A probable relationship between an endogenous digitalis-like substance and concentric cardiac hypertrophy in primary aldosteronism

A 44-year-old woman was admitted to our hospital due to severe hypertension. An electrocardiogram (ECG) and an echocardiogram showed severe left ventricular hypertrophy. Her plasma aldosterone level was elevated. Magnetic resonance imaging revealed a small mass in the right adrenal gland. Before removal of the tumor, plasma endogenous digitalis-like substance (EDLS) levels were elevated. After removal of the tumor, EDLS levels quickly returned to the normal level. A series of echocardiograms and ECGs over a 6- year period after removal of the tumor showed marked regression of cardiac hypertrophy. These findings suggest that EDLS may be closely related to the development of concentric cardiac hypertrophy in primary aldosteronism.

Role of platelet-activating factor acetylhydrolase gene mutation in Japanese childhood IgA nephropathy

Platelet-activating factor (PAF) is a potent mediator of inflammatory injury in renal diseases. PAF is degraded to inactive products by PAF acetylhydrolase. Recently, a point mutation (G to T transversion) of the PAF acetylhydrolase gene was observed at position 994, and this mutation was found to contribute to the variability in plasma PAF levels, with undetectable plasma PAF acetylhydrolase activity occurring in homozygous patients (TT genotype) and reduced levels of activity in heterozygous patients (GT genotype). Therefore, we investigated the effect of the PAF acetylhydrolase gene mutation on the pathogenesis and progression of immunoglobulin A (IgA) nephropathy. Genomic DNA was obtained from 89 children with IgA nephropathy and 100 controls. We identified the PAF acetylhydrolase gene mutation (G994T) by polymerase chain reaction. There was no significant difference in genotypic frequency between patients and controls. However, urinary protein excretion at the time of biopsy was significantly greater in patients with the GT/TT genotypes than in those with the GG genotype. The percentage of glomeruli with mesangial cell proliferation was significantly greater in patients with the GT/TT genotypes than in those with the GG genotype. These results indicate the PAF acetylhydrolase gene mutation may influence the degree of proteinuria and the extent of mesangial proliferation in the early stage of childhood IgA nephropathy.

Six new taxane diterpenoids from the seeds of taxus chinensis var. mairei and taxus yunnanensis

Six new taxane diterpenoids and three known 2(3-->20)abeotaxoids were isolated from the seeds of Taxus chinensis var. mairei and of Taxus yunnanensis. Their structures were established as 2alpha, 20-dihydroxy-9alpha-acetoxytaxa-4(20),11-dien-13-one (1), 5alpha-cinnamoyloxy-7beta,10beta, 13alpha-triacetoxy-2(3-->20)abeotaxa-2alpha-ol-4(20),11-dien-9-one (2), 5alpha-cinnamoyloxy-10beta, 13alpha-diacetoxy-2(3-->20)abeotaxa-2alpha,7beta-diol-4(20), 11-dien-9-one (3), 5alpha-cinnamoyloxy-2alpha,7beta,10beta, 13alpha-tetraacetoxy-2(3-->20)abeotaxa-4(20),11-dien-9-one (4), 7-O-acetyltaxine A (5), 2alpha,7beta,10beta, 13alpha-tetraacetoxy-5alpha-phenylisoserinatoxy-2(3-->20)abeotaxa-4(2 0),11-dien-9-one (6), 5-O-acetyltaxinine M (7), 5alpha-hydroxy-2alpha,7beta,10beta, 13alpha-tetraacetoxy-2(3-->20)abeotaxa-4(20),11-dien-9-one (8), and 2alpha,5alpha-dihydroxy-7beta,10beta, 13alpha-triacetoxy-2(3-->20)abeotaxa-4(20),11-dien-9-one (9), on the basis of 1D and 2D NMR spectroscopic analysis. Compound 1, as a new compound isolated from T. chinensis var. mairei, is a rare example of a taxane with a 4,11-diene unit, which is considered to be an important intermediate in the biogenesis of taxoids. Compounds 2-4, 6, and 7 are new compounds, isolated from T. yunnanensis, which also afforded the known compounds 5, 8, and 9.

