Neutrophils employ the myeloperoxidase system to generate antimicrobial brominating and chlorinating oxidants during sepsis

The myeloperoxidase system of neutrophils uses hydrogen peroxide and chloride to generate hypochlorous acid, a potent bactericidal oxidant in vitro. In a mouse model of polymicrobial sepsis, we observed that mice deficient in myeloperoxidase were more likely than wild-type mice to die from infection. Mass spectrometric analysis of peritoneal inflammatory fluid from septic wild-type mice detected elevated concentrations of 3-chlorotyrosine, a characteristic end product of the myeloperoxidase system. Levels of 3-chlorotyrosine did not rise in the septic myeloperoxidase-deficient mice. Thus, myeloperoxidase seems to protect against sepsis in vivo by producing halogenating species. Surprisingly, levels of 3-bromotyrosine also were elevated in peritoneal fluid from septic wild-type mice and were markedly reduced in peritoneal fluid from septic myeloperoxidase-deficient mice. Furthermore, physiologic concentrations of bromide modulated the bactericidal effects of myeloperoxidase in vitro. It seems, therefore, that myeloperoxidase can use bromide as well as chloride to produce oxidants in vivo, even though the extracellular concentration of bromide is at least 1,000-fold lower than that of chloride. Thus, myeloperoxidase plays an important role in host defense against bacterial pathogens, and bromide might be a previously unsuspected component of this system.

Molecular characteristics of catechol estrogen quinones in reactions with deoxyribonucleosides

Estrogens can have two roles in the induction of cancer: stimulating proliferation of cells by receptor-mediated processes, and generating electrophilic species that can covalently bind to DNA. The latter role is thought to proceed through catechol estrogen metabolites, which can be oxidized to o-quinones that bind to DNA. Four estrogen-deoxyribonucleoside adducts were synthesized by reaction of estrone 3,4-quinone (E1-3,4-Q), 17 beta-estradiol 3,4-quinone (E2-3,4-Q), or estrone 2,3-quinone (E1-2,3-Q) with deoxyguanosine (dG) or deoxyadenosine (dA) in CH3CO2H/H2O (1:1). Reaction of E1-3,4-Q or E2-3,4-Q with dG produced specifically 7-[4-hydroxyestron-1(alpha, beta)-yl]guanine (4-OHE1-1(alpha, beta)-N7Gua) or 7-[4-hydroxyestradiol-1(alpha, beta)-yl]-guanine (4-OHE2-1(alpha, beta)-N7Gua), respectively, in 40% yield, with loss of deoxyribose. These two quinones did not react with dA, deoxycytidine, or thymidine. When E1-2,3-Q was reacted with dG or dA, N2-(2-hydroxyestron-6-yl)deoxyguanosine (2-OHE1-6-N2dG, 10% yield) and N6-(2-hydroxyestron-6-yl)deoxyadenosine (2-OHE1-6-N6dA, 80% yield), respectively, were formed. These adducts provide insight into the type of DNA damage that can be caused by o-quinones of the catechol estrogens. The estrogen 3,4-quinones are expected to produce depurinating guanine adducts that are lost from DNA, generating apurinic sites, whereas the 2,3-quinones would form stable adducts that remain in DNA, unless repaired. The adducts reported here will be used as references in studies to elucidate the structure of estrogen adducts in biological systems.

CT features of systemic lupus erythematosus in patients with acute abdominal pain: emphasis on ischemic bowel disease

PURPOSE

To evaluate the computed tomographic (CT) features of systemic lupus erythematosus (SLE) in patients with acute abdominal pain. Special emphasis was placed on the analysis of ischemic bowel disease.

MATERIALS AND METHODS

The authors retrospectively reviewed the images from 39 abdominal CT examinations performed in 33 patients with SLE and acute abdominal pain. Images were evaluated for bowel wall changes, mesenteric changes, fluid collection, retroperitoneal lymphadenopathy, peritoneal enhancement, and hepatomegaly as well as for changes in other abdominal organs. Ischemic bowel disease was diagnosed if at least three of the following signs were seen: bowel wall thickening, target sign, dilatation of intestinal segments, engorgement of mesenteric vessels, and increased attenuation of mesenteric fat.

RESULTS

Thirty-one (79%) of the 39 examinations had CT findings diagnostic of ischemic bowel disease, including symmetric bowel wall thickening (n = 29), target sign (n = 26), and mesenteric vascular engorgement and haziness (n = 31). In 24 cases, bowel wall thickening was multifocal, with variable length, and did not appear to be confined to a single vascular territory.

CONCLUSION

The most common CT finding in patients with SLE and acute abdominal pain is ischemic bowel disease. CT is useful for detecting the primary cause of gastrointestinal symptoms, planning treatment, and monitoring for infarction or perforation.

