Endometrial carcinoma: dynamic MRI with turbo-FLASH technique

PURPOSE

Our goal was to investigate the usefulness of dynamic MRI with the turbo-FLASH technique in estimating myometrial invasion by endometrial carcinoma.

METHOD

Forty-six patients with endometrial carcinomas were evaluated with pathologic correlation. Dynamic MRI was performed with the rapid administration of Gd-DTPA using the turbo-FLASH technique.

RESULTS

The inner muscle layer showed more rapid contrast enhancement effects than the outer muscle layer even after menopause. Contrast-to-noise ratio between the inner muscle layer and endometrial carcinoma was maximum at approximately 50 s after administration of Gd-DTPA. In postmenopausal women, the accuracy in estimating myometrial invasion with T2-weighted images, contrast-enhanced T1-weighted images, and dynamic MRI was 66.7, 77.8, and 92.6%, respectively.

CONCLUSION

Dynamic MRI with the turbo-FLASH technique is considered to be a useful imaging method for the estimation of myometrial invasion by endometrial carcinoma, especially in postmenopausal patients.

Detection of intraoperative incidents by electronic scanning of computerized anesthesia records. Comparison with voluntary reporting

BACKGROUND

The use of a computerized anesthesia information management system provides an opportunity to scan case records electronically for deviations from specific limits for physiologic variables. Anesthesia department policy may define such deviations as intraoperative incidents and may require anesthesiologists to report their occurrence. The actual incidence of such events is not known. Neither is the level of compliance with voluntary reporting.

METHODS

Using automated anesthesia record-keeping with long-term storage, physiologic data were recorded every 15 s from 5,454 patients undergoing noncardiothoracic surgery. Recorded measurements of blood pressure, heart rate, arterial oxygen saturation, and temperature were electronically analyzed for deviations from defined limits. The computer system also was used by anesthesiologists to report voluntarily those deviations as intraoperative incidents. For each electronically detected incident: 1) the complete automated anesthesia record was examined by two senior anesthesiologists who, by consensus, eliminated case records with artifact or in which context suggested that the incident was not clinically relevant, and 2) the anesthesia information management system database was checked for voluntary reporting.

RESULTS

In 473 automated anesthesia records, 494 incidents were found by electronic scanning of 5,454 automated anesthesia records. Sixty intraoperative incidents were eliminated, 25 due to artifact and 35 due to context. When the remaining 434 intraoperative incidents were checked for voluntary reporting, 18 (4.1%) matching voluntary reports were found. All intraoperative incidents that were reported voluntarily also were detected by electronic scanning. Based on a 10% sample, the sensitivity rate of electronic scanning was 97.2% (35/36), and the specificity rate was 98.4% (427/434). Among 413 cases with electronically detected intraoperative incidents, there were 29 deaths (7.0%), whereas there were only 79 deaths (1.6%) among 5,041 cases without incidents (chi 2 = 58.5, P < 0.001).

CONCLUSIONS

The use of an anesthesia information management system facilitated analysis of intraoperative physiologic data and identified certain intraoperative incidents with high sensitivity and specificity. A low level of compliance with voluntary reporting of defined intraoperative incidents was found for all anesthesiologists studied. Finally, there was a strong association between intraoperative incidents and in-hospital mortality.

Vestibular findings and brainstem pathology in two siblings with Cockayne's syndrome

Two siblings with Cockayne's syndrome (CS) are described. Both showed cachectic dwarfism, photosensitivity and progressive neurological dysfunction. The damped-rotation test revealed no vestibular nystagmus in one of them, and reduced per-rotatory nystagmus in the other. Neuropathological examination in the former subject disclosed neuronal loss with fibrillary gliosis in the vestibular nuclei, whereas neuronal degeneration was not apparent in the abducens nuclei, the oculomotor nuclei and the paramedian pontine reticular formation. Our findings suggest that CS might cause vestibular dysfunction as well as hearing loss and that the lesions in the vestibular nuclei might be related to the vestibular dysfunction.