Developmental genetics of the Drosophila gut: specification of primordia, subdivision and overt-differentiation

The Drosophila gut is composed of three major parts, the foregut, midgut and hindgut, which arise from anterior and posterior invaginations of the early blastoderm. We review the process of the specification of the gut primordia, subsequent subdivision and region-specific cell differentiation in terms of developmental genetics. Graded activities of maternal signals at anterior and posterior terminal domains of the blastoderm, being mediated by activities of two zygotic gap genes, tailless and huckebein, lead to the activation of key genes that determine the gut primordia: serpent (GATA factor gene) for the endodermal midgut; brachyenteron (Brachyury homolog) for the ectodermal hindgut. fork head (HNF-3 homolog) and caudal (Cdx homolog) are also essential for the development of all gut primordia or hindgut primordium, respectively. Subdivision of the midgut epithelium is regulated by inductive signals emanating from the visceral mesoderm, which is under the control of HOM-C genes. In contrast, pattern formation of the ectodermal foregut and hindgut is regulated by secreted signaling molecules, such as Wingless (Wnt homolog), Hedgehog and Decapentaplegic (Bmp-4 homolog), as in the case of segmented structures and imaginal discs. Finally, the gut is subdivided into at least 36 compartments that are recognized asminimum tissue units of regional differentiation. A few genes that are responsible for determining and maintaining the state of overt-differentiation of the compartments have also been reported. A marked feature of the genetic mechanism of the gut development is the unexpectedly wide spectrum of the similarities of relevant genes and regulatory pathways of gene expression between Drosophila and vertebrates, which may imply a prototypic style of body plan common to protostomes and deuterostomes.

Gadolinium-DTPA-enhanced magnetic resonance imaging and functional outcome in patients with acute myocardial infarction

This study was designed to test the hypothesis that Gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA)-enhanced magnetic resonance images (MRI) reflect the severity of ischemic injury during the acute and chronic phases of myocardial infarction (MI). Twenty-nine patients with their first acute MI underwent Gd-DTPA-enhanced MRI in the first week (4.2+/-0.3 days) and at 1 month after onset. Pairs of left ventriculograms were compared with Gd-DTPA-enhanced magnetic resonance images, classified into 3 pattern groups: hyper-enhancement, with and without a central hypo-enhanced region (P1 and P2, respectively), and non-enhancement (P3). In the acute phase of MI, P1 was found in 10, P2 in 11, and P3 in 8 patients. One month later, the image pattern had changed from P1 to P2 in a single patient, from P2 to P3 in 4 patients, and had remained identical in the others. Patients with P3 showed improvement of anterior wall motion in the 1-month follow-up study, and had higher TIMI flow grades and lower peak creatine kinase values than those without recovery. Thus, Gd-DTPA-enhanced magnetic resonance images, closely reflecting the severity of myocardial injury, are useful in predicting myocardial functional recovery after MI.

Substituent effect of a fluorine atom on the mutagenicity of nitroquinolines

Some 16 nitroquinolines (NQs) and their fluorinated derivatives were tested for mutagenicity in Salmonella typhimurium TA100 without S9 mix to investigate the effect of fluorine-substitution on the mutagenicity. These NQs consist of 5-NQs, 5-nitroquinoline N-oxides (5-NQOs), N-methyl-5-nitroquinolinium methanesulfonates (N-Me-5-NQs) and 8-NQs, including three ortho-F-NQs, one meta-F-NQ, four para-F-NQs and four 3-F-NQs. For this purpose, eight F-NQs were newly synthesized. The data indicated that the ratio of the mutagenic activities (revertants/plate/nmol) of fluorinated NQs to those of the corresponding parent non-fluorinated compounds ranged from 0.6- to 119-fold. The fluorine atom located para to the nitro group markedly enhanced the mutagenicity (24-fold and more), while three ortho-fluorinated derivatives showed no significant increase in mutagenicity (enhancement ratio were 0.6, 0.8 and 1.7). With respect to 8-NQs, its meta-fluorinated derivative also had an enhanced mutagenicity over the parent compound (53-fold). In addition, although N-Me-5-NQ was less mutagenic than 5-NQ and 5-NQO, the mutagenicity of N-Me-5-NQ was most significantly enhanced by fluorine-substitution. These results suggest that introduction of a fluorine atom to the molecule in question may be a useful tool to modify their mutagenic potency and to better understand the mechanism of mutation.