Radiologic features of vasculitis involving the gastrointestinal tract

Vasculitides can cause local or diffuse pathologic changes in the gastrointestinal tract, resulting in nonspecific paralytic ileus, mesenteric ischemia, submucosal edema and hemorrhage, or bowel perforation or stricture. The extent and clinical course of disease depend on the size and location of the affected vessel and the histologic characteristics of the lesion. Vasculitis may primarily involve large vessels (eg, giant cell arteritis, Takayasu arteritis), medium-sized vessels (eg, polyarteritis nodosa, Kawasaki disease, primary granulomatous central nervous system vasculitis), or small vessels (eg, Wegener granulomatosis, Churg-Strauss syndrome, microscopic polyangiitis, Henoch-Schönlein syndrome, systemic lupus erythematosus, rheumatoid vasculitis, Behçet syndrome). Radiologic findings in various types of vasculitis often overlap considerably and therefore have limited value in making a specific diagnosis. Nevertheless, the possibility of vasculitis should be considered whenever mesenteric ischemic changes occur in young patients, are noted at unusual sites (eg, stomach, duodenum, rectum), have a tendency to concomitantly involve the small and large intestine, and are associated with genitourinary involvement. Knowledge of systemic clinical manifestations in affected patients may suggest and even help establish the specific diagnosis.

Production of brominating intermediates by myeloperoxidase. A transhalogenation pathway for generating mutagenic nucleobases during inflammation

The existence of interhalogen compounds was proposed more than a century ago, but no biological roles have been attributed to these highly oxidizing intermediates. In this study, we determined whether the peroxidases of white blood cells can generate the interhalogen gas bromine chloride (BrCl). Myeloperoxidase, the heme enzyme secreted by activated neutrophils and monocytes, uses H2O2 and Cl(-) to produce HOCl, a chlorinating intermediate. In contrast, eosinophil peroxidase preferentially converts Br(-) to HOBr. Remarkably, both myeloperoxidase and eosinophil peroxidase were able to brominate deoxycytidine, a nucleoside, and uracil, a nucleobase, at plasma concentrations of Br(-) (100 microM) and Cl(-) (100 mM). The two enzymes used different reaction pathways, however. When HOCl brominated deoxycytidine, the reaction required Br(-) and was inhibited by taurine. In contrast, bromination by HOBr was independent of Br(-) and unaffected by taurine. Moreover, taurine inhibited 5-bromodeoxycytidine production by the myeloperoxidase-H2O2-Cl(-)- Br(-) system but not by the eosinophil peroxidase-H2O2-Cl(-)-Br(-) system, indicating that bromination by myeloperoxidase involves the initial production of HOCl. Both HOCl-Br(-) and the myeloperoxidase-H2O2-Cl(-)-Br(-) system generated a gas that converted cyclohexene into 1-bromo-2-chlorocyclohexane, implicating BrCl in the reaction. Moreover, human neutrophils used myeloperoxidase, H2O2, and Br(-) to brominate deoxycytidine by a taurine-sensitive pathway, suggesting that transhalogenation reactions may be physiologically relevant. 5-Bromouracil incorporated into nuclear DNA is a well known mutagen. Our observations therefore raise the possibility that transhalogenation reactions initiated by phagocytes provide one pathway for mutagenesis and cytotoxicity at sites of inflammation.

The vascular manifestations of Behçet's disease: angiographic and CT findings

The purpose was to evaluate angiographic and CT manifestations of vascular Behçet's disease. The medical records of 64 patients with Behçet's disease, treated in our hospital during the last 4 years, were reviewed. 37 patients underwent angiography or CT in the symptomatic regions because of symptoms or clinical signs of vascular involvement by Behçet's disease. 33 (male:female ratio 28:5; mean age 35 years) of the 37 patients demonstrated vascular involvement, which was surgically proven (18 patients) or diagnosed on angiography (15 patients). Angiograms and CT images of these 33 patients were retrospectively analysed for lesion type, location, extent and other characteristic findings of vascular involvement. 12 patients had only venous lesions, 11 had only arterial lesions and 10 had both arterial and venous lesions. The major angiographic findings of vascular Behçet's disease were acute or chronic thrombosis in deep veins of the lower extremities (19 patients), in the inferior vena cava (4 patients) and in the superior vena cava (2 patients), pseudoaneurysms of large or medium sized arteries (11 patients), and occlusions/ stenoses of distal run-off arteries (13 patients). Common CT findings were obliterated deep veins (8 patients) and non-calcified thickened aneurysmal walls (9 patients), with or without contrast enhancement. The combination of these angiographic and CT findings with clinical manifestations are helpful in distinguishing vascular Behçet's disease from other vasculitides.

