Diagnostic criteria for Takayasu arteritis

Diagnosis of Takayasu arteritis (TA) is often delayed because of a non-specific clinical presentation. Ishikawa's criteria (1988) has been widely used for the diagnosis of this disease. Few modifications have been proposed in Ishikawa's criteria for the diagnosis of TA. The proposed modifications include: (a) removal of the obligatory criteria of age less than 40 years; (b) inclusion of characteristic signs and symptoms as a major criteria; (c) removal of age in defining hypertension; (d) deletion of the absence of aorto-iliac lesion, in defining abdominal aortic lesion; and (e) an addition of coronary artery lesion in absence of risk factors. The criteria proposed consists of three major criteria including left and right mid subclavian artery lesions and characteristic signs and symptoms of at least one month duration and ten minor criteria-a high erythrocyte sedimentation rate, carotid artery tenderness, hypertension, aortic regurgitation or annuloaortic ectasia, pulmonary artery lesion, left mid common carotid lesion, distal brachiocephalic trunk lesion, descending thoracic aorta lesion, abdominal aorta lesion and coronary artery lesion. Presence of two major or one major and two minor criteria or four minor criteria suggests a high probability of TA. When applied to 106 Indian patients of angiographically proven TA and 20 control subjects, it had a sensitivity of 92.5% and specificity of 95% that was higher than that of Ishikawa's criteria (sensitivity 60.4%, specificity 95%) and American college of Rheumatology criteria (sensitivity 77.4%, specificity 95%). Similarly, this criteria had a 96% sensitivity and 96% specificity in 79 Japanese patients of TA and 79 control subjects. Adoption of these criteria is expected to prevent the possibility of an under diagnosis of TA.

Percutaneous treatment of liver abscesses: needle aspiration versus catheter drainage

OBJECTIVE

This study was designed to determine and compare the efficacy of sonographically guided percutaneous needle aspiration and percutaneous catheter drainage in the treatment of liver abscesses.

SUBJECTS AND METHODS

In a randomized study, 50 patients (38 males and 12 females; age range, 2-72 years; average age, 35 years) with liver abscesses (amebic, 20; pyogenic, 11; indeterminate, 19) underwent either percutaneous needle aspiration (n = 25) or catheter drainage (n = 25) along with appropriate antimicrobial therapy. In patients assigned to the needle aspiration group, an 18-gauge needle was used to aspirate the abscess cavity. Repeated aspiration was attempted only once in each patient not responding to the first aspiration; nonresponse to the second aspiration was considered failure of treatment, and these patients were given catheter drainage (however, these patients were not included in the catheter drainage group). For catheter drainage, 8- to 12-French catheters were introduced into the abscess cavity using the Seldinger technique. In patients with multiple abscesses (seven in aspiration group and five in catheter group), all the abscesses except those smaller than 3 cm were subjected to percutaneous treatment. Patients were followed up to assess the outcome of the percutaneous treatment, length of hospital stay, and development of any complications. Sonography was performed every third day during hospitalization. After discharge of the patient, periodic clinical and sonographic examinations were done until total resolution of abscesses was achieved.

RESULTS

Although percutaneous needle aspiration was successful in only 15 (60%) of the 25 patients after one (n = 11) or two (n = 4) aspirations, catheter drainage was curative in all 25 patients (100%) (p < .05). Among the successfully treated patients, the average time for clinical improvement and the mean hospital stay were similar in the two treatment groups. Although the average time needed for a 50% reduction in the size of the abscess cavity was significantly (p < .05) greater in the aspiration group than in the catheter group (11 days versus 5 days), the average time taken for total resolution of abscess was the same (15 weeks) in both groups. No major complications were encountered. No relapse was documented on clinical and sonographic examination during follow-up, which ranged from 8 to 37 weeks.

CONCLUSION

Our results show that percutaneous catheter drainage is more effective than needle aspiration in the treatment of liver abscesses. Needle aspiration, if limited to two attempts, has a high failure rate.

