Ba2+ does not support synaptic vesicle retrieval in rat cerebrocortical synaptosomes

To investigate whether any specific requirement for extracellular Ca2+ exists in the control synaptic vesicle retrieval, we examined the ability of the divalent cation Ba2+ to substitute for Ca2+ in both vesicle exocytosis and endocytosis. Ba2+ stimulated glutamate release from rat cerebrocortical synaptosomes. Ba2+-evoked release was inhibited by bafilomycin A1, indicating release was via exocytosis of synaptic vesicles. However, Ba2+ did not stimulate vesicle retrieval, monitored by a FM2-10-based retrieval assay. Therefore synaptic vesicle retrieval in central nerve terminals has a specific requirement for extracellular Ca2+ and the Ca2+ receptor for retrieval has a different cation specificity to the Ca2+ receptor for exocytosis.

Tension pneumothorax secondary to grass head aspiration

Aspiration of inflorescence or grass heads (seed head of grasses) often presents with atypical signs and symptoms because grass heads have a tendency to rapidly migrate to the periphery of the lung. If this is not recognized, it can lead to delay in diagnosis and serious complications. Removal with rigid bronchoscopy maybe difficult, and surgery is often needed. We report a case of a seven-month-old child who had a delayed diagnosis of grass head aspiration and subsequently presented with a life threatening tension pneumothorax. This case highlights the importance of obtaining a detailed history in cases of foreign body aspiration and the need to include it in the differential diagnosis of unexplained respiratory symptoms, especially those of sudden onset in children.

Staging lymphoma with CT: comparison of contiguous and alternate 10 mm slice techniques

PURPOSE

To compare two computed tomography (CT) techniques, contiguous 10 mm and alternate 10 mm slices of the chest, abdomen and pelvis, for initial staging of lymphoma.

SUBJECTS AND METHODS

Fifty-two consecutive patients referred at initial diagnosis for lymphoma staging by CT were examined with contiguous 10 mm slices of the chest, abdomen and pelvis. Oral contrast was administered, but no intravenous contrast. Two sets of films for each examination were printed, one with 10 mm contiguous slices and one with 10 mm alternate slices. The two sets of films for each patient were reviewed separately in a randomized order and blinded fashion by two independent observers. Discrepancies were reviewed by a third observer and subsequently resolved by consensus.

RESULTS

Staging assessments by both techniques were concordant in 51 of 52 cases: one patient was recorded as stage II on the alternate slice technique, but stage III with contiguous slices but this difference did not affect management. Inter-technique agreement was very good (kappa=0.97). The staging assessments showed discrepancies between the two observers in 12 of the 52 cases which were independent of technique (kappa=0.71; good agreement). Consensus review showed them to result from differences in perception in seven cases and differences in interpretation of abnormalities in five cases.

CONCLUSION

Our findings support the use of an alternate 10 mm slice technique in the staging of lymphoma at initial diagnosis. Observer variation was greater than the difference between techniques.

Maturation of Qa-1b class I molecules requires beta 2-microglobulin but is TAP independent

Two conformationally distinct and stable forms of Qa-1b, one strongly associated with beta 2-microglobulin (beta 2m) and the other associated with a novel molecule, gp44, were observed during immunochemical studies on the expression of Qa-1b molecules in mouse spleen cells. Both forms are efficiently processed and expressed at the cell surface. However, a large proportion of Qa-1b was found to be disulfide linked to gp44 without any detectable beta 2m. In TAP1-deficient mice, both forms undergo carbohydrate processing and are expressed on the cell surface, suggesting that they may traffic using a pathway not requiring a TAP association step. Consistent with this, size exclusion chromatography of newly synthesized class I molecules shows that high molecular mass complexes containing H-2Kk do not contain Qa-1b. Although Qa-1b can be stably expressed without beta 2m, there was no maturation of either form in cells from beta 2m-deficient mice where heavy chains were rapidly degraded. These results suggest that Qa-1b, like most other class I molecules, requires beta 2m for an initial folding step. However, beta 2m is not essential for subsequent processing of Qa-1b molecules.

