis (2%), vesicovaginal fistula (2%) and rectovaginal fistula (2%). Our data clearly indicate that radiotherapy was effective in controlling central recurrence, but for peripheral recurrence, control rate and prognosis were less favorable.

Selective cytotoxic effects of immunotoxin--monoclonal anti-AFP-abrin-A chain conjugate on several human hepatoma cell lines

A highly specific monoclonal antibody (anti-AFP) against alpha-fetoprotein (AFP) was linked to N-succinimidyl-3-(2-pyridyldithio)propionate (SPDP) to form conjugates which were purified with a protein A-sepharose CL-4B affinity column. The conjugate, PDP-Anti-AFP was then covalently coupled to the toxic abrin-A chain to synthesize immunotoxins. The immunotoxin, anti-AFP-abrin-A conjugate, which was also purified with a protein A-sepharose CL-4B affinity column, had a molecular weight of 180,000 and had 80% antigen-binding activity that of anti-AFP activity and 92% toxicity of abrin-A chain. The immunotoxin showed selective cytotoxicities toward the AFP secreting human hepatoma cell lines, such HepG2 and Hep3B, but not toward AFP non-secreting human hepatoma cell line, PLC/PRF/5.

MR imaging findings of moyamoya disease

The brain MR images of 23 patients with angiographically proved moyamoya disease were reviewed to evaluate the capability of MR to demonstrate vascular and parenchymal abnormalities. All the MR images were obtained on a 2.0 T superconducting system and included T1-weighted sagittal and T2-weighted axial images without implementation of flow compensation (FC). The vascular abnormalities demonstrated on MR images were narrowing of the cavernous internal carotid artery (ICA) (73%), narrowing or occlusion of the supraclinoid ICA (87%) and proximal middle cerebral artery (MCA) (91%), and multiple collateral vessels in the basal ganglia and/or thalamus (96%). The parenchymal abnormalities included ischemic infarctions (74%), predominantly located in watershed areas, hemorrhagic infarctions (26%), intracerebral hematomas (13%), and intraventricular hemorrhage (13%). In conclusion, MR imaging was a useful diagnostic modality for detecting both vascular and parenchymal abnormalities associated with moyamoya disease. This may obviate the need for invasive angiography as far as the diagnosis is wanted at the non-quantitative level.

Deep sylvian meningioma in a child

Meningioma is a rare brain tumor in childhood, but one located deep in the sylvian fissure without any connection to the dura or ventricular system is even more unusual. A 2-year-old boy with a deep sylvian meningioma is presented. This is the youngest case as well as the third intrasylvian meningioma reported in the pediatric age group (up to age 15).

Palliative radiotherapy of cerebral metastasis from lung cancer

Cerebral metastasis is a common manifestation of lung cancer. Presenting signs and symptoms are often grave, and consequently often result in patients being debilitated for the rest of their lives. Radiotherapy has been used to treat a majority of these cases, and is considered as the treatment of choice. At Mackay Memorial Hospital, we collected from 1982 to 1985, the records of 42 lung cancer patients with brain metastasis. All the cases had a histological diagnosis of primary lung cancer; most of them were squamous cell carcinoma and adenocarcinoma; only two cases were small cell carcinoma. The diagnosis of brain metastasis was established by computed tomographic scans of the brain and radioisotopic brain scans. Of the 42 cases, 22 received palliative radiotherapy from a cobalt-60 teletherapy machine to the whole brain for a total dose of 30 Gray (Gy) in 10-15 fractions over a time span of 2 to 3 weeks, while the remaining patients only received medical treatment (e.g. cranial decompression with mannitol, steroids, etc.). Most of the patients have already died. In our study, those who received radiotherapy attained considerable palliation of their symptoms and signs, including improvement of their general performance status and neurological function. Although the treatment did not prolong the patient's survival, it did decrease considerably the disability caused by the metastatic disease.