Nitrogen dioxide radical generated by the myeloperoxidase-hydrogen peroxide-nitrite system promotes lipid peroxidation of low density lipoprotein

Myeloperoxidase, a heme protein secreted by activated phagocytes, is present and enzymatically active in human atherosclerotic lesions. In the current studies, we explored the possibility that reactive nitrogen species generated by myeloperoxidase promote lipid peroxidation of low density lipoprotein (LDL) -- a modification that may render the lipoprotein atherogenic. We found that myeloperoxidase, an H2O2-generating system and nitrite (NO2-) peroxidized LDL lipids. The process required NO2- and each component of the enzymatic system; it was inhibited by catalase, cyanide and ascorbate, a potent scavenger of aqueous phase radicals. LDL peroxidation did not require chloride ion, and it was little affected by the hypochlorous acid scavenger taurine. Collectively, these results suggest that lipid peroxidation is promoted by a nitrogen dioxide radical-like species. These observations indicate that myeloperoxidase, by virtue of its ability to form reactive nitrogen intermediates, may promote lipid peroxidation and atherogenesis.

Molecular chlorine generated by the myeloperoxidase-hydrogen peroxide-chloride system of phagocytes produces 5-chlorocytosine in bacterial RNA

Myeloperoxidase, a heme enzyme secreted by activated phagocytes, uses H(2)O(2) and Cl(-) to generate the chlorinating intermediate hypochlorous acid (HOCl). This potent cytotoxic oxidant plays a critical role in host defenses against invading pathogens. In this study, we explore the possibility that myeloperoxidase-derived HOCl might oxidize nucleic acids. When we exposed 2'-deoxycytidine to the myeloperoxidase-H(2)O(2)-Cl(-) system, we obtained a single major product that was identified as 5-chloro-2'-deoxycytidine using mass spectrometry, high performance liquid chromatography, UV-visible spectroscopy, and NMR spectroscopy. 5-Chloro-2'-deoxycytidine production by myeloperoxidase required H(2)O(2) and Cl(-), suggesting that HOCl is an intermediate in the reaction. However, reagent HOCl failed to generate 5-chloro-2'-deoxycytidine in the absence of Cl(-). Moreover, chlorination of 2'-deoxycytidine was optimal under acidic conditions in the presence of Cl(-). These results implicate molecular chlorine (Cl(2)), which is in equilibrium with HOCl through a reaction requiring Cl(-) and H(+), in the generation of 5-chloro-2'-deoxycytidine. Activated human neutrophils were able to generate 5-chloro-2'-deoxycytidine. Cellular chlorination was blocked by catalase and heme poisons, consistent with a myeloperoxidase-catalyzed reaction. The myeloperoxidase-H(2)O(2)-Cl(-) system generated similar levels of 5-chlorocytosine in RNA and DNA in vitro. In striking contrast, only cell-associated RNA acquired detectable levels of 5-chlorocytosine when intact Escherichia coli was exposed to the myeloperoxidase system. This observation suggests that oxidizing intermediates generated by myeloperoxidase selectively target intracellular RNA for chlorination. Collectively, these results indicate that Cl(2) derived from HOCl generates 5-chloro-2'-deoxycytidine during the myeloperoxidase-catalyzed oxidation of 2'-deoxycytidine. Phagocytic generation of Cl(2) therefore may constitute one mechanism for oxidizing nucleic acids at sites of inflammation.

Diffuse and focal adenomyosis: MR imaging findings

Adenomyosis is a common gynecologic disorder that affects women during their menstrual life. Preoperative magnetic resonance (MR) images obtained in 45 patients with pathologically proved adenomyosis who underwent hysterectomy were retrospectively reviewed. Diffuse adenomyosis was seen in 30 cases (66.7%) and focal adenomyosis in 15 cases (33.3%). On T2-weighted MR images, diffuse adenomyosis usually manifested as diffuse thickening of the endometrial-myometrial junctional zone (7-37 mm; mean, 16 mm) with homogeneous low signal intensity. T2-weighted MR images were superior to contrast material-enhanced T1-weighted images in the evaluation of junctional zone thickening. High-signal-intensity foci were observed on T2-weighted images only in nine cases and on both T1- and T2-weighted images in three cases. Focal adenomyosis manifested on both T2-weighted and contrast-enhanced T1-weighted MR images as a localized, low-signal-intensity round or oval mass with a diameter of 2-7 cm (mean, 3.8 cm). All but one of the focal lesions had ill-defined margins. High-signal-intensity foci were noted in all cases of focal adenomyosis, either on T2-weighted images only (four cases) or on both T1- and T2-weighted images (11 cases). MR imaging is useful in diagnosing adenomyosis, differentiating adenomyosis from uterine myoma, and planning appropriate treatment.