Bisphosphonates induce apoptosis in mouse macrophage-like cells in vitro by a nitric oxide-independent mechanism

Bisphosphonates (BPs) are an important class of antiresorptive drugs used in the treatment of bone diseases, including osteoporosis. Although their mechanism of action has not been identified at the molecular level, there is substantial evidence that BPs can have a direct effect on osteoclasts by mechanisms that may lead to osteoclast cell death by apoptosis. BPs can also inhibit proliferation and cause cell death in macrophages in vitro. We have now shown that the toxic effect of BPs on macrophages is also due to the induction of apoptotic, rather than necrotic, cell death. Morphological and biochemical features that are definitive of apoptosis (chromatin condensation, nuclear fragmentation, and endonuclease-mediated internucleosomal cleavage of DNA) could be identified in mouse macrophage-like J774 and RAW264 cells, following treatment with 100 microM pamidronate, alendronate, and ibandronate for 24 h or more. Clodronate was much less potent, even at 2000 microM, while 2000 microM etidronate did not cause apoptosis. Apoptosis was not due to increased synthesis of nitric oxide and could not be prevented by inhibitors of nitric oxide synthases. Since macrophages, like osteoclasts, are particularly susceptible to BPs, these observations support the recent suggestion that the mechanism by which BPs inhibit bone resorption may involve osteoclast apoptosis. Furthermore, the macrophage-like cell lines used in this study may be a convenient model with which to identify the molecular mechanisms by which BPs promote apoptosis in osteoclasts. Induction of macrophage apoptosis by BPs in vivo may also account, at least in part, for the anti-inflammatory properties of BPs as well as the ability of BPs to cause an acute phase response.

A vaccine that prevents pregnancy in women

We report here results of clinical trials on a birth control vaccine, consisting of a heterospecies dimer of the beta subunit of human chorionic gonadotropin (hCG) associated noncovalently with the alpha subunit of ovine luteinizing hormone and conjugated to tetanus and diphtheria toxoids as carriers, that induces antibodies of high avidity (K(a) approximately 10(10) M-1) against hCG. Fertile women exposed to conception over 1224 cycles recorded only one pregnancy at antibody titers of > 50 ng/ml (hCG bioneutralization capacity). The antibody response declines with time; fertility was regained when titers fell to < 35 ng/ml. This study presents evidence of the feasibility of a vaccine for control of human fertility.

Comparative evaluation of plain films, ultrasound and CT in the diagnosis of intestinal obstruction

BACKGROUND

There are limited studies in the literature comparing plain radiography, US and CT in the evaluation of intestinal obstruction. We carried out this prospective study to compare the relative efficacies of these three imaging techniques in patients with intestinal obstruction.

MATERIAL AND METHODS

Thirty-two patients presenting with clinical suspicion of intestinal obstruction were subjected to plain radiography, US and CT and the findings were compared with reference to the presence or absence of obstruction, the level of obstruction and the cause of obstruction. The final diagnosis was obtained by surgery (n=25), or by contrast studies and/or clinical follow-up in those who were treated conservatively (n=7).

RESULTS

Out of 32 patients, 30 had mechanical intestinal obstruction (22 had small bowel obstruction and 8 had large bowel obstruction). Of the remaining 2 patients, 1 had adynamic ileus and the other had a mesenteric cyst. CT had high sensitivity (93%), specificity (100%) and accuracy (94%) in diagnosing the presence of obstruction. The comparable sensitivity, specificity and accuracy were, respectively. 83%, 100% and 84% for US and 77%, 50% and 75% for plain radiography. The level of obstruction was correctly predicted in 93% on CT, in 70% on US and in 60% on plain films. CT was superior (87%) to both US (23%) and plain radiography (7%) in determining the aetiology of obstruction.

CONCLUSION

CT is a highly accurate method in the evaluation of intestinal obstruction especially for determining the level and cause of obstruction and should be the technique of choice when clinical or plain radiographic findings are equivocal.