[Neoadjuvant endocrine therapy in patients with locally advanced prostate cancer]

Recently, there has been an increasing interest in the application of preoperative endocrine therapy prior to radical prostatectomy. The main purpose of this treatment modality is to enhance surgical curability and increase survival. Endocrine therapy was performed before radical prostatectomy on 40 patients between 1986 and 1993; 15 had stage B2 and 25 had stage C disease. The median duration of preoperative endocrine therapy was 3.8 months. All patients subsequently underwent radical prostatectomy, pelvic lymphadenectomy and castration. There was on average a 25.5% (0-71.8%) decrease in maximal cross-sectional area of prostate gland as determined by transrectal ultrasonography. Treatment-related histological effects, divided into three grades were as follows; excellent in 17, moderate in 11 and poor or no regression in 12. Pathological downstaging of disease status from the diagnosis made at the initial clinical examination was seen in 13 of the 40 patients (33%). At a median follow-up of 50 months (19-118 months), 36 of the 40 patients are disease-free and two died of cancer 43 and 50 months postoperatively. These findings suggest that preoperative endocrine therapy plays an important role in the management of locally advanced prostatic cancer.

Atomic force microscopy proposes a novel model for stem-loop structure that binds a heat shock protein in the Staphylococcus aureus HSP70 operon

The Staphylococcus aureus HSP70 operon produces a polycistronic RNA in response to heat shock, and ORF37 is the first protein to be translated. The promoter of this operon contains a palindromic nucleotide sequence that may form a stem-loop structure. Structural analysis of the promoter regions by atomic force microscopy (AFM) revealed a quadruplet that consists of a pair of stem-loops. A novel "SL2S' (Stem-Loop-Loop-Stem) model was proposed for this structure. AFM also revealed the binding of ORF37 to the quadruplet, establishing a molecular mechanism for this heat shock gene expression; ORF37 acts as a regulator by binding to the SL2S structure in the promoter.

Soyacystatin, a novel cysteine proteinase inhibitor in soybean, is distinct in protein structure and gene organization from other cystatins of animal and plant origin

Cystatins, cysteine proteinase inhibitors, deserve note because of their regulatory and protective functions in plant tissues. We isolated both genomic DNA and cDNA clones from soybean that encode a cystatin consisting of 245 amino acid residues (soyacystatin). It is, while basically similar in sequence to known cystatins that are generally in the range of 12-15 kDa, characterized by having extremely large extension sequences in both its amino and carboxyl termini. The genomic DNA encoding soyacystatin is also unique in that it consists of four exons with three introns in its coding regions. The mRNA for soyacystatin is distinctly expressed in soybean seeds 2 weeks after flowering. Soyacystatin purified from mature soybean seeds had a molecular mass of about 26 kDa on SDS/PAGE which suggests that it contains the extension sequences. Papain-inhibition experiments demonstrate that this endogenous soyacystatin has almost the same inhibitory activity as that of its deletion mutant (102 amino acid residues) recombinantly produced by truncation of the amino and carboxyl terminal extensions, indicating that the occurrence of the extensions does not affect the cystatin activity. Immunohistochemical experiments reveal that soyacystatin is expressed nearly uniformly in the cotyledons. These results also suggest the possible occurrence of a cysteine proteinase as the target enzyme of soyacystatin.

[Intra-operative management during laparotomy for patients under hemodialysis]

We evaluated retrospectively 31 patients under hemodialysis who underwent scheduled laparotomy with a purpose to determine the optimal intra-operative water balance. The patients fell into two different periods according to the difference of the principle of anesthesia. Anesthesia method employed for the former eleven patients (1987.6-1990.12) was NLA with pancuronium for muscle relaxation and they were ventilated mechanically in ICU. More recent twenty patients (1991-1995) had epidural block plus nitrous oxide-oxygen-isoflurane with vecuronium and they were extubated early. These latter patients, compared with the preoperative values, did not show any significant changes in mean arterial pressure or systemic vascular resistance after the operation. Intra-operative water balance showed a positive correlation with PADP (r = 0.57) and a negative correlation with SVR (r = 0.36) at the end of operation. The adequate fluid infusion is necessary to maintain PADP, and the water balance of +3-5 ml x kg-1 x hr-1 is recommended during laparotomy for the patients under hemodialysis.

