False-positive hepatic blood pool SPECT study for hepatic hemangioma

Radionuclide hepatic blood pool scintigraphy is an extremely sensitive and highly specific test in diagnosing cavernous hemangioma of the liver. The authors report a false-positive hepatic blood pool scintigram for hepatic hemangioma in a patient with liver metastasis from adenocarcinoma of colon.

Photodynamic therapy of non-melanoma malignant tumours of the skin using topical delta-amino levulinic acid sensitization and laser irradiation

Eighty basal cell carcinomas (BCCs) in 21 patients, 10 lesions of Bowen's disease in three patients, and four lesions of cutaneous T-cell lymphoma in two patients, were treated with photodynamic laser therapy (PDT), using topical application of the haem precursor delta-amino levulinic acid (ALA). The diagnoses were confirmed histologically prior to treatment. Fifty-five of the BCCs were superficial lesions, and 25 were nodular. Of the 80 BCCs, 39 (49%) were located on the trunk, 36 (45%) on the head and neck region, four (15%) on the leg and one on the arm. The two principal locations of the 10 Bowen's disease lesions were the leg (50%) and the trunk (40%). The T-cell lymphoma lesions were located on the shoulder and on the arm. A water-in-oil based cream containing 20% ALA was applied to the lesions, with a margin of about 10-20 mm beyond the visible tumour border, 4-6 h before the laser procedure. During this period of time the highly fluorescent and photodynamically active substance protoporphyrin IX (Pp IX) is synthesized via the haem cycle. Laser-induced fluorescence (LIF) was used for real-time monitoring of the Pp IX distribution in the tumour and in the normal surrounding skin, before and after treatment in all patients. Before laser treatment the Pp IX distribution demonstrated by LIF showed a demarcation between tumour and normal skin of about 15:1 for BCC and Bowen's disease, and 5:1 for T-cell lymphomas.(ABSTRACT TRUNCATED AT 250 WORDS)

Duplex-guided compression of iatrogenic femoral artery pseudoaneurysms

The purpose of this report is to review our experience with duplex-guided compression in the management of iatrogenic femoral artery pseudoaneurysms. From February 1991 to July 1992, 13 consecutive asymptomatic femoral artery pseudoaneurysms were managed initially with duplex-guided compression. Twelve of these complications followed interventional cardiac procedures; the remaining case followed lysis of a femoral to tibial bypass. A Quantum Angiodynograph I duplex imager with a 5-MHz probe was used during this study. After the origin of the pseudoaneurysm was identified, compression was applied with the transducer head to obliterate flow in the pseudoaneurysm, while maintaining flow in the parent artery. Successful thrombosis was accomplished in 12 patients. The mean interval between the original femoral puncture and duplex-guided compression was 9.0 days (range, 1-22 days). The mean compression time was 30 minutes (range, 15-45 minutes). Pseudoaneurysm size ranged from 1.0 to 5.0 cm. Follow-up imaging, performed within 72 hours after compression, demonstrated sustained pseudoaneurysm thrombosis and patent femoral artery segments. Four patients were managed as out-patients, without the need for anesthesia or sedation. Eight patients were managed in the hospital, seven following interventional cardiac procedures, and one following bypass revision. Duplex-guided compression failed in one case. This patient was successfully treated operatively, at which time repair of both the profunda and superficial femoral artery was required. Asymptomatic iatrogenic femoral artery pseudoaneurysms can be successfully managed with duplex-guided compression. This maneuver appears to be a simple and cost-effective approach for initial management of these lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

[The course and results of the orthodontic treatment of 44 consecutively treated Class-II cases]

In this study treatment progress and treatment results of a consecutively treated group of 44 patients displaying a Class II malocclusion were evaluated in their relationship to the treatment goal. 41% of the patients had come to see the orthodontist on the advice of their family dentist but without any subjective problems as regards their tooth position. In 43% of the patients the treatment could not be finished in accordance with the treatment plan. In approximately 2/3 of these cases the reasons for the compromised results were due to patient cooperation problems. In the other 1/3 various types of treatment problems were encountered with loss of anchorage being the most typical. Over the entire treatment period patient cooperation was good in only approximately 50% of the cases. Oral hygiene was good in 27% of the patients at the first consultation appointment, but during the course of treatment this percentage increased to 64%. 85% of the patients expressed satisfaction with treatment results, but 34% of the patients did find the treatment to have been a burden. Enamel decalcifications were noticed in eleven patients. In another eleven patients root resorption of more than 2 mm of at least one upper incisor was noted.

