Hepatic involvement in hypereosinophilia: sonographic findings

Hypereosinophilic syndrome may cause eosinophil-related tissue damage to various organs. The purpose of this paper is to describe sonographic findings in 13 patients with hypereosinophilia in whom the liver was involved. The diagnosis in these 13 patients was based on liver biopsy in seven patients with bone marrow biopsy in six patients. Eight patients had hypereosinophilic syndrome and five patients had clonorchiasis. All 13 patients had mild to marked hepatomegaly. Seven of 13 patients showed multiple round or oval hypoechoic (n = 6) or variably echogenic (n = 1) lesions measuring 1 to 2 cm with poorly defined margins in both lobes of the liver. Four patients had one or two hypoechoic lesions 3 to 4 cm in size, with geographic pattern and poorly defined margins. Two patients showed diffuse hepatomegaly with increased parenchymal echogenicity. The number of lesions and the extent of diffuse lesions seem to be proportional to the degree of eosinophilia. Hypereosinophilia may produce multiple small focal hepatic lesions or diffuse segmental or lobar echogenic lesions simulating primary or metastatic tumor of the liver.

Clonazepam release from bioerodible hydrogels based on semi-interpenetrating polymer networks composed of poly(epsilon-caprolactone) and poly(ethylene glycol) macromer

Poly(ethylene glycol)(PEG) macromers terminated with acrylate groups and semi-interpenetrating polymer networks (SIPNs) composed of poly(epsilon-caprolactone)(PCL) and PEG macromer were synthesized to obtain a bioerodible hydrogel. Polymerization of PEG macromer resulted in the formation of cross-linked gels due to the multifunctionality of macromer. Glass transition temperature (Tg) and melting temperature (Tm) of PEG networks and PCL in the SIPNs were inner-shifted, indicating an interpenetration of PCL and PEG chains. Water content in the SIPNs increased with increasing PEG weight fraction due to the hydrophilicity of PEG. The amount of clonazepam (CNZ) released from the SIPNs increased with higher content in the SIPNs, lower drug loading, lower concentration of PEG macromer during the SIPNs preparation, and higher molecular weight of PEG. In particular, a combination with low PEG content and low CNZ solubility in water led to long-term constant release from these matrices in vitro and in vivo.

Contextualizing family risk factors for alcoholism and alcohol abuse

OBJECTIVE

Studies of alcohol and the family should represent the full range of family types in the U.S. population. Developments from studies of family systems in other research contexts may be usefully applied to the alcohol field.

METHOD

This commentary highlights important methodological and conceptual issues relevant for the design and conduct of family research.

RESULTS

Data indicate major changes in the composition of the American family over the past quarter century. Some recent conceptual developments in the field of family research are relevant for studies of alcohol and the family and for intervention development.

CONCLUSION

Family-based alcohol research should acknowledge and address the heterogeneity that exists among modern American families. Studies of family risk and resiliency should distinguish between threats to the family's ability to function as a whole, and threats to the well-being of individual members. Additional research is needed on the role of race and ethnicity in family processes.

Effects of chronic electroconvulsive shock on the expression of beta-adrenergic receptors in rat brain: immunological study

The purpose of the present study is to determine the effect of chronic electroconvulsive shock (ECS) on the expression of beta-adrenergic receptors in rat brain by Western blot using mAb beta CO2, a monoclonal antibody against beta-adrenergic receptors. Rats in ECS treated groups received maximal ECS (70 mA, 0.5 second, 60 Hz) through ear-clip electrodes for 12 consecutive days. The experiment was carried out in 14 discrete regions of brain. Chronic ECS reduced the expression of beta-adrenergic receptors in frontal cortex, temporal cortex, parietooccipital cortex, hippocampus and limbic forebrain, but not in other areas of brain. The regional specificity and the magnitude of the reduction of receptor expression are well correlated with those of the reduction of receptor ligand binding, which was determined using [3H]dihydroalprenolol. To the best of our knowledge, this is the first report to demonstrate that chronic ECS decreases the expression of receptor protein in specific regions of rat brain.

Monoacetyldiglycerides as new Ca2+ mobilizing agents in rat pancreatic acinar cells

Several monoacetyldiglycerides were synthesized from glycerol in search for new Ca2+ mobilizing agent in vitro. All monoacetyldiglycerides except linolenoyl and phenlycyclopropylcarbonyl derivatives showed activity toward Ca2+ release in pancreatic acinar cells. Linoleoyl and docosahexaenoyl derivatives were chosen for further test and exhibited unique activity.

