Single-photon-emission computed tomography (SPECT) in neurotologic assessment: a preliminary report

The single-photon-emission computed tomography (SPECT) scan enables clinicians to probe dynamic and metabolic changes in brain tissue through measurement of regional cerebral blood flow (rCBF). Diagnostic benefits of the SPECT scan in clinical neurology have been demonstrated. SPECT scanning has been shown to be more sensitive than morphologic imaging techniques [magnetic resonance imaging (MRI) and computed tomography (CT)] in many conditions. However, the use of the scan in assessing neurotologic complaints remains inadequately investigated. Few studies have explored the value of SPECT in establishing the causes of dizziness, hearing loss, and tinnitus. We studied SPECT along with MRI, CT scan, electroencephalogram (EEG), and other evaluations in patients with these neurotologic complaints, SPECT abnormalities were more frequent and prominent than those visualized by other imaging modalities. Overall, 78% of SPECT scans revealed abnormalities. Abnormalities were found in 46% of MRIs, 40% of CTs, and 29% of EEGs. The disparity between SPECT scanning and other procedures was also seen once patients were divided by their chief complaints. This study illustrates the sensitivity of SPECT scanning in evaluating neurotologic complaints and highlights the need for additional research into the importance of SPECT scanning in comprehensive neurotologic evaluation.

Interphase cytogenetics of non-Hodgkin's lymphoma using non-fluorescent in situ hybridization in paraffin embedded tissue

Paraffin-embedded tissue samples from 30 cases of non-Hodgkin's lymphoma(NHL) and 10 of reactive hyperplasia, were processed for interphase cytogenetic chromosomal study. We performed non-fluorescent in situ hybridization(NFISH) using the enzymatic method with digoxigenin-labeled DNA centromeric probes for chromosome 7,12,18 and X, and a painting probe for chromosome 18. Chromosomal aberrations were observed in 27(90%) out of 30 cases of NHL. The most commonly observed numerical aberration was extracopy of X chromosome. There were some characteristic aberrations corresponding to each grade and group of NHL by International Working Formulation: In low grade NHL(9 cases), a third were associated with extracopy of chromosome 12, and disomy X was frequently found in small lymphocytic lymphoma(75%). With intermediate grade(16 cases), tetraploidy(25%), translocation of chromosome 18(25%), and extracopy of chromosome 18(19%) were characteristically associated. These results suggest that interphase NFISH is an easily performable method in retrograde cytogenetic study of archival materials. Some specifically correlated chromosomal aberrations corresponding to the histopathologic grades and groups could provide us more valuable information for determining pathologic diagnosis and assessing the clinical outcome of NHL.

Cytokine transcriptional events during helper T cell subset differentiation

The molecular basis for changes in cytokine expression during T helper (Th) cell subset differentiation is not well understood. We have characterized transcriptional events related to cytokine gene expression in populations of naive T cell receptor-transgenic T cells as they are driven in vitro toward Th1 or Th2 phenotypes by interleukin (IL)-12 or IL-4 treatment, respectively. Quantitative reverse transcriptase-polymerase chain reaction analysis of cytokine transcripts indicates that interferon (IFN) gamma, IL-4, and IL-2 mRNA are expressed with distinct kinetics after naive T cells are stimulated with antigen and either IL-4 or IL-12. IFN-gamma mRNA appears as early as 6 h in IL-12-treated cultures, IL-4 appears only after 48 h in IL-4-treated cultures, and IL-2 is equivalently expressed in both types of cultures. Analyses were performed to determine if there were any differences in activation of IL-2 or IL-4 transcription factors that accompanied Th1 versus Th2 differentiation. These studies demonstrated that signal transducer and activator of transcription 6 (STAT6) binds to a sequence in the IL-4 promoter and that this STAT6-binding site can support IL-4-dependent transcription of a linked heterologous promoter. Prolonged activation of STAT6 is characteristic of populations undergoing Th2 differentiation. Furthermore, STAT6 is activated in an autocrine manner when differentiated Th2 populations are stimulated by antigen receptor ligation. Th1 populations derived from IL-12 plus antigen treatment of naive T cells remain responsive to IL-4 as indicated by induction of STAT6 and IL-4 mRNA. These data indicate that Th1 and Th2 differentiation represents the combination of different, apparently independently regulated transcriptional events. Furthermore, among transcription factors that bind to the IL-4 or IL-2 promoters, STAT6 is the one whose activation distinguishes Th2 versus Th1 development.

