Does bone SPECT actually have lower sensitivity for detecting vertebral metastasis than MRI?

We compared the ability of bone SPECT and MRI to detect vertebral metastasis.

METHODS

Skeletal scintigraphy, including planar and SPECT imaging, and spinal MRI examinations, were performed in 22 cancer patients in whom a total of 88 metastatic foci and 12 degenerative joint disease lesions were detected. Metastatic foci were defined as lesions that suggested metastasis on MRI and/or bone destruction on radiographs or CT and/or aggravation of increased tracer uptakes on serial bone scans. Image reconstruction of axial, coronal and sagittal sections was processed in a 128 X 128 matrix. MRI studies were performed with a 1.5 tesla signal scanner using fast spin-echo sequences. T1- and T2-weighted images were obtained in the sagittal plane.

RESULTS

Twenty patients had at least one vertebral metastasis. MRI diagnosed 86 of the 88 (97.7%) metastatic foci; bone SPECT correctly diagnosed 81 of 88 (92.0%); and planar imaging detected 62 of 88 (70.4%). The two vertebrae with metastasis not detected by MRI were clearly seen by bone SPECT. Extra-vertebral body metastases (e.g. in the pedicle, lamina, transverse and spinous processes) were, however, most often detected by SPECT, followed by MRI and planar imaging (40 versus 32 versus 4).

CONCLUSION

Vertebral SPECT, using high-resolution SPECT equipment, produced excellent results that were comparable to and complementary with MRI in detecting vertebral metastasis. Our data suggest that vertebral SPECT is superior to MRI in detecting extra-vertebral body metastasis.

Clinical implications of renal cyst in primary aldosteronism

The present study surveyed 69 patients with aldosteronoma to study the clinical implications of renal cysts demonstrated in computed tomography. Patients who had cysts (n = 16, 23.2%) were older and had a longer duration of hypertension and more severe hypokalemia than those without cysts (n = 53). Patients with cysts therefore had longer-term, more severe hypokalemia than those without cysts. Endogeneous creatinine clearance (Ccr), measured in 61 patients, was significantly lower in patients with cysts (58.4 +/- 7.1 ml/min, n = 16) than in those without cysts (77.3 +/- 7.1 ml/min, n = 45, P = 0.0039). This significant difference was observed even after adjusting for covariables (age, duration of hypertension, and serum potassium) between the two groups by analysis of covariance (ANCOVA). No significant difference was observed in gender, blood pressure, serum creatinine, plasma aldosterone, or PRA. Age, serum potassium levels, and systolic and diastolic blood pressure were the significant determinants in predicting Ccr in a backward stepwise multiple regression analysis (r = 0.505, n = 61, P = 0.0025). Cysts were graded into four classes on the basis of number and size. Cyst grading correlated negatively with Ccr at a Spearman rank correlation (rho = -0.33, n = 61, P = 0.0103). The incidence of chronic renal failure was significantly higher in patients with cysts (18.8%) than in patients without (0%) in a Fischer's exact probability test (P = 0.0107). Thus, both renal cysts and dysfunction arose and/or developed from common roots, i.e., the duration and severity of hypokalemia, in primary aldosteronism. In addition, we surveyed 27 patients with pheochromocytoma. Patients with renal cysts (n = 8) had a significantly longer duration of hypertension than those without cysts. No significant difference was observed in Ccr between patients with and those without cysts. Thus, a significant link between renal cysts and Ccr was a specific feature of primary aldosteronism, but not of pheochromocytoma. In summary, the renal cysts in primary aldosteronism should be recognized as a significant complication representing the extent of renal injury and dysfunction.

Gene organization in the ada-rplL region of Streptomyces virginiae

The gene organization of a 7.4-kb region of the Streptomyces virginiae (Sv) chromosome was determined. The predicted open reading frames (ORFs) and their predicted products, in sequence order, were (i) ada, encoding adenosine deaminase [EC 3.5.4.4], (ii) aat, encoding a protein homologous to aspartate aminotransferase [EC 2.6.1.1], (iii) secE, encoding a protein involved in protein secretion, (iv) vbrA, encoding a NusG-like protein involved in antitermination of transcription as described by Okamoto et al. [J. Biol. Chem. 267 (1992) 1093-1098], and (v) rplKAJL, encoding the large subunits of the ribosomal proteins L11, L1, L10 and L12. Six of the ORFs (secE-rplL) were oriented in the same direction, but the other two (ada and aat) had the opposite orientation. The gene organization of the secE-rplL region in Sv was identical to that in Escherichia coli.