Gd-DTPA-enhanced MR imaging of the brain in patients with meningitis: comparison with CT

Plain and Gd-DTPA-enhanced MR images of the brain were obtained in 18 consecutive patients with meningitis (eight with tuberculous, five with bacterial, three with viral, and two with fungal infections); the MR images were compared with CT scans. MR images were obtained on a 2.0-T superconducting unit with both T1- and T2-weighted pulse sequences before injection and with a T1-weighted sequence after injection of Gd-DTPA (0.1 mmol/kg) in all patients. In tuberculous meningitis, MR imaging depicted ischemia/infarct, hemorrhagic infarct of basal ganglia, meningeal enhancement at either basal cistern or convexity surface of brain, and associated small granulomas in a few more patients than CT did. In bacterial meningitis, primary foci of extracranial inflammation (i.e., mastoid, paranasal sinuses) and adjacent intracranial lesions including localized dural inflammation, subdural fluid collection, and/or brain parenchymal lesions were demonstrated much better on MR than on CT. Otherwise, MR images generally matched the CT scan. Although the plain MR images, both T1- and T2-weighted, were the most sensitive in delineating ischemia/infarct, hemorrhage, and edema, they were not as specific as Gd-DTPA-enhanced T1-weighted images and postcontrast CT scans in defining the active inflammatory process of the meninges and focal lesions precisely. We conclude that if Gd-DTPA is used, MR imaging appears to be superior to CT in the evaluation of patients with suspected meningitis. Precontrast MR is needed to delineate ischemia/infarct, edema, and subacute hemorrhage.

Gd-DTPA enhanced MR imaging in intracranial tuberculosis

Twenty-six patients with intracranial tuberculosis (Tb) (10 with acute meningitis, 5 with chronic meningitis, 5 with meningitic sequelae and 6 with localized tuberculoma(s)) were examined with MR before and after Gd-DTPA enhancement (0.1 mmol/kg), using 2.0T superconducting unit, and the images were retrospectively analyzed and compared with CT scans. Without Gd-DTPA enhancement, the MR images were generally insensitive to detection of active meningeal inflammation and granulomas. The signal intensity of granulomas was usually isointense to gray matter on both T1- and T2-weighted images, whether they were associated with diffuse meningitis or presented as localized tuberculoma(s). A few granulomas showed focal hypointensity on T2-weighted images. Calcifications seen on CT of the meningitic sequelae group usually appeared markedly hypointense on all spin-echo sequences. On Gd-DTPA enhanced T1-weighted images, abnormal meningeal enhancement indicating active inflammation was conspicuous, and the granulomas often appeared as conglomerated ring-enhancing nodules, which seems to be characteristic of granulomas. Thin rim enhancement around the suprasellar calcifications were observed in two out of 5 patients with meningitic sequelae. Compared with CT, MR detected a few more ischemic infarcts, hemorrhagic infarcts, meningeal enhancement and granulomas in the acute meningitis group, but missed small calcifications in the basal cisterns well shown on CT in the sequelae group. Otherwise, MR generally matched CT scans. MR imaging appears to be superior to CT in evaluation of active intracranial Tb only if Gd-DTPA is used, while CT is better than MR in evaluating meningitic sequelae with calcification.

Gd-DTPA-enhanced MR imaging of the brain in patients with meningitis: comparison with CT

Plain and Gd-DTPA-enhanced MR images of the brain were obtained in 18 consecutive patients with meningitis (eight with tuberculous, five with bacterial, three with viral, and two with fungal infections); the MR images were compared with CT scans. MR images were obtained on a 2.0-T superconducting unit with both T1- and T2-weighted pulse sequences before injection and with a T1-weighted sequence after injection of Gd-DTPA (0.1 mmol/kg) in all patients. In tuberculous meningitis, MR imaging depicted ischemia/infarct, hemorrhagic infarct of basal ganglia, meningeal enhancement at either basal cistern or convexity surface of brain, and associated small granulomas in a few more patients than CT did. In bacterial meningitis, primary foci of extracranial inflammation (i.e., mastoid, paranasal sinuses) and adjacent intracranial lesions including localized dural inflammation, subdural fluid collection, and/or brain parenchymal lesions were demonstrated much better on MR than on CT. Otherwise, MR images generally matched the CT scan. Although the plain MR images, both T1- and T2-weighted, were the most sensitive in delineating ischemia/infarct, hemorrhage, and edema, they were not as specific as Gd-DTPA-enhanced T1-weighted images and postcontrast CT scans in defining the active inflammatory process of the meninges and focal lesions precisely. We conclude that if Gd-DTPA is used, MR imaging appears to be superior to CT in the evaluation of patients with suspected meningitis. Precontrast MR is needed to delineate ischemia/infarct, edema, and subacute hemorrhage.