Tc-99m MIBI brain SPECT of cerebellopontine angle tumors

To prospectively evaluate the imaging feasibility of Tc-99m sestamibi brain SPECT of cerebellopontine angle (CPA) tumors, seven patients with CPA lesions seen on CT or MRI and five normal control subjects underwent brain SPECT using a triple-headed camera. Five of these patients had acoustic neuromas, one had a meningloma, and the other had a vascular loop. Subsequently, four patients underwent surgery. In normal control subjects and patients with CPA lesions, there was Tc-99m sestamibi activity in the pituitary gland, choroid plexi, and extraocular muscles. The uptake in these structures, especially the choroid plexi could not be blocked by the oral administration of potassium perchlorate in two normal subjects. Four of seven patients with CPA lesions larger than 1.0 cm in diameter showed tumor uptake (3 acoustic schwannomas, 1 meningloma). Two small ( > 1.0 cm in diameter) intracanalicular type acoustic neuromas failed to show uptake, despite additional attenuation correction for the petrous bone. There was no abnormal uptake in the patient with a vascular loop in the CPA. Preliminary data suggest that, with the exception of small intracanalicular neuromas, CPA tumors can be imaged using Tc-99m sestamibi brain SPECT.

Large, complex modular structure of a fission yeast DNA replication origin

BACKGROUND

In the budding yeast, Saccharomyces cerevisiae, each DNA replication origin is associated with an autonomously replicating sequence (ARS) element. Each element contains several modules, including an essential close match to the 11 base-pair (bp) ARS consensus sequence (ACS) and two or three short (< 20 bp) stimulatory motifs, within a stretch of approximately 150 bp or less. To determine whether a similar origin structure exists in the evolutionarily distant fission yeast, Schizosaccharomyces pombe, we used deletion and linker substitution scanning to identify the sequences important for the function of ars3002, a chromosomal replication origin.

RESULTS

We detected two large (30-55 bp) essential regions and several additional stimulatory sequences within a 600 bp stretch of a restriction fragment containing ars3002. The two essential regions are similar to each other, and sequences similar to them are found in all known S. pombe ARS elements, suggesting that one or both of them may represent the S. pombe equivalent of the S. cerevisiae ACS.

CONCLUSIONS

Like S. cerevisiae origins, the S. pombe origin, ars3002, possesses a modular structure, but the number and size of modules is greater for ars3002, and ars3002 is larger than S. cerevisiae origins. These observations suggest that origin function in S. pombe requires more protein-DNA interactions than in S. cerevisiae.

HTLV-I associated adult T cell leukemia/lymphoma: report of two cases from an Amerindian population in coastal northwest British Columbia

Epidemiological studies of HTLV-I infection have demonstrated the presence of this virus in certain Amerindian populations in Central and South America. We have recently reported the first evidence of endemic HTLV-I infection in North American Amerindians from the coastal regions of British Columbia, Canada. While the predominant HTLV-I-associated disease observed in British Columbia Amerindians is the HTLV-I associated neurological disease (HTLV-I-associated myelopathy/tropical spastic paraparesis), we report here the first two cases of HTLV-I-associated adult T cell leukemia/lymphoma (ATL). Clinical and PCR evidence to support the diagnosis of HTLV-I-associated ATL in these two Amerindians is presented. Both cases of ATL were found in the same tribe although neither patient was directly related to each other. While reports of HTLV-I-associated ATL have been reported in Circumartic native peoples, reports of ATL in North American single ancestry Amerindians have not been previously made to our knowledge.

Determination of the three-dimensional structure of hordothionin-alpha by nuclear magnetic resonance