Maturation of Qa-1b Class I Molecules Requires β2-Microglobulin But Is TAP Independent

Two conformationally distinct and stable forms of Qa-1b, one strongly associated with β2-microglobulin (β2m) and the other associated with a novel molecule, gp44, were observed during immunochemical studies on the expression of Qa-1b molecules in mouse spleen cells. Both forms are efficiently processed and expressed at the cell surface. However, a large proportion of Qa-1b was found to be disulfide linked to gp44 without any detectable β2m. In TAP1-deficient mice, both forms undergo carbohydrate processing and are expressed on the cell surface, suggesting that they may traffic using a pathway not requiring a TAP association step. Consistent with this, size exclusion chromatography of newly synthesized class I molecules shows that high molecular mass complexes containing H-2Kk do not contain Qa-1b. Although Qa-1b can be stably expressed without β2m, there was no maturation of either form in cells from β2m-deficient mice where heavy chains were rapidly degraded. These results suggest that Qa-1b, like most other class I molecules, requires β2m for an initial folding step. However, β2m is not essential for subsequent processing of Qa-1b molecules.

Assessment of resectability of pancreatic cancer with dynamic contrast-enhanced MR imaging: technique, surgical correlation and patient outcome

The aim of our work was to investigate the use of a dynamic contrast-enhanced MR (DCEMR) technique for staging apparently localised pancreatic cancer, and to determine the patterns of tumour and vascular enhancement with this technique. Thirty-five consecutive patients were examined. The MR findings were correlated with surgical findings in 13 patients and with clinical outcome in 22 patients. Breath-hold gradient-echo fast low angle shot (TR = 100, TE = 4, flip angle 80 degrees ) acquisitions were obtained at 10 and 40 s (right anterior coronal oblique plane) and at 90 s (axial plane) following intravenous gadolinium. Mean contrast-to-noise ratio was higher on the first than the second acquisition (p < 0. 001) and higher on the second acquisition than the third (p < 0.005). Tumour conspicuity was greatest and arterial anatomy was best demonstrated on the first acquisition and the portal venous anatomy on the second. Small tumours were isointense by the third acquisition. Maximal intensity projections were helpful. The MR findings correctly predicted the surgical findings in 11 of 13 cases (85 %) and the clinical course in the other 22 patients. The DCEMR imaging technique is valuable in the staging of patients with pancreatic cancer. Capillary and portal venous phase images are both required for complete local staging.

A six-month clinical comparison of the efficacy of the Sonicare and the Braun Oral-B electric toothbrushes on improving periodontal health in adult periodontitis patients

A sonic electric toothbrush (Sonicare) and an oscillating/rotating electric brush (Braun Oral-B) were compared for efficacy in removing supragingival plaque, reducing gingival inflammation, reducing probing pocket depth (Pd) and improving probing attachment levels (PAL) in a 6-month, single-blind clinical trial. Sixty-six adults with early-moderate periodontitis (5-7 mm Pd in at least two quadrants) entered the study, and 54 completed the entire study. The Sonicare and Braun groups were equally matched for plaque scores, and balanced for age, race and gender. Plaque was scored using the Turesky, Gilmore and Glickman Index. Gingival inflammation was determined by the Papillary Bleeding Score (PBS) of Loesche. Probing depths and attachment levels were determined using a manual North Carolina probe. All measurements were recorded at baseline, 2, 4 and 6 months. The mean overall plaque scores improved in both the Sonicare and the Braun groups at each of the follow-up visits. Interproximal plaque scores also improved in both groups with time, and the mean differential Sonicare post-brushing score was significantly better than the Braun at the 6-month visit (t-test; p = 0.039). Gingival inflammation also decreased in both groups over the 6-month period, but the Sonicare group showed significantly superior PBS scores at 4 months (t-test; p = 0.002) and 6 months (p = 0.005). The percentage reduction in inflammation from baseline at 6 months was 31.9% for Sonicare and 18.1% for Braun. Probing depth scores followed a similar pattern, with the Sonicare showing a mean reduction of 0.84 mm (15.8%) from baseline at 6 months, and Braun showing a 0.39 mm (7.2%) reduction (p = 0.002). In the Sonicare group probing attachment levels improved by 8.6% (MANOVA; p = 0.01), but no PAL improvement was seen in the Braun group. Overall, this study demonstrates that long-term use of these two electric toothbrushes improves periodontal health in adult periodontitis patients, and that the Sonicare brush is superior to the Braun brush in reducing gingival inflammation and probing depth. Moreover, 6 months' use of Sonicare led to actual improvement in probing attachment levels of periodontal pockets.