MR imaging of squamous cell carcinoma of the floor of the mouth. Appearance of the sublingual and submandibular glands

PURPOSE

To determine the diagnostic value of MR imaging for tumors of the floor of the mouth and the effects of the tumors on the sublingual and submandibular glands.

MATERIAL AND METHODS

Thirty-seven patients with proven squamous cell carcinoma of the floor of the mouth underwent MR imaging, including unenhanced T1-weighted, T2-weighted, dynamic, and contrast-enhanced T1-weighted images. The appearance of the tumor and the sublingual and submandibular glands was assessed qualitatively and quantitatively.

RESULTS

All tumors demonstrated replacement of the normal signal intensity in the adjacent sublingual gland. Twenty-one patients (57%) had abnormal signal intensity of the submandibular gland without tumor invasion, presumably secondary to submandibular duct obstruction by the tumor. Unenhanced T1-weighted images provided high contrast between tumor and sublingual gland. Tumors limited within the gland were well detected on unenhanced T1-weighted images. Large tumors extending beyond the gland were well delineated on dynamic images, but no better than on T2-weighted images.

CONCLUSION

At MR imaging for tumor of the floor of the mouth, one must carefully evaluate the appearance of the sublingual and submandibular glands. Contrast-enhanced studies are unnecessary when the tumor is limited within the sublingual gland on precontrast MR images.

Strangulation of small bowel due to Meckel diverticulum: CT findings

We report an unusual case of small bowel strangulation due to long Meckel diverticulum. CT demonstration of the bundle-like segment contiguous with the distended fluid-filled loops of bowel contributed to the prompt preoperative diagnosis.

Dynamic magnetic resonance imaging of head and neck lesions

Dynamic magnetic resonance imaging (MRI) has been used to improve the detection of tumors, to determine the tumor extension, and to make differential diagnosis. Most malignant lesions of the head and neck show early enhancement and early washout of contrast media on dynamic MRI, but the tumor characterization remains unclear. Pharmacokinetic analysis of dynamic MRI can provide information about the permeability of Gd-DTPA in the tumor that may reflect the oxygen concentration of the tumor and the amount of drug delivered to the tumor. This information may be useful in the prediction of radiation and/or chemotherapy response of the tumor.

Overexpression of insulin-like growth factor-1 (IGF-I) receptor and the invasiveness of cultured keloid fibroblasts

Keloid is a dermal fibroproliferative tissue of unknown etiology. Protein tyrosine kinases (PTKs) play an important role in the regulation of cell growth and differentiation. Activation of PTK cascades in keloid fibroblasts is thought to be closely linked to abnormal cell proliferation and migration. We determined the expression profile of PTK genes in normal skin and keloid fibroblasts using the homology cloning method with a degenerated primer. Eight PTK genes were expressed among a total of 46 receptor-type clones. The most abundant type of PTK receptors was the platelet-derived growth factor receptor in both fibroblasts. However, insulin-like growth factor-I receptor (IGF-IR) was overexpressed only in keloid-derived fibroblasts (9 of 24). Immunohistochemical analysis confirmed the high expression of IGF-IR in keloid fibroblasts, but not in normal fibroblasts. To examine the functional properties of the IGF-I/IGF-IR pathway, we investigated cell proliferation and invasion activities of both types of fibroblasts. The mitogenic effect of IGF-I on both fibroblasts was very weak compared with serum stimulation. In contrast, the invasive activity of keloid fibroblasts was markedly increased in the presence of IGF-I, and inhibited by a neutralizing antibody against IGF-IR. Our results indicate the involvement of activated IGF-I/IGF-IR in the pathogenesis of keloid by enhancing the invasive activity of fibroblasts.

Two new taxane diterpenoids from the seeds of the Chinese yew, Taxus yunnanensis

A new taxoid and a taxinine analogue were isolated from the seeds of the Chinese yew, Taxus yunnanensis. The structures were established as 13 alpha-acetoxy-5 alpha-(3'-dimethylamino-3'-phenyl)-propionyloxy-11(15-->1)-abeotaxa- 4(20),11-diene-9 alpha, 10 beta-diol and 2 alpha-acetoxy-5 alpha-cinnamoyloxy-9 alpha, 10 beta-dihydroxy-taxa- 4(20),11-diene-13-one on the basis of 1D, 2D NMR, and MS spectral analysis.