Clinical utility of partial flip angle T2-weighted spin-echo imaging of the brain

To assess the clinical usefulness of partial flip angle (PFA) spin-echo (SE) brain imaging, a total of eighty patients were examined with both conventional double echo T2-weighted SE (2500/30, 80/90 degrees/one excitation) and PFA double echo SE (1200/30, 70/45 degrees/two excitations) on 2.0T system. Two comparative studies were performed: (1) in 65 patients PFA SE technique was compared with conventional SE without flow compensating gradients, and (2) in 15 patients the former was compared with the latter with flow compensating gradients. Imaging time was nearly identical in each sequence. In both studies we found that PFA T2-weighted SE images were almost identical to those obtained with the conventional SE technique in the contrast characteristics and the detection rate of the abnormalities (100%, 85/85 lesions), and more importantly, PFA SE revealed few flow artifacts in the brain stem, temporal lobes and basal ganglia which were frequently seen on conventional SE without flow compensating gradients. Additionally, PFA SE images demonstrated no suppression of CSF flow void in the aqueduct which was commonly seen on conventional SE with flow compensating gradients. In overall image quality, the PFA SE images, particularly the second echo images, were almost comparable with those of conventional SE with flow compensating gradients. A flip angle of 45 degrees seems to be close to Ernst angle, the angle at which maximum signal occurs, for a given TR of 1200 msec for CSF and most of the abnormalities containing higher water content.(ABSTRACT TRUNCATED AT 250 WORDS)

The nucleotide sequence of coxsackievirus A9; implications for receptor binding and enterovirus classification

The complete nucleotide sequence of the genome of coxsackievirus A9 (CAV-9) has been determined from cDNA cloned in Escherichia coli. Excluding the 3' poly(A) stretch, the RNA genome is 7452 nucleotides long and encodes a single polyprotein of 2201 amino acids. Comparison of the nucleotide and predicted amino acid sequences with those of the coxsackieviruses B1, B3 and B4 reveals a surprising degree of homology, with overall amino acid homologies of 86.9%, 86.2% and 87.0%, respectively. In contrast, there is much less homology to another coxsackie A virus, CAV-21, 60.4% overall amino acid homology. This demonstrates the high degree of diversity within the CAV group and indicates that the current classification does not directly correlate with molecular genetic properties. One major feature of CAV-9 is an insertion, relative to all other enteroviruses sequenced to date, which is located at the C terminus of VP1, and includes an arginine-glycine-aspartic acid tripeptide. Such sequences in a number of other proteins are known to have activity in promoting attachment to cell receptors and the implications for CAV-9 receptor binding are discussed.

MR imaging of retroperitoneal teratoma: correlation with CT and pathology

A retroperitoneal teratoma was studied with CT and magnetic resonance (MR) imaging. The images were correlated with the pathologic findings. The tumor was composed of five portions: adipose tissue, bone, hair, sebum, and loose edematous fibrofatty tissue with skin. Computed tomography and MR both demonstrated a well defined mass with separate cystic and solid components and all five tissue elements of the tumor. Magnetic resonance was superior to CT in delineating the relationship of blood vessels to the tumor.

Unusual MR manifestations of neurocysticercosis

MR and CT features of neurocysticercosis are variable and depend fundametally on the stage in evolution of the infection, location, number and size of the worm. The authors retrospectively evaluated MR images obtained on a 2.0T superconducting unit in 22 neurocysticercosis patients and observed various MR features including some new findings. A variety of MR findings are presented with special reference to six case reports. The features include: (1) a large simple cyst containing both internal septations and a scolex; (2) suprasellar racemose cysts mimicking other cysts, (3) a fourth ventricular cyst readily depicted by aid of CSF flow-void in the sagittal plane; (4) degenerating cysts showing "white target" appearance; (5) granulomatous lesions having a "black target" appearance; and (6) a meningitic form showing Gd-DTPA enhancement of basal cisterns and of a subacute infarct.

