Breast cancer in dense breast: detection with contrast-enhanced dynamic MR imaging

The purpose of this study was to identify contrast enhancement patterns of dense breast parenchyma and to investigate the ability of dynamic magnetic resonance imaging (MRI) to detect cancer in the dense breast. Thirty-two patients with breast cancer in dense breast underwent gadolinium-enhanced dynamic MRI. The detectability of cancer by dynamic MRI, mammography, and physical examination was compared. Two parenchymal enhancement patterns could be identified. One was increasingly multiple patchy enhancement found predominantly in the periphery (type A), and the other was faint enhancement without any nodular opacification (type B). Type A was thought to reflect severe proliferative fibrocystic change (PFC). For both patterns, the detection rate of primary cancers by dynamic MRI was found to be superior to that by other modalities. Dynamic MRI also could detect multifocal cancers, which could not be found with other modalities, although the detectability of these small cancers might be reduced in patients with severe PFC.

Risk factors of atherosclerosis and aortic pulse wave velocity

Aortic pulse wave velocity (PWV) is a noninvasive technique that can estimate aortic stiffness or organic change quantitatively. The authors examined the correlation between age and the PWV value in 113 subjects and also examined the relationship between atherosclerotic associated diseases and PWV. A positive correlation was observed between age and the PWV value. No significant difference was found in the PWV value between groups with and without risk factors of atherosclerosis. No significant difference was observed in the PWV value between groups with and without a history of atherosclerotic disease.

Anaerobic oxidation of dissolved hydrogen sulfide in continuous culture of the phototrophic bacterium Prosthecochloris aestuarii

The anaerobic oxidation of dissolved H2S to elemental sulfur was studied at 23 degrees C and pH 6.5+/-0.3 in continuous culture of the phototrophic green sulfur bacterium Prosthecochloris aestuarii. The number of cells formed in the cultures was proportional to the amount of H2S oxidized, and the growth yield was independent of light intensity. The specific growth rate was significantly dependent on the dissolved H2S concentration and light intensity. The kinetic data were analyzed with a rate expression as a function of each rate-limiting factor. Under illumination by white fluorescent lamps, the specific oxidation rate of P. aestuarii reached a maximum of 2.02 x 10(-14) mol-H2S.h(-1).cell(-1) when the dissolved H2S concentration was 2.1 mM at 5000 lx. Simultaneous use of near infrared LED (light-emitting diode) and white fluorescent lamps provided a 35% increase in the maximum specific H2S oxidation rate.

[Recent spread of home parenteral nutrition in Japan--the view of an HPN managing company]

Terumo Corporation has developed a nation wide home healthcare management system "Home-Joint," which helps hospitals to safely discharge patients early. Recently, this system mainly has been adopted with HPN (home parenteral nutrition) patients. This report evaluates 472 HPN patients who underwent the "Home-Joint" program in 1998, and also presents some issues from the standpoint of a HPN managing company. I. Profiles of HPN patients Number: 472 (female 43%, male 57%) Age: 1-104 (47% patients over 70) DIAGNOSIS: cancer 54%, others 25%, unknown 21% Infusion devices: ambulatory pump 85%, stationary pump 15%, gravity none. Therapeutic periods: average 65.6 days (1-437) for 300 patients who completed the program. II. HPN trends from 1997 to 1998 1. Increase in patients directly supported by hospitals. 2. Wider patient variation: increase in patients under 70 years old, in non-cancer patients and in longer periods (longer than 2 months). III. Issues 1. Development of hospital-clinic-pharmacy local relationship. 2. Development of devices for easier infusion control. 3. Evaluation of HPN outcome for patients' QOL and for cost-effectiveness. HPN is becoming a popular home healthcare therapy in Japan, and it requires higher level of performance by medical staff and managing companies.

Right hepatic arterial supply to the posterior aspect of segment IV of the liver: analysis by CT during hepatic arteriography

OBJECTIVE

To examine the frequency of the right hepatic arterial supply to the posterior aspect of segment IV (PASIV) of the liver shown on computed tomography (CT) during hepatic arteriography (CTHA).

