Role of platelet-activating factor acetylhydrolase gene mutation in Japanese childhood IgA nephropathy

Platelet-activating factor (PAF) is a potent mediator of inflammatory injury in renal diseases. PAF is degraded to inactive products by PAF acetylhydrolase. Recently, a point mutation (G to T transversion) of the PAF acetylhydrolase gene was observed at position 994, and this mutation was found to contribute to the variability in plasma PAF levels, with undetectable plasma PAF acetylhydrolase activity occurring in homozygous patients (TT genotype) and reduced levels of activity in heterozygous patients (GT genotype). Therefore, we investigated the effect of the PAF acetylhydrolase gene mutation on the pathogenesis and progression of immunoglobulin A (IgA) nephropathy. Genomic DNA was obtained from 89 children with IgA nephropathy and 100 controls. We identified the PAF acetylhydrolase gene mutation (G994T) by polymerase chain reaction. There was no significant difference in genotypic frequency between patients and controls. However, urinary protein excretion at the time of biopsy was significantly greater in patients with the GT/TT genotypes than in those with the GG genotype. The percentage of glomeruli with mesangial cell proliferation was significantly greater in patients with the GT/TT genotypes than in those with the GG genotype. These results indicate the PAF acetylhydrolase gene mutation may influence the degree of proteinuria and the extent of mesangial proliferation in the early stage of childhood IgA nephropathy.

Six new taxane diterpenoids from the seeds of taxus chinensis var. mairei and taxus yunnanensis

Six new taxane diterpenoids and three known 2(3-->20)abeotaxoids were isolated from the seeds of Taxus chinensis var. mairei and of Taxus yunnanensis. Their structures were established as 2alpha, 20-dihydroxy-9alpha-acetoxytaxa-4(20),11-dien-13-one (1), 5alpha-cinnamoyloxy-7beta,10beta, 13alpha-triacetoxy-2(3-->20)abeotaxa-2alpha-ol-4(20),11-dien-9-one (2), 5alpha-cinnamoyloxy-10beta, 13alpha-diacetoxy-2(3-->20)abeotaxa-2alpha,7beta-diol-4(20), 11-dien-9-one (3), 5alpha-cinnamoyloxy-2alpha,7beta,10beta, 13alpha-tetraacetoxy-2(3-->20)abeotaxa-4(20),11-dien-9-one (4), 7-O-acetyltaxine A (5), 2alpha,7beta,10beta, 13alpha-tetraacetoxy-5alpha-phenylisoserinatoxy-2(3-->20)abeotaxa-4(2 0),11-dien-9-one (6), 5-O-acetyltaxinine M (7), 5alpha-hydroxy-2alpha,7beta,10beta, 13alpha-tetraacetoxy-2(3-->20)abeotaxa-4(20),11-dien-9-one (8), and 2alpha,5alpha-dihydroxy-7beta,10beta, 13alpha-triacetoxy-2(3-->20)abeotaxa-4(20),11-dien-9-one (9), on the basis of 1D and 2D NMR spectroscopic analysis. Compound 1, as a new compound isolated from T. chinensis var. mairei, is a rare example of a taxane with a 4,11-diene unit, which is considered to be an important intermediate in the biogenesis of taxoids. Compounds 2-4, 6, and 7 are new compounds, isolated from T. yunnanensis, which also afforded the known compounds 5, 8, and 9.

Developmental genetics of the Drosophila gut: specification of primordia, subdivision and overt-differentiation

The Drosophila gut is composed of three major parts, the foregut, midgut and hindgut, which arise from anterior and posterior invaginations of the early blastoderm. We review the process of the specification of the gut primordia, subsequent subdivision and region-specific cell differentiation in terms of developmental genetics. Graded activities of maternal signals at anterior and posterior terminal domains of the blastoderm, being mediated by activities of two zygotic gap genes, tailless and huckebein, lead to the activation of key genes that determine the gut primordia: serpent (GATA factor gene) for the endodermal midgut; brachyenteron (Brachyury homolog) for the ectodermal hindgut. fork head (HNF-3 homolog) and caudal (Cdx homolog) are also essential for the development of all gut primordia or hindgut primordium, respectively. Subdivision of the midgut epithelium is regulated by inductive signals emanating from the visceral mesoderm, which is under the control of HOM-C genes. In contrast, pattern formation of the ectodermal foregut and hindgut is regulated by secreted signaling molecules, such as Wingless (Wnt homolog), Hedgehog and Decapentaplegic (Bmp-4 homolog), as in the case of segmented structures and imaginal discs. Finally, the gut is subdivided into at least 36 compartments that are recognized asminimum tissue units of regional differentiation. A few genes that are responsible for determining and maintaining the state of overt-differentiation of the compartments have also been reported. A marked feature of the genetic mechanism of the gut development is the unexpectedly wide spectrum of the similarities of relevant genes and regulatory pathways of gene expression between Drosophila and vertebrates, which may imply a prototypic style of body plan common to protostomes and deuterostomes.

Gadolinium-DTPA-enhanced magnetic resonance imaging and functional outcome in patients with acute myocardial infarction

This study was designed to test the hypothesis that Gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA)-enhanced magnetic resonance images (MRI) reflect the severity of ischemic injury during the acute and chronic phases of myocardial infarction (MI). Twenty-nine patients with their first acute MI underwent Gd-DTPA-enhanced MRI in the first week (4.2+/-0.3 days) and at 1 month after onset. Pairs of left ventriculograms were compared with Gd-DTPA-enhanced magnetic resonance images, classified into 3 pattern groups: hyper-enhancement, with and without a central hypo-enhanced region (P1 and P2, respectively), and non-enhancement (P3). In the acute phase of MI, P1 was found in 10, P2 in 11, and P3 in 8 patients. One month later, the image pattern had changed from P1 to P2 in a single patient, from P2 to P3 in 4 patients, and had remained identical in the others. Patients with P3 showed improvement of anterior wall motion in the 1-month follow-up study, and had higher TIMI flow grades and lower peak creatine kinase values than those without recovery. Thus, Gd-DTPA-enhanced magnetic resonance images, closely reflecting the severity of myocardial injury, are useful in predicting myocardial functional recovery after MI.