The high-resolution three-dimensional solution structure of the plant toxin hordothionin-alpha obtained from korean barley was determined by using two-dimensional NMR techniques combined with distance geometry and restrained molecular dynamics. Experimentally derived restraints including 292 interproton distances from nuclear Overhauser effect measurements, 16 hydrogen bond restraints together with four disulphide bridge restraints were used as input to calculations of distance geometry and restrained molecular dynamics. Also included in the calculations were 36 phi and 17 chi 1 torsion angles obtained from 33JHN alpha and 3J alpha beta coupling constants in double quantum filtered COSY and primitive exclusive COSY experiments, respectively. The overall protein fold is similar to crambin and purothionin-alpha 1. Two alpha-helices running in opposite directions are found on the basis of 3JHN alpha and 3J alpha beta and deuterium exchange rates for backbone NH protons, and encompass residues 7-18 and 22-28. These two helices are connected by a turn and form a 'helix-turn-helix' motif. A short stretch of an anti-parallel beta-sheet exists between residues 1-4 and 31-34. the two protein termini of hordothionin-alpha are 'well-anchored'; the N-terminus of the protein is immobilized by this short beta-sheet whereas the C-terminus is 'pasted' to the carbonyl group of Cys-4 by a very stable hydrogen bond. The average root-mean-square differences for the backbone and heavy atoms after the restrained molecular dynamics calculations are 0.62 and 1.16 A respectively. These numbers represent a significant improvement over the corresponding values for the previous NMR structures of other thionins. The distance violation from the experimental interproton distances for the final structures is 0.14 for all atoms.

Cystic fibrosis mutation detection by hybridization to light-generated DNA probe arrays

We have combined photochemistry and photolithography with solid-phase DNA synthesis chemistry to form a new technology that makes high density oligonucleotide probe array synthesis possible. Hybridization to these two-dimensional arrays containing hundreds or thousands of oligonucleotide probes provides a powerful DNA sequence analysis tool. Two types of light-generated DNA probe arrays have been used to test for a variety of mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. One array, made up of 428 probes, was designed to scan through the length of CFTR exon 11 and identify differences from the wild type reference sequence. The second type of array contained 1480 probes chosen to detect known deletions, insertions, or base substitution mutations. The validity of the probe arrays was established by hybridizing them with fluorescently labeled control oligonucleotide targets. Characterized mutant CFTR genomic DNA samples were then used to further test probe array hybridization specificity. Finally, ten unknown patient samples were genotyped using the CFTR probe array assay. The genotype assignments were identical to those obtained by PCR product restriction fragment analysis. Our results show that light-generated DNA probe arrays are highly effective in analyzing complex mutation and polymorphism patterns in a relatively large gene such as CFTR.

Systemic lupus erythematosus with obstructive uropathy. Case report and review

We report a case of patient with documented SLE who displayed dysuria, gastrointestinal (GI) symptoms and renal insufficiency associated with the unusual occurrence of bilateral hydroureteronephrosis due to urterovesical junction stricture (obstructive uropathy). Pathologic investigations disclosed chronic interstitial cystitis (IC) with evidence of focal immune complex deposition in the blood vessel walls of the bladder. The GI symptoms and dysuria regressed with initial therapy for SLE with steroids. However, the persistent obstructive uropathy (OU) and renal insufficiency required bilateral nephrostomy followed by steroids plus intravenous pulse injection of cyclophosphamide. The obstructive uropathy was relieved even after removing the nephrostomy tube and renal function remained stable. Including this case, nineteen SLE patients associated with clinical and radiographic findings of OU were found in the world literature and reviewed to find any consistent pattern of clinical features. Most of the patients with OU in SLE were female (mean age, 31.7 yr) and orientals (63%), and had interstitial cystitis (89%) as a common underlying cause with concomitant involvement of the GI tract (89%) and WHO class IV or V advanced glomerulonephritis (67%). Despite the remarkable response (68%) to steroids in majority of OU patients associated with SLE, certain patients still required surgical correction (32%) and some even died (32%). OU, potentially reversible, was not an exception in patients with SLE, which might be overshadowed by other major organ involvement of SLE.

Association of exposure to polycyclic aromatic hydrocarbons (estimated from job category) with concentration of 1-hydroxypyrene glucuronide in urine from workers at a steel plant

OBJECTIVES

Increased risk of lung cancer has been associated with employment in the steel industry. This association is thought to be due in part to increased concentrations of polycyclic aromatic hydrocarbons (PAHs) in air found in this work environment. Measurement of PAH metabolites in human urine provides a means of assessing individual internal dose of PAHs. This study examined the relative contribution of occupation and smoking to urinary concentration of 1-hydroxypyrene glucuronide (1-OHPG) among a group of workers at a steel plant.

METHODS

Concentrations of 1-OHPG in urine from 44 workers with jobs associated with increased air concentrations of PAHs and 40 workers with jobs with low or no exposure to PAHs were measured. 20 workers in each group were not current smokers. Urinary 1-OHPG was measured by synchronous fluorescence spectroscopy after immunoaffinity chromatography specific for PAH metabolites.