Effect of an antidiabetic extract of Catharanthus roseus on enzymic activities in streptozotocin induced diabetic rats

Hypoglycemic activity was detected in dichloromethane:methanol extract (1:1) of leaves and twigs of Catharanthus roseus (family Apocynaceae), a traditionally used medicinal plant, using streptozotocin (STZ) induced diabetic rat model. Extract at dose 500 mg/kg given orally for 7 and 15 days showed 48.6 and 57.6% hypoglycemic activity, respectively. Prior treatment at the same dose for 30 days provided complete protection against STZ challenge (75 mg/kg/i.p.x1). Enzymic activities of glycogen synthase, glucose 6-phosphate-dehydrogenase, succinate dehydrogenase and malate dehydrogenase were decreased in liver of diabetic animals in comparison to normal and were significantly improved after treatment with extract at dose 500 mg/kg p.o. for 7 days. Results indicate increased metabolization of glucose in treated rats. Increased levels of lipid peroxidation measured as 2-thiobarbituric acid reactive substances (TBARS) indicative of oxidative stress in diabetic rats were also normalized by treatment with the extract.

Computed tomography in abdominal tuberculosis

The diagnosis of abdominal tuberculosis is often difficult because of its protean clinical manifestations and non-specific laboratory investigations. In the abdomen, tuberculosis may affect the intestinal tract, lymph nodes, peritoneum and solid viscera in varying combinations. CT, with its ability to provide a comprehensive overview of abdominal structures, is the imaging modality of choice for evaluation of such patients. This pictorial review illustrates the spectrum of CT appearances of abdominal tuberculosis which includes intestinal, lymph nodal, peritoneal, mesenteric, hepatic, splenic and pancreatic disease.

Biliary changes in extrahepatic portal venous obstruction: compression by collaterals or ischemic?

BACKGROUND

The postulated mechanisms of biliary abnormalities in extrahepatic portal venous obstruction (EHPVO) are either extrinsic compression by collaterals or ischemic injury due to venous thrombosis. If the former hypothesis is correct, then biliary changes should revert to normal after portasystemic shunt surgery.

METHODS

Five patients with EHPVO who underwent portasystemic shunt surgery were studied. One of these patients had obstructive jaundice due to portal cavernoma. Endoscopic retrograde cholangiography (ERC) was performed before as well as after the shunt surgery. Doppler ultrasound and splenoportovenography were obtained to confirm the diagnosis of EHPVO as well as shunt patency.

RESULTS

All patients had biliary abnormalities on pre-shunt ERC. The post-shunt ERC showed partial reversal of biliary abnormalities in 3 patients, complete reversal in 1 patient, and no reversal in 1 patient. Smooth strictures opened after shunt surgery and proximal dilatation disappeared in most patients. The indentations and caliber irregularities disappeared after shunt surgery, whereas angulations and ectasias of biliary ducts persisted.

CONCLUSION

Shunt surgery results in regression of some of the biliary abnormalities and relieves biliary obstruction, suggesting that mechanical compression by collaterals is the mechanism behind biliary abnormalities in EHPVO. However, some biliary changes persist after shunt surgery signifying fixed obstruction due to ischemia or fibrous scarring. Thus, the two theories are not mutually exclusive.

Nitrogen-containing bisphosphonates induce apoptosis of Caco-2 cells in vitro by inhibiting the mevalonate pathway: a model of bisphosphonate-induced gastrointestinal toxicity

Bisphosphonates have become an important addition to the pharmacological armamentarium against postmenopausal osteoporosis. One of the major side effects of oral therapy with some nitrogen-containing bisphosphonates appears to be gastrointestinal (GI) intolerability, particularly esophageal irritation and ulceration. Because nitrogen-containing bisphosphonates can cause apoptosis in a variety of cell types in vitro, by inhibiting the mevalonate pathway, we hypothesized that the effect of these agents on the GI tract may be due to apoptosis or inhibition of growth of gut epithelial cells. A comparison between clodronate, etidronate, pamidronate, alendronate, and risedronate demonstrated that only the nitrogen-containing bisphosphonates were effective at inducing apoptosis or inhibiting proliferation of Caco-2 human epithelial cells in vitro, at concentrations of between 10 and 1000 micromol/L. The ability of nitrogen-containing bisphosphonates to cause apoptosis and inhibit Caco-2 cell proliferation was due to inhibition of the mevalonate pathway, because the addition of farnesol, oxidized low-density lipoprotein (LDL) cholesterol, or especially geranylgeraniol suppressed the effects. Furthermore, pamidronate, alendronate, and risedronate inhibited protein prenylation in Caco-2 cells, as determined by analysis of the processing of Rap1A, a prenylated small GTPase. These studies suggest that the effects of nitrogen-containing bisphosphonates observed in the GI tract may be due to inhibition of proliferation or apoptosis of gut epithelial cells, following loss of prenylated proteins and sterols.