Substituent effect of a fluorine atom on the mutagenicity of nitroquinolines

Some 16 nitroquinolines (NQs) and their fluorinated derivatives were tested for mutagenicity in Salmonella typhimurium TA100 without S9 mix to investigate the effect of fluorine-substitution on the mutagenicity. These NQs consist of 5-NQs, 5-nitroquinoline N-oxides (5-NQOs), N-methyl-5-nitroquinolinium methanesulfonates (N-Me-5-NQs) and 8-NQs, including three ortho-F-NQs, one meta-F-NQ, four para-F-NQs and four 3-F-NQs. For this purpose, eight F-NQs were newly synthesized. The data indicated that the ratio of the mutagenic activities (revertants/plate/nmol) of fluorinated NQs to those of the corresponding parent non-fluorinated compounds ranged from 0.6- to 119-fold. The fluorine atom located para to the nitro group markedly enhanced the mutagenicity (24-fold and more), while three ortho-fluorinated derivatives showed no significant increase in mutagenicity (enhancement ratio were 0.6, 0.8 and 1.7). With respect to 8-NQs, its meta-fluorinated derivative also had an enhanced mutagenicity over the parent compound (53-fold). In addition, although N-Me-5-NQ was less mutagenic than 5-NQ and 5-NQO, the mutagenicity of N-Me-5-NQ was most significantly enhanced by fluorine-substitution. These results suggest that introduction of a fluorine atom to the molecule in question may be a useful tool to modify their mutagenic potency and to better understand the mechanism of mutation.

MR imaging of squamous cell carcinoma of the floor of the mouth. Appearance of the sublingual and submandibular glands

PURPOSE

To determine the diagnostic value of MR imaging for tumors of the floor of the mouth and the effects of the tumors on the sublingual and submandibular glands.

MATERIAL AND METHODS

Thirty-seven patients with proven squamous cell carcinoma of the floor of the mouth underwent MR imaging, including unenhanced T1-weighted, T2-weighted, dynamic, and contrast-enhanced T1-weighted images. The appearance of the tumor and the sublingual and submandibular glands was assessed qualitatively and quantitatively.

RESULTS

All tumors demonstrated replacement of the normal signal intensity in the adjacent sublingual gland. Twenty-one patients (57%) had abnormal signal intensity of the submandibular gland without tumor invasion, presumably secondary to submandibular duct obstruction by the tumor. Unenhanced T1-weighted images provided high contrast between tumor and sublingual gland. Tumors limited within the gland were well detected on unenhanced T1-weighted images. Large tumors extending beyond the gland were well delineated on dynamic images, but no better than on T2-weighted images.

CONCLUSION

At MR imaging for tumor of the floor of the mouth, one must carefully evaluate the appearance of the sublingual and submandibular glands. Contrast-enhanced studies are unnecessary when the tumor is limited within the sublingual gland on precontrast MR images.

Strangulation of small bowel due to Meckel diverticulum: CT findings

We report an unusual case of small bowel strangulation due to long Meckel diverticulum. CT demonstration of the bundle-like segment contiguous with the distended fluid-filled loops of bowel contributed to the prompt preoperative diagnosis.

Dynamic magnetic resonance imaging of head and neck lesions

Dynamic magnetic resonance imaging (MRI) has been used to improve the detection of tumors, to determine the tumor extension, and to make differential diagnosis. Most malignant lesions of the head and neck show early enhancement and early washout of contrast media on dynamic MRI, but the tumor characterization remains unclear. Pharmacokinetic analysis of dynamic MRI can provide information about the permeability of Gd-DTPA in the tumor that may reflect the oxygen concentration of the tumor and the amount of drug delivered to the tumor. This information may be useful in the prediction of radiation and/or chemotherapy response of the tumor.

Overexpression of insulin-like growth factor-1 (IGF-I) receptor and the invasiveness of cultured keloid fibroblasts

Keloid is a dermal fibroproliferative tissue of unknown etiology. Protein tyrosine kinases (PTKs) play an important role in the regulation of cell growth and differentiation. Activation of PTK cascades in keloid fibroblasts is thought to be closely linked to abnormal cell proliferation and migration. We determined the expression profile of PTK genes in normal skin and keloid fibroblasts using the homology cloning method with a degenerated primer. Eight PTK genes were expressed among a total of 46 receptor-type clones. The most abundant type of PTK receptors was the platelet-derived growth factor receptor in both fibroblasts. However, insulin-like growth factor-I receptor (IGF-IR) was overexpressed only in keloid-derived fibroblasts (9 of 24). Immunohistochemical analysis confirmed the high expression of IGF-IR in keloid fibroblasts, but not in normal fibroblasts. To examine the functional properties of the IGF-I/IGF-IR pathway, we investigated cell proliferation and invasion activities of both types of fibroblasts. The mitogenic effect of IGF-I on both fibroblasts was very weak compared with serum stimulation. In contrast, the invasive activity of keloid fibroblasts was markedly increased in the presence of IGF-I, and inhibited by a neutralizing antibody against IGF-IR. Our results indicate the involvement of activated IGF-I/IGF-IR in the pathogenesis of keloid by enhancing the invasive activity of fibroblasts.

Two new taxane diterpenoids from the seeds of the Chinese yew, Taxus yunnanensis

A new taxoid and a taxinine analogue were isolated from the seeds of the Chinese yew, Taxus yunnanensis. The structures were established as 13 alpha-acetoxy-5 alpha-(3'-dimethylamino-3'-phenyl)-propionyloxy-11(15-->1)-abeotaxa- 4(20),11-diene-9 alpha, 10 beta-diol and 2 alpha-acetoxy-5 alpha-cinnamoyloxy-9 alpha, 10 beta-dihydroxy-taxa- 4(20),11-diene-13-one on the basis of 1D, 2D NMR, and MS spectral analysis.

Three new bicyclic taxane diterpenoids from the needles of Japanese yew, Taxus cuspidata Sieb. et Zucc

Three new bicyclic taxane diterpenes were isolated from the needles of the Japanese yew, Taxus cuspidata Sieb. et Zucc. Their structures were established to be 7,9,10,13-tetraacetoxy-5-cinnamoyloxy-4-hydroxy-methyl-8,12,15,15- tetramethyl-bicyclo[9.3.1] pentadeca-3,8,11-trien-2-ol (2,20-dideacetyl taxuspine X), 7,9,10,13,20-pentaacetoxy-5-cinnamoyloxy-8,12,15,15-tetramethyl bicyclo[9.3.1] pentadeca-3,8,11-trien-2-ol (2-deacetyl taxuspine X), and 9,10,13,20-tetraacetoxy-5-cinnamoyloxy-8,12,15,15-tetramethyl-bicyclo[9.3.1] pentadeca-3,8,11-trien-2,7-diol (2,7-dideacetyl taxuspine X) with the aid of spectroscopic techniques and by comparing with taxuspine X.