Brenner tumor of the ovary: CT and MR findings

PURPOSE

The purpose of this study was to determine the CT and MR characteristics of Brenner tumors, rare epithelial neoplasms of the ovary.

METHOD

CT and MR scans of eight pathologically proven Brenner tumors of the ovary (seven benign, one malignant, and one associated with mucinous cystadenoma) were retrospectively reviewed. The masses were analyzed for location, size, external configuration, internal architecture, enhancement pattern, presence of calcification, and metastatic spread.

RESULTS

The patients' median age was 63 years (range 39-79 years), and the mean size of the tumors was 11.4 cm (7.5-17 cm). All tumors were unilateral and had a well-defined margin. The mass was mostly solid in three, mostly cystic in one, and "mixed" solid and cystic in four cases. The tumors with cystic components (n = 5) were mostly multilocular in appearance (n = 4). All the solid components showed mild homogeneous enhancement on postcontrast CT and MRI. Extensive amorphous calcification within the solid component on CT was seen in five of six cases (83%). No characteristic findings discriminating malignancy from benign Brenner tumor could be found.

CONCLUSION

Extensive amorphous calcification in a solid mass or solid component in a multilocular cystic mass is a characteristic finding of Brenner tumor of the ovary on CT and MRI.

8-Nitro-2'-deoxyguanosine, a specific marker of oxidation by reactive nitrogen species, is generated by the myeloperoxidase-hydrogen peroxide-nitrite system of activated human phagocytes

Reactive intermediates generated by phagocytes damage DNA and may contribute to the link between chronic inflammation and cancer. Myeloperoxidase, a heme protein secreted by activated phagocytes, is a potential catalyst for such reactions. Recent studies demonstrate that this enzyme uses hydrogen peroxide (H2O2) and nitrite (NO2-) to generate reactive nitrogen species which convert tyrosine to 3-nitrotyrosine. We now report that activated human neutrophils use myeloperoxidase, H2O2, and NO2- to nitrate 2'-deoxyguanosine, one of the nucleosides of DNA. Through HPLC, UV/vis spectroscopy, and mass spectrometry, the two major products of this reaction were identified as 8-nitroguanine and 8-nitro-2'-deoxyguanosine. Nitration required each component of the complete enzymatic system and was inhibited by catalase and heme poisons. However, it was independent of chloride ion and little affected by scavengers of hypochlorous acid, suggesting that the reactive agent is a nitrogen dioxide-like species that results from the one-electron oxidation of NO2- by myeloperoxidase. Alternatively, 2'-deoxyguanosine might be oxidized directly by the enzyme to yield a radical species which subsequently reacts with NO2- or NO2* to generate the observed products. Human neutrophils stimulated with phorbol ester also generated 8-nitroguanine and 8-nitro-2'-deoxyguanosine. The reaction required NO2- and was inhibited by catalase and heme poisons, implicating myeloperoxidase in the cell-mediated pathway. These results indicate that human neutrophils use the myeloperoxidase-H2O2-NO2- system to generate reactive species that can nitrate the C-8 position of 2'-deoxyguanosine. Our observations raise the possibility that reactive nitrogen species generated by myeloperoxidase and other peroxidases contribute to nucleobase oxidation and tissue injury at sites of inflammation.

Mucocele of the appendix: ultrasonographic and CT findings

BACKGROUND

Mucocele of the appendix is a rare disease entity, but preoperative diagnosis is very important. With the advent of ultrasonography (US) and computed tomography (CT), it has been possible to preoperatively diagnose mucocele of the appendix. We describe the spectrum of US and CT findings of mucocele of the appendix and the differential points from mimicking diseases.

METHODS

We evaluated 17 patients with pathologically proven mucocele of the appendix by using US and CT. Pathologic diagnoses of 17 patients were mucinous cystadenoma in 11 patients, mucinous cystadenocarcinoma in two, and mucosal hyperplasia in four. We analyzed morphologic characteristics of mucocele of the appendix at US and CT.

RESULTS

The typical US finding were a cystic mass with variable internal echogenicity, layered wall, and calcification in the wall. The CT finding was a well-encapsulated cystic mass with a wall of variable thickness. Both cases with focal nodular solid enhancing portion in the wall on CT were pathologically proven as mucinous cystadenocarcinoma.

CONCLUSION

US and CT were useful methods in diagnosing mucocele of the appendix and differentiating this condition from mimicking diseases. Nodular enhancing lesion in the wall of the mucocele may be a finding suggestive of malignant cause of mucocele.

Genome-wide methylation profile of nasal polyps: relation to aspirin hypersensitivity in asthmatics

BACKGROUND

In addition to the dysregulation of arachidonic acid metabolism in aspirin-intolerant asthma (AIA), aspirin acetylsalicylic acid (ASA) exerts effects on inflammation and immunity; however, many of these effects are unknown.