The use of lithium carbonate to correct leukopenia during cancer treatment

Leukopenia is a common complication noted in patients receiving radiotherapy and/or chemotherapy but no effective method has been reported so far to correct this complication. In the field of psychiatry, lithium carbonate used in treating depression has been noted to have induced leukocytosis as a side effect. From July 1985 to December 1987, a total of 111 patients receiving radiotherapy and/or chemotherapy with leukopenia were included in this study. There were sixty nine patients who received lithium carbonate and the remaining forty two patients served as control group were allowed to stop their primary treatment temporarily without medication during their period of leukopenia. For the group given lithium carbonate, 79% of the patients were able to recover their white blood count (WBC) above 3,000/cu.mm. within 5 days and finished their primary treatment smoothly. For the control group, it took them on the average about 11.8 days of rest in order to recover their WBC level to 3,000/cu.mm. and above. Reports in the recent literature indicates that the average toxic level is around 1.5 mEq/l to 2.0 mEq/l. In our study, the average serum lithium level before administration is 0.44 mEq/l, it reached 0.59 mEq/l and 1.08 mEq/l after the fifth and the 10th day of intake respectively. From this laboratory data, obviously no patient reached the toxic level and no side effects were noted clinically. Based on these figures, we can see clearly that lithium carbonate can shorten the period of leukopenia in comparison to the control group which was not given any medication.

Tuberculous arachnoiditis of the spine: findings on myelography, CT, and MR imaging

Tuberculosis (TB) is a rare cause of spinal arachnoiditis. It may occur primarily or secondary to intracranial or vertebral infection; unlike other types of arachnoiditis, it frequently involves the spinal cord as well as the meninges and the nerve roots. We retrospectively reviewed 13 conventional myelograms, eight CT myelograms, and five Gd-DTPA-enhanced MR images in 13 patients with spinal TB radiculomyelitis (arachnoiditis). Eleven patients had intracranial TB meningitis at the time of diagnosis or before. Ten patients were less than 30 years old. Conventional myelographic findings included a block of the CSF (11/13), most commonly at the level of the conus medullaris; irregular or indistinct thecal sac contour (9/13); multiple fine and/or coarse nodular defects (8/13); nerve-root thickening (7/13); and vertical bandlike adhesive defects (4/13). CT myelography showed intradural nodular masses suggesting tuberculomas at or just above the level of the block (4/8), irregularity of the spinal cord surface (4/8), irregular filling or obliteration of subarachnoidal space (6/8), and root thickening (5/8). Gd-DTPA-enhanced MR images revealed enhancing nodules suggesting tuberculomas (2/5); enhancement of the dura-arachnoid complex around the cord (3/5); and segmental enhancement of the thoracic cord, suggesting either infarction caused by vasculitis or TB myelitis in association with diffuse cord swelling (1/5). Plain MR findings were much less conspicuous, showing only an indistinct or irregular dura-arachnoid-cord complex (4/5). In conclusion, the conventional myelographic findings are considered to be virtually diagnostic of spinal TB radiculomyelitis in young patients with antecedent or coexisting TB meningitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Computed tomography of cavernous sinus diseases

We retrospectively analyzed CT scans of 21 cavernous sinus lesions in an attempt to discover CT findings helpful to the differential diagnosis. With the integration of various CT observations it was possible to categorize the lesions into inflammatory, vascular, benign neoplastic and malignant metastatic lesions with few exceptions. Four of 5 cases of septic cavernous sinus thrombophlebitis revealed unilateral or bilateral multiple irregular filling defects in the enhancing cavernous sinus with or without orbital inflammatory change. Four of 5 cases of carotid-cavernous fistula demonstrated unilateral or bilateral diffuse bulging and homogeneous enhancement of the cavernous sinus with obliteration of normal low densities of cranial nerves and gasserian ganglion. Dilatation and tortuosity of superior ophthalmic vein were also associated. Four of 5 cases of benign neoplastic lesion showed well-circumscribed enhancing masses confined to the cavernous sinus with pressure erosion or hyperostosis of adjacent bone. Five of 6 cases of malignant metastatic lesion showed changes suggesting malignancy such as destruction of adjacent bone or associated manifestations of intracranial spread. As compared with the axial scan, coronal scans proved to be more sensitive in detection of subtle cavernous sinus expansion, and superior in evaluation of intracavernous neural structures, relationships with the pituitary gland and changes in the skull base. Axial scans, however, were superior in detection of associated orbital and intracranial abnormalities. Scans in both projections are needed in the evaluation of most cavernous sinus diseases.