Elemental diet-induced bacterial translocation and immunosuppression is not reversed by glutamine

Previously, we documented that bacterial translocation occurs in rats fed an elemental liquid diet (4.25% amino acids plus 28% glucose) for 7 days. Since controversy exists over the protective effect of glutamine on diet-induced bacterial translocation, we compared the effect of two elemental diets, one containing 0% and the other 30% of amino acids as glutamine. After 7 days on the test diets or chow (307 kcal/kg/day), the rats were killed and half the animals had their organs cultured for translocating bacteria; immune function was quantitated in the other half by measuring the blood, splenic, and mesenteric lymph node (MLN) blastogenic responses to the T-cell mitogens phytohemagglutinin (PHA) and concanavalin A (ConA). The incidence of bacterial translocation was higher in the rats fed the glutamine (88%) or nonglutamine (75%) elemental diets than in the chow-fed rats (13%) (p < 0.05). Both elemental diets equally reduced the blastogenic response of lymphocytes harvested from all three lymphoid compartments (blood, spleen, MLN) (p < 0.01 vs. chow). The percentage of reduction averaged 30% to 40% when PHA was used as the test mitogen and 50% to 70% when ConA was used. These results indicate that glutamine does not prevent elemental diet-induced bacterial translocation or immune suppression.

Inhibition of Candida albicans translocation from the gastrointestinal tract of mice by oral administration of Saccharomyces boulardii

Microbial translocation is defined as the passage of viable microbes from the gastrointestinal (GI) tract to extraintestinal sites, such as the mesenteric lymph node (MLN), spleen, liver, kidneys, and blood. The ability of orally administered viable Saccharomyces boulardii to inhibit Candida albicans translocation from the GI tract was tested in antibiotic-decontaminated, specific pathogen-free (SPF) mice, which were orally challenged with C. albicans to promote intestinal overgrowth and subsequent translocation of this organism. Oral S. boulardii treatment reduced the incidence of MLN cultures positive for C. albicans but did not decrease the numbers of C. albicans per gram of MLN in these immunocompetent mice. Prednisolone immunosuppression increased translocation of C. albicans to the MLN and allowed translocating C. albicans to spread systemically to the spleen, liver, and kidneys. In these immunosuppressed mice, orally administered S. boulardii decreased both the incidence of C. albicans translocation to the MLN, liver, and kidneys and the number of translocating C. albicans per gram of MLN, spleen, and kidneys.

Multispectral tissue characterization with time-resolved detection of diffusely scattered white light

A novel technique for the noninvasive measurement of tissue optical properties simultaneously at all visible and near-infrared wavelengths is presented. The technique is based on the time-resolved detection of multicolor diffusely scattered light. Short pulses of white light are produced by using self-phase modulation by focusing the light from a short-pulsed high-power laser into a cuvette filled with water. After spectral dispersion in a polychromator and temporal dispersion in a streak tube, a two-dimensional CCD camera was used as a detector, with one dimension used for time resolution and the other one for wavelength separation.

Anterior open bite malocclusion: a follow-up study of orthodontic treatment effects

Treatment response and stability of the anterior open bite malocclusion were evaluated in 20 open bite patients (17 females, 3 males), who were treated with the Edgewise appliance. The overbite, the number of teeth in occlusion, the functional occlusal contacts of the incisors and the cephalometric characteristics were studied before treatment (T1), at the end of retention (T2), and at least 1 year out of retention (T3). The apical root resorption of the upper incisors was analysed before and after treatment. The mean age at the follow-up control was 17 years 10 months. In 15 patients at least two occlusal contacts of the incisors were possible at the end of the retention period as well as at the follow-up control. The number of teeth in occlusion mesial to the second molars, expressed in percentage of the maximum possible, increased from 40 to 70 per cent during treatment with a positive tendency from T2 to T3. Apical root resorption of the upper incisors exceeded 10 per cent of the original root length in 4 out of 19 measurable cases. One of these patients had a history of trauma and the three others displayed atypical root form. Cases with an increased facial convexity, in which the uprighting of the incisors was possible, seemed to have a favourable treatment prognosis.