OBJECTIVE

The aim of the study was to evaluate the methylation status of whole genome in blood and polyp tissues with and without aspirin hypersensitivity.

METHODS

Genome-wide DNA methylation levels in nasal polyps and peripheral blood cells were examined by microarray analysis using five subjects with AIA and four subjects with aspirin-tolerant asthma (ATA).

RESULTS

In the nasal polyps of the patients with AIA, hypermethylation was detected at 332 loci in 296 genes, while hypomethylation was detected at 158 loci in 141 genes. Gene ontologic and pathway enrichment analyses revealed that genes involved in lymphocyte proliferation, cell proliferation, leukocyte activation, cytokine biosynthesis, cytokine secretion, immune responses, inflammation, and immunoglobulin binding were hypomethylated, while genes involved in ectoderm development, hemostasis, wound healing, calcium ion binding, and oxidoreductase activity were hypermethylated. In the arachidonate pathway, PGDS, ALOX5AP, and LTB4R were hypomethylated, whereas PTGES was hypermethylated.

CONCLUSION

The nasal polyps of patients with AIA have characteristic methylation patterns affecting 337 genes. The genes and pathways identified in this study may be associated with the presence of aspirin hypersensitivity in asthmatics and are therefore attractive targets for future research.

The findings of ruptured hepatocellular carcinoma on helical CT

To evaluate the helical CT findings of ruptured hepatocellular carcinoma (HCC), 12 patients with ruptured HCC were reviewed with regard to the tumour's location, size and contour protrusion, the appearance of the mass, the enhancement pattern, multiplicity and secondary changes. All ruptured tumours were located at the periphery of the liver and had a protruding contour. The maximum diameter of tumours ranged from 2 cm to 16 cm. Discontinuity of the hepatic surface was seen in 11 cases. In eight cases, CT images during the arterial phase showed a non-enhancing low attenuating lesion with focal discontinuity and peripheral rim enhancement. Seven cases showed separation of tumour content from the peripheral enhancing rim and intraperitoneal rupture of tumour content into the perihepatic space. Because of the similar appearance to an enucleated orbital globe with remaining sclera, this was termed the "enucleation sign". As well as ruptured masses, 10 cases with non-ruptured masses also showed a non-enhancing low attenuating pattern. Seven cases showed a haematoma with high attenuation around the ruptured mass. The peripheral location, protruding contour, discontinuity of the hepatic surface and surrounding haematoma are helpful signs in the diagnosis of ruptured HCC. The "enucleation sign" may be a characteristic finding in ruptured HCC.

The eosinophil peroxidase-hydrogen peroxide-bromide system of human eosinophils generates 5-bromouracil, a mutagenic thymine analogue

Eosinophils use eosinophil peroxidase, hydrogen peroxide (H(2)O(2)), and bromide ion (Br(-)) to generate hypobromous acid (HOBr), a brominating intermediate. This potent oxidant may play a role in host defenses against invading parasites and eosinophil-mediated tissue damage. In this study, we explore the possibility that HOBr generated by eosinophil peroxidase might oxidize nucleic acids. When we exposed uracil, uridine, or deoxyuridine to reagent HOBr, each reaction mixture yielded a single major oxidation product that comigrated on reversed-phase HPLC with the corresponding authentic brominated pyrimidine. The eosinophil peroxidase-H(2)O(2)-Br(-) system also converted uracil into a single major oxidation product, and the yield was near-quantitative. Mass spectrometry, HPLC, UV--visible spectroscopy, and NMR spectroscopy identified the product as 5-bromouracil. Eosinophil peroxidase required H(2)O(2) and Br(-) to produce 5-bromouracil, implicating HOBr as an intermediate in the reaction. Primary and secondary bromamines also brominated uracil, suggesting that long-lived bromamines also might be physiologically relevant brominating intermediates. Human eosinophils used the eosinophil peroxidase-H(2)O(2)-Br(-) system to oxidize uracil. The product was identified as 5-bromouracil by mass spectrometry, HPLC, and UV--visible spectroscopy. Collectively, these results indicate that HOBr generated by eosinophil peroxidase oxidizes uracil to 5-bromouracil. Thymidine phosphorylase, a pyrimidine salvage enzyme, transforms 5-bromouracil to 5-bromodeoxyridine, a mutagenic analogue of thymidine. These findings raise the possibility that halogenated nucleobases generated by eosinophil peroxidase exert cytotoxic and mutagenic effects at eosinophil-rich sites of inflammation.