Studies of the chemical structure of gangliosides in deer antler, Cervus nippon

The biological activity of deer antler has been considered to originate in the gangliosides, although the structures of gangliosides have not been well elucidated. The quality of deer antler as an Asian folk medicine has often been evaluated by the amount of gangliosides contained in the crude drug. We have completed the structural determination of five gangliosides isolated from deer antler in the present study. Five ganglioside fractions were isolated and purified from deer antler, Cervus nippon, by the Folch-Suzuki partition method, DEAE-Sephadex A-25, and further by silica gel column chromatography. High field proton nuclear magnetic resonance spectroscopy, gas chromatography/mass spectrometry, and fast atom bombardment-mass spectrometry studies characterized the isolated ganglioside fractions. GM3 and GD3 were present in the isolated ganglioside fractions. Samples were hydrolyzed in trifluoroacetic acid for direct compositional analysis and analyzed for sialic acid and neutral sugar without prior derivatization. Separation of the monosaccharides was achieved by HPLC on a Dionex CarboPac column eluted at a high pH. The resolved monosaccharides were identified using standard monosaccharides by pulsed amperometric detection. N-Acetyl GM3 (Neu5Ac), N-glycolyl GM3 (Neu5Gc), and N-acetyl GD3 (Neu5Ac) were present in the antler. The major ceramide moiety was composed of C16:0 or C22:0 fatty acids along with either C18 sphingosine or C20 eicosasphingosine.

Sjögren's syndrome with acute renal failure

We experienced a 65-year-old woman with Sjögren's syndrome who presented with acute renal failure, hypergammaglobulinemia with monoclonal gammopathy, and hypocomplementemia. She improved with steroid pulse therapy (methylprednisolone 0.5 g/day for 3 days). This patient had also sensorineural hearing loss, symmetric sensory polyneuropathy of legs, and interstitial lung disease. Ten months after recovery from acute renal failure, low-dose oral prednisolone (0.1 mg/kg/day) was withdrawn. On the third month of steroid withdrawal, acute renal failure recurred with hypergammaglobulinemia, hyperamylasemia, and autoimmune cholangitis-like biochemical derangements, which also responded to steroid pulse therapy (methylprednisolone 0.3 g/day for 3 days). When we would withdraw steroid in a patient with visceral involvement of Sjögren's syndrome, we should consider multiple clinical and laboratorial variables, including erythrocyte sedimentation rate, serum levels of IgG, total protein, C3/C4, CRP, amylase, lipase, and alkaline phosphatase. We report this case which exhibited various unusual manifestations with a review of literature.

Abnormal ventricular looping and abnormal laterality of the atrial chambers are the main morphogenetic mechanisms of cardiac lesions in cultured rat embryos treated with retinoic acid

To establish the early morphogenetic mechanism in retinoid induced cardiac lesions, we investigated the morphology of the heart in cultured rat embryos treated with retinoic acid (RA) at 9.0 and 9.5 days post coitum (d.p.c). Wistar rat embryos were treated with RA (2 x 10(-7) M) for 6 hours from the embryonic day equivalent of 9.0 or 9.5 d.p.c. After further culture in an RA free medium for 2.5 days, embryos were fixed and examined with a stereomicroscope and a scanning electron microscope. Sixty three embryos were treated at 9.0 d.p.c., 14 embryos were treated at 9.5 d.p.c. and 30 embryos were used as control. Abnormal ventricular looping was seen in 31 embryos (49.2%) from the group treated at 9.0 d.p.c., and isomerism of right appendages occurred in 15 (23.8%). Embryos treated with RA at 9.5 d.p.c. showed a low incidence of abnormal ventricular looping (14.3%). We could summarize those abnormal looping as three variants of each looping. The mildest form was hypoplasia of the right ventricle observed in 20 cases. Both the right and left ventricles in the second variant were shifted far to the left or right (10 cases). The third variant was a heart with generalized hypoplasia of both ventricles (3 cases). The incidence of branchial arch anomalies was higher at 9.5 d.p.c. than at 9.0 d.p.c. (71.4% and 30.2%, respectively). Abnormalities in the ventricular looping and the atrial laterality at 9.0 d.p.c. suggest that RA induces derangement in the development of laterality, while at 9.5 d.p.c., the abnormality of the migration of neural crest cells is the principal mechanism.