[Development of highly sensitive assay for detection of low serum level of PIVKA-II and its clinical usefulness]

PIVKA-II is well known as a tumor marker of hepatocellular carcinoma. We describe the adaptations to render a commercially available PIVKA-II immunoassay kit (Eitest MONO P-II: Eisai Co., Ltd, Tokyo) more sensitive and evaluated clinical usefulness of this highly sensitive assay for early diagnosis of hepatocellular carcinoma. We measured serum PIVKA-II concentrations with the Eitest kit as described for the kit. To measure serum PIVKA-II concentrations below the sensitivity limit of the Eitest kit (0.0625AU/ml), linearity was determined using a series of dilutions of standard antigen diluted in standard diluent, including PIVKA-II concentrations of 0.002, 0.004, 0.008, 0.016, 0.031, 0.0625AU/ml. The assay was found to be liner from 0.004AU/ml. In this way, one can detect as low PIVKA-II concentrations as 0.004AU/ml. The repeatability-assay coefficients of variation (CV%) obtained from sixteen repeated assays of four sera were distributed between 3.63 and 18.75% and the reproducibility-assay coefficients of variation (CV%) obtained from ten repeated assays of four sera were distributed between 6.27 and 14.04%. We determined the serial changes in serum PIVKA-II levels of two patients with hepatocellular carcinoma after the resection of hepatic tumor. In these patients, elevation of serum PIVKA-II level determined by the highly sensitive assay preceded the detection of relapse by imaging diagnostic procedures. In summary, the assay system we developed has good accuracy and reproducibility for assaying low concentrations of PIVKA-II in serum and is suitable for detecting small increases in PIVKA-II concentrations. This assay system may be useful to earlier detect a relapse of hepatocellular carcinoma.

Thermosensitivity and thermotolerance in the adriamycin-resistant strain of Ehrlich ascites tumor cells

The acquisition of resistance to anticancer drugs is an important problem in cancer chemotherapy. Ehrlich ascites tumor cells (wild type EAT cells) were grown in a medium containing 1 microgram/ml adriamycin (ADR) (ADR-resistant strain) and the cells that proliferated were established in our laboratory. Intracellular ADR accumulation and the killing effect of ADR in the ADR-resistant strain were markedly reduced compared with those of the wild type EAT cells. In this study, we initially observed thermosensitivity in both strains and found no difference in the thermosensitivity. These findings demonstrated that hyperthermic treatment was effective in the ADR-resistant strain as well as in the wild type EAT cells. On the other hand, thermotolerance is an important problem in the hyperthermic treatment of cancer. We next observed the thermotolerance of both strains and found that the thermotolerance in the ADR-resistant strain was greater than that in the wild type EAT cells, but the thermotolerance was almost restored within 24 hours. Furthermore, we investigated the influence of thermotolerance on the intracellular accumulation and killing effects of ADR in the wild type EAT cells. There was no difference in the intracellular ADR accumulation and the killing effect of ADR between non-thermoresistant cells and thermoresistant cells. These results suggested that hyperthermia was effective in the ADR-resistant cells either alone or combination with ADR.

Anatomic considerations for sciatic nerve block in the popliteal fossa through the lateral approach

BACKGROUND AND OBJECTIVES

The disadvantage of the classic posterior approach to block of the sciatic nerve at the knee level (popliteal nerve block [PNB]) is the need to position a patient in the prone position for performance of the block. In this study on cadavers, a lateral approach to the popliteal nerve in the supine position was investigated, and some anatomic considerations of relevance to popliteal nerve block were addressed.

METHODS

In 19 cadaver right legs, the lateral approach to PNB was simulated with a needle, introduced in the groove between the biceps femoris and vastus lateralis muscles 7 cm above the knee, at either 30 degrees or 60 degrees relative to the horizontal plane, and 1 mL of dye solution was injected through the needle. After dissection of the popliteal fossa, the position of the solidified bolus of dye in relation to the popliteal nerve was determined. Additionally, the dye was injected into the popliteal nerve sheath, and the spread of the dye and continuity of the sheaths were determined.