Enhancement of SPARC (osteonectin) synthesis in arthritic cartilage. Increased levels in synovial fluids from patients with rheumatoid arthritis and regulation by growth factors and cytokines in chondrocyte cultures

OBJECTIVE

To investigate the roles of SPARC (secreted protein, acidic and rich in cysteine) (osteonectin) in arthritis, using cartilage and synovium specimens and synovial fluids (SF) from patients with rheumatoid arthritis (RA) or osteoarthritis (OA), and to examine the effects of cytokines, growth factors, and hormones on SPARC synthesis by chondrocytes in culture.

METHODS

SPARC in cartilage and synovium was immunostained with monoclonal antibodies. SPARC synthesis by cultured chondrocytes was measured by Northern blot analysis, immunoblotting, and sandwich enzyme-linked immunosorbent assay.

RESULTS

SPARC was identified in numerous chondrocytes in the superficial and middle zones and in regenerating chondrocytes of RA and OA joints, whereas such staining was absent in these zones of normal cartilage, except for weak signals from a few chondrocytes in the deep zone. In addition, SPARC synthesis was enhanced in synovial cells of RA and OA joints. The average SPARC level in SF was 10-fold higher in the RA than in the OA population. In rabbit articular chondrocyte cultures, administration of transforming growth factor beta 1 (TGF beta 1) and bone morphogenetic protein 2 increased SPARC levels at 24-48 hours, whereas interleukin-lbeta (IL-1 beta), IL-1 alpha, tumor necrosis factor alpha, lipopolysaccharide, phorbol myristate acetate, basic fibroblast growth factor, and dexamethasone decreased SPARC levels at 24-72 hours. TGF beta increased SPARC messenger RNA (mRNA) levels at 24 hours, whereas IL-1 beta caused a marked decrease in SPARC mRNA levels at 24 hours. Furthermore, IL-1 decreased the glycosylation of SPARC.

CONCLUSION

These findings suggest that various growth factors and cytokines, including TGF beta 1 and IL-1 beta, regulate the production of SPARC by chondrocytes at pre- and posttranslational levels, and that SPARC synthesis is markedly enhanced in arthritic joints.

[Hepatic arterial perfusion scintigraphy with 99mTc-MAA for assessment of the hepatic distribution of drugs given by intrahepatic arterial infusion]

Twenty-six hepatic arterial perfusion studies using 99mTc-MAA were carried out in 21 patients who underwent hepatic arterial infusion chemotherapy. Inhomogeneous perfusion of the liver area supplied by the artery in which the catheter was placed was seen in 11 (42%) of 26 studies, which may be caused by poor mixing of drug with blood at infusion site. To evaluate whether pulsed arterial infusion reduces this phenomenon, 99mTc-MAA was injected with pulsatile infusion in studies. Improved RI distribution of the liver was obtained in 2 of 15 with pulsatile infusion. Extrahepatic perfusion was noted in 6 (23%) of 26 studies. Displaced catheter was demonstrated in 3 (12%) of 26 studies. Despite the attempts to correct the arterial abnormalities to ensure homogeneous perfusion of the liver in 4 patients with anatomic variants, inhomogeneous perfusion was seen in 3 of 4 patients. Hepatic arterial perfusion scintigraphy by 99mTc-MAA has advantages for assessing intrahepatic distribution of the chemotherapeutic agents, in addition to helping to avoid clinical complications caused by extrahepatic perfusion.

Penetrating injury of the vertebral artery caused by a nail gun: preoperative embolization

We describe a penetrating injury of the vertebral artery caused by a nail gun. The artery was preoperatively embolized using mechanical detachable coils (MDC).

