Dual isotope SPECT in the evaluation of recurrent brain tumor

Dual isotope brain SPECT was performed in a patient with recurrent brain tumor (grade II astrocytoma). In this case, a good coregistration of brain perfusion and tumor images was obtained because Tc-99m HMPAO and the Tl-201 chloride imaging were done simultaneously using a Triad SPECT unit. This method might play an important clinical role in the evaluation of patients with recurrent brain tumors.

Nonpustular psoriatic lesions detected by Tc-99m HMPAO labeled granulocytes

A patient with a fever of unknown origin was evaluated by abdominal SPECT using Tc-99m HMPAO labeled granulocytes and a triple detector camera. Although no abscesses were located, nonpustular psoriatic skin lesions were demonstrated incidentally on the reprojectional images. Psoriatic scales contain a chemotactic factor for leukocytes, and this is a likely explanation for the increased uptake of the radiotracer by psoriatic lesions.

Present status of periampullary cancer treatment in Korea

The incidence of periampullary cancer has been steadily risen in Korea. In the present study, we have reviewed 766 cases of surgically treated periampullary cancers, including 122 cases of our own, that were published in the Korean literatures in last ten years. The 6th decade was the most common age group, occupying 37.9% of the patients. Male to female, ratio was 1.7 to 1. C-T scan was the principal modality available for diagnosis and preoperative staging, and recorded 84% of diagnostic accuracy. The accuracy rate of PTC was 72%, ERCP of 68%, and USG of 51%, in order of frequency. For the screening of pancreatic cancer, diagnostic serologic test using serum markers such as CA 19-9, CEA, CA 125, and various combinations were studied. The combinations of these markers recorded higher positivity. Overall resectability was 36.2%. Preoperative C-T scan with antigraphy correlated with better discrimination of the resectable lesion preoperatively than C-T scan alone was performed (63% VS 46%). The morbidity and mortality after pancreaticoduodenectomy were 46% and 13.2%, and 1, 3, and 5-year survival rates after the resection were 68, 25, and 15%, respectively. In non-resected group, none survived at 18 months after treatment. To improve resectability; early detection, precise preoperative staging, and improved surgical approach are imperative. Future studies will be necessary to find a better multimodality therapy.

Scintigraphic diagnosis of right ventricular ischemia

We present a patient with exercise induced right ventricular ischemia demonstrated on stress TI-201 myocardial scintiscan. The patient underwent cardiac catheterization, and subtotal occlusion was found at the proximal right coronary artery. Repeat stress TI-201 scan became normal following the successful percutaneous transluminal coronary angioplasty.

Two cases of mitochondrial myopathy with predominant respiratory dysfunction

Although it is well known that the respiratory failure is a major cause of death in most patients with chronic neuromuscular disease, predominant respiratory dysfunction without severe involvement of limb muscles is an unusual complication of mitochondrial myopathy in adult age. We experienced two cases of mitochondrial myopathy with severe involvement of respiratory function and only mild involvement of limb muscles. One is a 16 year old female and another is a 22 year old male. The diagnosis is based on morphologic characteristics of "ragged red fibers" under the light microscope and abnormal mitochondrias on the electron microscope in the muscle biopsy.

Malignant glomus tumor originating in the superior mediastinum--an immunohistochemical and ultrastructural study

An extremely rare case of malignant glomus tumor originating in the superior mediastinum was evaluated immunohistochemically and ultrastructurally. A 78-year-old woman who had been suffering from dysphagia and dyspnea had poorly-defined soft tissue mass, 4.5 x 2.5cm, in the superior mediastinum with direct invasion into the esophagus, trachea, and bilateral thyroid glands. This case is believed to be unique in several respects. There were neither recognizable findings of benign glomus tumor nor sarcomatous areas, in contrast to the previously reported cases. A definite direct invasion into the surrounding organs was identified. We therefore interpreted this case as primary malignant glomus tumor, not as glomangiosarcoma arising in a benign glomus tumor.

Solitary myeloma with massive extracellular crystalline structures--a case report

We describe a case of solitary myeloma showing cystic change filled with massive crystalline structures in a 54-year-old woman. A bone X-ray showed a solitary cystic osteolytic lesion in the right iliac bone. Serum and urine protein electrophoresis showed no demonstrable M-protein, and bone-marrow aspirates did not show any myeloma cells. Histologic examination of the tumor revealed aggregation of plasma cells with massive extracellular infiltration of the rhomboid-shaped crystalline structures. In immunoperoxidase staining, both these crystalline structures and the cytoplasms of the myeloma cells demonstrated a positive reaction for lambda light chain. By electron microscope, the large extracellular crystalline structures were observed, and we found unique rhomboid or rectangular-shaped crystalline structures in the cytoplasms of the myeloma cells.