Comparison of CT venography with MR venography in cerebral sinovenous thrombosis

OBJECTIVE

The purpose of this study was to compare cerebral CT venography with MR venography and determine the reliability of CT venography in the diagnosis of cerebral sinovenous thrombosis.

SUBJECTS AND METHODS

Fifty patients who were clinically suspected of having cerebral sinovenous thrombosis, irrespective of age and sex, underwent cerebral CT venography and MR venography. Projection venograms were displayed using maximum-intensity-projection images for both CT venography and MR venography. The CT venograms were also displayed using the integral algorithm, which depicts the average intensity value of the first five voxels deep in relation to the model surface that is nearest the viewer, allowing direct visualization of the thrombus in the sinuses. All CT venograms and MR venograms were independently evaluated by experienced neuroradiologists.

RESULTS

Of these 50 patients, 30 patients were diagnosed as having cerebral sinovenous thrombosis on both CT venography and MR venography. The total numbers of sinuses involved were 81 and 77 (CT venography and MR venography). When MR venography was used as the gold standard, CT venography was found to have both a sensitivity and a specificity of 75-100%, depending on the sinus and vein involved.

CONCLUSION

CT venography is as accurate as MR venography for diagnosing cerebral sinovenous thrombosis.

In vitro evaluation ofin situ gels as short term vitreous substitutes

Dysfunction of the vitreous humor, present in the posterior cavity of the eye, leads to its detachment from the retina and vision loss. In this study, biopolymers were evaluated as in situ gels for short term vitreous substitution. Biophysical characterization revealed that the viscosity of the vitreous was >4000 cP at a shear rate of 0.15/s and it formed a gel with elastic modulus G' greater than the viscous modulus G''. Biopolymers of gellan and hyaluronic acid (8:2 w/w, 1% concentration) were low viscosity liquids at 37 degrees C and gelation was triggered both by the addition of 0.18 mM CaCl(2) as well as ocular temperature, thus making them feasible as in situ gels. Gelation was confirmed by viscoelastic moduli where G' was greater than G'', similar to the vitreous and unlike that of silicone oil, a common vitreous substitute. The gels had a viscosity >5000 cP at a shear rate of 0.512/s, excellent light transmittance and absence of syneresis. Contact angle studies with water and simulated ocular fluids showed that gellan hyaluronic acid gels had similar wetting properties to that of vitreous with contact angles of 27 degrees +/- 1 degrees , 36.7 degrees +/- 1.6 degrees , and 33.7 degrees +/- 0.5 degrees for water, simulated tear fluid, and simulated aqueous humor, respectively. The results of this study suggest that biopolymers of gellan and hylauronic acid are suitable as in situ gels, have biophysical properties similar to that of the vitreous, and may be promising as alternatives to silicone oil as short-term vitreous substitutes.

Packet classification using tuple space search

Routers must perform packet classification at high speeds to efficiently implement functions such as firewalls and QoS routing. Packet classification requires matching each packet against a database of filters (or rules), and forwarding the packet according to the highest priority filter. Existing filter schemes with fast lookup time do not scale to large filter databases. Other more scalable schemes work for 2-dimensional filters, but their lookup times degrade quickly with each additional dimension. While there exist good hardware solutions, our new schemes are geared towards software implementation.We introduce a generic packet classification algorithm, called Tuple Space Search (TSS) . Because real databases typically use only a small number of distinct field lengths, by mapping filters to tuples even a simple linear search of the tuple space can provide significant speedup over naive linear search over the filters. Each tuple is maintained as a hash table that can be searched in one memory access. We then introduce techniques for further refining the search of the tuple space, and demonstrate their effectiveness on some firewall databases. For example, a real database of 278 filters had a tuple space of 41 which our algorithm prunes to 11 tuples. Even as we increased the filter database size from 1K to 100K (using a random two-dimensional filter generation model), the number of tuples grew from 53 to only 186, and the pruned tuples only grew from 1 to 4. Our Pruned Tuple Space search is also the only scheme known to us that allows fast updates and fast search times. We also show a lower bound on the general tuple space search problem, and describe an optimal algorithm, called Rectangle Search , for two-dimensional filters.