Atrial natriuretic peptide, cyclic GMP analogues and modulation of guanylyl cyclase do not alter stimulated POMC peptide release from perifused rat or sheep corticotrophs

Corticotrophin-releasing hormone (CRH) and arginine vasopressin (AVP) are two potent stimulators for secretion of proopiomelanocortin (POMC)-derived hormones, from corticotrophs. CRH also stimulates POMC synthesis. Atrial natriuretic peptide (ANP) has been reported to inhibit POMC peptide release and is thought to act through cGMP signalling pathways. A multicolumn cell perifusion system was used to investigate the role of cGMP signalling pathways in CRH- and AVP-stimulated POMC peptide release from primary cultures of ovine or rat anterior pituitary cells. The CRH and/or AVP stimulations were applied at 30 min intervals as 5 min pulses, and the various treatments were infused over a period of 50 min, overlapping with 2 of the stimulations. ANP (10 nM) had no effect on beta-endorphin (betaEP) release from ovine cells, stimulated by 0.5 nM CRH and 5 nM AVP together, or 5 nM CRH and 50 nM AVP separately. Rat anterior pituitary cells were stimulated with 0.05 nM CRH/0.5 nM AVP or 0.5 nM CRH/5 nM AVP and treated with 1 nM or 10 nM ANP, respectively. No inhibition of ACTH or betaEP was observed. Similarly, the nitric oxide donors molsidomine (100 microM), SIN-1 (100 microM) and NaNO2 (100 microM) did not inhibit betaEP release stimulated by 0.5 nM CRH/5 nM AVP in ovine cells. The cGMP analogues 8-bromo-cGMP (10 microM and 100 microM) and dibutyryl cGMP (100 microM) also had no effect on betaEP and ACTH release from ovine or rat anterior pituitary cells. Dexamethasone (8 microM), a synthetic glucocorticoid known to block POMC synthesis and secretion of betaEP and ACTH by a distinct mechanism, was used as a control and suppressed CRH/AVP-stimulated betaEP secretion from ovine anterior pituitary cells. These results contrast with some previous studies and demonstrate that the cGMP signalling pathway in sheep or rat anterior pituitary cells does not directly inhibit secretion of POMC-derived hormones from corticotrophs.

Radiology's Achilles' heel: error and variation in the interpretation of the Röntgen image

The performance of the human eye and brain has failed to keep pace with the enormous technical progress in the first full century of radiology. Errors and variations in interpretation now represent the weakest aspect of clinical imaging. Those interpretations which differ from the consensus view of a panel of "experts" may be regarded as errors; where experts fail to achieve consensus, differing reports are regarded as "observer variation". Errors arise from poor technique, failures of perception, lack of knowledge and misjudgments. Observer variation is substantial and should be taken into account when different diagnostic methods are compared; in many cases the difference between observers outweighs the difference between techniques. Strategies for reducing error include attention to viewing conditions, training of the observers, availability of previous films and relevant clinical data, dual or multiple reporting, standardization of terminology and report format, and assistance from computers. Digital acquisition and display will probably not affect observer variation but the performance of radiologists, as measured by receiver operating characteristic (ROC) analysis, may be improved by computer-directed search for specific image features. Other current developments show that where image features can be comprehensively described, computer analysis can replace the perception function of the observer, whilst the function of interpretation can in some cases be performed better by artificial neural networks. However, computer-assisted diagnosis is still in its infancy and complete replacement of the human observer is as yet a remote possibility.