Oxidation of D(-)3-hydroxybutyrate administered to rats with extensive burns

Although the suppressive effect of 3-hydroxybutyrate (3-OHB) on post-traumatic protein catabolism in traumatized patients is well documented, the oxidation of exogenously administered 3-OHB during catabolic stress has not been investigated. The present study was designed to evaluate, using radioactive isotopes, total body oxidation in rats with and without burn stress to which 3-OHB had been exogenously administered, in comparison with total body oxidation in such rats that had received glucose. The rats were divided into four groups, based on whether or not a 30% full-thickness burn was inflicted, and the type of infusate they received after the burn, namely, 3-OHB or glucose. The total exhaled CO2 was collected for 6h after the infusion was commenced, and 14CO2 was assayed in a liquid scintillation spectrometer. Oxidation of the infusate was calculated from the percentage of exhaled 14CO2 derived from the infused substrates. The plasma concentration of 3-OHB was significantly increased after the infusion in both the burned and non-burned rats. The total exhaled 14CO2 from the rats infused with glucose decreased from 48.2 +/- 2.4% to 40.8 +/- 3.7% (means +/- SD, P < 0.001) after thermal injury. However, the total exhaled 14CO2 from the rats infused with 3-OHB appeared sooner, and there was no difference in the total expired 14CO2 derived from 3-OHB between the burned and non-burned rats, at 68.1 +/- 2.7% vs 66.4 +/- 3.4%, respectively. These findings suggest that even under conditions of burn stress, 3-OHB can be oxidized normally if the plasma concentration of 3-OHB is elevated by exogenous administration.

LH and testosterone modulate mercuric chloride-induced acute renal failure in male rats: the implication of stress-induced hypogonadism

The significance of stress-induced hypogonadism remains unclear. Since plasma testosterone and LH have renotropic activity that is other than reproductive, we hypothesize that stress-induced hypogonadism is an adaptive response to protect the kidney. To examine this hypothesis, we prepared hypogonadal male rats with different levels of LH and testosterone through orchiectomy (castration), through chronic treatment with a slowly secreted form of gonadotropin-releasing hormone agonist (GnRHA; GnRHA pretreatment), or through both treatments concomitantly (castration with GnRHA pretreatment). Castrated rats had undetectable plasma testosterone and high plasma LH. GnRHA-pretreated rats had low plasma testosterone and normal plasma LH. Castrated rats with GnRHA pretreatment had undetectable plasma testosterone and normal plasma LH. We compared their sensitivity to HgCl2 nephrotoxicity and found that, when a low dose of HgCl2 (1.5 mg/kg body weight (BW)) was injected s.c. to induce acute renal failure, endogenous creatinine clearance (Ccr) decreased from 390 +/- 30 to 94 +/- 17 ml/h per kg BW in intact (unpretreated) rats. Such a decrease in Ccr was completely prevented in castrated rats (388 +/- 30 ml/h per kg BW) and partially prevented in GnRHA-pretreated rats (216 +/- 40 ml/h per kg BW). When a high dose of HgCl2 (2.25 mg/kg BW) was injected, half of the eight intact rats died but castrated rats and GnRHA-pretreated rats survived (P < 0.05). The elevated resistance in castrated rats was reduced when plasma LH was reduced with GnRHA pretreatment, but was restored by additional pretreatment with ovine LH (40 micrograms/day), as evidenced by changes in Ccr. Elevated resistance in castrated rats was also reduced by the administration of testosterone propionate. In conclusion, hypogonadism activated the preventive and defensive mechanisms that protect the kidney through both decreased plasma testosterone and high or even normal plasma LH.

Spontaneous complete necrosis of hepatocellular carcinoma

We report a 69-yr-old female with a liver mass which, when surgically resected, was believed to be the spontaneous complete necrosis of hepatocellular carcinoma. The preoperative level of alpha-fetoprotein was high at 1050 ng/ml, and the mass was grossly an encapsulated nodular lesion with septa. Histologically, no viable tumor cells were demonstrated. The alpha-fetoprotein level decreased to a normal range. The postoperative course was uneventful, and the patient is alive and well 1 yr after surgery.