Three new bicyclic taxane diterpenoids from the needles of Japanese yew, Taxus cuspidata Sieb. et Zucc

Three new bicyclic taxane diterpenes were isolated from the needles of the Japanese yew, Taxus cuspidata Sieb. et Zucc. Their structures were established to be 7,9,10,13-tetraacetoxy-5-cinnamoyloxy-4-hydroxy-methyl-8,12,15,15- tetramethyl-bicyclo[9.3.1] pentadeca-3,8,11-trien-2-ol (2,20-dideacetyl taxuspine X), 7,9,10,13,20-pentaacetoxy-5-cinnamoyloxy-8,12,15,15-tetramethyl bicyclo[9.3.1] pentadeca-3,8,11-trien-2-ol (2-deacetyl taxuspine X), and 9,10,13,20-tetraacetoxy-5-cinnamoyloxy-8,12,15,15-tetramethyl-bicyclo[9.3.1] pentadeca-3,8,11-trien-2,7-diol (2,7-dideacetyl taxuspine X) with the aid of spectroscopic techniques and by comparing with taxuspine X.

[Endothelial-derived nitric oxide mediates the peripheral vasodilatory effects of amrinone in humans]

Amrinone, which is used for the treatment of acute congestive heart failure, has vasodilatory and positive inotropic effects through the increment of intracellular cyclic adenosine monophosphate. Recent in vitro investigations have shown that amrinone has an endothelium-dependent vasodilatory effect. The present study examined whether amrinone shows this endothelium-dependent vasodilatory effect in human peripheral vessels. Forearm blood flow during intra-arterial infusion of graded doses (12.5, 25, 50, 100, 200 micrograms/min) of amrinone was measured using plethysmography in 10 healthy subjects without organic vascular disease before and after nitric oxide synthase blocking with NG-monomethyl-L-arginine (L-NMMA, 400 mumol). The graded dose of amrinone produced progressive increases in amrinone plasma concentrations, and a dose over 100 micrograms/min caused amrinone plasma concentrations of more than 1.0 microgram/ml. The increase in forearm blood flow in response to amrinone was significantly depressed after L-NMMA doses of less than 100 micrograms/min, but the increase in forearm blood flow during infusion of higher doses (100, 200 micrograms/min) was not affected by L-NMMA. These results suggest that endothelial-derived nitric oxide may partially contribute to amrinone-induced vasodilation in humans. Thus, the vasodilatory effect of amrinone might be impaired in patients with endothelial dysfunction.

Primary leiomyoma of the ovary: a case report

The imaging features of primary ovarian leiomyoma have seldom been described because of the very low prevalence of the tumor. Herein we present a case report on its magnetic resonance imaging features. Both T1- and T2-weighted images revealed a low-signal-intensity mass, which was well circumscribed and sharply demarcated from the uterus. Magnetic resonance imaging was useful in distinguishing it from a malignant ovarian tumor and uterine leiomyoma.

[A case of Sjögren's syndrome associated with inflammatory pseudotumor of the liver]

A 71-year-old man had noticed a dry sensation in the mouth with swelling of bilateral parotid glands in 1988. He was given a diagnosis of Sjögren's syndrome (SS) on the basis of characteristic findings of sialography and a minor salivary gland biopsy. He was admitted to our department in Febuary 1995 because of general fatigue of 2 month's duration. Laboratory data showed both positive anti-SSA and anti-SSB antibodies, liver dysfunction, hypoalbuminemia, and thrombocytopenia. Abdominal CT and MRI demonstrated a 2-cm intrahepatic mass (S 6) with enhanced areas at the periphery. The liver biopsy yielded fragments from the intrahepatic mass and hepatic parenchyma. The former was composed of plasma cells, lymphocytes, and histiocytes, compatible with the diagnosis of inflammatory pseudotumor of the liver. The pathological diagnosis of the latter specimen was primary biliary cirrhosis, although antimitochondrial antibody was negative. The intrahepatic mass gradually decreased in size without treatment. Inflammatory pseudotumor is considered to be a benign inflammatory condition simulating a neoplasma and the possibility of an autoimmune reaction is suggested on the basis of etiology. This is the first report of an inflammatory pseudotumor associated with Sjögren's syndrome developing in the liver. The inflammatory pseudotumor should be considered as a possible diagnosis in cases where the tumor is embedded in the liver.