RESULTS

Mean (SEM) urinary 1-OHPG concentration was 2.16 (0.42) pmol/ml urine among the 44 occupationally exposed workers compared with 0.38 (0.05) among the 40 workers with no or low exposure (P < 0.0001). Mean urinary 1-OHPG concentration was 1.82 (0.41) pmol/ml urine among the 44 current smokers compared with 0.75 (0.20) among the 40 non-smokers (P < 0.005). Mean 1-OHPG concentrations in non-smokers were 0.26 (n = 20), 0.70 (n = 15), and 2.84 pmol/ml urine (n = 5) for strata of exposure to PAHs (no or low, mid, and high) based on job category; the corresponding values in smokers were 0.55 (n = 20), 0.94 (n = 12), and 4.91 pmol/ml (n = 12), respectively. Multiple linear regression showed significant differences between subjects in different PAH exposure with increased concentrations of 1-OHPG in urine. Amounts of foods containing PAHs ingested by this group of workers were relatively low and did not contribute significantly to urinary 1-OHPG concentrations.

CONCLUSIONS

These results indicate that 1-OHPG is a common urinary metabolite in people with recent occupational exposure to PAHs and is associated with both job category and estimated stratum of PAH exposure.

Prognostic significance of ST-segment depression during adenosine perfusion imaging

To determine the significance of ST-segment depression during adenosine perfusion imaging for predicting future cardiac events, 188 patients with interpretable electrocardiograms were assessed 1 to 3 years (mean 21.5 +/- 6.6 months) after adenosine testing. At least 1 mm of ST-segment depression was observed in 32 (17%) patients, with > or = 2 mm of ST-segment depression in 10 (5.3%). Thirty-seven cardiac events occurred during the study period: 2 cardiac deaths, 5 nonfatal myocardial infarctions, 6 admissions for unstable angina, and 24 revascularizations. Univariate predictors of events were a history of congestive heart failure, previous non-Q-wave myocardial infarction, previous coronary angioplasty, use of antianginal medication, ST-segment depression during adenosine infusion (particularly > or = 2 mm), any reversible perfusion defect, transient left ventricular cavity dilation, and the severity of perfusion defects. Multivariate analysis identified > or = 2 mm ST-segment depression as the most significant predictor of cardiac events (relative risk [RR] = 6.5; p = 0.0001). Other independent predictors of events were left ventricular dilation (RR = 3.8; p = 0.002), previous coronary angioplasty (RR = 3.3; p = 0.001), a history of non-Q-wave myocardial infarction (RR = 2.3; p = 0.01), and the presence of any reversible defect (RR = 2.0; p = 0.05). We conclude that ST-segment depression occurs uncommonly during adenosine infusion, but the presence of > or = 2 mm of ST-segment depression is an independent predictor of future cardiac events and provides information in addition to that obtained from clinical variables and the results of adenosine perfusion imaging.

Delayed radioiodine organification in Plummer's disease

Hyperfunctioning thyroid adenomas causing thyrotoxicosis (Plummer's disease) is not an uncommon cause of hyperthyroidism in the elderly. Most commonly, the adenoma appears as a so-called "hot" nodule on thyroid scintigraphy causing suppression (i.e., nonvisualization) of the remainder of the gland. This report describes a case of Plummer's disease in an elderly patient in whom the toxic nodule primarily responsible for causing the hyperthyroidism became scintigraphically apparent at 96 hours after I-131 therapeutic ablation.

Localization of intracellular monoclonal antibody specific for mycobacteria in experimentally induced pulmonary tuberculous lesion

To determine the intracellular localization of intravenously injected infection-specific monoclonal antibodies (mAbs) in the infected cells, immunohistochemical staining was carried out in an animal model having pulmonary tuberculous lesions induced by inoculation of heat-killed Mycobacterium tuberculosis H37Rv. One milligram of intact mouse mAb against mycobacteria (group I, n = 10) and F(ab')2 (group II, n = 6) was intravenously injected to the rabbits of each group. Immunohistochemical staining using an antimouse Ab was performed at days 1, 3, 5, 7 and 8 in group I and at days 1, 2 and 3 in group II by the streptavidin-biotin method. For the control study, 1 ml of nonspecific polyclonal human IgG (group III, n = 10) and 100 micrograms of normal rabbit IgG F(ab')2 (group IV, n = 6) was injected to rabbits and guinea pigs having tuberculous inflammation, respectively. Both groups (group I and II) showed a positive antigen (Ag)-Ab reaction within the cytoplasm of monocytes. A weak but positive reaction was observed intracellularly in group III; however, no positive reaction was seen in group IV. Our results suggest that an intracellular Ag-Ab reaction plays an important role in the localization of infection by immunoscintigraphy using specific mAb fragments.