RESULTS

In 10 legs, the lateral approach was attempted at a 30 degrees angle and in 9 legs at a 60 degrees angle. The solidified injectates at 30 degrees were closely distributed anterolaterally to the nerve, while injectates at 60 degrees tended to be further from the nerve and scattered along its posterolateral aspect (P = .02). The dye injected into the nerve sheaths traveled 5 to 10 cm within the sheath, surrounding both main divisions of the popliteal nerve, the tibial and the common peroneal nerve.

CONCLUSION

A lateral approach to the popliteal nerve with insertion of the needle at a 30 degrees angle relative to the horizontal plane results in predictable approximation of the needle tip to the popliteal nerve. The results also suggest the existence of a continuous neural sheath encompassing the popliteal nerve and its main branches. This may have clinical implications similar to those in perivascular neuronal block.

Giant hydronephrosis of bilateral duplex systems associated with ureteral ectopia: a case report

Giant hydronephrosis is an uncommon clinical entity. Even more uncommon is the association of giant hydronephrosis with a double collecting system and ectopic ureter. Here, we report a case of giant hydronephrosis of the bilateral duplex systems associated with ureteral ectopia. The patient underwent upper pole nephrectomy and upper ureterectomy. To our knowledge, only four similar cases have been reported previously.

Steroidal saponins from Nolina recurvata stems and their inhibitory activity on cyclic AMP phosphodiesterase

Seven steroidal saponins were isolated from the stems of Nolina recurvata, five of which appeared to be new compounds and were assigned as spirosta-5,25(27)-diene-1 beta,3 beta-diol (neoruscogenin) 1-O--O-alpha-L-rhamnopyranosyl-(1--> 2)-O-[beta-D-xylopyranosyl-(1-->3)]-alpha-L-arabinopyranoside-, (25S)-spirost-5-ene-1 beta,3 beta-diol [(25S)-ruscogenin] 1-O-{O-alpha-L-rhamnopyranosyl-(1-->2)-O-[beta-D-xylopyranosyl-(1--> 3)]-alpha-L-arabinopyranoside}, neoruscogenin 1-O-{O-alpha-L-rhamnopyranosyl-(1-->2)-O-[beta-D-xylopyranosyl-(1--> 3)]-beta-D-fucopyranoside}, 26-O-beta-D-glucopyranosyl-22-O-methylfurosta-5,25(27)-diene-1 beta,3 beta,22 xi,26-tetrol 1-O--O-alpha-L-rhamnopyranosyl-(1--> 2)-O-[beta-D-xylopyranosyl-(1-->3)]-alpha-L-arabinopyranoside- and 26-O-beta-D-glucopyranosylfurosta-5,20(22),25(27)-triene-1 beta,3 beta,26-triol 1-O-{O-alpha-L-rhamnopyranosyl-(1--> 2)-alpha-L-arabinopyranoside}. The isolated saponins were evaluated for their inhibitory activity on cyclic AMP phosphodiesterase to identify new compounds with medicinal potential.

Steroidal saponins from Hosta longipes and their inhibitory activity on tumour promoter-induced phospholipid metabolism of HeLa cells

Three new spirostanol saponins and two new furostanol saponins were isolated from the underground parts of Hosta longipes. Their structures were determined to be (25R)-5 alpha-spirostane-2 alpha, 3 beta-diol (gitogenin) 3-O-{O-alpha-L -rhamnopyranosyl-(1-->2)-beta-D-galactopyranoside}, gitogenin 3-O-{O-alpha-L-rhamnopyranosyl-(1-->2) -O-[beta-D-glucopyranosyl-(1-->4)]-beta-D-galactopyranoside-, (25R)-5 alpha-spirostan-3 beta-ol (tigogenin) 3-O-{O-alpha-L-rhamnopyranosyl-(1-->2) -O-[beta-D-glucopyranosyl-(1-->4)]-beta-D-galactopyranoside-, 26-O-beta-D-glucopyranosyl-22-O-methyl-(25R)-5 alpha-furostane-2 alpha,3 beta, 22 xi,26-tetrol 3-O-{O-alpha-L-rhamnopyranosyl -(1-->2)-beta-D-galactopyranoside} and 26-O-beta -D-glucopyranosyl-22-O-methyl-(25R)-5 alpha-furostane-2 alpha,3 beta,22 xi,26-tetrol 3-O-{O-alpha-L -rhamnopyranosyl-(1-->2)-O-[beta-D-glucopyranosyl -(1-->4)]-beta-D-galactopyranoside}, respectively. The isolated saponins and their derivatives were examined for inhibitory activity on 12-O-tetradecanoylphorbor-13-acetate-stimulated 32P-incorporation into phospholipids of HeLa cells as the primary screening test to find new antitumour-promoter compounds.