Bromination of deoxycytidine by eosinophil peroxidase: a mechanism for mutagenesis by oxidative damage of nucleotide precursors

Oxidants generated by eosinophils during chronic inflammation may lead to mutagenesis in adjacent epithelial cells. Eosinophil peroxidase, a heme enzyme released by eosinophils, generates hypobromous acid that damages tissue in inflammatory conditions. We show that human eosinophils use eosinophil peroxidase to produce 5-bromodeoxycytidine. Flow cytometric, immunohistochemical, and mass spectrometric analyses all demonstrated that 5-bromodeoxycytidine generated by eosinophil peroxidase was taken up by cultured cells and incorporated into genomic DNA as 5-bromodeoxyuridine. Although previous studies have focused on oxidation of chromosomal DNA, our observations suggest another mechanism for oxidative damage of DNA. In this scenario, peroxidase-catalyzed halogenation of nucleotide precursors yields products that subsequently can be incorporated into DNA. Because the thymine analog 5-BrUra mispairs with guanine in DNA, generation of brominated pyrimidines by eosinophils might constitute a mechanism for cytotoxicity and mutagenesis at sites of inflammation.

Characteristic MR findings of cervical pregnancy

The aim of this study was to define the characteristic MR findings of cervical pregnancy. Twelve patients with cervical pregnancy underwent MRI because of difficulty in the diagnosis by ultrasonography, human chorionic gonadotropin assessment, and other clinical evaluations. The assessment of MRI included size and location of the lesion, margin, MR signal intensity, rim of low-signal intensity, enhancement pattern, appearance of enhancing solid component, parametrial change, endometrial change, pelvic fluid collection, and ovarian change. All cases showed ill-marginated mass with very heterogeneous signal intensity on T2-weighted images, irregular internal high-signal intensities on T1-weighted images, a partial or circumferential rim of low-signal intensity, dense irregular peripheral enhancement and enhancing papillary solid components with accompanying tubular signal voids, and variably increased parametrial vascularities. This heterogeneous hemorrhagic mass with densely enhancing papillary solid components may be the typical MR finding for cervical pregnancy. J. Magn. Reson. Imaging 2001;13:918-922.

Staging of early endometrial carcinoma: assessment with T2-weighted and gadolinium-enhanced T1-weighted MR imaging

This study evaluated the usefulness of T2-weighted and gadolinium-enhanced T1-weighted magnetic resonance (MR) images correlated with patients' menopausal status in assessing the depth of myometrial invasion in stage I endometrial carcinoma. MR images of 46 patients with stage I endometrial carcinoma were retrospectively reviewed. Twenty-five patients were premenopausal, and 21 were postmenopausal. The staging accuracy without regard to menopausal status was 59% for T2-weighted images and 61% for gadolinium-enhanced T1-weighted images. However, when staging accuracy was evaluated separately in the premenopausal and postmenopausal patient groups, T2-weighted imaging had an accuracy of 80% in the premenopausal group and gadolinium-enhanced T1-weighted imaging had an accuracy of 81% in the postmenopausal group. Therefore, T2-weighted imaging was more accurate in premenopausal patients and gadolinium-enhanced T1-weighted imaging was more accurate in postmenopausal patients. The overall accuracy of staging with MR imaging improved to 80% when patients' menopausal status was considered. Therefore, menopausal status should be considered when T2-weighted and gadolinium-enhanced T1-weighted MR images are used to stage early endometrial carcinoma.

Intestinal infarction secondary to mesenteric venous thrombosis: CT-pathologic correlation

We reviewed CT of four patients with surgically proved bowel infarction secondary to superior mesenteric vein (SMV) thrombosis. Pathologic correlation was available in all patients. Three patients had thrombus in both portal vein and proximal SMV and the remaining patient had thrombus that was seen only in the peripheral branches of the SMV. Contrast-enhanced CT showed a segmental distribution of marked concentric bowel wall thickening in all four patients. Two patients also showed zones of different attenuation in the bowel wall, which were caused by varying degrees of edema and hemorrhage in the submucosa. Dense peripheral enhancement of the bowel wall was present in one patient. Other CT findings included ascites and mesenteric changes such as edema and vascular engorgement. The combination of thrombus in the SMV with bowel wall thickening strongly suggests bowel infarction and, therefore, warrants initiation of appropriate therapy.