MATERIALS AND METHODS

Seventy-four patients who underwent CTHA from the right and/or left hepatic artery were studied. The right arterial supply to the PASIV was determined when the PASIV was stained on CT during right hepatic arteriography without any opacified arteries originating from the right hepatic artery and distributing to segment IV through the left hepatic hilum or when no staining was seen in the PASIV on CT during left hepatic arteriography. The frequency of the right hepatic arterial supply to the PASIV demonstrated on CTHA was analyzed.

RESULTS

In six of 74 patients (8%), the PASIV was supplied from the right hepatic artery.

CONCLUSION

This PASIV was supplied by the right hepatic artery in a significant proportion of cases.

A new translocation, t(2;4;12)(p21;q12;p13), in CD7-positive acute myeloid leukemia: a variant form of t(4;12)

We describe a 41-year-old man with CD7-positive acute myeloid leukemia (AML-M0) with trilineage-myelodysplasia. Chromosome analysis of the bone marrow cells showed 46.XY.t(2;4;12) (p21;q12;p13). Cytological and clinical features of our case were quite similar to those of AML with t(4;12)(q11-12;p13). The karyotypic interpretation was confirmed by fluorescence in situ hybridization (FISH) by using the whole-chromosome painting probes specific for chromosomes 2, 4, and 12. FISH analysis with the use of the YAC 936e2 probe, which covers the TEL gene, did not show the split signal, suggesting that a gene other than TEL was involved in the leukemogenesis of the present case. Our case with AML with t(2;4;12)(p21;q12;p13) appears to be the first case of a variant type of AML with t(4;12) (q11-12;p13).

The GABA(B) receptor antagonist CGP36742 improves learned helplessness in rats

Effects of 3-aminopropyl-n-butyl-phosphinic acid (CGP36742), a GABA(B) receptor antagonist, in the learned helplessness paradigm were examined in rats in comparison with those of imipramine and endo-8-methyl-8-azabicyclo[3,2,1]oct-3-ol indol-3-yl-carboxylate hydrochloride (ICS205-930). Rats were treated with CGP36742, imipramine or ICS205-930 for 14 days. On day 14, the rats were subjected to 90 inescapable shocks. On day 15, the rats received the 40-trial escape test. The inescapable shocks increased escape failures in the escape test. CGP36742, imipramine and ICS205-930 dose-dependently improved the escape failures induced by the inescapable shocks. Baclofen attenuated the escape failures-improving effect of CGP36742, imipramine and ICS205-930. Although the action of imipramine and ICS205-930 was attenuated by 1-(m-chlorophenyl)-biguanide (mCPBG), mCPBG failed to influence the CGP36742 action. Therefore, it is suggested that CGP36742 may have an antidepressant profile and that the mechanisms of CGP36742 in antidepressant action may be different from those of imipramine and ICS205-930.

In vivo anatomical analysis of arterial contact with trigeminal nerve: detection with three-dimensional spoiled grass imaging

The purpose of this study was to review the normal in vivo neurovascular relationship between the trigeminal nerve and surrounding arteries without the use of volunteers. 290 nerves in 145 cases were reviewed during a 1-year period. Axial source images and multiplanar reconstructed (MPR) images were used to determine the neurovascular contact and direction of contact. Multiplanar volume reformation (MPVR) was used to identify the contact vessels and to demonstrate the relationship between the nerve and arteries. Vascular contact was found in 29% of the 290 nerves (83 nerves). The arteries involved were the superior cerebellar artery (SCA) or the anterior inferior cerebellar artery (AICA). Vascular contact with two arteries was found in 3%. Of the 286 asymptomatic nerves, the nerve was located between the two vessels in 3% and compression was seen in 1%. Three points of vascular contact by the two arteries were identified in one asymptomatic nerve. The direction of contact between the SCA and the nerve was superior (38%), superomedial (32%) or medial (15%) in most cases. The direction of contact between the AICA and the nerve was inferior, inferolateral or lateral in all cases. Vascular contact at the root entry zone (REZ) was noted in 90%. Four nerves were affected by trigeminal neuralgia, one of which touched an artery and two were compressed. It was concluded that arterial contact can be assessed without difficulty but evaluation of vascular compression is not easy.