Okadaic acid interferes with phorbol-ester-mediated down-regulation of protein kinase C-alpha, C-delta and C-epsilon

A prolonged cell exposure of all examined cell types to tumour-promoting phorbol esters leads to a substantial inactivation and degradation of protein kinase C (PKC), a phenomenon known as down-regulation. With a combination of one- and two-dimensional immunoblot analyses we have previously shown the existence in PC12 cells of distinct PKC-alpha forms that differentially respond to cell treatment with phorbol ester [Gatti, A. & Robinson, P. J. (1996) J. Biol. Chem. 271, 31 718-31722]. Using the same experimental model, in the present study we investigated a possible relationship between PKC-alpha phosphorylation and its down-regulation. The exposure of PC12 cells to okadaic acid, a potent inhibitor of biologically relevant protein phosphatases, was found to partially protect PKC-alpha against phorbol-ester-mediated down-regulation. Further, a similar protective effect of okadaic acid was observed for PKC-delta and PKC-epsilon, which are also expressed in PC12 cells. These results indicate that the tumour-promoting activity of okadaic acid itself may be due to a sustained phosphorylation of PKC.

Allergic sensitization increases airway reactivity in guinea pigs with respiratory syncytial virus bronchiolitis

BACKGROUND

Respiratory syncytial virus (RSV) causes acute bronchiolitis in children and has been implicated in the pathogenesis of recurrent wheezing and asthma. However, few children exposed to RSV experience acute bronchiolitis or its sequelae, suggesting a subgroup of susceptible children. An allergic diathesis may predispose children to subsequent airway disease.

OBJECTIVE

This study was carried out to determine whether a preexisting allergic state, induced by repeated inhalational exposures to ovalbumin, potentiates nonspecific airway responsiveness to acetylcholine and increases airway inflammation during acute RSV bronchiolitis in guinea pigs.

METHODS

Forty guinea pigs were randomized into four groups: nonsensitized, noninfected (ovalbumin-, RSV-); sensitized, noninfected (ovalbumin+, RSV-); nonsensitized, infected (ovalbumin-, RSV+); sensitized, infected (ovalbumin+, RSV+). Depending on grouping, animals were exposed to either repeated aerosols of ovalbumin or saline solution and were subsequently inoculated with either human RSV or uninfected culture medium. Six days after inoculation, animals underwent acetylcholine challenge, and lung specimens were prepared for histologic scoring of airway inflammation.

RESULTS

Maximal increases in pulmonary resistance (centimeters of water per milliliter per second) to acetylcholine were greater for RSV alone (12.4 +/- 3.9) and ovalbumin alone (13.7 +/- 3.9) compared with controls (4.3 +/- 1.1), but significantly greater increases occurred in ovalbumin+, RSV+ animals (34.0 +/- 11.0). These ovalbumin+, RSV+ animals demonstrated the combined histologic changes noted with RSV alone and ovalbumin alone including airway epithelial necrosis, mononuclear and granulocyte infiltrates, airway wall edema, hyperplasia of bronchus-associated lymphoid tissue, and goblet cell metaplasia.

CONCLUSION

Prior allergic sensitization potentiates the physiologic and structural changes induced by acute RSV bronchiolitis. These results suggest that an allergic diathesis may increase the severity of RSV infections in children.