[Endothelial-derived nitric oxide mediates the peripheral vasodilatory effects of amrinone in humans]

Amrinone, which is used for the treatment of acute congestive heart failure, has vasodilatory and positive inotropic effects through the increment of intracellular cyclic adenosine monophosphate. Recent in vitro investigations have shown that amrinone has an endothelium-dependent vasodilatory effect. The present study examined whether amrinone shows this endothelium-dependent vasodilatory effect in human peripheral vessels. Forearm blood flow during intra-arterial infusion of graded doses (12.5, 25, 50, 100, 200 micrograms/min) of amrinone was measured using plethysmography in 10 healthy subjects without organic vascular disease before and after nitric oxide synthase blocking with NG-monomethyl-L-arginine (L-NMMA, 400 mumol). The graded dose of amrinone produced progressive increases in amrinone plasma concentrations, and a dose over 100 micrograms/min caused amrinone plasma concentrations of more than 1.0 microgram/ml. The increase in forearm blood flow in response to amrinone was significantly depressed after L-NMMA doses of less than 100 micrograms/min, but the increase in forearm blood flow during infusion of higher doses (100, 200 micrograms/min) was not affected by L-NMMA. These results suggest that endothelial-derived nitric oxide may partially contribute to amrinone-induced vasodilation in humans. Thus, the vasodilatory effect of amrinone might be impaired in patients with endothelial dysfunction.

Primary leiomyoma of the ovary: a case report

The imaging features of primary ovarian leiomyoma have seldom been described because of the very low prevalence of the tumor. Herein we present a case report on its magnetic resonance imaging features. Both T1- and T2-weighted images revealed a low-signal-intensity mass, which was well circumscribed and sharply demarcated from the uterus. Magnetic resonance imaging was useful in distinguishing it from a malignant ovarian tumor and uterine leiomyoma.

[A case of Sjögren's syndrome associated with inflammatory pseudotumor of the liver]

A 71-year-old man had noticed a dry sensation in the mouth with swelling of bilateral parotid glands in 1988. He was given a diagnosis of Sjögren's syndrome (SS) on the basis of characteristic findings of sialography and a minor salivary gland biopsy. He was admitted to our department in Febuary 1995 because of general fatigue of 2 month's duration. Laboratory data showed both positive anti-SSA and anti-SSB antibodies, liver dysfunction, hypoalbuminemia, and thrombocytopenia. Abdominal CT and MRI demonstrated a 2-cm intrahepatic mass (S 6) with enhanced areas at the periphery. The liver biopsy yielded fragments from the intrahepatic mass and hepatic parenchyma. The former was composed of plasma cells, lymphocytes, and histiocytes, compatible with the diagnosis of inflammatory pseudotumor of the liver. The pathological diagnosis of the latter specimen was primary biliary cirrhosis, although antimitochondrial antibody was negative. The intrahepatic mass gradually decreased in size without treatment. Inflammatory pseudotumor is considered to be a benign inflammatory condition simulating a neoplasma and the possibility of an autoimmune reaction is suggested on the basis of etiology. This is the first report of an inflammatory pseudotumor associated with Sjögren's syndrome developing in the liver. The inflammatory pseudotumor should be considered as a possible diagnosis in cases where the tumor is embedded in the liver.

[A case of dermatomyositis associated with asymptomatic pneumomediastinum]

A 20-year-old woman initially presented with edematous erythema in the upper eyelids in December 1995. She was admitted to our department in January 1996 because of fever and multiple arthralgia. She was given a diagnosis of dermatomyositis (DM) on the basis of characteristic eruption, elevated serum level of creatine kinase, and increased inflammatory reaction. Chest computed tomography (CT) revealed faint interstitial changes in the left lower lung. The administration of corticosteroid caused improvement in the patient's condition and the interstitial lesion in the lung. Although she was asymptomatic, chest CT showed pneumomediastinum in the pretracheal space and concomitant pneumothorax around left bronchus. Those changes spontaneously disappeared 4 weeks later without treatment. The occurrence of pneumomediastinum in patients with DM has been well documented as an indicator of poor prognosis in the literature. It seems that a severe pulmonary disorder could secondary cause pneumomediastinum. In our case, however, the pneumomediastinum developed in spite of the low grade severity of the pulmonary lesion. This finding suggested that the pneumomediastinum may be associated with the development of DM itself.

Venous drainage through bone marrow after replantation: an experimental study

Venous drainage is vital for successful replantation, but it is not always possible to reconstruct because of missing or damaged veins. We devised an experimental model to study venous drainage through bone marrow while the new subcutaneous venous system regenerated. Adult male Wistar rats were placed into three groups. Group A rats had their hindlimbs amputated at the lower leg, but the tibia and sural and saphenous artery connections were preserved. Group B rats were prepared the same as Group A, except that a step-cut osteotomy was performed in the tibia. The bone ends were then realigned and kept in place with stainless steel wire. Group C rats were prepared the same as Group B, except that the ends of the bone were not aligned. All unoperated limbs served as controls for evaluations of blood flow. Experimental limbs were evaluated for skin colour and viability, blood flow and dye injection. Skin colour was investigated daily. Blood flow was measured postoperatively during three phases: immediate (up to 1 h), early (from 1 h to 24 h), and late (from 1 day to 7 days after operation). Survival of limbs varied in Groups A and B, while all limbs in Group C necrosed by day 7. Blood flow was returning to near control (normal) levels by day 7 in Group A and B limbs. India ink was observed in the medullary cavity at day 7. After replantation, bone marrow plays a critical role in venous drainage until the subcutaneous venous drainage system regenerates.

[A case of protein-losing gastroenteropathy in association with mixed connective tissue disease which was successfully treated with cyclophosphamide pulse therapy]

A 47-year-old man had been given a diagnosis of mixed connective tissue disease (MCTD) on 1987 when he had presented with Raynaud's phenomenon, polyarthralgia, sclerodactyly, and a high titre of anti-RNP antibody. Once his symptoms had improved following the administration of prednisolone orally and the treatment was discontinued since 1995. He noticed dyspnea and chest pain in February 1997. The bilateral pleural effusion was pointed out in the local hospital and he was admitted to our hospital in March 1997 for further examination. In addition to pleural effusion and ascites, laboratory studies revealed hypoalbuminemia and low serum levels of complements. Renal and liver function tests were normal and the urine gave a trace test for protein. The presence of protein loss in the gut was confirmed by an elevated alpha 1-antitrypsin clearance and 99mTc-albumin scintigraphy showing abnormal radioactivity in the gastrointestinal tract. Although endoscopic examination showed no abnormal findings macroscopically and gastrointestinal biopsies revealed nonspecific inflammation only, immunofluorescent studies demonstrated deposits of C 3, C 4 and IgG in the stomach, colon, and pleura. These findings supported the pathogenesis that immune deposits in tissues caused protein-losing gastroenteropathy (PLGE) in MCTD. Intravenous administration of cyclophosphamide started since July 1997, while the high-dose corticosteroid therapy including methylprednisolone pulse therapy were not effective. Hypoalbuminemia and low serum levels of complements improved remarkably and the pleural effusion and ascites disappeared after cyclophosphamide pulse therapy four times monthly. Cyclophosphamide pulse therapy should be considered as a possibly effective treatment for PLGE in association with collagen disease resistant to corticosteroid therapy.