[Role of Candida allergen in atopic dermatitis and efficacy of oral therapy with various antifungal agents]

We studied whether fungal allergens play a role in exacerbating the clinical symptoms of atopic dermatitis (AD). We found that the percentage of the patients who showed CAP-RAST positive (2 < or = score) to Candida albicans (Ca) was significantly higher in the patients with severe symptoms and high serum IgE level than those with mild symptoms and lower IgE. This was also true for the patients with CAP-RAST positive to Pityrosporum ovale (Po). AD patients with their symptoms localized to head and neck showed significantly higher tendency to have positive CAP-RAST (2 < or = score) to Ca and Po when compared to those with their eruption distributing to the extremities. We then evaluated the efficacy of oral therapy with antifungal agents in 140 cases of refractory AD with positive CAP-RAST to Ca. Good or excellent response was obtained in 60% with fluconazole, 35% with itraconazole, 31% with amphotericin B, 28% with nystatin. The present finding that amphotericin B and nystatin, both of which are not absorbed through intestine, were effective for approximately a third of the patients indicates that Ca in the intestine plays an important role in triggering AD symptoms. Fluconazole was more effective than amphotericin B and nystatin, suggesting that fungal colonizing in other parts of the body but the digestive tract also play a role in the exacerbation of AD symptoms.

Effect of stress on atopic dermatitis: investigation in patients after the great hanshin earthquake

BACKGROUND

Although a variety of factors are responsible for atopic dermatitis (AD), very little is known about the effect of stress caused by a natural disaster on AD symptoms.

OBJECTIVE

This study was conducted to assess the effect of stress or trauma on the symptoms of AD.

METHODS

One thousand four hundred fifty-seven patients with AD (745 males and 712 females), diagnosed by using the criteria of the Japanese Dermatology Association, were enrolled in the study. The data were obtained from a self-administered questionnaire given to patients with AD after experiencing the Great Hanshin Earthquake. The data were analyzed by multivariate logistic regression analysis. Patients were divided into 3 groups: area A, severe damage to buildings and houses; area B, mild damage; and control area, no damage.

RESULTS

Exacerbation of skin symptoms was found in 38% and 34% of patients in areas A and B, respectively, whereas similar exacerbation was seen in 7% of control patients. Nine percent and 5% of the patients in areas A and B, respectively, showed improvement in their symptoms compared with 1% in the control group. The earthquake caused stress in 63% and 48% of the patients in areas A and B, respectively, but fewer patients felt stress in undamaged areas (19%). Multiple logistic regression analysis revealed that of the factors examined here, subjective distress is the factor that is most responsible for the exacerbation of skin symptoms (odds ratio, 2.98; 95% confidence interval, 2.25-3.96).

CONCLUSION

The results presented here strongly suggest that stress caused by a natural disaster influences AD symptoms.

New tissue substitutes representing cortical bone and adipose tissue in quantitative radiology

To employ quantitative radiology more accurately, we examined phantom materials for cortical bone and adipose tissue as calibration standards and as experimental phantoms. New tissue substitutes for cortical bone and adipose tissue composed of liquid phantom were verified by computing their attenuation coefficients and observing their chemical properties. We showed that a potassium pyrophosphate (K4P2O7) solution for cortical bone was comparable to a dipotassium hydrogen phosphate (K2HPO4) solution. Also, the use of methyl alcohol for adipose tissue was more suitable than ethyl alcohol as a phantom material because of its physical and chemical properties.