Comparative evaluation of brain CT and ELISA in the diagnosis of neurocysticercosis

This study compares the results of cysticercus-specific IgG antibody levels, as measured by enzyme-linked immunosorbent assay (ELISA), with brain CT findings in suspected neurocysticercosis and to assess the clinical significance of ELISA. One hundred twenty-three neurologic patients were examined by both brain CT and ELISA. Sensitivity and specificity of ELISA in confirmed cases were 94% and 91%, respectively. Patients with multiple cysts without enhancement on CT, which were thought to represent viable cysticerci, were positive by ELISA. Those with cysts with enhancement or poorly defined low densities or enhancing nodules, which represented cysticerci on degeneration, were also positive by ELISA. Those with multiple spotty calcifications, which represent cysticerci in the inactive stage, were negative by ELISA. Those with mixed CT findings of the above, which represent the various stages of infection in a patient, were positive by ELISA. Those with only enhancing nodules with surrounding edema, which were thought to be other inflammatory granulomas, were negative by ELISA. If patients with only hydrocephalus on CT are positive by ELISA, they can be confidently diagnosed as having ventricular cysticercosis. The results indicate that ELISA is useful as a complementary diagnostic tool, especially in patients with equivocal CT findings of neurocysticercosis. Provision of etiologic information on a biologic basis was the advantage of this serologic test.

Cerebral sparganosis: CT characteristics

Cerebral sparganosis is an extremely rare parasitic zoonosis caused by a migrating plerocercoid tapeworm larva, genus Spirometra. Nineteen computed tomography (CT) scans of 12 patients with cerebral sparganosis were retrospectively analyzed and correlated with clinical and pathologic data. On CT scans, the following characteristics were noted: (a) unilateral involvement; (b) extensive or multifocal areas of low density along white matter bundles, with ipsilateral ventricular dilatation and localized cortical atrophy; (c) nodular or irregular enhancement with spotty calcification; and (d) change in location of enhancing nodules on sequential scans. These pathognomonic features reflect a chronic inflammatory process with both active granulomatous lesions and widespread degeneration of brain tissue, especially in the white matter. Degeneration is probably caused by migration of the long-surviving larva along the fiber tracts of white matter.

PSK immunotherapy in cancer patients--a preliminary report

A clinical trial was conducted by the Department of Radiation Oncology, Mackay Memorial Hospital, between 1981 and 1986, using PSK (Krestin) as an adjuvant immunotherapy to assess its potential benefit in cancer patients. The protocol called for a daily administration of 1 gram tid of PSK orally for at least a month upon completion of primary treatment for the tumor. A total of 67 patients were included in this study; 13 patients were excluded from evaluation because of noncompliance with the protocol. When three cases of toxicity were noted, PSK was discontinued for the three patients. Among the different groups of patients, nasopharyngeal carcinoma patients under PSK immunotherapy showed a significantly better survival when compared with historical controls (28% vs 17% five-year survival rate, p less than 0.05, generalized Wilcoxon test). It is therefore concluded that PSK can serve as an important adjunct in the treatment of nasopharyngeal carcinoma.

Magnetic resonance imaging in neurologic diseases--comparison with computed tomography

Magnetic resonance (MR) and computed tomography (CT) imagings were compared in 121 patients with various neurologic diseases. MR was performed with either 0.15 Tesla resistive or 2.0 Tesla superconducting systems developed by Korea Advanced Institute of Science and Technology (KAIST), using multi-slice spin echo technique with a variety of pulse sequences reflecting proton density, T1 and T2 relaxation times. MR was more advantageous in the detection of the lesions, accurate depiction of the lesion extents, and/or demonstration of anatomic details in sagittal or coronal plane in 36 of the 121 patients. These included white matter diseases, cervical cord tumors, syringomyelia, brain stem tumors, foramen magnum tumor, acute cerebellar infarction, Chiari malformation, isodense subacute subdural hematomas, cavernous hemangioma, A-V malformation with hemorrhage and some unknown pathologies. Even though 2.0T superconducting system showed greater capability of demonstrating the anatomic details and contrast discrimination between normal and abnormal tissues, the ability of MR to separate the tumor from the edema and to differentiate among different pathologic entities remained to be further evaluated. CT was superior to MR in 13 patients with acute intracranial hematomas, small calcific lesions, inflammatory granulomas or meningiomas. CT takes less time and may be preferable in very young or elderly patients. Both MR and CT gave equivalent information in the remaining patients. MR proved to complement CT in the evaluation of many disease entities and may actually supplant CT in some.

CT findings of lobar bronchioloalveolar carcinoma

The CT findings in a case of lobar bronchioloalveolar carcinoma included stretching, spreading, and uniform narrowing of the involved bronchi without obstruction.