Image-guided percutaneous drainage of thoracic empyema: can sonography predict the outcome?

The aim of this study was to assess the safety and efficacy of image-guided percutaneous catheter drainage (IGPCD) of thoracic empyemas, and to correlate the outcome of IGPCD with the pre-procedural sonographic appearance. One hundred three patients (74 males and 29 females) with thoracic empyema (age range 1 month to 70 years, median age 28 years) underwent IGPCD. In 63 (61.17%) patients, IGPCD was the primary treatment modality; in 40 (38.84%) patients it was used after unsuccessful intercostal chest tube drainage (ICTD). Ultrasound was the main modality used for guidance; CT guidance was used in only 7 patients (6.8%). Eight- to 12-F pigtail catheters or 10- to 14-F Malecot catheters were used. The outcome was correlated with the pre-procedural US appearance (anechoic, complex non-septated or complex septated) of the empyema. The IGPCD technique was successful in 80 of 102 patients. Based on the US appearance, IGPCD was successful in 12 of 13 (92.3%) patients with anechoic empyemas; 53 of 65 (81.54%) patients with complex non-septated empyemas, and in 15 of 24 (62.5%) patients with complex septated empyemas. A statistically significant difference (p < 0.01) was seen in the outcome of IGPCD in the three categories. Twenty-two patients required further treatment: ICTD (n = 9; 2 of them later also underwent surgery); and surgery (n = 15). The duration of catheter drainage ranged from 2-60 days. No major complications were encountered. Percutaneous catheter drainage of thoracic empyemas with imaging guidance ensures accurate catheter placement with a high success and a low complication rate. Pre-procedural US can predict the likelihood of success of IGPCD.

Takayasu arteritis in India

Takayasu arteritis is the commonest cause of renovascular hypertension in India. The clinical and radiological features, complications and course of 83 patients (51 females, 32 males) seen during the period from 1972-1990 are described in this study. The age of the patients ranged from 5 to 53 years with the mean +/- SD of 26.9 +/- 9.7. Hypertension (n = 50) and the related symptom of headache (n = 40), dyspnea (n = 24), and giddiness (n = 20) were common at presentation. Twelve patients were in congestive cardiac failure. The symptoms of activity with fever and arthralgia were present in only 16% contrary to reports from Japan and Mexico. Abnormal arterial pulses and bruit over abdominal (37%) or extra abdominal great arteries (25%) were useful clinical clues to suspect Takayasu arteritis. Rapid sequence intravenous urography was a sensitive screening procedure and predicted correctly the presence of renovascular disease in 80% of the patients. The diagnosis was confirmed on aortography in 72. In the rest, the clinical features and autopsy findings confirmed the same. The four patterns of the disease based on the anatomical extent of involvement were recognised. These were: type I (n = 8) with involvement of aortic arch and its branches, type II (n = 25) descending thoracic and abdominal aorta type III (n = 46) combination of I and II and type IV (n = 4) pulmonary artery in addition to any of the above.(ABSTRACT TRUNCATED AT 250 WORDS)

Fast and scalable layer four switching

In Layer Four switching, the route and resources allocated to a packet are determined by the destination address as well as other header fields of the packet such as source address, TCP and UDP port numbers. Layer Four switching unifies firewall processing, RSVP style resource reservation filters, QoS Routing, and normal unicast and multicast forwarding into a single framework. In this framework, the forwarding database of a router consists of a potentially large number of filters on key header fields. A given packet header can match multiple filters, so each filter is given a cost, and the packet is forwarded using the least cost matching filter .In this paper, we describe two new algorithms for solving the least cost matching filter problem at high speeds. Our first algorithm is based on a grid-of-tries construction and works optimally for processing filters consisting of two prefix fields (such as destination-source filters) using linear space. Our second algorithm, cross-producting, provides fast lookup times for arbitrary filters but potentially requires large storage. We describe a combination scheme that combines the advantages of both schemes. The combination scheme can be optimized to handle pure destination prefix filters in 4 memory accesses, destination-source filters in 8 memory accesses worst case, and all other filters in 11 memory accesses in the typical case.