NADPH oxidase of neutrophils elevates o,o'-dityrosine cross-links in proteins and urine during inflammation

Reactive intermediates generated by phagocytic white blood cells are of central importance in destroying microorganisms, but they may also damage normal tissue at sites of inflammation. To investigate the potential role of such oxidants in tissue injury, we used gas chromatography/mass spectrometry to quantify levels of o,o'-dityrosine in mouse peritoneal neutrophils and urine. In wild-type animals, neutrophils markedly increased their content of protein-bound dityrosine when they were activated in vivo. This increase failed to occur in mice that were deficient in the phagocyte NADPH oxidase. Levels of o,o'-dityrosine in urine mirrored those in neutrophil proteins. When o,o'-[(14)C]dityrosine was injected intravenously into mice, the radiolabel was not metabolized or incorporated into tissue proteins: instead, it was recovered in urine with near-quantitative yield. Patients with sepsis markedly increased their output of o,o'-dityrosine into urine, suggesting that systemic inflammation also may be a potent source of oxidative stress in humans. These observations demonstrate that activated neutrophils produce o,o'-dityrosine cross-links in tissue proteins, which may subsequently be degraded into free amino acids and excreted into urine. Our results indicate that mouse phagocytes use oxidants produced by the NADPH oxidase to create o,o'-dityrosine cross-links in vivo and raise the possibility that reactive intermediates produced by this pathway promote inflammatory tissue damage in humans.

Collision tumors of the ovary associated with teratoma: clues to the correct preoperative diagnosis

PURPOSE

Collision tumors represent a coexistence of two adjacent but histologically distinct tumors without histologic admixture in an organ. The purpose of this study was to describe the imaging findings of collision tumors of the ovary associated with teratoma and to look for clues that might lead to the correct preoperative diagnosis.

METHOD

Seven pathologically proven cases of collision tumor of the ovary associated with teratoma were retrospectively reviewed. Ovarian teratomas were coexistent with mucinous cystadenoma (n = 4), borderline mucinous tumor (n = 1), mucinous cystadenocarcinoma (n = 1), and dysgerminoma (n = 1). US (n = 5), CT (n = 3), and/or MRI (n = 4) findings were evaluated.

RESULTS

In addition to the typical findings of teratoma, the mass contained a multiloculated cystic portion filled with nonfatty fluid, suggesting the coexistent epithelial tumor in five cases. In one case, the mass contained a large solid component, suggesting the possibility of collision tumor. In the remaining one case, coexistent small mucinous cystadenoma could not be identified.

CONCLUSION

Preoperative imaging for ovarian teratoma revealed a collision tumor in six of seven cases. The possibility of a collision tumor should be considered when an ovarian teratoma has imaging findings that cannot be explained solely by an ovarian teratoma.

Metabolic activation and formation of DNA adducts of hexestrol, a synthetic nonsteroidal carcinogenic estrogen

Hexestrol (HES), a synthetic nonsteroidal estrogen, is carcinogenic in Syrian golden hamsters. The major metabolite of HES is its catechol, 3'-OH-HES, which can be metabolically converted to the electrophilic catechol quinone, HES-3',4'-Q, by peroxidases and cytochrome P450. Standard adducts were synthesized by reacting HES-3',4'-Q with dG and dA to produce the adducts 3'-OH-HES-6'(alpha, beta)-N7Gua and HES-3',4'-Q-6'-N6dA, respectively. When HES-3',4'-Q was reacted with calf thymus DNA, 3'-OH-HES-6'(alpha,beta)-N7Gua was identified by HPLC and tandem mass spectrometry as the depurinating adduct, with minor amounts of stable adducts. 3'-OH-HES was bound to DNA after activation by horseradish peroxidase, lactoperoxidase, or rat liver microsomes. The depurinating adduct 3'-OH-HES-6'(alpha, beta)-N7Gua was identified in these systems at levels of 65, 41, and 11 micromol/mol of DNA-P, respectively. Unidentified stable adducts were observed in much lower amounts and were quantified by the 32P-postlabeling method. Similarly to 3'-OH-HES, the catechol metabolites of the natural steroidal estrogens estrone (E1) and estradiol (E2), namely, 2-OHE1, 4-OHE1, 2-OHE2, and 4-OHE2, can be oxidized to their corresponding quinones by peroxidases and cytochrome P450. The quinones of the carcinogenic 4-OHE1 and 4-OHE2 have chemical and biochemical properties similar to those of HES-3',4'-Q. The results suggest that formation of HES-3',4'-Q may be a critical event in tumor initiation by HES and that HES is an excellent model compound to corroborate the hypothesis that estrogen-3,4-quinones are ultimate carcinogenic metabolites of the natural steroidal estrogens E1 and E2.