Transcardiac 5-hydroxytryptamine release and impaired coronary endothelial function in patients with vasospastic angina

1. The present study was designed to test the hypotheses whether platelet degranulation across the coronary bed is detectable during non-ischaemic periods in patients with vasospastic angina (VSA) and whether the exogenous nitric oxide (NO) donor nitroglycerin (GTN) is able to modify platelet degranulation, reflecting an impaired endothelial production of NO. 2. We studied 13 patients with VSA and 10 controls. The time course of coronary sinus (CS) plasma 5-hydroxytryptamine (5-HT) levels was evaluated every 4 h before and after intravenous infusion of GTN over a period of 40 h. Coronary sinus plasma 5-HT levels were significantly higher at any measured time point in patients with VSA compared with control and were significantly decreased in patients with VSA following treatment with GTN, but not in controls. Femoral artery plasma 5-HT levels remained almost constant throughout the study. The ratio of CS:aorta 6-keto-prostaglandin F1 alpha was significantly and inversely correlated with the transcardiac plasma 5-HT difference only in patients with VSA (r = -0.68; P < 0.02; n = 13). 3. The time course of CS 5-HT levels confirmed significant platelet degranulation across the coronary bed supplied by the spasming artery in patients with VSA and this was modified by GTN. The present data suggest that platelet degranulation occurs during non-ischaemic periods in patients with VSA and that prostacyclin biosynthesis may be a compensatory response to an impaired endothelial release of NO, limiting the degree of the effects of platelet degranulation.

Enhanced secretion of insulin plays a role in the development of atherosclerosis and restenosis of coronary arteries: elective percutaneous transluminal coronary angioplasty in patients with effort angina

OBJECTIVES

We investigated the relation between insulin and coronary atherosclerosis and restenosis of the coronary arteries, by performing elective percutaneous transluminal coronary angioplasty (PTCA).

BACKGROUND

Insulin is known to promote atherosclerosis of the arteries and has been implicated in the development of restenosis after PTCA.

METHODS

Of 210 angina patients who underwent PTCA, newly detected lesions in 35 consecutive nondiabetic subjects without previous intervention on the same main coronary arteries were analyzed after a 75-g oral glucose tolerance test (OGTT) and follow-up coronary angiography. Atherosclerotic lesions were evaluated by pattern, severity and extent. Restenosis was defined as loss of gain, the percentage of loss of the initial gain in the coronary diameter achieved by PTCA > or = 50%.

RESULTS

Patients with restenosis had a significantly higher extent index (a marker of atherosclerosis), insulin area, ratio of insulin area to glucose area, insulinogenic index and minimal lumen diameter after PTCA than those without restenosis (p=0.001, 0.011, 0.002, 0.016 and 0.041, respectively). Simple regression analysis revealed that only the ratio of insulin area to glucose area (a relative marker of enhanced insulin secretion) significantly correlated with the extent index (p=0.035). Extent index, insulin area, the ratio of insulin area to glucose area and insulinogenic index significantly correlated with loss of gain (p=0.001, 0.010, 0.002 and 0.032, respectively). Stepwise multiple regression analyses revealed that extent index and the ratio of insulin area to glucose area significantly correlated with loss of gain.

CONCLUSIONS

Enhanced secretion of insulin during the OGTT might be useful as a predictor of coronary atherosclerosis and of restenosis after elective PTCA in nondiabetic patients with effort angina.

Optimal image resolution for digital storage of radiotherapy-planning images

PURPOSE

To evaluate the quality of digitized radiation-planning images at different resolution and to determine the optimal resolution for digital storage.

METHODS AND MATERIALS

Twenty-five planning films were scanned and digitized using a film scanner at a resolution of 72 dots per inch (dpi) with 8-bit depth. The resolution of scanned images was reduced to 48, 36, 24, and 18 dpi using computer software. Image qualities of these five images (72, 48, 36, 24, and 18 dpi) were evaluated and given scores (4 = excellent; 3 = good; 2 = fair; and 1 = poor) by three radiation oncologists. An image data compression algorithm by the Joint Photographic Experts Group (JPEG) (not reversible and some information will be lost) was also evaluated.

RESULTS

The scores of digitized images with 72, 48, 36, 24, and 17 dpi resolution were 3.8 +/- 0.3, 3.5 +/- 0.3, 3.3 +/- 0.5, 2.7 +/- 0.5, and 1.6 +/- 0.3, respectively. The quality of 36-dpi images were definitely worse compared to 72-dpi images, but were good enough as planning films. Digitized planning images with 72- and 36-dpi resolution requires about 800 and 200 KBytes, respectively. The JPEG compression algorithm produces little degradation in 36-dpi images at compression ratios of 5:1.

CONCLUSION

The quality of digitized images with 36-dpi resolution was good enough as radiation-planning images and required 200 KBytes/image.

Effect of iodixanol on renal function immediately after abdominal angiography. Clinical comparison with iomeprol and ioxaglate

PURPOSE

To investigate the acute renal effects of three contrast media in a double-blind randomized parallel-group study. The contrast media investigated were: the nonionic dimeric iso-osmolality medium iodixanol; the nonionic monomeric medium iomeprol; and the ionic dimeric medium ioxaglate.

MATERIAL AND METHODS

A total of 30 patients were given the following doses of contrast medium: 10 patients received iodixanol 320 mg I/ml; 10 received iomeprol 300 mg I/ml; and 10 received ioxaglate 320 mg I/ml. The doses were given intra-arterially at routine abdominal angiography and the renal effects of these three contrast media were studied for up to 120 min after injection.

RESULTS

The urinary minute volume increased immediately after angiography but tended to return to baseline values after 120 min; these changes were more pronounced with iomeprol and ioxaglate than with iodixanol. Creatinine clearance was not reduced by any of the contrast media. Fraction excretion of sodium increased immediately and lasted for 30 min after angiography; these changes were more pronounced with ioxaglate than with iomeprol and iodixanol. Urinary gamma-glutamyl transferase increased for 120 min after angiography with iodixanol and iomeprol; these changes were more pronounced with iomeprol than with iodixanol. On the other hand, urinary nu-acetyl-beta-glucosaminidase increased for 120 min after angiography with iomeprol, but was unchanged with iodixanol.

CONCLUSION

The use of contrast media induces osmotic diuresis and its acute effects on the proximal tubular function. However, the iso-osmolality medium iodixanol induces fewer changes than the other two media.