Differences in structural and pain phenotypes in the sodium monoiodoacetate and meniscal transection models of osteoarthritis

OBJECTIVES

To characterize differences in joint pathology and pain behavior between two rat models of osteoarthritis (OA) in order to inform selection of animal models for interventional studies.

METHOD

Knee OA was induced in Sprague Dawley rats by either meniscal transection (MNX) or intra-articular injection of monosodium iodoacetate (MIA). Controls were subjected to sham surgery or saline-injection. In a separate experiment, a single intra-articular injection of triamcinolone acetonide was administered 14 days after MNX or MIA arthritis induction. Pain behavior and joint pathology were quantified.

RESULTS

Both models displayed synovial inflammation, chondropathy and osteophytosis. Chondropathy scores increased with time similarly in the two models. Inflammation and osteophyte scores were greater in MNX model compared to the MIA model. At day 49, the MNX model exhibited a greater number of channels crossing the osteochondral junction compared to all other groups. The MNX model exhibited greater weight bearing asymmetry compared to the MIA model, whereas the MIA model displayed more consistent hindpaw allodynia. Triamcinolone attenuated weight bearing asymmetry and distal allodynia to control levels in the MNX model, but distal allodynia was unaltered in the MIA model.

CONCLUSIONS

The comparison of the two models of OA in rats, using identical assessment tools has demonstrated that although both models display features of OA, there are differences between the models which may represent different aspects of human OA. Thus, model selection should be based on the pathological aspects of OA under investigation.

Ultrasound guided fine needle aspiration biopsy of splenic lesions

Fine needle aspiration biopsy (FNAB) of focal splenic lesions has been infrequently utilized because of the risk of haemorrhage. This study was carried out to evaluate the safety and efficacy of ultrasound guided FNAB of splenic lesions. 35 patients with focal splenic lesions underwent FNAB under real-time ultrasound guidance using a free hand technique. Ultrasound findings were single or multiple focal hypoechoic lesions (n = 33), focal hyperechoic lesion (n = 1) and diffuse heterogeneous echotexture (n = 1). Aspirations were performed with 22 G spinal needles using either the subcostal or the intercostal approach. Definite cytological diagnosis was made in 22 patients (62.8%), including tuberculosis in 10 patients, lymphoma in seven patients, extramedullary haematopoiesis in two patients and aspergillosis, histoplasmosis and bacterial abscess in one patient each. FNAB was negative in 12 patients because the aspirates were either scanty or contained only blood. FNAB was falsely positive in one patient. Only one patient had significant intraabdominal bleeding, which was managed conservatively. In conclusion, splenic FNAB performed under ultrasound guidance is a safe and accurate method in the diagnosis of focal splenic lesions.

Ilio-psoas abscesses: percutaneous drainage under image guidance

Over a 5-year period, 56 psoas abscesses occurring in 51 patients were managed by image-guided percutaneous drainage, either by needle aspiration (n = 10) or by catheter drainage (n = 46) in conjunction with medical therapy. Twenty-seven patients had tuberculous abscesses (bilateral in five) while 24 patients had pyogenic abscesses. Percutaneous treatment was successful in 16 of the 24 patients (66.7%) with pyogenic abscesses. The reasons for failure were co-existent bowel lesions, phlegmonous involvement of muscle without liquefaction, multiloculated abscess cavity and thick tenacious pus not amenable to percutaneous drainage. Surgery was required in seven patients, either for failed percutaneous drainage or for the management of co-existent disease. Percutaneous drainage was initially successful in all 27 patients of tuberculous psoas abscesses. However, eight patients presented with recurrence requiring repeat intervention. The average duration of catheter drainage was longer in patients with tuberculous abscess (11 days) than in patients with pyogenic abscess (6 days). Percutaneous drainage under image guidance provides an effective and safe alternative to more invasive surgical drainage in most patients with psoas abscesses.

Duplex Doppler sonography in patients with Budd-Chiari syndrome

BACKGROUND

Angiography has been the mainstay for diagnosis of Budd-Chiari syndrome even though other modalities are increasingly being used. We have evaluated our findings of duplex Doppler sonography (DDS) in patients with Budd-Chiari syndrome.