Evaluation of plantar fasciitis by three-phase bone scintigraphy

Fifteen patients complaining of chronic heel pain underwent three-phase Tc-99m MDP bone scintigraphy. Ten patients demonstrated abnormal scan findings consistent with plantar fasciitis (PF) and had responded to conventional therapy. Two patients were found to have calcaneal stress fractures, and one patient demonstrated a calcaneal spur that required no treatment. The remaining two patients had normal scans and did not appear clinically to have PF. The three-phase bone scan is therefore very useful in diagnosing PF and in distinguishing it from other etiologies of the painful heel syndrome.

Benign brainstem hemorrhage simulating transient ischemic attack

A 48-year-old hypertensive man had sudden onset of symptoms suggesting vertebrobasilar insufficiency, which were transient in nature lasted for only 4 hours. Brain computed tomography revealed a small hematoma in the pontomedullary junction. This is an uncommon presentation of benign brainstem hemorrhage simulating transient ischemic attack. We propose that computed tomographic scan using thin slices of 3mm to 5mm thickness at the level of brainstem is required before starting anticoagulation therapy for vertebrobasilar transient ischemic attack.

Gallium uptake in tryptophan-related pulmonary disease

We describe a patient who developed fever, fatigue, muscle weakness, dyspnea, skin rash, and eosinophilia after taking "high doses" of tryptophan for insomnia for two years. A gallium-67 scan revealed diffuse increased uptake in the lung and no abnormal uptake in the muscular distribution. Bronchoscopy and biopsy confirmed inflammatory reactions with infiltration by eosinophils, mast cells, and lymphocytes. CT scan showed an interstitial alveolar pattern without fibrosis. EMG demonstrated diffuse myopathy. Muscle biopsy from the right thigh showed an inflammatory myositis with eosinophilic and lymphocytic infiltrations.

Rapid resolution of pulmonary embolism by tissue plasminogen activator

A case of multiple bilateral pulmonary emboli demonstrating complete resolution 48 hours after the intravenous administration of tissue plasminogen activator is presented.

Two cases of anterior choroidal artery territory infarction

Occlusion of the anterior choroidal artery (AChA) can cause infarction in the posterior limb of the internal capsule. Infarction is less frequently observed in the thalamus, midbrain, temporal lobe, and lateral geniculate body (LGB) territories of the AChA. The most common clinical finding is hemiparesis. Hemianesthesia may be severe at onset but is usually transient. Homonymous hemianopia, upper-quadrant anopia, or upper- and lower-quadrant sector anopia can be present. Occasionally these patients are reported to have transient abnormalities of higher cortical function. The most common stroke mechanism is known to be small-vessel occlusive disease, predominantly found in hypertensive and diabetic patients. Vasospasm due to ruptured aneurysm or intraoperative mechanical manipulation, and cardiac origin the AChA territory. The infarct lesion is usually recognized and diagnosed by computed tomography. The best treatment is still unknown.

Thallium-201 imaging in anomalous left coronary artery originating from pulmonary trunk

A 3-month-old infant with anomalous origin of the left main coronary artery (LMCA) from the pulmonary trunk was evaluated using resting thallium imaging. The imaging findings were consistent with myocardial scar and ischemia of the anterolateral and posterolateral walls in the distribution of the LMCA.

Redistribution of crossed cerebellar diaschisis

Crossed cerebellar diaschisis refers to a functional decrease in blood flow to the cerebellar hemisphere contralateral to the infarcted or ischemic cerebral hemisphere. This phenomenon can be depicted using PET as well as using SPECT. This condition, seen on early I-123 IMP brain scans, can show redistribution on the three hour delayed scan, presumably due to normal non-specific amine receptor sites of the affected cerebellum. One such case is reported.

Scintigraphic evaluation of regional migratory osteoporosis

Three patients with regional migratory osteoporosis (RMO) of the lower extremity were observed over a period of time with clinical and scintigraphic follow-up. The diagnosis of RMO is clinically and radiographically difficult, but a three-phase bone image is very helpful in diagnosing patients with RMO.