ACE gene polymorphism in childhood IgA nephropathy: association with clinicopathologic findings

A deletion polymorphism in the angiotensin-converting enzyme (ACE) gene has been reported to be a risk factor for progression to chronic renal failure in immunoglobulin A nephropathy (IgAN). In this study, we investigated the association between ACE gene polymorphism and clinical findings, early biopsy findings such as the extent of mesangial proliferation, focal lesions (capsular adhesions, glomerulosclerosis, and crescents), and the glomerular area in childhood IgAN. Genomic DNA was obtained from 97 patients and control subjects. Gene polymorphisms, consisting of an insertion (I) or deletion (D) of the 287-base pair Alu sequence, were detected using the polymerase chain reaction. The extent of capsular adhesions and glomerulosclerosis was significantly higher in patients with the ID/DD genotypes than in those with the II genotype (ID/DD v II: 8.0%+/-1.4% v 2.5%+/-0.8% [P = 0.017] and 5.1%+/-1.3% v 1.4%+/-0.6% [P = 0.028], respectively). Whereas there was no difference in the extent of mesangial proliferation and crescents between the ID/DD genotypes and the II genotype. Urinary protein excretion at the time of biopsy was significantly greater in patients with the ID/DD genotypes than in those with the II genotype (1.02+/-0.15 g/d/m2 body surface area v 0.56+/-0.13 g/d/m2 body surface area; P = 0.012). These results indicate that ACE gene polymorphism may not influence the extent of mesangial proliferation and crescents that are acute lesions. However, the ID/DD genotypes are associated with chronic lesions, such as capsular adhesions or glomerulosclerosis and urinary protein excretion in childhood IgAN.

MR sialography using half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences

We describe our preliminary experience with the half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences for MR imaging of the salivary gland ducts. In the majority of patients, the main parotid and/or submandibular gland ducts and large branches within the glands were detectable on MR images obtained in 2 seconds per section and within 3 minutes for the entire examination. MR sialography using HASTE sequences can be combined with conventional MR studies for the salivary glands.

Mesenteric schwannoma

Schwannoma is a benign neurogenic tumor arising from the sheath of peripheral nerves. It occurs very rarely in the mesentery, where it is difficult to diagnose. Herein we describe a case in which contrast-enhanced CT and gadolinium-DTPA-enhanced MR showed a locally enhanced well-defined tumor with a cystic component just anterior to the duodenum. These findings corresponded well to the resected specimen.

Acute traumatic injury of the distal descending aorta associated with thoracic spine injury

A rare case of traumatic injury of the distal descending aorta associated with thoracic spine injury is reported. A 21-year-old man was admitted after a traffic accident. Thoracic CT and angiography demonstrated a false aneurysm of the distal descending aorta and a compression fracture of the eleventh thoracic vertebra. At emergency surgery, a transverse linear tear at the level of the aortic hiatus was confirmed and repaired.

MR of denervated tongue: temporal changes after radical neck dissection

PURPOSE

The purpose of this study was to evaluate the temporal changes of MR imaging in the denervated tongue after a radical neck dissection.

METHODS

One hundred seventy-four consecutive MR studies in 116 patients with radical neck dissections for malignant tumors of the head and neck were evaluated retrospectively. Patients with tumors involving the tongue or hypoglossal nerve were not included in this study.

RESULTS

Abnormal signal intensity and/or hemiatrophy on the side of the tongue operated on was seen in 22 patients who had hypoglossal paralysis after radical neck dissection. The denervated side of the tongue appeared hypointense to hyperintense relative to the normal side on T1-weighted images and hyperintense on T2-weighted images. Signal intensity ratios of the abnormal to normal muscles were 0.9-1.6 on T1-weighted images and 1.3-2.8 on T2-weighted images. High signal intensity on T1-weighted images appeared 5 months or more after the dissection, whereas on T2-weighted images, the most prominent increases in signal intensity appeared in the first several months after denervation. Hemiatrophy of the tongue was observed on MR images obtained more than 6 months after surgery.

CONCLUSION

MR findings in the denervated tongue are compatible with histologic changes and are characterized by an enlarged extracellular fluid space or fatty infiltration. The pattern of signal intensity and the degree of hemiatrophy suggest the duration of denervation.

Use of fluid-attenuated inversion recovery (FLAIR) pulse sequences in perinatal hypoxic-ischaemic encephalopathy

The purpose of this study was to evaluate the usefulness of fluid-attenuated inversion recovery (FLAIR) techniques in patients with perinatal hypoxic-ischaemic encephalopathy. 13 patients with a history of perinatal hypoxic-ischaemic encephalopathy (age range 1 month to 3.6 years) underwent T1 and T2 weighted spin echo and FLAIR imaging with a 1.5 T superconducting unit. FLAIR images were qualitatively evaluated in comparison with T1 and T2 weighted images by three experienced radiologists. Quantitative analysis (contrast and contrast-to-noise ratio) was also performed. FLAIR images were preferred to T1 and T2 weighted images in the demonstration of periventricular leukomalacia (PVL), cystic PVL and subcortical lesions near the brain surface. On T1 and T2 weighted images, almost all lesions were demonstrated as hypointense or hyperintense areas, respectively. However, FLAIR images could differentiate cystic lesions by their signal intensities. FLAIR images were not diagnostic in two cases with PVL. In conclusion FLAIR sequences provide useful information in patients with perinatal hypoxic-ischaemic encephalopathy.

Totally occluded iliac arteries: long-term results of percutaneous transluminal angioplasty

PURPOSE

To evaluate the initial and long-term results of percutaneous transluminal angioplasty (PTA) for totally occluded iliac arteries.

METHODS

Fifty-four occluded iliac arteries in 54 patients were treated by PTA. The mean length of the occlusions was 8.0 cm (range 0.5-24.0 cm). Patients were followed for a maximum of 124 months (mean, 56 months).

RESULTS

The initial success rate was 57% (31 of 54). On follow-up study, two arteries were reoccluded, and six showed evidence of restenosis. These recurrences were observed within 20 months after PTA. The long-term results obtained by Kaplan-Meier life-table analysis revealed a 71% primary patency rate and 93% secondary patency rate for 124 months. Thirteen arteries were treated by surgical intervention, while the other arteries with unsuccessful PTA were followed conservatively because of a high risk for surgery or patients' refusal to have surgery. Major complications were recorded in 7% (4 of 54) of cases: thrombosis requiring emergent bypass surgery in one artery, and distal embolization requiring thromboembolectomy in three.

CONCLUSION

Although the procedure is difficult, the long-term results suggest that PTA is an effective method and a treatment of choice for totally occluded iliac arteries.