METHODS

Duplex Doppler sonography was performed in 37 consecutive angiographically proven patients with Budd-Chiari syndrome.

RESULTS

Real time ultrasonography showed abnormalities of right, middle and left hepatic veins (HV) in 21, 15 and 18 patients, respectively. Duplex Doppler sonography showed abnormal flow patterns in 37, 22 and 31 patients in the right, middle and left HV, respectively, thereby increasing the diagnostic yield by 40%. An abnormal waveform in one or more HV was present in all 37 patients. Uniphasic flow was the commonest abnormality and was seen in 22, nine and 14 patients, respectively, in the right, middle and left HV, while there was no flow in five, four and seven patients in the right, middle and left HV, respectively. Intrahepatic collaterals were seen in 35 of 37 patients (94.6%). Hepatopetal flow was found in the portal vein of 21 of 23 patients (91.3%), while flow was hepatofugal in one and portal vein thrombosis was found in another.

CONCLUSION

Duplex Doppler sonography is a useful procedure which helps in the diagnosis of patients with Budd-Chiari syndrome.

Quercetin and its major metabolites selectively modulate cyclic GMP-dependent relaxations and associated tolerance in pig isolated coronary artery

BACKGROUND AND PURPOSE

Quercetin is a major flavonoid that contributes to the reduced risk of cardiovascular disease associated with dietary ingestion of fruits and vegetables. We have pharmacologically characterized the effect of quercetin, and its sulphate and glucuronide metabolites, on vasoconstrictor and vasodilator responses in the porcine isolated coronary artery.

EXPERIMENTAL APPROACH

Segments of the porcine coronary artery were prepared for either isometric tension recording or determination of cyclic GMP content. The effect of quercetin and metabolites on submaximal responses to U46619 was examined in the presence and absence of substance P, bradykinin, forskolin, sodium nitroprusside (SNP) and glyceryl trinitrate (GTN).

KEY RESULTS

Quercetin and quercetin 3'-sulphate inhibited endothelin and U46619-induced contractions with greater potency (three- to fivefold) against the former, while quercetin 3-glucoronide was inactive. Quercetin enhanced both the cyclic GMP content of the artery (threefold) and cyclic GMP-dependent relaxations to GTN and SNP (two to threefold), but forskolin-induced relaxations were unaffected. Although the effect of quercetin was qualitatively similar to that noted for UK-114,542, a selective inhibitor of phosphodiesterase 5, it was still evident against SNP-induced relaxations in the presence of 10 nM UK-114,542. Quercetin and quercetin 3'-sulphate significantly reduced the development of GTN-associated 'tolerance'.

CONCLUSIONS AND IMPLICATIONS

Quercetin and quercetin 3'-sulphate inhibited receptor-mediated contractions of the porcine isolated coronary artery by an endothelium-independent action. Quercetin selectively enhanced cyclic-GMP-dependent relaxations by a mechanism not involving phosphodiesterase 5 inhibition. In addition, quercetin and quercetin 3'-sulphate opposed GTN-induced tolerance in vitro, which may be beneficial for patients treated for angina pectoris.

Ultrasound guided fine needle aspiration cytology in abdominal tuberculosis

Although barium studies and CT are useful in assessing abdominal pathology in tuberculosis, imaging findings are not always specific and a histopathological or bacteriological confirmation is often required. The aim of the present study was to evaluate the role of ultrasound (US) guided fine needle aspiration cytology (FNAC) in the diagnosis of abdominal tuberculosis in patients with non-palpable lesions detected on US/CT. FNAC was performed on 31 sites in 30 patients. The sites included enlarged lymph nodes (n = 14), focal lesions in liver (n = 2) and spleen (n = 8), and thickened bowel in the ileocaecal region (n = 7). The results were classified cytomorphologically into four groups: (1) definite evidence of tuberculosis; (2) presumptive evidence of tuberculosis; (3) suggestive of tuberculosis; and (4) negative for tuberculosis. 18 of the 31 FNACs (58%) revealed a positive diagnosis of tuberculosis (definite evidence in nine patients and presumptive evidence in nine patients). 13 of the 31 FNACs (42%) showed either necrosis alone (n = 4) or negative results (n = 9). Zeihl-Neelson staining for acid-fast bacilli on direct smear was positive in only nine patients (29%). Splenic and lymph nodal FNAC had a high sensitivity (87.5% and 78.6%, respectively) in the diagnosis of tuberculosis. None of the bowel and liver FNACs was diagnostic. No complications were encountered. US guided FNAC offers a safe and accurate method of achieving a diagnosis in patients with suspected abdominal tuberculosis who present with radiologically demonstrable but non-palpable lesions, especially those involving lymph nodes and spleen.