Assessment of sexual orientation in lesbian/gay/bisexual studies

This article provides a critical review of various methods for assessing sexual orientation in previous lesbian/gay/bisexual studies. A content analysis of 144 lesbian/gay/bisexual studies published in the Journal of Homosexuality (Volumes 1 to 24; 1974-93) was conducted by two independent reviewers. Findings suggest that women and bisexuals were underrepresented, and, in about one third of the studies, participants' sexual orientations were assumed rather than assessed. Five methods for the assessment of sexual orientation were identified, with self-identification (as heterosexual/homosexual/bisexual/lesbian/gay) the most typical. Each assessment method was critically examined and a 2-by-2 multidimensional assessment model was suggested for use in lesbian/gay/bisexual studies.

A canine study of cold water drowning in fresh versus salt water

OBJECTIVE

To compare the pathophysiologic changes occurring during drowning in cold fresh water and cold salt water with reference to viability.

DESIGN

Randomized, prospective, controlled submersion experiments in two contrasting cold liquids.

SETTING

A laboratory at a large university-affiliated medical institution.

SUBJECTS

Thirteen healthy, anesthetized mongrel dogs. Three dogs served as controls and were immersed but not submerged. The remainder were submerged in cold fresh water or cold salt water (4 degrees C).

INTERVENTIONS

Catheters were placed in the femoral artery, right carotid artery and right internal jugular vein. Electrocardiogram, pneumogram, and rectal temperatures were measured continuously during submersion/immersion.

MEASUREMENTS AND MAIN RESULTS

Cold water submersion with drowning produced a large initial decrease in carotid artery temperature (approximately 7.5 degrees C in the first 2 mins) compared with a minor decrease (approximately 0.8 degrees C with immersion). No significant differences were noted in the rate of decrease of temperature between drowning in fresh water and salt water. During cold fresh water drowning, aspiration produced gross hemodilution with an average increase in body weight of 16.5%. Hematocrit values, serum sodium concentrations, and osmolality decreased while serum potassium concentrations, catecholamines, and free hemoglobin increased. All measured biochemical data (except PaO2) remained at viable levels. By contrast, during cold salt water drowning, average body weight increased by only 6%, with hemoconcentration and a shrinkage of vascular volume. Hematocrit and hemoglobin values increased by 30%, but initial plasma free hemoglobin values remained unchanged. Serum sodium concentrations, osmolality, and potassium concentrations increased rapidly to critical levels.

CONCLUSIONS

On submersion in cold water, all of the experimental animals developed tachypnea immediately, followed by aspiration with predictable effects. The biochemical and pathophysiologic changes in cold water drowning approximated those changes reported for warm water drowning for both fresh and salt water with one exception and continued aspiration of cold water produced extremely rapid core cooling as long as the circulation remained intact. This process of acute submersion hypothermia may protect the brain temporarily from lethal damage, as reported in cases of cold fresh water drowning. Concentrations of circulating catecholamines increased exponentially in both groups of test animals. Clinically, their acute effects on the circulation, compounded by significant hypothermia and extreme anoxia, must hamper the detection of residual circulation at rescue and may play a role in sudden death from cold water in the absence of drowning.

[Muscle afferent block for the treatment of writer's cramp]

A 29-year-old man suffered from dystonic writer's cramp for over three years. When he wrote, typed and did other tasks using right hand, dystonic involuntary movement triggered medial rotation of the arm, wrist extension and shoulder elevation. Medication, biofeedback, and botulinum injection were performed without much success. We tried to block the sensory input from muscles by using lidocaine and ethanol. We made injections of 0.5% lidocaine 50ml and 99% ethanol 5ml into muscles with abnormal activity at the frequency of twice a week for about six months. After the treatment, dystonic movement was remarkably improved and he was then able to write, type and perform other tasks with the right hand. Side effects included pain of the injection site, nausea and dizziness, which lasted for a few hours. This "muscle afferent block" did not cause muscle weakness. We speculate that muscle afferent plays a pivotal role in dystonia so that its blocking may be of clinical use.

Optical resolution of 1-arylethanols with a condensed aromatic ring by lipase from Pseudomonas aeruginosa

Enantioselective syntheses of both enantiomers of 1-arylethanols with a condensed aromatic ring have been done through acetylation of the racemic alcohols with vinyl acetate in the presence of a lipase from Pseudomonas aeruginosa (Toyobo, LIP). The lipase LIP showed high enantioselectivity and reactivity for the title compounds, reacted acetates, and remaining alcohols were obtained with high optical purity.