Oxime derivatives of the intermediary oncostatic metabolites of cyclophosphamide and ifosfamide: synthesis and deuterium labeling for applications to metabolite quantification

There is ongoing interest in the selective, quantitative analysis of the cyclophosphamide metabolites 4-hydroxycyclophosphamide (2a) and aldophosphamide (3a) because these tautomers are generally believed to play a key role in oncostatic selectivity and metabolite transport. O-(2,3,4,5,6-Pentafluorobenzyl)hydroxylamine (C6F5CH2ONH2, 1 equiv) provided for the complete conversion (by 31P NMR, 60% reaction within 15 min at 20 degrees C) of 2a/3a (17 mM in H2O/CH3OH) to E/Z-aldophosphamide O-(2,3,4,5,6-pentafluorobenzyl)oxime [C6F5CH2ON = CHCH2CH2OP-(O)(NH2)N(CH2CH2Cl)2; E:Z = 54:46 (+/- 3% average deviation)]. Under these conditions, the oxime exhibited little (6%) decomposition over 3 weeks. Parallel studies showed that 4-hydroxyifosfamide/aldoifosfamide reacted completely to give the analogous aldoifosfamide oxime [C6F5CH2ON = CHCH2CH2OP(O)(NHCH2CH2Cl)2; E:Z = 52:48 (+/- 1% average deviation)] with 50% reaction within 15 min at 20 degrees C with no product decomposition over 3 weeks. In aqueous methanol and with 2 equiv C6F5CH2ONH2, clinically useful 4-hydroperoxycyclophosphamide (10 mM; tau 1/2 = 10 min, 37 degrees C) and its isomer 4-hydroperoxyifosfamide (10 mM; tau 1/2 = 25 min, 20 degrees C) underwent complete conversion to the corresponding aldehyde oximes. Each oxime was synthesized with deuterium in the chloroethyl moieties for use as internal standards in GC/MS applications.

Expression of the betaine aldehyde dehydrogenase gene in barley in response to osmotic stress and abscisic acid

When subjected to salt stress or drought, some vascular plants such as barley respond with an increased accumulation of the osmoprotectant glycine betaine (betaine), being the last step of betaine synthesis catalyzed by betaine aldehyde dehydrogenase (BADH). We report here cloning and characterization of BADH cDNA from barley, a monocot, and the expression pattern of a BADH transcript. An open reading frame of 1515 bp encoded a protein which showed high homology to BADH enzymes present in other plants (spinach and sugar-beet) and in Escherichia coli. Transgenic tobacco plants harboring the clone expressed high levels of both BADH protein and its enzymatic activity. Northern blot analyses indicated that BADH mRNA levels increased almost 8-fold and 2-fold, respectively, in leaves and roots of barley plants grown in high-salt conditions, and that these levels decreased upon release of the stress, whereas they did not decrease under continuous salt stress. BADH transcripts also accumulate in response to water stress or drought, indicating a common response of the plant to osmotic changes that affect its water status. The addition of abscisic acid (ABA) to plants during growth also increased the levels of BADH transcripts dramatically, although the response was delayed when compared to that found for salt-stressed plants. Removal of plant roots before transferring the plants to high-salt conditions reduced only slightly the accumulation of BADH transcripts in the leaves.

Radiologic evaluation of continent urinary reservoirs

A variety of methods are currently used for urinary diversion after cystectomy in adults. Radiologists are generally familiar with ileal and colonic conduits but are less familiar with the recently popularized continent urinary reservoirs. We describe and illustrate the surgical technique, normal anatomy, and normal radiographic appearance of a variety of urinary reservoirs, including the Kock pouch, Camey procedure, and various ileocecal reservoirs. Complications of various reservoirs are also discussed and illustrated.

Patient-initiated mobile mammography: analysis of the patients and the problems

Patient initiation of mammographic screening is one method of increasing compliance with screening mammography guidelines. A low-cost screening project using a mobile van was developed at the University of Alabama at Birmingham. Analysis of the first 2,099 patients revealed that the participants were generally white (92%), more likely to have had a previous mammogram than the norm (33% in this study vs 19% in a 1986 Gallup survey), and relatively high-risk (30% having a breast cancer risk factor). The cancer detection rate was 6.2 per 1,000 women screened, with a biopsy rate of 1.3% and a positive predictive value of 48%. More than half the cancers detected were in situ lesions or invasive carcinomas smaller than 1 cm. Our results suggest that low-cost mobile mammographic screening can operate at appropriate levels of sensitivity and specificity and is well accepted by participants. Such projects require considerable preliminary planning, significant financial and time commitment by the physicians involved, and meticulous follow-up. A mammography management software system was developed to facilitate tracking of patients for routine and diagnostic follow-up studies and rapid communication of results. Although most follow-up studies and biopsies were done in the community, resistance in the medical community was significant and is perhaps the greatest impediment to such screening endeavors.

The CT findings in pseudomembranous colitis

The authors present their experience with the CT appearance of pseudomembranous colitis in 6 patients. In addition to the previously reported thickened colon wall, pericolonic inflammation was also noted in 5 of the patients.