Antibody response of three different strains of mice to alpha s1-casein analyzed by using proteolytic and synthetic peptides

The location of immunodominant regions on bovine alpha s1-casein (alpha s1-CN) was compared among three strains of mice (BALB/c, C3H/He and C57BL/6). Anti-alpha s1-CN antisera were separated 5 weeks after the first immunization. Thirty-seven kinds of peptides were obtained from alpha s1-CN by proteolysis, and the segmental 19- to 20-residue peptides overlapping with their adjacent neighbors by 5 residues were synthesized over the entire polypeptide chain of alpha s1-CN. The ability of the anti-alpha s1-CN antibody to bind peptides was tested by an enzyme-linked immunosorbent assay, in which the peptides were adsorbed to the solid phase. All the strains responded highly to alpha s1-CN. The immunodominant antigenic regions of alpha s1-CN were not common to the three strains of mice, the H-2 haplotypes being different from each other (BALB/c, regions 1, 3, 5, 6 and 7; C3H/He, regions 2, 3, 5, 6, 6', 7 and 7'; and C57BL/6, regions 2, 4, 5, 6 and 7).

Pure signet ring cell type early gastric carcinoma with extensive lymph node metastases--a case report

A 42-year old man was admitted with indigestion and left upper quadrant pain. A gastrofiberscopic examination revealed a depressed, discolored lesion (1.5 × 1.5 cm) with converging irregular radiating folds in the antral portion, suggestive of early gastric cancer (type IIc). Histologically, signet ring cell carcinoma was seen. A subtotal gastrectomy was performed and the opeartive findings showed a shallow depression in the anterior wall of the greater curvature side in the antrum and multiple perigastric lymph node enlargment. On microscopic examination, the authors observed pure signet ring cell carcinoma confined to the mucosa but with widespread lymph node metastases.

Platelet sequestration in widespread pulmonary hemangiolymphangiectasia. Demonstration by indium-111 labeled platelets

A thrombocytopenic patient with pulmonary hemangiolymphangiectasia proven by biopsy, was studied for platelet sequestration with In-111-labeled autologous platelets. The 24-hour scan showed diffuse increased uptake throughout both lung fields, indicating platelet sequestration by the diffuse pulmonary hemangiolymphangiectasia.

Stress fracture of the pubic ramus in a swimmer

Stress fracture is common in military recruits, joggers, and runners. Stress fracture in the pubic ramus is not common, and it constitutes only 1.25% of all stress fractures. A stress fracture, avulsion type of the pubis at the insertion of adductor magnus on an active swimmer is reported here.

Pathognomonic scintigraphic finding of hepatic cavernous hemangioma

Hemangioma is the most common benign tumor of the liver. An accurate diagnosis of such tumor is essential for proper management of patients with hepatic cavernous hemangioma (HCH). Noninvasive diagnosis of HCH can be made using sequential Tc-99m RBC scintigraphy by demonstrating a "perfusion-blood pool mismatch." In addition, a case of HCH was observed which demonstrated peripheral enhancement with subsequent central enhancement on a sequential Tc-99m RBC blood pool scintigraphy. It is felt that this scintigraphic finding is pathognomonic for HCH.

The primary structure of porcine Cu-Zn superoxide dismutase. Evidence for allotypes of superoxide dismutase in pigs

Cu-Zn superoxide dismutase was purified to homogeneity from mixed pig blood and from a single pig. The isolated product had an absorption ratio 280/260 nm of 0.91, a specific activity of 3 000 +/- 200 units (cytochrome c reduction test), and an isoelectric point of 7.5 (chromatofocusing) or 7.25 (isoelectric focusing), respectively. Sequence determination was performed by automated solid-phase Edman degradation of fragments of the reduced S-carboxymethylated proteins obtained by digestion with trypsin or Staphylococcus aureus proteinase V8 or treatment with cyanogen bromide. Acetylation of the N-terminus was confirmed by comparing high performance liquid chromatography retention times of N-terminal peptides with those of authentic samples. Sequencing of the superoxide dismutase of mixed porcine blood revealed heterogeneity (70% Leu; 30% Val at position 29), whereas the sample derived from a single French pig proved to be homogeneous (100% Leu at position 29). The complete sequence of pig superoxide dismutase comprised 152 amino-acid residues, which corresponds to a theoretical molecular mass of 15 800 Da per subunit, and exhibited the expected high homology with those of other mammals. The aspartate and all 7 histidine residues known to complex the metal ions in bovine superoxide dismutase are conserved in the porcine sequence at the homologous positions Asp82 and His45, His47, His62, His70, His79, His119, respectively.