Qa-1 interaction and T cell recognition of the Qa-1 determinant modifier peptide

The peptide-binding properties of the nonclassical major histocompatibility complex (MHC) class 1b molecule Qa-1 were investigated using a transfected hybrid molecule composed of the alpha 1 and alpha 2 domains of Qa-1b and the alpha 3 domain of H-2Db. This allowed the use of a monoclonal antibody directed against H-2Db whilst retaining the peptide-binding groove of Qa-1b. By comparison with classical MHC class I molecules, intracellular maturation of the chimeric molecule was inefficient with weak intracellular association with beta 2-microglobulin. However, at the cell surface the hybrid molecules were stably associated with beta 2-microglobulin and were recognized by cytotoxic T lymphocyte (CTL) clones specific for the Qa-1b-presented peptide Qdm (AMAPRTLLL). A whole-cell binding assay was used to determine which residues of Qdm were important for binding to Qa-1b and CTL clones served to identify residues important for T cell recognition. Substitutions at position 1 and 5 did not reduce the efficiency of binding and had little effect on CTL recognition. In contrast, substitutions at position 9 resulted in loss of MHC class I binding. Mass spectrometric analysis of peptides eluted from immunopurified Qa-1b/Db molecules indicated that Qdm was the dominant peptide. The closely related peptide, AMVPRTLLL, which is derived from the signal sequence of H-2Dk, was also present, although it was considerably less abundant. The mass profile suggested the presence of additional peptides the majority of which consisted of eight to ten amino acid residues. Finally, the finding that a peptide derived from Klebsiella pneumoniae can bind raises the possibility that this non-classical MHC class I molecule may play a role in the presentation of peptides of microorganisms.

Root planing following short-term pocket distention

This study evaluated the effectiveness of root planing following short-term pocket distention. Seventy-five single-rooted teeth with probing depths > or = 5 mm and < or = 10 mm were selected. The teeth were randomly divided into three treatment groups. In groups 1 and 2 a gingival retraction cord (aluminum sulfate-impregnated in group 1 and non-impregnated cord in group 2) was packed subgingivally for 30 minutes. Following removal of the cord, the teeth were scaled and root planed. In group 3 the teeth were root planed only. Following instrumentation, the teeth were extracted and examined under a stereomicroscope. The residual calculus on the root surface of each tooth was measured using a computerized image analysis system. The quantities were compared using a two-way ANOVA and Chi-square test. The results showed that 46.3% of all root surfaces had detectable residual calculus and that the mean percentage of residual calculus per root surface was 4.41% following root planing. Forty percent of the root surfaces in group 1 had residual calculus, 38.0% in group 2, and 61.0% in group 3. There was a statistically significant difference (P < 0.01) between groups 1 and 2 compared to group 3. The mean calculus per root surface for groups 1, 2, and 3 was 3.03%, 3.04%, and 7.15%, respectively. Significant differences (P < 0.005) were found between groups 1 and 2 compared to group 3. These results indicate that subgingival calculus removal in deep pockets is enhanced with short-term pocket distention, and that there is no added benefit to having aluminum sulfate present in the retraction cord.

Hepatic lesion detection at MR imaging: a comparative study with four sequences

PURPOSE

To compare results with the following magnetic resonance (MR) imaging sequences in the detection of focal hepatic lesions: fast spin-echo (SE) before and after administration of superparamagnetic iron oxide (SPIO) particles, fat-suppressed T2-weighted SE, and dynamic gadolinium-enhanced fast low-angle shot (FLASH).

MATERIALS AND METHODS

In 26 patients with known malignancy and documented focal liver lesions, 1.0-T MR imaging was performed prior to hepatic resection. All images were reviewed independently by four blinded observers. Sensitivity was calculated for each sequence and for each observer by means of alternative-free-response receiver operating characteristic (ROC) methods.

RESULTS

The mean area under the alternative-free-response ROC curve with SPIO-enhanced fast SE (0.85) was significantly greater (P < .02) than that with all other sequences. Detection was significantly improved with SPIO-enhanced fast SE compared with dynamic gadolinium-enhanced FLASH (which was the best of the other three sequences) for all lesions (P < .002) and for malignant lesions (P < .0002).