The convergence of axon terminals from the mediodorsal thalamic nucleus and ventral tegmental area on pyramidal cells in layer V of the rat prelimbic cortex

We investigated the ultrastructural basis of the synaptic convergence of afferent fibres from the mediodorsal thalamic nucleus (MD) and the ventral tegmental area (VTA) on the prefrontal cortical neurons of the rat by examining the synaptic relationships between thalamocortical or tegmentocortical terminals labelled with anterograde markers [lesion-induced degeneration or transport of wheat germ agglutinin conjugated to horseradish peroxidase (WGA-HRP)] and randomly selected unlabelled apical dendrites of layer V pyramidal cells in the prelimbic cortex. WGA-HRP-labelled terminals from the VTA ranged in diameter from 0.7 to 2.8 microm and established synaptic contacts with large dendritic profiles, i.e. proximal segments of apical dendritic shafts and spines from layer V pyramidal cells. Symmetrical synapses, i.e. inhibitory synapses, were more often seen than asymmetrical ones. Degenerating terminals from the MD formed asymmetrical synapses on dendritic spines or occasionally on small dendritic shafts of apical dendrites from layer V pyramidal cells, which received tegmentocortical synapses, mostly within layer III. Thalamocortical synapses were more distally distributed over common apical dendrites than tegmentocortical synapses, although some of them overlapped. The numerical density of direct synaptic inputs from the MD and VTA was low. These results suggest that fibres from the VTA exert their inhibitory effects directly on pyramidal cells in layer V via synaptic junctions with apical dendrites of these pyramidal cells, and that the tegmentocortical fibres are in an ideal anatomical position to modulate the reverberatory circuits between the MD and the prelimbic cortex.

Case report: hepatic adenoma with bone marrow metaplasia in a patient with glycogen storage disease type 1a

A 34 year old man with glycogen storage disease type 1a had two hepatic tumours since 18 years of age. They had continued to grow until he was 24 years old, but showed no further growth since then. He underwent a right hepatic trisegmentectomy with caudate lobectomy under veno-venous bypass. The tumour in the posterior segment showed nodule-within-nodule appearance. Histologically, the inner adenoma with dysplasia, bone marrow metaplasia and lymphocytic infiltration was separated by a fibrous band from the outer adenoma of usual histology.

A new cytotoxic cholestane bisdesmoside from Ornithogalum saundersiae bulbs

Bioassay-guided fractionation of the MeOH extract of Ornithogalum saundersiae bulbs led to the isolation of a new cholestane bisdesmoside with potent cytotoxic activities toward leukemia HL-60 and MOLT-4 cells. The structure was deduced mainly from spectroscopic information.

[An immunohistochemical study of proliferating cell nuclear antigen (PCNA) and MIB-1 in epithelial hyperplasia and dysplasia of the vocal cords]