Percutaneous nephrostomy with real-time sonographic guidance

PURPOSE

Percutaneous nephrostomy (PCN) is an effective method for achieving temporary drainage of the obstructed urinary system and is usually performed under fluoroscopic guidance alone or more commonly under combined sonographic and fluoroscopic guidance. We undertook a retrospective analysis of 273 PCNs performed solely under ultrasound (US) guidance with the aim of evaluating the technique and the safety and efficacy of the procedure.

MATERIAL AND METHODS

A total of 273 PCN procedures in 267 patients were performed under real-time US guidance using the Seldinger technique. The indications for PCNs comprised benign (n = 215) and malignant (n = 46) urinary obstruction, and urinary fistulae (n = 6).

RESULTS

PCN was successful in 269 of the 273 attempts (98.5%). Satisfactory catheter placement was achieved in 245 of the 269 procedures (91.1%) under US guidance. Fluoroscopic assistance for catheter repositioning was required in 24 PCNs owing to the unsatisfactory position of the catheter tip. Major complications occurred in 15 patients (5.6%). Catheter dislodgement and catheter blockage was seen in respectively 12.6% and 3.3% of procedures.

CONCLUSION

In most patients, PCN can be performed safely using real-time sonographic guidance.

Computed tomography and ultrasonographic evaluation of metastatic cervical lymph nodes with surgicoclinicopathologic correlation

The detection of cervical lymph nodal metastasis and carotid artery invasion by metastatic lymph nodes is an important issue in the management of head and neck malignancies. This study compared the evaluation of metastasis by palpation, ultrasonography (USG) and computed tomography (CT) in patients with known head and neck malignancies. Twenty-five consecutive patients with head and neck malignancy were prospectively evaluated for the presence of cervical lymphadenopathy and carotid artery invasion. All patients underwent clinical examination (palpation), USG and CT examination. A modified CT criteria was employed which yielded acceptable results for the detection of metastatic nodes. Radical neck dissection was performed for 26 neck sides, and the results of pre-operative evaluation were confirmed by the surgical and histopathological findings. Palpation, ultrasound and CT have comparable sensitivity in the determination of metastasis involving cervical lymph nodes. Thus palpation should be employed as the primary method of assessment of secondaries in the neck. However, palpation is less sensitive than CT and USG in the detection of carotid artery involvement, hence the clinical suspicion of arterial invasion should be confirmed by either CT or USG which have similar accuracy in the detection of carotid artery invasion.

CT-guided fine-needle aspiration biopsy of spinal lesions

PURPOSE

A retrospective study of CT-guided fine-needle aspiration biopsies (FNABs) of spinal lesions performed over a period of 6 years was carried out with the aim of assessing the safety and efficacy of the procedure and to analyse the various approaches used.

MATERIAL AND METHODS

Ninety-three FNABs were performed in 87 patients, 4-70 years of age, under CT guidance. Lytic or mixed vertebral lesions with or without a paraspinal soft tissue component were included in the study. The approach depended on the anatomic region and part of the vertebra involved.

RESULTS

A definite cytological diagnosis was obtained in 77 patients (88.5%); of these, 47 patients had benign lesions and 30 patients had neoplasms. The most common pathologies encountered were tuberculosis (n=33) and metastases (n=17). There were 10 inconclusive FNABs; these showed blood only, necrotic material or scanty material insufficient for diagnosis. There were no procedure-related complications.

CONCLUSION

CT-guided FNAB is a safe and effective technique for the evaluation of spinal lesions and is helpful in planning therapy. Choosing the appropriate approach results in a low complication rate.