Free groin flap for reconstruction of the tongue and oral floor

The authors report the use of free groin flaps to close intraoral defects in 24 patients following ablative tongue cancer surgery. The lateral thin portion of the flap was used for tongue reconstruction, and the deepithelialized medial thick portion for filling the mandibular defect and for covering the important vessels in the neck. In lean patients, if the medial deepithelialized portion was too thin for adequate coverage, the proximal sartorius muscle was included to prevent postoperative orocervical fistula. The advantages of the groin flap in reconstructing the tongue and oral floor after hemiglossectomy include the following: (1) a suitable amount of tissue is available for both the tongue and oral floor; (2) the important vessels in the neck may be protected with the flap; (3) the proximal sartorius muscle can be included with the flap, if necessary; (4) donor-site morbidity is less than with other flaps; and (5) flap elevation can be done concurrently with the hemiglossectomy and radical neck dissection.

The effect of starvation on brain carnitine concentration in neonatal rats

BACKGROUND

We examined carnitine concentrations in fasted neonatal rat brain to evaluate the effect of starvation on fatty acid metabolism.

METHODS

The free- and acylcarnitine concentrations in neonatal rat brain and heart were determined after a 72-hour starvation period from the 3rd to 6th postnatal day. They were also determined in rats at 3 and 6 days of age fed normally by the mother rats as controls.

RESULTS

In the brain, the mean free carnitine concentration in the fasted group showed an increase similar to that in normal rats and there was no difference between the fasted and 6-day-old control rats. However, the mean acylcarnitine concentration was significantly higher in the fasted group than in the control group at both 3 and 6 days of age. Almost all of the increased acylcarnitine in the fasted group was short-chain acylcarnitine. In the heart, there was no difference in the mean free carnitine concentration between the fasted group and control group at 6 days of age. The 6-day-old rats in both the fasted and control groups showed higher levels compared to 3-day-old rats in the control group. The mean acylcarnitine concentration in the fasted group was not different from that in control group at 6 days of age, while the amount of short-chain acylcarnitine was less than that in the control group at 6 days of age.

CONCLUSIONS

These findings suggest that in the brain, carnitine is accumulated as a result of redistribution during starvation, and is utilized for energy supply by fatty acid oxidation.

Ethanol sclerosis: one of the best treatments for thymic cyst in very elderly patients?

An 83-year-old female patient with a giant thymic cyst that was successfully treated by percutaneous aspiration and ethanol injection. The patient had complained of coughing and chest discomfort for several years. A chest X-ray film revealed the shadow of a large abnormal mass in the anterior mediastinum. We diagnosed it as a thymic cyst. The patient refused surgery because of her age. We chose a less invasive therapy, namely, ethanol sclerosis of the cyst. The cyst was successfully treated without any complications, and no recurrence was found at the one-year follow-up. This therapy may be one of the best treatments for thymic cysts, especially in very elderly patients.

MR evaluation of radiation otomastoiditis

PURPOSE

The purpose of this study was to evaluate the incidence of radiation otomastoiditis, on using T2-weighted magnetic resonance (MR) imaging, in relation to radiation fields, doses, intervals, and clinical symptoms after radiotherapy that included the temporal bone in the fields.

METHODS AND MATERIALS

We performed follow-up MR examinations at various intervals after radiotherapy including the temporal bones for 270 ears of 114 patients with various diseases of the head and neck and intracranial regions. The middle ear and mastoid air cells on T2-weighted images were scored as follows; showing no high signal intensity, a local high signal intensity area, or a high signal intensity area occupying the entire middle ear and all mastoid air cells. The radiation fields as depicted on the lateral simulator films classed as anterior to the clival line, posterior to the clival line, or both.

RESULTS

The incidence of radiation otomastoiditis depicted on T2-weighted MR images increased in the patients who had received irradiation doses of 50 Gy or more. In the patients with doses of less than 50 Gy, the incidence was 18% within 6 months following radiotherapy, 13% at between 6 and 12 months, and 8% after 12 months, whereas it was more than 50% at any period after radiotherapy in the patients with 50 Gy or more. The incidence of radiation otomastoiditis was quite high in the patients whose radiation fields included region both anterior and posterior to the clival line.

CONCLUSION

The incidence of radiation otomastoiditis as demonstrated on T2-weighted MR images is increased at irradiation doses of 50 Gy or more. To reduce the incidence of severe radiation otomastoiditis, the irradiation fields of the temporal bone when the dose is 50 Gy or more should be limited to as small as possible. The clival line is considered to be a good landmark in reducing the irradiation field when doses of 60-70 Gy are delivered in curative radiotherapy.

Relationship between progressive microvascular damage and intramyocardial hemorrhage in patients with reperfused anterior myocardial infarction: myocardial contrast echocardiographic study

BACKGROUND

Recent studies indicated that ischemic microvascular damage may be reversible or progressive after coronary reflow. Intramyocardial hemorrhage is a phenomenon that reflects severe microvascular injury. We examined the relationship between temporal changes in microvascular perfusion patterns detected by myocardial contrast echocardiography (MCE) and intramyocardial hemorrhage detected by magnetic resonance imaging (MRI) in patients with acute myocardial infarction (AMI).

METHODS AND RESULTS

The study population consisted of 24 patients with anterior AMI. All patients underwent MCE shortly after reflow and in the chronic stage (a mean of 31 days after reflow). Wall motion score (WMS) was determined as the sum of 16 segmental scores (dyskinetic/akinetic=3 to normal=0) at days 1 and 31. Gradient-echo acquisition and gadolinium-DTPA-enhanced spin-echo MRI were performed within 10 days after reflow. In MCE shortly after reflow, 16 patients (67%) showed contrast enhancement and the other 8 patients (33%) showed a sizable contrast defect. In the chronic stage, a persistent contrast defect was observed in 7 of 8 patients with a contrast defect shortly after reflow. Consistent contrast enhancement was observed in 12 of 16 patients (75%) with contrast enhancement shortly after reflow, indicating that a contrast defect newly appeared in 4 patients (25%). Intramyocardial hemorrhage was detected in 9 patients (38%): 5 of 7 patients with a persistent contrast defect and in all 4 patients with a new appearance of a contrast defect during the chronic stage. The patients without hemorrhage showed a significant improvement in WMS compared with patients with hemorrhage at day 31 (5+/-5 versus 19+/-6, P<.0005).

CONCLUSIONS

These results suggest that irreversible microvascular damage to the ischemic myocardium may cause intramyocardial hemorrhage after reflow, associated with impaired recovery of left ventricular function. Contrast enhancement within the risk area shortly after reflow does not necessarily indicate long-term microvascular salvage.