Differential inhibition of T and B cell responses to individual antigenic determinants in orally tolerized mice

Immunological tolerance of systemic immunity can be induced by the oral administration of an exogenous antigen, which is termed oral tolerance. We examined whether there was a difference in the degree of tolerance between individual antigenic determinants in oral tolerance. Feeding bovine alpha s1-casein, a major protein in cow's milk, as a constituent of the diet induces oral tolerance in mice. However, a weak antibody response can be elicited in the alpha s1-casein-fed animals by subsequent immunization with the antigen. We examined the fine specificity of such anti-alpha s1-casein antibodies produced in alpha s1-casein-fed mice. The results demonstrated that there was a difference in the inhibition of antibody response between different B cell determinants. Differential inhibition could also be observed for T cell responses. T cells specific for dominant determinants were preferentially tolerized, while those for cryptic determinants escaped oral tolerance. Our results imply the importance of antigen presentation for this differential inhibition of antigenic determinants. We suggest that orally administered antigen does not induce tolerance to some of the B and T lymphocyte repertoire which could potentially induce harmful food hypersensitivity.

Brain SPECT artifact in multidetector SPECT system

Stringent quality control cannot be overemphasized in performing SPECT. SPECT artifacts related to camera uniformity, center of rotation, and the patient's motion are well recognized. In this communication, another rare cause of a SPECT artifact related to a triad system is reported. A triple-headed SPECT system was accidentally equipped with two ultrahigh-resolution collimators and a general all-purpose collimator during a brain SPECT study, causing a false cerebral blood flow defect.

The "count loss" artifact in Tc-99m HMPAO leukocyte SPECT of the abdomen

During SPECT studies of the abdomen with Tc-99m labeled autologous leukocytes, the authors had observed false defects involving the vertebral bodies of the lower thoracic spine in two patients. To investigate this "count loss" artifact, a phantom simulating liver, spleen, and spine was constructed. Four clinical situations were simulated by positioning cylinders in the different locations: normal spine-spleen model, normal liver-spine-spleen model, spine-enlarged spleen model, and enlarged liver-spine-enlarged spleen model. SPECT studies were performed at different concentration ratios between the spleen and the spine on the disparate models with varying distance from the spleen to the spine. The results showed that the count loss artifact is not only related to the concentration ratio between the structures but also is related to the size, position, and distance between the structures. The correction steps for this artifact include: 1) identifying average count value of the spine and spleen from ECT sinogram count data, and 2) replacing the original high-count value in the spleen by the count value close to the average value at the region of the spine in the 120 raw projection data. Using these new modified ECT data, the reconstructed orthogonal images are almost free of the count loss artifact.

Epstein-Barr virus associated posttransplant malignant lymphoma in renal allograft recipients

We report two cases of posttransplant malignant lymphoma(PTML) of B cell origin associated with Epstein-Barr virus(EBV) infection. They were a 52-year-old male and a 37 year-old-female, in whom intermediate-grade diffuse malignant lymphomas of large cell type developed in the submandibular area and jejunum, respectively. DNA and RNA in situ hybridization revealed the presence of EBV-specific DNA and RNA sequences in the tumor cells.

Thyroid scintigraphy of hyperthyroxinemia

The term "hyperthyroxinemia" encompasses clinical syndromes associated with elevated levels of thyroid hormone in the presence of increased, normal, or decreased thyroid function. The clinical presentation (i.e., history and physical examination), in vitro thyroid function tests, as well as radioisotope thyroid imaging all play key roles in the diagnosis of the underlying thyroid disorder. Many of these disorders and their appearance on thyroid scintigraphy are presented in this atlas.