Flow analysis with digital subtraction angiography: 2. Acquisition and accuracy of transit-flow measurements

A steady-state flow model was used to optimize methods of data analysis, to investigate variables that affect the time-density curves, and to determine the accuracy of transit-flow measurements with digital subtraction angiography. The most accurate data were obtained by using a small region of interest placed within the vessel, averaged data acquisition, and a gamma-variate fit applied to the time-density curve. The integrated area of the curve depended on the flow, vessel size, amount of iodine injected, framing rate, and the kVp. The integrated area was not affected by the mAs; the matrix size; or the volume, concentration, or rate of injection of the contrast material. Subject density, image intensifier mode, and field size did not affect the curves except for their contribution to scatter and beam hardening. There was good correlation between digital subtraction angiographic transit-flow measurements and known flow values.

Pituitary atrophy in Korean (epidemic) hemorrhagic fever: CT correlation with pituitary function and visual field

Eleven patients with Korean (epidemic) hemorrhagic fever were each studied three times with high-resolution CT in order to demonstrate necrosis of the pituitary gland and to correlate the CT findings with the patients' pituitary function and visual fields. Seven of the 11 patients showed varying degrees of progressive decrease in the height of the pituitary gland: one severe, two moderate, and four mild. The visual fields of all the patients were checked at the time of the third (last) follow-up CT. Six of the 11 patients had bitemporal superior quadrantanopsia. In five patients, the decreased height (atrophic change) of the pituitary gland and the visual-field defect were coincidental. The visual-field defects in those patients were not improved on follow-up examination 5 weeks later. Two patients in whom a 1-year follow-up examination was performed showed no interval changes in the defects. Pituitary function tests were performed in nine of the 11 patients (six with atrophic pituitary glands and three without atrophic changes) at the time of the third CT. Five of the six patients with atrophy showed decreased pituitary reserve function for follicle-stimulating hormone, cortisol, or human growth hormone, while only one patient showed decreased reserve function for cortisol among the three patients without atrophic change. The pituitary atrophic changes observed on follow-up sellar CT are thought to be the result of the ischemic necrosis of the gland. The high probability (five of seven) of visual-field defects in those patients with atrophic glands suggests optochiasmatic and pituitary ischemia as the basic pathogenesis.

Flow analysis with digital subtraction angiography: 1. Description of a simplified flow model

An inexpensive, simplified flow model for use with digital subtraction angiographic (DSA) equipment is described. System tests show that the model gives reproducible data with a standard deviation of +/- 2.6%. Flow analysis also reveals an appropriate response to flow rates of 20-240 ml per min. The flow model can be used to investigate many of the variables and sources of error in DSA flow measurements.

Sonographic evaluation of inferior vena caval obstruction: correlative study with vena cavography

Sonographic findings of obstruction of the inferior vena cava (IVC) in 14 cases are described and correlated with venographic findings. The causes of the obstruction were membrane (five cases), thrombosis (three), and intraluminal tumor invasion by hypernephroma, hepatoma, and adrenal carcinoma in six. Sonographic examination revealed highly echogenic segmental obliteration or membrane in membranous obstruction and echogenic intraluminal mass in thrombotic occlusion. Absence of an identifiable patent lumen in a technically satisfactory study was another finding in thrombotic obstruction. On real-time sonograms, the normal respiratory changes of the IVC were absent when there was complete occlusion. Transhepatic collaterals, patency of other segments of the IVC, and associated malignancy were additional sonographic findings. Comparison to venography suggested that in addition to ease and safety, sonography has advantages in delineation of the cephalad extent of occlusion, dynamic evaluation of the IVC below the obstruction, and the simultaneous evaluation of adjacent organs.

Leigh's subacute necrotizing encephalomyelopathy: possible diagnosis by CT scan

A 28-month-old Korean girl developed a rapidly progressive disease, characterized by disturbance of consciousness, tremor, nystagmus, ophthalmoplegia, irregular deep respiration and vomiting. The patient succumbed 2 weeks after the onset of the illness. CT scan disclosed bilaterally symmetrical, low density lesions in the white matter and lateral basal ganglia. Distinctive histopathological findings at postmortem included spongiotic necrosis of the neuropil, marked capillary vascularity, persistence of relatively normal neurons in severely damaged zones, and comparatively little astrocytosis. The bilaterally symmetrical distribution of these changes in the putamen and periaqueductal gray matter of the midbrain were compatible with Leigh's disease.