Myeloperoxidase-specific anti-neutrophil cytoplasmic autoantibodies -- related scleroderma renal crisis treated with double-filtration plasmapheresis

A 46-year-old female patient who was diagnosed with systemic sclerosis (SSc) developed rapidly progressive renal failure without elevation of blood pressure or plasma renin concentration. Renal biopsy revealed necrotizing crescentic glomerulonephritis (pauci-immune type) and the myeloperoxidase-specific anti-neutrophil cytoplasmic autoantibodies (MPO-ANCA) titer was found to be elevated to 669 EU/ml. Methylprednisolone (MP) pulse therapy followed by prednisolone (PSL) and mizoribine (MZR) did not suppress the progression of renal failure. Therefore, we started double-filtration plasmapheresis (DFPP) which effectively removed MPO-ANCA and prevented renal failure despite the relatively low dose of immunosuppressive agents.

Percutaneous microwave coagulation therapy: an experimental study

PURPOSE

Microwave coagulation therapy (MCT) is a surgical alternative for inoperable hepatocellular carcinomas (HCCs). We have recently developed a percutaneous method for using MCT under ultrasound guidance. The purpose of this study was to investigate the feasibility of percutaneous MCT (PMCT) in an animal model and correlate the ultrasound findings with histological results.

MATERIALS AND METHODS

Microwaves were administered for 30, 45, 60 and 90 seconds to 12 cadaveric porcine livers in vivo one hour after sacrificing them, to determine the most suitable coagulation time for the percutaneous method. The cadaveric livers were then subjected to histologic evaluation. The temperature around the electrode was measured in both cadaveric and living livers during PMCT. Ultrasound-guided MCT was also performed in nine rabbits. The histological findings after PMCT were evaluated in the cadaveric and living livers, and the areas of coagulation necrosis were correlated with the ultrasound findings.

RESULTS

After microwave emission, coagulation necrosis of a spindle shape occurred primarily from the base of the electrode. The maximum area of coagulation was obtained at 60 seconds. The maximum temperature of cadaveric liver under PMCT was 95 degrees at 3 mm from the electrode; that of living liver was 85.1 degrees at 5 mm. Ultrasound revealed hyperechoic areas after PMCT in both cadaveric and living livers. On microscopy, parenchymal necrosis of the liver was observed only in living livers one month after MCT. Hyperechoic areas measured with ultrasound were significantly larger than the actual necrotic areas (p < 0.01), probably due to air bubbles which developed within the tissue.

CONCLUSIONS

PMCT completely coagulated the liver tissue around the electrode. These preliminary results indicate that PMCT should be an effective treatment for hepatic neoplasms. In terms of clinical application, the hyperechoic areas observed during PMCT appear to be considerably larger than the areas actually treated.

Percutaneous microwave coagulation therapy in liver tumors. A 3-year experience

PURPOSE

Percutaneous microwave coagulation therapy (PMCT) is an interventional alternative for inoperable malignant liver tumors. In this paper, we report the results of our 3-year experience of PMCT in order to establish suitable indications for this treatment.

MATERIAL AND METHODS

We studied a total of 27 inoperable liver tumors in 24 patients. Histology of the tumors showed 20 hepatocellular carcinomas (HCCs) (13 well differentiated, 4 moderately differentiated, and 3 poorly differentiated) and 7 metastases. These tumors were treated by PMCT and were followed for 4-40 months (average 18 months). Under US guidance, the tumors were coagulated by microwaves emitted from an electrode. The changes of tumor size after PMCT were evaluated by CT. When the tumors disappeared or were reduced in size after treatment, PMCT was regarded as effective. Complications from PMCT were also evaluated. The patient survival rate was obtained by means of the Kaplan-Meier method.

RESULTS

In tumors of 30 mm or less, treatment response was obtained in 70% of cases, while 55% of tumors larger than 30 mm responded. The tumor became smaller or disappeared in 85% of the well differentiated HCCs, and in 25% of the moderately differentiated HCCs, but none of the poorly differentiated HCCs responded. In metastatic tumors, PMCT was effective in 57% of cases. Slight pain (24%), fever (20%) and subcutaneous hematoma (8%) were experienced immediately after PMCT. In 2 poorly differentiated HCCs, needle tract seeding was observed. No case of liver dysfunction was seen after PMCT. The overall survival rate was 83.1% at 1 year and 68.7% at 2 years.

CONCLUSION

Good therapeutic results were achieved with PMCT in lesions of 30 mm or less, and in well differentiated HCCs.

Percutaneous transluminal angioplasty for carotid artery stenosis in Takayasu arteritis: persistent benefit over 10 years

A 66-year-old man was admitted to our hospital with right hemiplegia due to a cerebral infarction associated with Takayasu arteries. We successfully performed percutaneous transluminal angioplasty for stenoses of the innominate and right common carotid arteries. Improvement of the stenotic lesions persisted over 10 years.

CT and MR findings of denervated tongue after radical neck dissection

PURPOSE

To describe the CT and MR findings in the denervated tongue after a radical neck dissection.

METHODS

We retrospectively evaluated the radiologic findings in seven patients who had hypoglossal paralysis following radical neck dissection. None of the patients had clinical or radiologic evidence of tumor recurrence.

RESULTS

The side of the tongue operated on showed low density on CT scans. At MR imaging, denervated tongues were clearly seen as hyperintense relative to muscle on T2-weighted images; on T1-weighted images, the signal was hypointense to hyperintense, representing increased extracellular water or fatty degeneration.

CONCLUSION

In patients who have undergone a neck dissection for a malignant process, abnormal imaging findings in the tongue not only might indicate a recurrence of tumor involving the hypoglossal nerve but also suggest the possibility of postoperative change. Our findings emphasize the importance of the denervated tongue in differentiating inflammatory from neoplastic diseases of the the tongue.

The effect of azelastine on acute radiation dermatitis in mice models

PURPOSE

In our previous report we described the clinical value of azelastine, an oral antiallergic agent, as an inhibitor of radiation dermatitis. Here we studied the effect of azelastine on normal skin and tumor size after irradiation in a mouse model.

METHODS AND MATERIALS

The modifying effects of azelastine on both the degree of radiation dermatitis and antitumoral effect of radiation therapy were investigated in the normal skin as well as in SCC VII tumors of C3H/He mice. The right hind legs, with or without tumors, were irradiated with 20-60 Gy at 0.62 Gy/min. Azelastine was administered via the mouse chow, and acute skin reactions and tumor growth curves were compared between the azelastine and control groups.

RESULTS

The acute skin reactions of the azelastine group were significantly less prominent than those of the control group (p < 0.01). At a dose of 40 Gy the dose modification factors were 1.19-1.25. The tumor growth curves of the azelastine and control groups were almost identical, indicating that the treatment response of irradiation was not affected by administration of azelastine.