[A case of dermatomyositis associated with asymptomatic pneumomediastinum]

A 20-year-old woman initially presented with edematous erythema in the upper eyelids in December 1995. She was admitted to our department in January 1996 because of fever and multiple arthralgia. She was given a diagnosis of dermatomyositis (DM) on the basis of characteristic eruption, elevated serum level of creatine kinase, and increased inflammatory reaction. Chest computed tomography (CT) revealed faint interstitial changes in the left lower lung. The administration of corticosteroid caused improvement in the patient's condition and the interstitial lesion in the lung. Although she was asymptomatic, chest CT showed pneumomediastinum in the pretracheal space and concomitant pneumothorax around left bronchus. Those changes spontaneously disappeared 4 weeks later without treatment. The occurrence of pneumomediastinum in patients with DM has been well documented as an indicator of poor prognosis in the literature. It seems that a severe pulmonary disorder could secondary cause pneumomediastinum. In our case, however, the pneumomediastinum developed in spite of the low grade severity of the pulmonary lesion. This finding suggested that the pneumomediastinum may be associated with the development of DM itself.

Venous drainage through bone marrow after replantation: an experimental study

Venous drainage is vital for successful replantation, but it is not always possible to reconstruct because of missing or damaged veins. We devised an experimental model to study venous drainage through bone marrow while the new subcutaneous venous system regenerated. Adult male Wistar rats were placed into three groups. Group A rats had their hindlimbs amputated at the lower leg, but the tibia and sural and saphenous artery connections were preserved. Group B rats were prepared the same as Group A, except that a step-cut osteotomy was performed in the tibia. The bone ends were then realigned and kept in place with stainless steel wire. Group C rats were prepared the same as Group B, except that the ends of the bone were not aligned. All unoperated limbs served as controls for evaluations of blood flow. Experimental limbs were evaluated for skin colour and viability, blood flow and dye injection. Skin colour was investigated daily. Blood flow was measured postoperatively during three phases: immediate (up to 1 h), early (from 1 h to 24 h), and late (from 1 day to 7 days after operation). Survival of limbs varied in Groups A and B, while all limbs in Group C necrosed by day 7. Blood flow was returning to near control (normal) levels by day 7 in Group A and B limbs. India ink was observed in the medullary cavity at day 7. After replantation, bone marrow plays a critical role in venous drainage until the subcutaneous venous drainage system regenerates.

[A case of protein-losing gastroenteropathy in association with mixed connective tissue disease which was successfully treated with cyclophosphamide pulse therapy]

A 47-year-old man had been given a diagnosis of mixed connective tissue disease (MCTD) on 1987 when he had presented with Raynaud's phenomenon, polyarthralgia, sclerodactyly, and a high titre of anti-RNP antibody. Once his symptoms had improved following the administration of prednisolone orally and the treatment was discontinued since 1995. He noticed dyspnea and chest pain in February 1997. The bilateral pleural effusion was pointed out in the local hospital and he was admitted to our hospital in March 1997 for further examination. In addition to pleural effusion and ascites, laboratory studies revealed hypoalbuminemia and low serum levels of complements. Renal and liver function tests were normal and the urine gave a trace test for protein. The presence of protein loss in the gut was confirmed by an elevated alpha 1-antitrypsin clearance and 99mTc-albumin scintigraphy showing abnormal radioactivity in the gastrointestinal tract. Although endoscopic examination showed no abnormal findings macroscopically and gastrointestinal biopsies revealed nonspecific inflammation only, immunofluorescent studies demonstrated deposits of C 3, C 4 and IgG in the stomach, colon, and pleura. These findings supported the pathogenesis that immune deposits in tissues caused protein-losing gastroenteropathy (PLGE) in MCTD. Intravenous administration of cyclophosphamide started since July 1997, while the high-dose corticosteroid therapy including methylprednisolone pulse therapy were not effective. Hypoalbuminemia and low serum levels of complements improved remarkably and the pleural effusion and ascites disappeared after cyclophosphamide pulse therapy four times monthly. Cyclophosphamide pulse therapy should be considered as a possibly effective treatment for PLGE in association with collagen disease resistant to corticosteroid therapy.