Technetium-99m tetrofosmin and technetium-99m sestamibi imaging of multiple metastases from differentiated thyroid carcinoma

A 79-year-old male with follicular thyroid carcinoma metastasizing to the lung, bone and lymph nodes was subjected to whole-body scintigraphy using technetium-99m tetrofosmin and 99mTc-sestamibi. Both agents delineated the metastatic lesions and the two image qualities were comparable. We believe that 99mTc-tetrofosmin and 99mTc-sestamibi images may be helpful in localizing metastatic foci and substitute for thallium-201 in the follow-up of patients with differentiated thyroid carcinoma.

HPLC/RIA analysis of bioactive methionine enkephalin content in the seizure-susceptible El mouse brain

We previously reported a deficit of methionine enkephalin-like immunoreactivity (ME-LI), in the cerebral cortex, septal area, hippocampus, and striatum and the abnormal metabolism of opioid peptides in the hippocampus and striatum of seizure-susceptible El mice, which are involved in the pathogenesis of seizures. However, these findings suggest that the ME-LI does not necessarily reflect the bioactive methionine enkephalin (ME). Herein, we measured the biologically active peptide, ME excluding cross-reactive substances by using HPLC coupled with radioimmunoassay to clarify the abnormal function of enkephalinergic neurons in the El mouse brain. The ME content in 25-day-old El mice that had no seizures was significantly decreased in the hippocampus and septal area, as compared with corresponding regions in ddY mice (seizure-nonsusceptible; the mother strain of El). At the age of 50 days when El mice displayed abortive seizures, this content in both stimulated El[s] and nonstimulated El[ns] was significantly reduced in the septal area and cerebral cortex. At the age of 150 days when El mice exhibit tonic-clonic seizures, this content in both El[s] and El[ns] was significantly reduced in the septal area, cerebral cortex and striatum. These findings were generally compatible with our previous findings. This study further supports our hypothesis that a deficit of anticonvulsant endogenous ME, in the cerebral cortex, septal area, and hippocampus of seizure-susceptible El mice play an important role in the pathogenesis of seizures.

Multiple angiomyolipomas of the liver (case report)

Angiomyolipoma of the liver is an extremely rare type of tumor and reported cases are few and far between. This case study reports on a 37-year-old woman who suffered from multiple angiomyolipomas of the liver. Ultrasonography (US) and computed tomography (CT) initially revealed the existence of two tumors located in the right lobe of the liver and measuring 20 x 15 mm and 8 x 7 mm in size. The patient underwent partial resections of the liver. Histopathologic examination of both the resected specimens revealed angiomyolipoma. This is the first reported case of multiple angiomyolipomas of the liver. Furthermore, the lesions of our case study were small in size and rich in fat component. Under such conditions, preoperative examination resulting in an angiomyolipoma diagnosis is difficult even with the aid of imaging modality and needle biopsy techniques.

Characterization of neurotrophic factors produced by immortalized mouse brain glial cells (VR-2g)

We analyzed the neurotrophic factors secreted by immortalized fetal mouse brain glial cells (VR-2g). Concentrated conditioned medium of VR-2g cells were applied to a gel filtration column and the trophic activities of the fractions were determined by the bioassay method with primary fetal rat striatal neurons. Several peaks of neurotrophic activity were detected, the most prominent of which was found in a fraction of molecular weight 5-7 kDa. In peak fractions of molecular weight 13-26 kDa, molecules reactive to anti-NGF antibodies were detected by Western blotting only in non-reduced condition of SDS-PAGE. Anti-NGF antibodies absorbed 40% of the neurotrophic activities in the conditioned medium of VR-2g cells.