CONCLUSION

Findings with the SPIO-enhanced fast SE sequence improved detection of focal liver lesions and had the highest diagnostic accuracy.

HIP1 propagates in cyanobacterial DNA via nucleotide substitutions but promotes excision at similar frequencies in Escherichia coli and Synechococcus PCC 7942

The sequence 5'-GCGATCGC-3', designated HIP1, for highly iterated palindrome, was first identified at the borders of a gene-deletion event and subsequently shown to constitute up to 2.5% of the DNA in some cyanobacteria. It is now reported that HIP1 is polyphyletic, occurring in several distinct cyanobacterial lineages and not defining a clade. HIP1 does not introduce gaps into sequence alignments. It aligns with partial HIP1 sites in related sequences showing that it propagates by nucleotide substitutions rather than insertion. Constructs have been created to determine the frequencies at which deletion events occur between palindromes located within the selectable marker neo. Deletion between HIP1 sites was more frequent in Synechococcus PCC 7942 than deletion between control palindromes, 5'-CCGATCGG-3', designated PAL0. However, this is not due to a recombinase that recognises HIP1 and is peculiar to cyanobacteria because similar deletion frequencies were detected in Escherichia coli. Furthermore, the frequency of deletion of DNA flanked asymmetrically by one HIP1 site and one PAL0 site was less than the frequency of deletion of DNA flanked asymmetrically by identical copies of either palindrome. This is consistent with deletion by copy-choice.

Phosphorylation of the NC-1.1 receptor and regulation of natural cytotoxicity by protein kinase C and cyclic GMP-dependent protein kinase

Natural cytotoxicity (NC) against cancer involves receptor-ligand interactions between lymphohemopoietic cells that mediate NC against tumor cells. The only candidate for a receptor on cells mediating NC is NC-1.1, identified using mAb 1C4. In this study we showed that mAb 1C4 blocked NC-1.1+ cell conjugation to WEHI-164 tumor cells, indicating that NC-1.1 is a surface protein required for cell-cell interaction. Affinity-purified NC-1.1 was a 45-kDa monomeric protein. It was a good in vitro substrate for cyclic GMP (cGMP)-dependent protein kinase (PKG) and protein kinase C (PKC) and a relatively poor substrate for cAMP-dependent protein kinase (PKA). Phosphopeptide mapping revealed one phosphopeptide phosphorylated by PKG and PKA, and two additional peptides phosphorylated by PKC. Phosphorylation by PKG or PKA abolished phosphorylation at the PKC sites, while coincubation of NC-1.1 with both PKG and PKC reduced phosphorylation of all sites. NC-1.1 was also a phosphoprotein after immunoprecipitation from intact spleen cells and its phosphorylation was increased after cell stimulation with PKC or PKG activators (phorbol esters or 8-bromo-cGMP). The possible consequences of intracellular signaling were tested in functional assays for NC. Phorbol ester activation of spleen cells increased NC, while 8-bromo-cGMP and 8-bromo-cAMP had little effect. However, coincubation with both phorbol ester and either 8-bromo-cGMP or 8-bromo-cAMP virtually abolished NC without affecting cell conjugation. These results suggest that NC-1.1 is a receptor for a ligand on certain tumor cells and reveal that key intracellular signaling pathways involving PKC, PKG, and PKA interact to effect a coordinated control of NC.