Hepatic, gut, and renal substrate flux rates in patients with hepatic cirrhosis

The roles of liver, kidney, and gut in maintaining fuel homeostasis were studied in 28 patients with severe hepatic cirrhosis, 25 of whom had alcohol-induced cirrhosis. Hepatic, portal, and renal blood flow rates were measured and combined with substrate concentration differences across liver, gut, and kidney to calculate the net flux of free fatty acids, ketone bodies, triglycerides, and glucose with selected glucose precursors, including glycerol, lactate, pyruvate, and amino acids. Data from the catheterization studies were related to hepatic histology, glycogen content, and activities of gluconeogenic enzymes and compared with data obtained from control patients. The effects of food deprivation on net flux of fuels across the liver, gut, and kidney were assessed after overnight and after 3d of fasting. Activities of gluconeogenic enzymes were normal, but hepatic glycogen content was diminished in cirrhotic livers, probably as a consequence of extensive hepatic fibrosis. Extrahepatic splanchnic tissues (gut) had only a small influence on total splanchnic flux rates of carbohydrates, lipids and, amino acids. In cirrhotic patients, there was no mean renal glucose contribution to the bloodstream after an overnight or after a 3-d fast. After an overnight fast hepatic glucose production in patients with cirrhosis was diminished as a result of low-rate glycogenolysis. Hepatic gluconeogenesis and ketogenesis were increased. This pattern of hepatic metabolism mimics that seen in "normal" patients after more advanced stages of starvation. After 3 d of starvation, patients with hepatic cirrhosis have hepatic gluconeogenic and ketogenic profiles comparable to those of normal patients undergoing starvation of similar duration. Nevertheless, the total number of caloric equivalents derived from ketone bodies plus glucose corrected for recycled lactate and pyruvate added to the bloodstream by the cirrhotic livers that could be terminally oxidized by peripheral tissues was less than the contributions made by the normal livers, both after and overnight and after a 3-d fast.

The mechanism of postshunt liver failure

To determine the influence on postoperative hepatic mass, body weight, ammonia clearance, hepatic urea cycle enzyme activity, and hepatic protein metabolism, 59 dogs were divided into six experimental groups: sham operation end-to-side portacaval shunt, mesocaval shunt with subsequent end-to-side portacaval shunt, distal splenorenal shunt, caval left portal shunt, and portal venous seqregation with juglar vein interposition. Compared to total shunt, selective diversion of portal blood from the liver produces less postshunt liver atrophy, less body weight loss, improved maintenance of urea cycle enzyme activity, improved ammonia tolerance, and less decrease in hepatic deoxyribonucleic acid (DNA), ribonucleic acid (RNA), and protein content. Segregation of left from right hepatic lobes, in relationship to portal or systemic venous hepatic perfusion or in relationship to gastroduodenopancreaticosplenic or intestinal portal venous drainage, caused little change in enzyme or protein metabolism in respective hepatic lobes.

A scanning and transmission electron microscope study of the luminal coating on Dacron prostheses in the canine thoracic aorta

The sequence of events occurring in a woven Dacron bypass in the canine thoracic aorta was followed from the first exposure to flowing blood for a period of 27 months. After 10 and 40 minutes exposure to flowing blood the surface was covered with masses of leukocytes, platelets, red cells, and some fibrin. By 24 and 48 hours most of the leukocytes had disappeared leaving the two end areas of the bypass covered with a thick film composed of red cells entrapped in a fibrin net. In the central portion of the bypass the Dacron fibers were covered by a rough film of particulate material and widely spaced clumps of platelets and occasional leukocytes connected by a few fibrin strands. AT 6 AND 7 DAYS THE SURFACE COVERING CONSISTED PRIMARILY OF RED CELLS AND FIBRIN. Between 2 and 8 weeks this was replaced by a matrix that was composed mostly of cells resembling fibroblasts or transition forms between these and smooth muscle cells. Some typical smooth muscle cells were observed in grafts 4 months or older. A sheet of flat cells had grown a few millimeters below the anastomoses at 7, 12, and 14 months. By 27 months the entire length of the graft had a patchy covering of endothelium. Only occasional isolated platelets were stuck to the exposed collagen. Thickening of the intraprosthetic lining was associated with infiltration of the cell-fiber matrix by masses of red cells. Thus it appears that under proper conditions of flow, thrombogenic surfaces such as Dacron and collagen are "conditioned" to become nonthrombogenic by the limited deposition of blood elements.