Efficient expression of the vascular endothelial growth factor gene in vitro and in vivo, using an adeno-associated virus vector

Vascular endothelial growth factor (VEGF) has proven to be one of the most effective growth factors for therapeutic angiogenesis. The biological efficacy of the adeno-associated virus (AAV) vector has recently been demonstrated in muscle tissues, including the heart. Apart from these promising insights into VEGF and the AAV vector, studies on VEGF gene transfer using the AAV vector have been limited. Here, we evaluate AAV-mediated VEGF gene transfer, both in vitro and in vivo, using the AAV-mVEGF vector that contains cDNA for murine VEGF(120) within an HCMV-driven expression cassette. Transient transfection of AAV-mVEGF plasmid significantly increased mVEGF expression in 293T cells. The secreted VEGF in the conditioned medium had strong biological activity, as confirmed by the Miles' vascular permeability assay. Transduction of 293T and HeLa cells with AAV-mVEGF stock of high titer, that is essentially adenovirus-free, showed significantly increased mVEGF expression above that of AAV-eGFP-transduced cells. When human umbilical vein endothelial cells were transduced, a higher level of mVEGF expression, together with higher cell counts, was observed compared to AAV-eGFP-transduced cells. In vivo transduction of mouse tibialis anterior muscle resulted in an increased level of mVEGF expression, and higher capillary-to-myofibre ratio, 8 weeks post-transduction. In a rat hindlimb ischemia model, regional blood flow, as well as the capillary-to-myofibre ratio, was significantly increased at 4 weeks post-transduction. These findings demonstrate the efficient delivery of the VEGF gene using an AAV vector, which has implications for angiogenic gene therapy in ischemic diseases.

Resistive index of the intrascrotal artery in scrotal inflammatory disease

PURPOSE

To investigate the utility of the resistive indices (RIs) of the epididymal and intratesticular arteries, and to establish diagnostic criteria for scrotal inflammatory disease on the basis of quantitative color Doppler sonography.

MATERIAL AND METHODS

We prospectively examined 29 consecutive patients with scrotal pain, and 15 normal control subjects. The RIs of the intratesticular and epididymal arteries were obtained from color Doppler sonographs.

RESULTS

The RIs of the testicular artery in epididymoorchitis were significantly lower than those in normal control subjects and in epididymitis (p < 0.01) while the RIs of the testicular artery in epididymitis and control subjects were similar (p > 0.5). With a cut-off value of RI = 0.5, sensitivity, specificity, accuracy, and positive and negative predictive values were 91%, 94%, 94%, 83%, and 77% respectively. The mean RI of the epididymal arteries in epididymitis and epididymoorchitis was 0.49 +/- 0.11. A high level of diagnostic accuracy in scrotal inflammatory disease was achieved when the RIs of the intratesticular and epididymal arteries were less than 0.5 and 0.7 respectively.

CONCLUSION

The RI of the intrascrotal artery would give a more objective evaluation than subjective assessment and could provide diagnostic criteria for scrotal inflammatory disease.

CT of hypervascular hepatic tumors: are unenhanced scans necessary for diagnosis?

OBJECTIVE

In most institutions, a combination of unenhanced and contrast-enhanced CT is used to screen patients for suspected hypervascular hepatic neoplasms. Elimination of the unenhanced examination could save time and expense and reduce the patient's exposure to radiation. We compared unenhanced and incremental bolus dynamic contrast-enhanced CT for detection of hypervascular hepatic neoplasms and evaluated the need for preliminary unenhanced hepatic CT.

SUBJECTS AND METHODS

We prospectively examined 101 consecutive patients with hypervascular primary hepatic malignant tumors or suspected hypervascular metastases. Primary hepatic neoplasms included hepatocellular carcinoma (seven), sarcoma (two), and hemangioendothelioma (one); extrahepatic primary tumors included breast (37) and renal cell (24) carcinoma, melanoma (15), carcinoid (nine), and endocrine and other tumors (six). All patients had both unenhanced and bolus dynamic contrast-enhanced CT with 5-mm collimated sections at 8-mm intervals. For contrast-enhanced CT, 150-180 ml of IV contrast material, a mechanical power injector, and a scanning protocol that allowed completion of liver imaging within 2 min were used. Both unenhanced and contrast-enhanced CT scans were compared for detection and conspicuousness of hepatic lesions.

RESULTS

Hepatic lesions were found in 34 patients. In 21 patients, all hepatic lesions seen on unenhanced scans also were apparent on contrast-enhanced scans. However, in 12 (57%) of 21 patients, lesions were more conspicuous and better defined on contrast-enhanced scans. The absolute number of lesions detected with each method of scanning differed in 12 patients. In four patients, the contrast-enhanced scan showed more lesions; in five patients, the unenhanced scan showed more lesions; and in three patients, administration of contrast material obscured some lesions shown on unenhanced scans and made others more conspicuous. If only a contrast-enhanced CT scan had been obtained, the presence of malignant hepatic neoplasm would have been missed in only one case (a patient with a single 2.8-cm metastasis from renal cell carcinoma).

CONCLUSION

Bolus dynamic contrast-enhanced CT alone correctly showed the presence or absence of primary or metastatic hypervascular hepatic tumors in 100 of 101 cases. If the goal of CT examination is detection of hypervascular hepatic lesions, use of contrast-enhanced CT alone may be adequate and the addition of unenhanced scans is not cost-effective.