Phosphorylation of the NC-1.1 receptor and regulation of natural cytotoxicity by protein kinase C and cyclic GMP-dependent protein kinase

Natural cytotoxicity (NC) against cancer involves receptor-ligand interactions between lymphohemopoietic cells that mediate NC against tumor cells. The only candidate for a receptor on cells mediating NC is NC-1.1, identified using mAb 1C4. In this study we showed that mAb 1C4 blocked NC-1.1+ cell conjugation to WEHI-164 tumor cells, indicating that NC-1.1 is a surface protein required for cell-cell interaction. Affinity-purified NC-1.1 was a 45-kDa monomeric protein. It was a good in vitro substrate for cyclic GMP (cGMP)-dependent protein kinase (PKG) and protein kinase C (PKC) and a relatively poor substrate for cAMP-dependent protein kinase (PKA). Phosphopeptide mapping revealed one phosphopeptide phosphorylated by PKG and PKA, and two additional peptides phosphorylated by PKC. Phosphorylation by PKG or PKA abolished phosphorylation at the PKC sites, while coincubation of NC-1.1 with both PKG and PKC reduced phosphorylation of all sites. NC-1.1 was also a phosphoprotein after immunoprecipitation from intact spleen cells and its phosphorylation was increased after cell stimulation with PKC or PKG activators (phorbol esters or 8-bromo-cGMP). The possible consequences of intracellular signaling were tested in functional assays for NC. Phorbol ester activation of spleen cells increased NC, while 8-bromo-cGMP and 8-bromo-cAMP had little effect. However, coincubation with both phorbol ester and either 8-bromo-cGMP or 8-bromo-cAMP virtually abolished NC without affecting cell conjugation. These results suggest that NC-1.1 is a receptor for a ligand on certain tumor cells and reveal that key intracellular signaling pathways involving PKC, PKG, and PKA interact to effect a coordinated control of NC.

Cyclic GMP-dependent protein kinase and cellular signaling in the nervous system

Nitric oxide (NO) and natriuretic peptide hormones play key roles in a surprising number of neuronal functions, including learning and memory. Most data suggest that they exert converging actions by elevation of intracellular cyclic GMP (cGMP) levels through activation of soluble and particulate guanylyl cyclases. However, cGMP is only the starting point for multiple signaling cascades, which are now beginning to be defined. A primary action of elevated cGMP levels is the stimulation of cGMP-dependent protein kinase (PKG), the major intracellular receptor protein for cGMP, which phosphorylates substrate proteins to exert its actions. It has become increasingly clear that PKG mediates some of the neuronal effects of cGMP, but how is not yet clear. One clear illustration of this pathway has been reported in striatonigral nerve terminals, where NO mediates phosphorylation of the protein phosphatase regulator dopamine- and cyclic AMP-regulated phosphoprotein having a molecular mass of 32,000 (DARPP-32) by PKG. There are remarkably few PKG substrates in brain whose identities are known. A survey of these proteins and those known from other tissues that might also be found in the nervous system reveals the key molecular sites where cGMP and PKG signaling is likely to be regulating neural function. These potential substrates are critically placed to have profound effects on the protein phosphorylation network through regulation of protein phosphatases, intracellular calcium levels, and the function of many ion channels and neurotransmitter receptors. The brain also contains a rich diversity of specific PKG substrates whose identities are not yet known. Their future identification will provide exciting new leads that will permit better understanding of the role of PKG signaling in both basic and higher orders of brain function.

T2-weighted and dynamic enhanced MRI in acute pancreatitis: comparison with contrast enhanced CT

The purpose of this study was to compare T2-weighted and dynamic contrast enhanced MRI with contrast enhanced CT in patients with severe acute pancreatitis. Thirty-two patients were examined using axial T2-weighted spin-echo imaging (TR 1801, TE 15/90) and a multi-slice rapid gradient-echo sequence (TR 135, TE 4, FA 80 degrees) (FLASH) in axial and coronal planes. Fifteen 5 mm axial slices at 10 mm intervals were acquired during a single breath-hold of 19 s before, and at 10 and 40 s after a bolus injection of Gd-DTPA. Additional FLASH images in the coronal plane were obtained 2 min after injection of contrast medium. MR was compared with contemporary enhanced CT by two blinded observers who scored pancreatic viability and the content of intra and extra-pancreatic fluid collections. The presence of gas, calcification and haemorrhage was noted. Abnormalities in adjacent organs, evidence of vascular occlusion and indicators of aetiology were also recorded. MR and CT were concordant in distinguishing viable pancreatic tissue from areas of necrosis. MR appeared to be more effective than CT in characterizing the content of fluid collections and in demonstrating gall stones, although CT remains superior in detecting flecks of gas and calcification. MR carries some advantages over CT and can be regarded as an alternative primary technique in patients with severe pancreatitis.