We investigated the proliferative activities in epithelial hyperplasia and dysplasia of the human vocal cords as precancerous lesions, using immunohistochemical staining with anti-PCNA and MIB-1 (anti-Ki-67) monoclonal antibody. The series for this study consisted of nine patients with hyperplasia, 12 with mild dysplasia, ten with moderate dysplasia, eight with severe dysplasia, eight with vocal cord polyps, and 14 with invasive squamous cell carcinoma. The following results were obtained: 1) The mean PCNA labeling index was 1.12 +/- 1.05 (MEAN +/- STD%) in polyp, 4.88 +/- 2.02 in hyperplasia, 2.76 +/- 1.76 in mild dysplasia, 3.80 +/- 2.03 in moderate dysplasia, 6.12 +/- 3.01 in severe dysplasia, and 19.07 +/- 10.37 in invasive cancer. 2) The mean MIB-1 positive rates were 5.50 +/- 2.47 (MEAN +/- STD%) in polyp, 13.08 +/- 6.86 in hyperplasia, 16.55 +/- 7.34 in mild dysplasia, 15.94 +/- 6.73 in moderate dysplasia, 21.43 +/- 8.16 in severe dysplasia, and 41.48 +/- 14.05 in invasive cancer. In cases of hyperplasia, dysplasia and invasive cancer, PCNA labeling index values and MIB-1 positive rates increased in proportion to the histological atypical grade increasing. Some lesions which recurred or progressed to cancer were found show high expression of PCNA and MIB-1. In cancer cases, there was no significant correlation between the PCNA labeling index, MIB-1 positive rates and either the degree of tumor cell differentiation or the T-classification. There was a positive correlation between the PCNA labeling index and MIB-1 positive rates among all cases. In this study, those cases showing a high PCNA labeling index and/or MIB-1 positive rates may indicate the possibility of recurrence or progression to malignancy in precancerous lesions of the vocal cords.

A pyrroline glucoside ester and steroidal saponins from Lilium martagon

A new phenylpropanoid ester of a pyrroline derivative and two new steroidal saponins were isolated from the fresh bulbs of Lilium martagon, along with several previously known compounds. The structures of the new compounds were determined by spectroscopic data, hydrolysis, and by comparison with spectral data of known compounds to be (-)-5-hydroxy-3-methyl-3-pyrrolin-2-one 5-O-(6-O-p-coumaroyl-beta-D- glucopyranoside), (25S)-spirost-5-ene-3 beta,17 alpha, 27-triol 3-O-[O-beta-D-glucopyranosyl-(1-->2)-O-beta-D-glucopyranosyl- (1-->4)-beta-D-glucopyranoside] and (25S)-5 alpha-spirostane-3 beta,17 alpha,27-triol 3-O-[O-beta-D-glucopyranosyl-(1-->2)-O-beta-D-glucopyranosyl-(1-->4)-bet a-D- glucopyranoside], respectively. Lilium martagon crosses well with L. hansonii to produce a valuable garden hybrid lily. In this study, the secondary metabolites of L. martagon were revealed to be closely related to those of L. hansonii, giving a good example of the correlation between the secondary metabolites and cross-compatibility.

Influence of cell membrane potential, and selectivity of the Na+/H+ exchanger and Cl-/HCO3- exchanger on the intracellular accumulation of adriamycin

Intracellular accumulation of adriamycin (ADR) has been reported to be influenced by cell membrane potential. We first evaluated intracellular accumulation of ADR and 3,3'-(di-n-hexyl)-2,2'-oxacarbocyanine iodide (NK-2280), an indicator of cell membrane potential, and found a good correlation between ADR and NK-2280 intracellular accumulation in several cell lines. This suggests that ADR accumulation may be influenced by cell membrane potential or the mechanisms of NK-2280 accumulation may be similar to those of ADR accumulation. Next, we observed the influence of the NA+/H+ exchanger and Cl-/HCO3- exchanger on the intracellular accumulation of ADR and NK-2280, and found that ADR accumulation decreased with increasing concentrations of 3,5-diamino-6-chloro-N-(diaminomethylene)pyrazinecarboxamide (amiloride), an inhibitor of the Na+/H+ exchanger, and 4,4'-diisothiocyanato-stilbene-2,2'-disulfonic acid (DIDS), an inhibitor of the Cl-/HCO3- exchanger, however, NK-2280 accumulation was increased by amiloride, and decreased by DIDS. The increased accumulation of NK-2280 induced by amiloride may be due to the increased cell membrane potential caused by the inhibition of H+ ion efflux and NA+ ion influx due to the inhibition of the Na+/H+ exchanger. The decreased accumulation of NK-2280 may be also due to the decreased cell membrane potential caused by the inhibition of Cl- ion efflux due to the inhibition of the Cl-/HCO3- exchanger by DIDS. However, the decreased rate caused by DIDS was greater than the increased rate caused by amiloride. Therefore, it is suggested that the decreased accumulation of NK-2280 by DIDS may be influenced by other factors apart from cell membrane potential. These results suggest that the Cl-/HCO3- exchanger may be related to both ADR accumulation, and NK-2280 accumulation, and that the Na+/H+ exchanger may be related to ADR accumulation, but not NK-2280. This suggests that the Cl-/HCO3- exchanger is of low selectivity.