Cancer of the stomach: a review of two hospitals in Korea and Japan

The records of 525 patients with primary adenocarcinoma of the stomach treated at Korea University Hospital (K.U.H.), Seoul, Korea, and 1,932 patients treated at National Cancer Center Hospital (N.C.C.), Tokyo, Japan, over a 7-year period were reviewed to study biologic characteristics and treatment results in the two hospitals. More than 70% of the patients were 41 to 70 years old in both hospitals, though K.U.H. had more younger patients and N.C.C. had more older patients. Comparison in regard to clinicopathologic features showed significant differences in type of cancer, tumor size, depth of invasion, lymph node metastasis, stage, and histologic type. Such a difference mostly was due to a greater frequency of early gastric cancer in N.C.C. patients (51.2%) than in K.U.H. patients (19.0%). Patients of K.U.H. were more likely to have advanced cancer, large invasive tumors, a higher percentage of lymph node metastasis, a higher stage, and more undifferentiated tumors. The 5-year survival rate of all resected cases was 69.5% in N.C.C. and 54.2% in K.U.H. (p > 0.05). Those factors which showed a significant difference in clinicopathologic features did not affect the survival difference between the two hospitals except in stage IIIb and signet-ring-cell cancer. The 5-year survival rate for stage IIIb was 18.0% in K.U.H. and 36.8% in N.C.C. It would seem that survival difference in stage IIIb related to extensive lymph node dissection in N.C.C. Survival difference in signet-ring-cell gastric cancer (31.2% in K.U.H. and 91.0% in N.C.C.) was related to the fact that 79.1% of signet-ring-cell gastric cancer patients in N.C.C. had early gastric cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosis of tuberculous meningitis by detection of immunoglobulin G antibodies to purified protein derivative and lipoarabinomannan antigen in cerebrospinal fluid

Enzyme-linked immunosorbent assay of immunoglobulin G (IgG) activity in cerebrospinal fluid (CSF) and sera was conducted prospectively in 27 patients with tuberculous meningitis (TBM) by using purified protein derivative (PPD) and lipoarabinomannan (LAM) antigens, from January 1989 to August 1990. 29 patients with aseptic meningitis and 49 patients with non-inflammatory neurological illnesses served as controls. All patients had a computed tomography (CT) scan of the head before a lumbar puncture. The IgG antibodies to the antigens were significantly elevated in TBM, and the reactivity was more frequently positive in the CSF than in the sera, suggesting a local synthesis of IgG in the central nervous system (CNS). The sensitivity and the specificity for the diagnosis of TBM were 59.2% and 93.9% for PPD antigen, and 85.2% and 95.9% for LAM antigen, respectively. Assay of IgG reactivity to LAM antigen was clinically very useful for the early diagnosis of TBM and was superior to PPD for detecting the serological evidence of TBM.

[Identification of enterotoxin-producing Clostridium perfringens by the polymerase chain reaction]

Polymerase chain reaction was applied to identify enterotoxin-producing Clostridium perfringens by amplifying a segment of the C. perfringens enterotoxin gene. All of the four enterotoxin-positive reference strains tested were PCR positive while an enterotoxin-negative strain was PCR positive. All 17 clostridial strains (16 species) other than C. perfringens were PCR negative. With clinical strains isolated from various clinical specimens in Japan, Korea, and Thailand, all three enterotoxin-positive isolates were PCR positive and all 82 enterotoxin-negative isolates were PCR negative. PCR results for amplifying a region containing the initiation codon of the C. perfringens enterotoxin gene also demonstrated complete agreement with enterotoxin producibility. These results suggested that the PCR assay is a rapid and simple test for identifying the enterotoxin-producing C. perfringens without using any cultures and spore treatments.

The attenuation effect in brain SPECT

False perfusion defects simulating Alzheimer's disease can be attributed to skull thickness and head holders of a SPECT scan table. Brain phantom SPECT was performed using a different type of head holder in order to evaluate the effect of attenuation due to head holders and skull thickness on brain SPECT. Skull thickness was measured in 10 normal or non-Alzheimer's patients and 10 patients with suspected Alzheimer's disease. Visual and quantitative analysis of regional perfusion showed a 19% count loss due to attenuation by commercially available head holders and average skull thickness, less than 18% count difference between frontal-temporal and parietal-occipital skull in non-Alzheimer's disease patients, and more than 22% count difference observed in suspected Alzheimer's patients.

The expression of p53 antigen in primary malignant epithelial tumors of the liver: an immunohistochemical study

We examined the expression of mutant p53 gene products in primary malignant epithelial tumors of the liver. Fourteen of 68 hepatocellular carcinomas, one of seven hepatoblastomas and one of nine intrahepatic cholangiocarcinomas showed nuclear staining for p53 proteins. None of the surrounding non-tumorous tissues expressed nuclear staining. The detection of p53 proteins in tumor cells was significantly higher in hepatocellular carcinomas of Oriental patients (31.6%) compared to non-Orientals (6.7%, p < 0.015). No significant differences were seen in p53 antigen expression between hepatitis B and non-hepatitis B associated hepatocellular carcinomas in Oriental patients. These results suggest a role for other environmental factors, such as aflatoxin, in the etiology of p53 mutation in hepatocellular carcinoma in Oriental patients.