Anatomy of the arterial supply to the liver demonstrated by MRI

The aim of this study was to establish the accuracy of dynamic contrast-enhanced magnetic resonance imaging (DCEMRI) in assessing the site of origin and the patency of the hepatic arteries. Sixty-one patients were examined with serial DCEMRI. MRI was performed at 1.0 T with a rapid multi-section breath-hold fast low-angle shot (FLASH) technique in the coronal oblique plane before and at 10, 40 and 70 s after a bolus of gadolinium-DTPA. The hepatic, left gastric, gastroduodenal, splenic and superior mesenteric arteries were examined. The main portal vein, its right and left intrahepatic divisions, and the splenic and superior mesenteric veins were also assessed. The common hepatic artery was occluded in one patient. The right hepatic artery was seen in 59 patients, left hepatic in 54, left gastric in 43, gastroduodenal in 54, splenic in 60 and superior mesenteric artery in 61. Results were concordant with surgery in 38 of 39 cases and with X-ray angiography in 21 of 22 cases. In the detection of aberrant vessels DCEMRI had a sensitivity of 89 %, a specificity of 100 % and an accuracy of 97 %. All five veins were occluded in 1 patient. The main portal vein was patent in 56 patients, occluded in 2 and narrowed in 2. Thirty-two patients had upper abdominal varices. It is concluded that DCEMRI with sequential imaging provides a non-invasive demonstration of hepatic arterial and venous structures.

Pseudolipoma of inverted Meckel's diverticulum: clinical, radiological and pathological correlation

Three cases of isolated inverted Meckel's diverticulum are described. In two cases an initial pathological diagnosis of small bowel lipoma was suggested. In a third case central fat was demonstrated on CT and peristalsis of the intraluminal polypoid mass was observed during US examination. In all three cases small bowel enema examination demonstrated the lesion. Correlation of the clinical, radiological and pathological features is emphasised, as this will allow the correct diagnosis.

Comparison of dynamic contrast enhanced MRI and Doppler ultrasound in the pre-operative assessment of the portal venous system

The purpose of this study was to compare dynamic contrast enhanced MRI (DCEMR) with Doppler ultrasound (US) in the assessment of portal venous anatomy and to analyse the causes of discrepancy. Over a 1 year period, 97 patients undergoing assessment prior to hepatic surgery underwent imaging of the liver and portal venous system using US with colour and spectral Doppler and MRI with axial T2 weighted spin echo (SE) and coronal oblique T1 weighted rapid gradient echo (GRE) imaging before and immediately after bolus injection of Gd-DTPA (0.1 mmol kg-1). When the US and MRI findings were discrepant, the images were reviewed by two observers and compared with surgical findings. US and DCEMR were concordant in 90 patients (portal vein patent in 80, occluded in 10). In three patients with cirrhosis and gross ascites the portal vein was reported as occluded on US and patent on MRI; surgery confirmed the MRI findings. In one patient the portal vein was patient on US but not on MRI, but there was a 3 week interval between the examinations. In three patients the portal vein was patent on US, but MRI detected occlusion of intrahepatic portal vein branches in two, and encasement of an intrahepatic branch in the third case. Spontaneous splenorenal shunts were seen in 15 patients only on MRI; varices were seen in 39 patients on MRI and in 22 patients on US. Both US and DCEMR contribute to the pre-operative assessment of the portal venous system. MRI provides additional information over US in assessing intrahepatic portal branches and detecting varices and splenorenal shunts, and is recommended for all surgical candidates and in patients with abnormal portal venous anatomy and equivocal US findings.