[Sarcomatous malignant mesothelioma diagnosed after death]

A 77-year-old man with diabetes mellitus who was being treated as an outpatient had abnormal shadow in the right lower lobe on a chest roentgenogram in June 1993. In July 1994, a productive cough developed, and subsequent dyspnea obliged him to enter our hospital. Retention of pleural fluid led us to suspect tuberculosis pleurisy and to perform a pleural biopsy and a thoracentesis to remove pleural fluid but no final diagnosis was reached. About 14 months later he died of dyspnea with a rapidly growing tumor. An autopsy disclosed a giant tumor that occupied the right pleural cavity, excluding the lung. The tumor was well-defined between the lung and had infiltrated into the mediastinum. The histopathological diagnosis was primary malignant mesothelioma, sarcomatous type, of the visceral pleura.

Uterine cirsoid aneurysm: MRI and MRA

Uterine cirsoid aneurysm is uncommon. It is important to make a diagnosis of this disease preoperatively, because repeated curettages may induce life-threatening massive genital bleeding. We present a case of a 51-year-old woman with uterine cirsoid aneurysm in whom MRI and MRA were very useful for the preoperative diagnosis. The radiologic appearances on ultrasonography, CT, conventional SE MRI, MRA, dynamic MRI, and pelvic angiography are presented. Conventional SE T1-weighted and T2-weighted images demonstrated multiple flow voids in the uterus and bilateral adnexal regions. MRA demonstrated a cluster of distinct, tortuous, and coiled vascular channels in the pelvis. MRA could obtain images almost equal to angiography and was considered to be an excellent noninvasive imaging technique for the diagnosis of uterine cirsoid aneurysm.

Synaptic relationships between axon terminals from the mediodorsal thalamic nucleus and layer III pyramidal cells in the prelimbic cortex of the rat

A combined study of anterograde axonal degeneration and Golgi electron microscopic technique was designed to examine the distribution and density of axon terminals from the mediodorsal thalamic nucleus (MD) over layer III pyramidal cells in the prelimbic cortex of the rat. The reconstructive analysis of serial ultrathin sections of gold-toned apical and basal dendrites of layer III pyramidal cells showed that degenerating thalamocortical axon terminals from MD formed asymmetrical synaptic contacts predominantly with dendritic spines of the identified basal dendrites as well as apical dendrites. There was little difference in the numerical density of thalamocortical synapses from MD per unit length of both apical and basal dendrites.

[Continuous monitoring of blood volume change by measuring hematocrit during cardiopulmonary bypass]

The usefulness of the continuous monitoring system of blood volume change (BV%), by using measured hematocrit, has been evaluated during cardiopulmonary bypass (CPB). Twelve patients for CABG were studied. The optical sensor was incorporated in the venous outlet site of CPB to measure Hct and hemoglobin oxygen saturation. The infusion of the cardioplegia caused a sharp deviation in BV%, and the use of extracorporeal ultrafiltration helped to reduce BV% rapidly. At the end of CPB, BV% was -1.4 +/- 7.7% and showed a good correlation with total water balance during CPB (r = 0.75, P < 0.01). However, the discrepancy between BV% and the positive water balance was observed in a case with LOS. This suggests fluid maldistribution from intra- to extra-vascular space. Continuous BV% monitoring during CPB is useful as an index of water balance and for assessing an optimum blood volume.