CONCLUSIONS

Application of azelastine reduces the degree of acute radiation dermatitis without affecting the antitumoral effect of radiation therapy.

Role of dynamic MRI in the evaluation of head and neck cancers treated with radiation therapy

PURPOSE

To study the usefulness of dynamic magnetic resonance imaging in the evaluation of head and neck cancers treated with radiation therapy.

METHODS AND MATERIALS

Seventy-six patients (58 males and 18 females; ages 20-82) with head and neck cancers (10 nasopharyngeal carcinomas, 22 mesopharyngeal carcinomas, 10 hypopharyngeal carcinomas, 16 oral cavity carcinomas, 11 lingual carcinomas, and 7 laryngeal carcinomas) were treated by radiation therapy combined with concomitant low-dose cisplatinum. Magnetic resonance imaging (MRI) was performed before and 2 weeks after the irradiation in all cases. After bolus administration of gadopentetate dimeglumine (Gd-DTPA) (0.1 mmol kg), images were obtained every 30 s (repetition time 200 ms, echo time 16 ms) using a 1.5 or 0.5-T superconductive unit. Biopsy or surgery was performed after radiation therapy and the histologic findings were correlated with the MRI findings (T1, T2, dynamic, and enhanced T1).

RESULTS

Complete remission, partial response, and no response were obtained in 18, 36, and 7 cases, respectively. Dynamic MRI correctly diagnosed 17 of the 18 complete remission cases, 33 of the 36 partial response cases, and all of the 7 no-response cases. The accuracy of dynamic MRI, T1-weighted image, T2-weighted image, and Gd-enhanced T1-weighted image was 94.4%, 68%, 82%, and 86%, respectively.

CONCLUSION

Dynamic MRI proved to be useful in the evaluation of the radiation therapy of head and neck cancers.

[Diagnostic imaging of "body packers"]

Drug smuggling by intra-abdominal concealment, so called "body packing," has recently increased, even in Japan. Because of fatal drug intoxication and other adverse side effects, it is important to make a radiological diagnosis of body packers as soon as possible. A retrospective analysis of the images of plain abdominal radiography, computed tomography (CT) and ultrasound (US) was performed in twenty-three body packers to evaluate the imaging characteristics of three drugs (cannabis, cocaine and heroin). Cannabis (16 patients) and cocaine (5 patients) packages were demonstrated as well-demarcated rectangular-shaped high-density shadows surrounded by gas halo ("double condom sign") in abdominal plain radiographs and CT. Heroin packages (2 patients) were demonstrated as obscure shadows and were difficult to identify on plain radiographs, because they resembled stool masses. US was performed in one cannabis patient because of the refusal of radiological examination, and packages were demonstrated as round echogenic structures with dorsal echo extinctions. In conclusion, abdominal plain radiography, CT and US represent valuable diagnostic modalities in the assessment of body packers.

Short communication: the value of embolization therapy in painful osseous metastases from hepatocellular carcinomas; comparative study with radiation therapy

We evaluated the therapeutic effect of transcatheter arterial embolization therapy (TAE) for painful osseous metastases from hepatocellular carcinoma (HCC) in comparison with radiation therapy (RT). TAE using gelatin sponge particles was performed for seven lesions in seven patients. Selective catheterization and embolization were successfully performed in all lesions. Within 10 days after TAE, complete pain relief (CR), partial relief (PR) and no relief (NR) were attained in 57%, 29% and 14%, respectively. RT was used to treat 34 lesions in 22 patients. The dose fractionation schedules were in the range 28.0-50.4 Gy, with 1.8-4.0 Gy per fraction. CR, PR and NR were attained in 47%, 47% and 6%, respectively. There were no serious complications related to these treatments. Both TAE and RT are effective and the treatment of choice should be selected on an individual basis.

Effect of iomeprol on renal function immediately after abdominal angiography

PURPOSE

To investigate the acute renal effects of 2 osmolality levels of iomeprol in a double-blind, randomized, parallel-group study.

MATERIAL AND METHODS

Ten patients received iomeprol 300 mg I/ml, and a further 10 received iomeprol 400 mg I/ml intraarterially at routine abdominal angiography. The mean volume of contrast medium administered was 227.3+/-59.3 ml in the iomeprol 300 group and 221.5+/-30.9 ml in the iomeprol 400 group.

RESULTS

The urinary minute volume increased immediately after angiography, but tended to return to baseline 120 min after the examination. No significant decrease in creatinine clearance occurred; however, the fraction excretion of sodium increased immediately after angiography. The lysosomal enzyme N-acetyl-beta-glucosaminidase and the proximal tubular brush border enzyme gamma-glutamyl transferase increased up to 120 min after the procedure. Free water clearance was negative during each study period. No statistical differences in any parameter were evident between these 2 groups.

CONCLUSION

These results suggest that osmotic diuresis and its acute effect on proximal tubular function are induced by the administration of iomeprol, but that these changes are reversible.

Ethanol sclerosis can be a safe and useful treatment for pericardial cyst

We report the case of a 41-year-old man with a pericardial cyst treated by percutaneous aspiration and ethanol injection. He was referred to our hospital because of electrocardiographic abnormality. On admission, chest x-ray revealed a large pericardial cyst in the right cardiophrenic angle. The cyst was examined by echocardiography, computed tomography, and cytological analysis of aspiration fluid from the cyst. Ethanol sclerosis was applied for treatment of the cyst, which had continued to increase in size. There was no recurrence of the cyst 6 months after the treatment. Percutaneous ethanol sclerosis can be the first choice of treatment for pericardial cyst.

hiiragi, a gene essential for wing development in Drosophila melanogaster, affects the Notch cascade

A recessive mutation, hiiragiP1, on the second chromosome of Drosophila was obtained by P element insertion mutagenesis. Flies homozygous for hiiragiP1 have notched wing margins. Genetic interactions between hiiragi and the genes that encode components of Notch signaling, such as Notch, Hairless, Serrate and deltex, strongly support the involvement of hiiragi in the signal transduction cascade of Notch. It has been reported that Serrate and Delta, other components of Notch signaling, share EGF-like repeats and a second conserved cysteine-rich motif, and that these components interact physically with the same region of Notch. In hiiragiP1; SerrateD/+ double mutants, we observed synergistic enhancement of the notched phenotype of wing margins. In contrast, Delta FX3 had no phenotypic effect on hiiragiP1 in hiiragiP1; Delta FX3/+ double mutants. Taken together, these results indicate that hiiragi is involved in the Notch signaling cascade induced by Serrate rather than by Delta.