Transcardiac 5-hydroxytryptamine release and impaired coronary endothelial function in patients with vasospastic angina

1. The present study was designed to test the hypotheses whether platelet degranulation across the coronary bed is detectable during non-ischaemic periods in patients with vasospastic angina (VSA) and whether the exogenous nitric oxide (NO) donor nitroglycerin (GTN) is able to modify platelet degranulation, reflecting an impaired endothelial production of NO. 2. We studied 13 patients with VSA and 10 controls. The time course of coronary sinus (CS) plasma 5-hydroxytryptamine (5-HT) levels was evaluated every 4 h before and after intravenous infusion of GTN over a period of 40 h. Coronary sinus plasma 5-HT levels were significantly higher at any measured time point in patients with VSA compared with control and were significantly decreased in patients with VSA following treatment with GTN, but not in controls. Femoral artery plasma 5-HT levels remained almost constant throughout the study. The ratio of CS:aorta 6-keto-prostaglandin F1 alpha was significantly and inversely correlated with the transcardiac plasma 5-HT difference only in patients with VSA (r = -0.68; P < 0.02; n = 13). 3. The time course of CS 5-HT levels confirmed significant platelet degranulation across the coronary bed supplied by the spasming artery in patients with VSA and this was modified by GTN. The present data suggest that platelet degranulation occurs during non-ischaemic periods in patients with VSA and that prostacyclin biosynthesis may be a compensatory response to an impaired endothelial release of NO, limiting the degree of the effects of platelet degranulation.

Enhanced secretion of insulin plays a role in the development of atherosclerosis and restenosis of coronary arteries: elective percutaneous transluminal coronary angioplasty in patients with effort angina

OBJECTIVES

We investigated the relation between insulin and coronary atherosclerosis and restenosis of the coronary arteries, by performing elective percutaneous transluminal coronary angioplasty (PTCA).

BACKGROUND

Insulin is known to promote atherosclerosis of the arteries and has been implicated in the development of restenosis after PTCA.

METHODS

Of 210 angina patients who underwent PTCA, newly detected lesions in 35 consecutive nondiabetic subjects without previous intervention on the same main coronary arteries were analyzed after a 75-g oral glucose tolerance test (OGTT) and follow-up coronary angiography. Atherosclerotic lesions were evaluated by pattern, severity and extent. Restenosis was defined as loss of gain, the percentage of loss of the initial gain in the coronary diameter achieved by PTCA > or = 50%.

RESULTS

Patients with restenosis had a significantly higher extent index (a marker of atherosclerosis), insulin area, ratio of insulin area to glucose area, insulinogenic index and minimal lumen diameter after PTCA than those without restenosis (p=0.001, 0.011, 0.002, 0.016 and 0.041, respectively). Simple regression analysis revealed that only the ratio of insulin area to glucose area (a relative marker of enhanced insulin secretion) significantly correlated with the extent index (p=0.035). Extent index, insulin area, the ratio of insulin area to glucose area and insulinogenic index significantly correlated with loss of gain (p=0.001, 0.010, 0.002 and 0.032, respectively). Stepwise multiple regression analyses revealed that extent index and the ratio of insulin area to glucose area significantly correlated with loss of gain.

CONCLUSIONS

Enhanced secretion of insulin during the OGTT might be useful as a predictor of coronary atherosclerosis and of restenosis after elective PTCA in nondiabetic patients with effort angina.

Optimal image resolution for digital storage of radiotherapy-planning images

PURPOSE

To evaluate the quality of digitized radiation-planning images at different resolution and to determine the optimal resolution for digital storage.

METHODS AND MATERIALS

Twenty-five planning films were scanned and digitized using a film scanner at a resolution of 72 dots per inch (dpi) with 8-bit depth. The resolution of scanned images was reduced to 48, 36, 24, and 18 dpi using computer software. Image qualities of these five images (72, 48, 36, 24, and 18 dpi) were evaluated and given scores (4 = excellent; 3 = good; 2 = fair; and 1 = poor) by three radiation oncologists. An image data compression algorithm by the Joint Photographic Experts Group (JPEG) (not reversible and some information will be lost) was also evaluated.