Elemental diet-induced immune suppression is caused by both bacterial and dietary factors

Because it is unclear whether elemental diet-induced immune suppression is an indirect effect caused by the translocating bacteria or is directly caused by the elemental diet, we tested whether prevention of diet-induced bacterial translocation or disruption of the gut microflora ecology would prevent diet-induced impaired lymphocyte function in a rat elemental diet model. Prevention of diet-induced bacterial translocation was accomplished by the addition of cellulose fiber or oral antibiotics (penicillin and streptomycin) to the elemental diet feeding regimen. Control groups consisted of rat food-fed and elemental diet-fed (4.25% amino acids; 28% glucose) rats. Immune function was quantitated by measuring the mitogen-induced blastogenic response of peripheral blood or splenic mononuclear cells to the mitogens concanavalin A and phytohemagglutinin. Bacterial translocation from the gut to the mesenteric lymph node and cecal bacterial population levels were measured in all groups. Although the incidence of elemental diet-induced bacterial translocation was reduced from 100% to 25% (p < .01) by the addition of dietary fiber, fiber did not prevent diet-induced impaired lymphocyte function. Because fiber supplementation of the elemental diet did not completely prevent diet-induced intestinal bacterial overgrowth or bacterial translocation, the experiment was repeated in antibiotic-decontaminated rats. Antibiotic decontamination completely prevented diet-induced intestinal bacterial overgrowth and bacterial translocation. Although antibiotic decontamination reduced the magnitude of lymphocyte mitogen suppression (p < .05), it was not fully effective in reversing the diet-induced lymphocyte suppression. These results indicate that elemental diet-induced lymphocyte blastogenic suppression is related to both bacterial and dietary factors.

Mechanisms of endotoxin-induced intestinal injury in a hyperdynamic model of sepsis

The goal of this study was to test the hypothesis that endotoxin-induced bacterial translocation is the result of a selective decrease in intestinal blood flow that causes an oxidant-mediated intestinal mucosal injury. To accomplish this goal, 116 instrumented rats receiving a nonlethal dose of endotoxin (5 mg/kg IP) or saline were studied. Organ blood flow and cardiac output were measured using the microsphere technique and intestinal permeability was measured both by the blood to luminal clearance of 51Cr-EDTA and by horseradish peroxidase. Cardiac output was higher in the endotoxin-treated group than in the saline group (76 +/- 12 versus 95 +/- 17 mL/min; p < 0.05). Although endotoxin induced a hyperdynamic state, blood flow to the distal ileum and cecum was selectively decreased by 35%-50% (p < 0.01), whereas blood flow to the rest of the intestine, spleen, pancreas, and liver was normal. Furthermore, blood flow to the ileal mucosa was decreased to a greater extent than to the remainder of the gut wall (p < 0.05). Small bowel permeability to 51Cr-EDTA was increased at sites of decreased blood flow (ileum) but not at sites of normal (jejunum) blood flow. Allopurinol, a competitive inhibitor of xanthine oxidase, ameliorated the endotoxin-induced decrease in ileal blood flow as well as the increase in ileal permeability. Thus these studies support the hypothesis that endotoxin-induced mucosal injury is the result of an ischemia reperfusion-mediated injury of the distal small intestine and cecum.

Clinical fluorescence diagnosis of human bladder carcinoma following low-dose Photofrin injection

A point-monitoring fluorescence diagnostic system based on a low-energy pulsed laser, fiber transmission optics, and an optical multichannel analyzer was used for diagnosis of patients with bladder malignancies. Twenty-four patients with bladder carcinoma, carcinoma in situ, and/or dysplasia were injected with hematoporphyrin derivative, Photofrin, 0.35 or 0.5 mg/kg body weight, forty-eight hours prior to the investigation. The ratio between the red sensitizer emission and the bluish tissue autofluorescence provided excellent demarcation between papillary tumors and normal bladder wall. Certain cases of dysplasia also could be differentiated from normal mucosa. Benign exophytic lesions such as malakoplakia appeared different from malignant tumors in fluorescence. Flat suspicious bladder mucosa such as seen in infectious diseases or after radiation therapy appeared normal on fluorescence.