Distribution of HLA class I alleles and haplotypes in Korean

The antigen (phenotype), gene (allele) and haplotype frequencies of HLA class I were analysed in 4,622 Koreans. With allele frequencies of over 0.05, the most frequent HLA-A,-B and -C antigens were A2, A24, A33, A11, A26, A31; B62, B51, B44, B54, B61, B35, B58, B60; Cw3, Cw1, Cw4, Cw7. Of these A2, A24, Cw1 and Cw3 were present in very high frequencies, respectively (0.3211, 0.2200, 0.2204, and 0.3737). The most common haplotypes with frequencies larger than 0.02 were A2-Blank, A33-B44, A33-B58, A11-B62, A24-B51, A24-B54, A2-B27, B54-Cw1, B58-Cw3, B51-Blank, B61-Cw3, B62-Cw4, B35-Cw3, B44-Blank, B60-Cw3, B27-Cw1, A2-Cw3, A2-Cw1, A24-Cw1, A33-Cw3, A26-Cw3, and A11-Cw4. A significant negative linkage disequilibrium was found for the haplotypes of A2-B7, A2-B44, A2-B58, A24-B13, A24-B27, A33-B54 and A33-B62, of which frequencies were larger than 0.003. The B-C and A-C haplotypes which showed the significant negative linkage disequilibrium were B44-Cw1, B51-Cw1, B44-Cw3,B62-Blank, A2-Cw4, A2-Blank, A11-Cw3, A11-Blank and A33-Cw1 and had frequencies higher than 0.01. The findings presented here could be used per se to estimate the populational relationships or as the control data for HLA-disease investigation. Furthermore they could provide the scope for the definition of new antigens.

Brain SPECT in a patient with post-stroke hallucination

A patient developed visual hallucinations following a left-sided cerebrovascular accident (CVA). Brain SPECT using Tc-99m HMPAO demonstrated increased perfusion at the biparieto-occipital lobes. Following antiepileptic medication, repeat brain SPECT showed interval decrease in perfusion in the same areas with the symptomatic relief of hallucinatory episode. While it is possible that the interval decrease is due to natural resolution, the authors believe that it is likely due to drug treatment.

Scintigraphic recognition of papillary muscles and papillary muscle ischemia

During stress thallium imaging, papillary muscles (anterolateral and posteromedial) appear scintigraphically as focal regions of enhanced activity in sites corresponding to their anatomic position. In the normal case, enhancement after exercise is greater than or equal to enhancement at rest. With papillary muscle ischemia, the involved papillary muscle demonstrates more enhanced activity at rest than at postexercise. This pattern change with papillary muscle ischemia was observed in four patients. Three cases demonstrated complete reversal of those ischemic changes after angioplasty and the remaining case failed to show any significant improvement after angioplasty.

Clinical, laboratory, and scintigraphic manifestations of subacute and chronic thyroiditis

The term "thyroiditis" refers to several syndromes of differing etiology. Chronic or Hashimoto's thyroiditis (HT), an autoimmune disorder that is manifested by goiter and hypothyroidism, is by far the most common of these syndromes. Subacute thyroiditis (SAT) encompasses two distinct syndromes: subacute granulomatous thyroiditis (SAGT) and subacute lymphocytic thyroiditis (SLT). SAGT is viral in origin and usually presents with neck tenderness and hyperthyroid symptoms, while SLT, which is likely to be an autoimmune entity, results in goiter and transient hyperthyroidism. SLT is often seen in the postpartum period and is referred to as postpartum thyroiditis (PPT). Less common forms of thyroiditis include Riedel's struma, which is characterized by extensive fibrosis of the thyroid gland, and acute suppurative thyroiditis, which is a bacterial infection. Twenty patients with goiter were evaluated by thyroid scintigraphy. They were ultimately diagnosed as having either HT (14), SAGT (3), SLT (1), or PPT (2). Their scan findings were correlated with both clinical presentations as well as in vitro laboratory analysis.