Effects of basic fibroblast growth factor on proliferation, the expression of osteonectin (SPARC) and alkaline phosphatase, and calcification in cultures of human pulp cells

Basic fibroblast growth factor (bFGF) may be involved in the development and repair of dentine and pulp because bFGF, its related peptides, and FGF receptors are expressed in dental mesenchymal cells. In this study, we examined the effects of bFGF on DNA synthesis, osteonectin/SPARC levels, alkaline phosphatase (ALPase) activity, their mRNA levels, and calcium levels in cultures of human pulp cells. Pulp cells were isolated from three healthy upper wisdom teeth of three patients and maintained separately. These cells produced SPARC, ALPase, and calcified nodules and there was a close correlation between the SPARC-synthetic activity of the cell lines and their levels of ALPase and calcification. The levels of SPARC, ALPase and calcium deposits in the three pulp cell cultures were 10-250 times those of human foreskin fibroblasts. Western blots showed that the pulp cells produced 38-kDa SPARC. Northern blots showed that the pulp cells expressed flg (FGF receptor type 1) transcripts throughout all culture stages, irrespective of the presence or absence of bFGF. The addition of bFGF to the pulp cultures suppressed the increases in ALPase activity, SPARC synthesis, and their mRNA levels, although it increased the incorporation of [3H]thymidine into DNA > 10-fold. The effects of bFGF on ALPase activity and SPARC synthesis were reversible. Furthermore, bFGF abolished the calcification of the extracellular matrix; the calcium content of bFGF-free cultures. These findings suggest that bFGF is a potent mitogen for human pulp cells and that it inhibits the expression of the odontoblast phenotype by the cells at least partly at pretranslational levels.

Tonic vibration reflex and muscle afferent block in writer's cramp

Patients with focal dystonia take advantage of certain cutaneous or proprioceptive sensory inputs to alleviate their symptoms ("sensory trick"). We examined the effects of increasing muscle spindle activity by the tonic vibration reflex maneuver and decreasing it by intramuscular injection of lidocaine. The vibration was applied to the palm or the tendon of forearm muscles in 15 patients with writer's cramp and 15 age-matched normal subjects. In 11 patients, the vibration induced dystonic postures or movements typical of those seen during writing. Normal subjects showed either no response to the vibration or a gradually developing tonic vibration reflex only in the wrist and finger flexors, which produced visible movements with a significantly longer latency (12.5 +/- 6.7 seconds [mean +/- standard deviation]) than what was observed in the patients (2.7 +/- 2.5 seconds, p < 0.0001). Local injection of lidocaine (0.5%, 5-40 ml/muscle) attenuated the tendon reflex with relatively little effect on the M response. Injection into muscles with increased activity produced marked reduction of dystonic movements and significant clinical improvement in 13 patients, whereas injection into the other muscles had no effect. The clinical benefit lasted for 1 to 24 hours after injection. In 13 patients who had additional injections of 10% ethanol, which blocks sodium channels for a longer period than does lidocaine, the duration of action was prolonged to 5 to 21 days. These findings suggest that muscles causing dystonic movements have abnormal sensitivities to vibration at rest and that muscle afferents may play a pivotal role in producing dystonic movements.(ABSTRACT TRUNCATED AT 250 WORDS)

Molecular cloning of the cyanobacterial adenylate cyclase gene from the filamentous cyanobacterium Anabaena cylindrica

Molecular cloning of the structural gene for adenylate cyclase (cya) of the cyanobacterium Anabaena cylindrica was carried out by complementation of an Escherichia coli strain defective in the cya gene. The cya-defective strain produced significant amounts of cyclic AMP when it was transformed with the cya gene isolated from A. cylindrica. This gene encodes a polypeptide consisting of 502 amino acid residues (molecular weight, 55,300). The deduced primary protein structure showed that the carboxyl-terminal region of the adenylate cyclase of A. cylindrica shows strong structural similarity to the conserved regions of the adenylate cyclases of various eukaryotes. No similarity was found between the amino acid sequences of the cya gene of A. cylindrica and that of E. coli. A hydropathy plot suggests that this protein has two hydrophobic regions, a transmembrane span and a signal peptide. An antiserum specific to this adenylate cyclase was prepared by immunizing a rabbit with a glutathione S-transferase-adenylate cyclase fusion protein expressed in E. coli. This antiserum recognized a 55-kDa protein in Anabaena cell lysates. Subcellular fractionation analysis showed that A. cylindrica adenylate cyclase localized in the thylakoid membrane.