Prevention of perinatal transmission of hepatitis B virus: a comparison between the efficacy of passive and passive-active immunization in Korea

In a study to compare the prophylactic efficacy of passive and passive-active immunization against hepatitis B virus (HBV) among newborn infants of HBV carrier mothers positive for hepatitis B e in Korea, both regimens resulted in effective protection against development of hepatitis B surface antigen (HBsAg): 10 of 12 recipients of hepatitis B immune globulin (HBIG) and 25 of 29 recipients of HBIG and vaccine during nine months of follow-up. Among untreated controls in the same population just before the present study, 12 of 16 developed HBsAg within nine months of birth. Seven recipients of HBIG and vaccine and four untreated infants who had HBsAg in their blood at birth were excluded. The declining antibody levels in infants who received only HBIG as compared with the rising antibody levels in infants who received HBIG followed by three doses of HBV vaccine suggest that long-term protection will be seen only in the latter group.

Isolated proximal musculocutaneous nerve palsy: case report

Isolated musculocutaneous nerve injury is extremely rare. The few reported cases were associated with heavy exercises and violent extension of the forearm. The lesions in those cases were below the coracobrachialis muscle, involving the biceps, brachialis, and cutaneous nerves of the forearm. This patient's lesion was unique, located proximal to the coracobrachialis. There was no antecedent trauma. At follow-up six weeks and four months after onset of symptoms, significant improvement was noted both clinically and electrophysiologically. Musculocutaneous nerve palsy is important to distinguish in certain differential diagnoses, particularly with C5 or C6 radiculopathy and brachial plexus injury.

Furazolidone residues in chicken and swine tissues after feeding trials

Broiler chickens and swine fed furazolidone in their diet were sacrificed, and samples of liver, kidney, skin/fat and muscle were harvested and analyzed for furazolidone residue. Chickens fed 200 g of furazolidone/ton of feed were withdrawn from treatment 21, 14, 7, 5, 3, or 0 days before slaughter. Birds withdrawn from medication more than 5 days prior to slaughter had no residues in any of the tissues sampled. One of the 12 birds in each of the 5 day and 3 day withdrawal groups had detectable residues in the skin/fat. Seven of the 12 birds in the 0 day withdrawal group had residues of less than 2 ppb in skin/fat samples. Chickens fed 400 g furazolidone/ton of feed were withdrawn from treatment 0 days before slaughter. Residues of 0.7 to 3.5 ppb were found in the skin of these birds; residues were not found in other tissues. Swine were fed 300 g furazolidone/ton of feed for 2 weeks or 150 g/ton for 5 weeks. They were withdrawn from treatment 10, 7, 5, 3, or 0 days before slaughter. Tissue samples taken from these swine did not contain detectable furazolidone residues.

The amino-acid sequence of bovine glutathione peroxidase

The amino-acid sequence of the seleno-enzyme glutathione peroxidase from bovine erythrocytes was completely determined. Fragmentation of the carboxymethylated protein comprised cleavages with trypsin, with endoproteinase Lys-C, and with cyanogen bromide in 70% formic acid. The resulting peptides were separated by reversed-phase high-performance chromatography or by gel filtration. For sequence determination automated solid or liquid phase techniques of Edman degradation were used. The proper alignment of fragments was experimentally proven in all but one instance. In this case, consistent indirect evidence was provided. The monomer of glutathione peroxidase was shown to consist of 198 amino acids representing a molecular mass ob about 21 900 Da. The active site selenocysteine was localized at position 45. In addition, four cysteine residues were found at positions 74, 91, 111, and 152. The N-terminal part of the sequence obtained revealed a pronounced homology with a partial sequence of the rat liver enzyme. Moreover, tentative sequence data predicted from X-ray crystallographic analysis of bovine glutathione peroxidase were found to agree in about 80% of the residues with the sequence presented. Differences between the predicted and the experimentally determined sequence are discussed.

The primary structure of Cu-Zn superoxide dismutase from Photobacterium leiognathi: evidence for a separate evolution of Cu-Zn superoxide dismutase in bacteria

The complete amino-acid sequence of the copper-zinc superoxide dismutase of the Photobacterium leiognathi was determined. The fragmentation strategy employed included cyanogen bromide cleavage at its methionine residues and the only tryptophan residue. The S-carboxymethylated chain was further cleaved by means of trypsin, in order to obtain overlapping fragments. For sequence determination automated solid or liquid-phase techniques of Edman degradation were used. C-Terminal amino acids of the entire chain were determined after treatment with carboxypeptidase A. Comparison of the primary structure of this bacterial Cu-Zn superoxide dismutase with the established amino-acid sequences of the other eukaryotic Cu-Zn superoxide dismutases revealed clear homologies. Correspondingly, the Cu-Zn-binding amino-acid residues of the active centre were localized: His45, His47, His70, His79, His125 and Asp91. The two cysteine residues in position 52 and 147 were homologous to the cysteine residues, modelling the essential intrachain disulfide bridge of the corresponding bovine enzyme. As only 25-30% of aligned sequence positions were found to be identical, the enzyme of P. leiognathi shows only a remote phylogenetic relationship towards eukaryotic Cu-Zn superoxide dismutases. When compared to the established phylogenetic tree of the cytochrome c family, this indicates a separate evolution of Cu-Zn superoxide dismutase in Photobacterium. Therefore, a natural gene transfer from the eukaryotic host (ponyfish) to the prokaryotic photobacterium, which Martin and Fridovich postulated 1981 (J. Biol. Chem. 256, 6080-6089) on the basis of amino-acid compositions, can be excluded.