RESULTS

The scores of digitized images with 72, 48, 36, 24, and 17 dpi resolution were 3.8 +/- 0.3, 3.5 +/- 0.3, 3.3 +/- 0.5, 2.7 +/- 0.5, and 1.6 +/- 0.3, respectively. The quality of 36-dpi images were definitely worse compared to 72-dpi images, but were good enough as planning films. Digitized planning images with 72- and 36-dpi resolution requires about 800 and 200 KBytes, respectively. The JPEG compression algorithm produces little degradation in 36-dpi images at compression ratios of 5:1.

CONCLUSION

The quality of digitized images with 36-dpi resolution was good enough as radiation-planning images and required 200 KBytes/image.

Effect of iodixanol on renal function immediately after abdominal angiography. Clinical comparison with iomeprol and ioxaglate

PURPOSE

To investigate the acute renal effects of three contrast media in a double-blind randomized parallel-group study. The contrast media investigated were: the nonionic dimeric iso-osmolality medium iodixanol; the nonionic monomeric medium iomeprol; and the ionic dimeric medium ioxaglate.

MATERIAL AND METHODS

A total of 30 patients were given the following doses of contrast medium: 10 patients received iodixanol 320 mg I/ml; 10 received iomeprol 300 mg I/ml; and 10 received ioxaglate 320 mg I/ml. The doses were given intra-arterially at routine abdominal angiography and the renal effects of these three contrast media were studied for up to 120 min after injection.

RESULTS

The urinary minute volume increased immediately after angiography but tended to return to baseline values after 120 min; these changes were more pronounced with iomeprol and ioxaglate than with iodixanol. Creatinine clearance was not reduced by any of the contrast media. Fraction excretion of sodium increased immediately and lasted for 30 min after angiography; these changes were more pronounced with ioxaglate than with iomeprol and iodixanol. Urinary gamma-glutamyl transferase increased for 120 min after angiography with iodixanol and iomeprol; these changes were more pronounced with iomeprol than with iodixanol. On the other hand, urinary nu-acetyl-beta-glucosaminidase increased for 120 min after angiography with iomeprol, but was unchanged with iodixanol.

CONCLUSION

The use of contrast media induces osmotic diuresis and its acute effects on the proximal tubular function. However, the iso-osmolality medium iodixanol induces fewer changes than the other two media.

ACE gene polymorphism in childhood IgA nephropathy: association with clinicopathologic findings

A deletion polymorphism in the angiotensin-converting enzyme (ACE) gene has been reported to be a risk factor for progression to chronic renal failure in immunoglobulin A nephropathy (IgAN). In this study, we investigated the association between ACE gene polymorphism and clinical findings, early biopsy findings such as the extent of mesangial proliferation, focal lesions (capsular adhesions, glomerulosclerosis, and crescents), and the glomerular area in childhood IgAN. Genomic DNA was obtained from 97 patients and control subjects. Gene polymorphisms, consisting of an insertion (I) or deletion (D) of the 287-base pair Alu sequence, were detected using the polymerase chain reaction. The extent of capsular adhesions and glomerulosclerosis was significantly higher in patients with the ID/DD genotypes than in those with the II genotype (ID/DD v II: 8.0%+/-1.4% v 2.5%+/-0.8% [P = 0.017] and 5.1%+/-1.3% v 1.4%+/-0.6% [P = 0.028], respectively). Whereas there was no difference in the extent of mesangial proliferation and crescents between the ID/DD genotypes and the II genotype. Urinary protein excretion at the time of biopsy was significantly greater in patients with the ID/DD genotypes than in those with the II genotype (1.02+/-0.15 g/d/m2 body surface area v 0.56+/-0.13 g/d/m2 body surface area; P = 0.012). These results indicate that ACE gene polymorphism may not influence the extent of mesangial proliferation and crescents that are acute lesions. However, the ID/DD genotypes are associated with chronic lesions, such as capsular adhesions or glomerulosclerosis and urinary protein excretion in childhood IgAN.