Serum antibody response elicited by a casein diet is directed to only limited determinants of alpha s1-casein

Feeding mice with bovine whole casein as a diet constituent elicited an anti-alpha s1-casein (alpha s1-CN) systemic humoral response. The mice fed with the casein (CN) diet responded poorly to subsequent parenteral immunization with the antigen, indicating that oral tolerance was induced in the animals. The serum antibodies elicited by feeding CN were tested for binding to a panel of synthetic peptides and are shown to recognize only a limited number of potential antigenic determinants on alpha s1-CN. Our results suggest that a similar mechanism may be involved in the onset of milk allergy.

Tc-99m DTPA diffuse pulmonary uptake in patients with coronary artery disease and renal insufficiency

Diffuse bilateral lung uptake was observed in 10 patients undergoing Tc-99m DTPA renal scanning, referred for the evaluation of rising serum creatinine levels. All 10 patients demonstrated renal insufficiency (RI) as shown by both decreased bilateral renal tracer concentration and elevated background activity. Nine of the patients were known to have coronary artery disease (CAD) and six of these nine patients were in congestive heart failure (CHF), at or around the time of scanning. However, Tc-99m DTPA lung uptake was not observed in five other patients whose scans demonstrated RI, in whom there was no CAD or other cardiac disease. Diffuse lung uptake of Tc-99m DTPA in patients with RI therefore is highly suggestive of cardiac dysfunction (i.e. CAD and/or CHF).

Surgical treatment of periampullary cancer--review of 766 surgical experiences of 8 hospitals

The incidence of periampullary cancer has been steadily rising in Korea. In the present study, we have reviewed 766 cases of surgically treated periampullary cancers, including 122 cases of our own, which were published in the Korean literature from 1984 to 1992. The 6th decade was the most prevalent age group, occupying 38% of the patients. The ratio of male of female was 1.7 to 1. Approximately 60% of lesion located at the head of the pancreas. Computed tomography which had 85% sensitivity was the most commonly employed modality for a diagnosis. The diagnostic sensitivity of percutaneous transhepatic cholangiography was 72%, of endoscopic retrograde cholangiopancreatography was 71%, and of ultrasonography was 54% in order of frequency. Tumor markers such as CA-19, CEA, and CA-125 were also studied in pancreatic cancer. The combinations of these markers recorded a higher positivity than using solely. The resection rate for lesions at the head of the pancreas was 21%, and that of distal common bile duct, ampulla of vater, and duodenum were 37%, 85%, and 50%, respectively. The morbidity and mortality rates after pancreatoduodenectomy were 44% and 12%, respectively. TNM staging revealed 66% of patients were in stage III, 26% in stage I, and 8% in stage II. The actual 5-year survival rates for cancer of the head of the pancreas was 11%, and that of duodenal cancer, distal choledochal cancer, and ampullary cancer were 21%, 18%, and 15%, respectively. In nonresected group, none survived over 18 months after treatment. Relatively high portion of lymph node metastatic patients may explain the poor survival observed in our series.

Diabetic nephropathy: duplex Doppler ultrasound findings

To evaluate the correlations among Doppler sonographic findings, morphologic sonographic findings, and laboratory findings representing renal functional status, duplex Doppler sonography of the kidney was performed in 32 patients with diabetes mellitus. Resistive indices obtained in the region of the arcuate or the interlobar arteries in patients with elevated serum creatinine levels were significantly higher than those in patients with normal serum creatinine levels (P < 0.05). Also, there was a significant correlation between the resistive indices and creatinine clearance levels (correlation coefficient, -0.828). There was a significant difference between the serum creatinine levels of patients with normal renal cortical echogenicity and those with increased cortical echogenicity (P < 0.05). Analysis of the Doppler spectrum of the intrarenal arteries in conjunction with careful evaluation of the renal cortical echogenicity may be helpful in sonographic prediction of the renal functional status in patients with diabetes mellitus.

Reverse crossed cerebellar diaschisis in partial complex seizures related to herpes simplex encephalitis

Tc-99m HMPAO brain SPECT was performed in a patient who had partial complex seizures for 1 year after successful acyclovir treatment of biopsy-proven herpes simplex encephalitis 2 years earlier. In spite of antiepileptic medications, her seizures were intractable and occurred daily. Tc-99m HMPAO was administered intravenously while she was having subclinical seizures, and brain SPECT demonstrated an area of hyperperfusion in the right temporal lobe medially and in the contralateral cerebellum. This reverse of the crossed cerebellar diaschisis phenomenon in epileptic disorders has not previously been documented.