Intestinal ischemia: comparison of plain radiographic and computed tomographic findings

This article illustrates the radiographic and CT findings in 14 patients with proved intestinal ischemia or infarction. Gaseous bowel distention, thumbprinting and pneumatosis were the most frequent radiographic findings; intestinal distention, thickening of the bowel wall, engorgement of mesenteric vessels, and pneumatosis, the most frequent CT findings. The authors conclude that CT offers major advantages for evaluating patients suspected of having intestinal ischemia or infarction.

Synthesis of side chain-modified iodothyronines

New side chain-modified iodothyronines have been synthesized. They include: 1-[4-(4-hydroxyphenoxy)-3,5-diiodophenyl]-1,2-ethanediol (T2EG); alpha-hydroxy-4-(4-hydroxyphenoxy)-3,5-diiodobenzeneacetic acid (T2HAA) and their 4-methyl ether derivatives (MT2EG, MT2HAA); 1-[4-(4-hydroxyphenoxy)-3,5-diiodophenyl]-2-aminoethanol (T2EA); 1-[4-(4-hydroxy-3-iodophenoxy)-3,5-diiodophenyl]-1,2-ethaned iol (T3EG); 1-[4-(4-hydroxy-3-iodophenoxy)-3,5-diiodophenyl]-2-aminoetha nol (T3EA); and alpha-hydroxy-4-(3-iodo-4-hydroxyphenoxy)-3,5-diiodobenzeneacet ic acid (T3HAA). These model compounds are being used to study thyroid hormone metabolism and to determine structure-activity relationships of iododiphenylether derivatives.

Pneumopericardium occurring as a complication of achalasia

Esophagopericardial fistula is a rare complication of benign esophageal disease. It has not previously been described occurring in achalasia. The authors present such a case. This cause should be considered in the differential diagnosis of pneumopericardium in patients with achalasia. Early diagnosis is stressed and esophagoscopic examination should be performed if the result of barium swallow test is negative.

Perforation of the esophagus: correlation of site and cause with plain film findings

The medical records and plain films of the chest and neck of 24 patients with esophageal perforation that had occurred either spontaneously or as a complication of instrumentation were reviewed. Plain films provide useful guidelines as to cause and location of perforation, and were found to be valuable in performing the subsequent confirmatory esophagram. Perforation of the distal esophagus usually results in pleural effusion or hydropneumothorax on the left, while perforation of the midesophagus tends to produce pleural effusion or hydropneumothorax on the right. Spontaneous perforation (Boerhaave syndrome) usually occurs in the distal esophagus, with resultant hydropneumothorax on the left. The plain films were unremarkable in about 12% of patients with esophageal perforation.

Hand-held real-time breast sonography

The results of real-time hand-held sonographic breast examinations on 86 patients are presented. The technique is described in detail. Sonography was found to be a useful adjunct to the x-ray mammogram in three groups of patients: (1) patients with dense breasts and localized symptomatology or a suspicious area on x-ray mammogram; (2) patients with nonpalpable abnormalities discovered on x-ray mammogram; and (3) patients with palpable masses considered indeterminate on x-ray mammogram. The examination was also found useful for guiding needle aspiration biopsies, in patients with persistent nipple discharge, and in those with breast prostheses. Advantages of the hand-held real-time technique include supine positioning, the ability to flexibly orient the probe, improved resolution due to higher frequency transducers and the lack of compounding, and the ability to vary the amount of compression to assess tissue compliance and fixation. The disadvantage of decreased resolution in the near field can be overcome by attaching a detachable water-path step-off device to the transducer. Geometric distortion from the pressure of the transducer was not believed to be a problem. Hand-held sonographic technique is useful when attention can be directed to a specific area of the breast. The additional information provided results in fewer equivocal interpretations of the x-ray mammogram; however, it should not be used as a substitute for routine mammography.

Extraperitoneal gas: compartmental localization and identification of source

We evaluated the plain films of the abdomen and chest in 24 patients with documented extraperitoneal gas collections. Compartmental localization of the extraperitoneal ectopic gas in these patients was as follows: the anterior pararenal space in 10 patients, the perirenal space in five and the posterior pararenal space in 15. In six of these 24 patients, the extraperitoneal gas was present in two compartments. The extraperitoneal gas collection resulted from perforation of the retroperitoneally located alimentary tract in 11, necrotizing pancreatitis in five, gas-producing infection in four and from extension of extra-alveolar air in three patients. Air insufflation of the scrotum was the cause of the extraperitoneal gas in another patient.