Collagen content in porcine myocardium and its impact on gross anatomical heart data, thyroid gland and adrenals

60 fattening pigs of the Leicoma breed were studied. The material was of high homogeneity (age 185 +/- 2 days, body weight 114 kg). The animals were raised and slaughtered under low-stress conditions. Collagen levels in both heart ventricles of each of the animals were morphometrically evaluated and were correlated with gross anatomical and histological data of the total body, heart, thyroid and adrenal cortices. The measured data are expected to be a representative basis for a pig breed with solid cardiovascular stability. The importance of the collagen content of the myocardium and factors of influence on it are discussed.

Medical transillumination imaging using short-pulse diode lasers

The recently introduced time-resolved technique for enhanced medical transillumination imaging has been demonstrated for the important case of a diode laser transmitter. This type of gated-viewing technique utilizes early received light only to reject multiply scattered, delayed light, normally blurring the image. Human breast-cancer detection is demonstrated in vitro, and the observations are explained by using theoretical modeling and tissue phantom experiments.

Bilateral internal carotid artery agenesis: a case study and review of the literature

Bilateral internal carotid artery agenesis is a rare lesion, with only 18 cases previously reported. Blood supply to the anterior cerebral circulation is most commonly through enlarged basilar and posterior communicating arteries. Occasionally collateral flow is through abnormal transsellar anastomoses or anastomoses between the external carotid and intracranial systems. Associated intracranial aneurysms occur in 25% of patients, accounting for a significant incidence of intracranial hemorrhage as the initial symptom. Diagnosis is best made by cerebral arteriography with computed tomography to verify the congenital nature of the abnormality by demonstrating the absence of carotid canals. This is the second case to begin with transient ischemic attacks suggestive of carotid territory ischemia but originating from the vertebral system. Angiographic findings included absent internal carotid arteries, small common carotid arteries, and bilateral high-grade stenoses at the origins of large vertebral arteries. This is the first such case to be treated with reimplantation of the vertebral artery with resolution of symptoms.

Effects of optical constants on time-gated transillumination of tissue and tissue-like media

Light transillumination was used to study structures inside turbid media. Time-gated viewing was performed to suppress multiply-scattered light and thus improve spatial resolution. We demonstrate that, for the case of scattering-dominated attenuation (scattering coefficient much greater than the absorption coefficient), the detection of early transmitted light will be practically insensitive to variations in the absorption coefficient. This is an important observation for the development of time-gated optical mammography, since optical mammography using continuous-wave light is based on increased light absorption in the tumour region caused by the neovascularization surrounding a tumour. In order to detect tumours in time-gated viewing it is the scattering coefficient of the tumour that must be characteristic. The scattering coefficient is measured to be lower in the tumour region than in the surrounding breast tissue for one resected breast specimen.

Influence of arterial access sites and interventional procedures on vascular complications after cardiac catheterizations

The purpose of this study is to define the incidence of complications at the arterial access site after cardiac catheterization. The influence of the arterial access site on these complications was identified, as were the clinical characteristics of these problems. A total of 8,797 cardiac catheterizations were performed over the 3-year period of this study. Diagnostic catheterizations and percutaneous transluminal coronary angioplasties (PTCAs) were included, and the arterial access site was identified. Diagnostic catheterizations were performed via the brachial artery (group I, n = 3,137) or the femoral artery (group II, n = 4,055). PTCAs were also performed via the brachial artery (group III, n = 32) or the femoral route (group IV, n = 1,573). Ninety-five major vascular complications occurred during the course of this study. The frequency of complications was higher with brachial artery catheterization when compared with the femoral route. PTCA was associated with a higher complication rate than diagnostic studies. Brachial artery complications were primarily arterial thromboses, which were easily diagnosed and treated. Femoral artery complications were more complicated, difficult to identify, and associated with significant morbidity.