The primary structure of high molecular mass urokinase from human urine. The complete amino acid sequence of the A chain

The complete sequence of 157 amino acids of the light (A) chain of high molecular mass urokinase from human urine was determined. The fragmentation strategy included cyanogen bromide cleavage of the S-carboxymethylated A chain at the methionine and/or tryptophan residues and use of the specific endoproteinase Lys-C. For sequence determination automated solid- or liquid-phase techniques of Edman degradation were used. C-terminal amino acids of the A chain were determined by consecutive treatment with carboxypeptidase A and B. The amino acid sequence obtained revealed a significant homology to peptide chains of other serine proteinases. Accordingly, the sequence of the A chain can be divided into three domains: 1) The growth factor domain with homologies to murine epidermal growth factor and a particular sequence of bovine clotting factor X, 2) The "kringle" domain with homologies to "kringle" structures, e.g. in plasminogen, and 3) the connecting peptide domain containing the A1 chain of low molecular mass urokinase. Together with the amino acid sequence of the B chain, which was presented by us in an earlier communication, the sequence data presented complete the primary structure of high molecular mass urokinase from human urine.

Physical characteristics of human transferrin from small angle neutron scattering

The technique of small angle neutron scattering has been used to determine the molecular shape, the volume, and the molecular weight of pooled human transferrin in an aqueous solution isotonic with blood. Analysis of the measurements assuming a spheroidal molecular shape indicates that an oblate spheroid with semi-axes of length 46.6 +/- 1.4, 46.6 +/- 1.4 and 15.8 +/- 3.8 A, and a molecular volume of (144 +/- 45) X 10(3) A3 is the best simple approximation to the shape of the transferrin molecule. The radius of gyration, Rg, determined from a Guinier plot is 30.25 +/- 0.49 A, in agreement with Rg calculated for the oblate spheroidal shape. The molecular weight is determined to be (75 +/- 5) X 10(3). The shape-independent molecular volume is found to be (98 +/- 10) X 10(3) A3. The difference in the two volumes suggests that transferrin is not a uniform spheroid but may have a more complex shape.

Effects of different cereal grains in diets for laying hens on production parameters and liver fat content

Two experiments were conducted with White Leghorn laying hens to study the effects of different cereal grains on production criteria and liver fat content. The results of Experiment 1, in which pullets 21 weeks of age were used for a period of 22 weeks indicated that Gaines wheat or triticale (Trailblazer) were equal to corn in supporting egg production, egg weight and body weight, with comparable feed consumption. Henry wheat(a hard red winter class) was slightly, yet significantly (P less than 0.05) inferior to corn for the above criteria. No significant differences were observed among four treatments in wet liver weight and liver fat content. Hens fed the corn diet had significantly (P less than 0.05) lower carcass fat followed by the hens fed triticale in comparison with those fed Gaines or Henyry wheat. Mortality was very low and not related to dietary treatments. Neither dietary fat nor energy content was related to fat content of liver and carcass of the hens. Body weight and liver fat content were not closely related to each other. Wet liver weight was the only significantly (P less than 0.05) related factor to liver fat content. In the second experiment, in which hens 33 weeks of age were used for an experimental period of 20 weeks, opaque-2 corn was slightly superior to normal corn and triticale was comparable to normal corn in supporting egg production and egg weight. Supplementation of the diets containing the two corns and triticale with lysine failed to improve egg production and egg weight. Hens fed the diets containing either normal corn or opaque-2 corn as the only grain in the diet had significantly (P less than 0.05) higher liver fat content in comparison with hens fed the diet containing triticale as the only grain. Mortality, however, was much higher among hens fed triticale-containing diets in comparison with groups fed corn-containing diets in spite of the fact that they had significantly lower liver fat content. Regardless of dietary treatments or grains used, the hens that died were diagnosed to have fatty liver hemorrhagic syndrome. Dietary fat content was postively and significantly (P less than 0.05) related to liver fat content. Dietary energy or body weight was not closely related to liver content. Liver fat content and mortality were negatively related to each other. The higher for content did not adversely affect laying performance.