A case of ruptured mesenchymal chondrosarcoma of the pancreas

A 25-year-old woman who underwent surgical removal of a right frontal meningeal mesenchymal chondrosarcoma in 1980 manifested abdominal pain and progressive anemia after a traffic accident in April 1997. CT disclosed a well-enhanced solid mass 2.5 cm in diameter with internal calcific deposits at the tail of the pancreas and a surrounding hematoma of 5.5 cm in diameter. Surgical resection revealed a ruptured metastatic mesenchymal chondrosarcoma of the pancreas.

Interaction between fibronectin and eosinophils in the growth of nasal polyps

OBJECTIVES

The aim of this study was to determine roles of fibronectin and eosinophils in the etiology of nasal polyposis.

STUDY DESIGN

We designed a cohort study of cases with nasal polyposis. Sampled nasal polyps were differentiated by their histopathologic characteristics, and compared by size and computed tomography (CT) stage.

METHODS

The size of nasal polyps was determined on the basis of the endoscopic findings, and the extent of sinusitis was evaluated by CT staging. Nasal polyp samples were taken from 82 patients during ethmoidectomy and differentiated by morphologic characteristics, infiltration cell types, or fibronectin positivity. Then their sizes and CT stages were compared. In addition, correlation among these histological characteristics was analyzed.

RESULTS

Nasal polyps showing edematous morphology, eosinophil infiltration, or fibronectin expression were significantly large in size. Concerning CT stages, only the infiltration cell type showed a significant difference. Significant correlation among edematous morphology, eosinophil infiltration, and fibronectin expression was also recognized.

CONCLUSIONS

These findings suggest that interaction between eosinophils and fibronectin may play a role in edema formation, which contributes to the growth of nasal polyps.

Correlation between the blood supply and grade of malignancy of hepatocellular nodules associated with liver cirrhosis: evaluation by CT during intraarterial injection of contrast medium

OBJECTIVE

The purpose of this study is to evaluate the correlation between the intranodular blood supply revealed by CT during intraarterial injection of contrast medium, mainly using helical CT, and the grade of malignancy of hepatocellular nodules associated with liver cirrhosis as classified by the International Working Party of the World Congress of Gastroenterology.

SUBJECTS AND METHODS

We studied 201 histologically proven nodules (101 resected and 100 biopsied nodules), including 47 low-grade dysplastic nodules (low-DNs), 56 high-grade dysplastic nodules (high-DNs), 24 well-differentiated hepatocellular carcinomas (wd-HCCs), and 74 moderately or poorly differentiated HCCs (mp-HCCs), in 139 cirrhotic patients. Findings on CT during arterial portography (n = 201) and CT during hepatic arteriography (n = 74) were reviewed and compared with the histologic diagnosis.

RESULTS

CT findings were classified into four types relative to the surrounding liver: type A (isodense), type B (slightly hypodense), type C (partially hypodense), and type D (markedly hypodense) on CT during arterial portography and type I (isodense), type II (hypodense), type III (partially hyperdense), and type IV (hyperdense) on CT during hepatic arteriography. On CT during arterial portography, the distributions of each type were low-DN (n = 47 [A, n = 36; B, n = 8; C, n = 3]), high-DN (n = 56 [A, n = 18; B, n = 20; C, n = 10; D, n = 8]), wd-HCC (n = 24; [B, n = 4; C, n = 13; D, n = 7]), and mp-HCC (n = 74 [D, n = 74]). On CT during hepatic arteriography, the distributions were low-DN (n = 26 [I, n = 18; II, n = 7; III, n = 1]), high-DN (n = 19 [I, n = 6; II, n = 7; III, n = 4; IV, n = 2]), wd-HCC (n = 15 [I, n = 1; III, n = 8; IV, n = 6]), and mp-HCC (n = 14 [IV, n = 14]). We found a statistically significant correlation between the four types and the grade of malignancy of these nodules.

CONCLUSION

Findings on CT during arterial portography and CT during hepatic arteriography correlated positively with histologic grading when overlap in appearance between dysplastic nodules and HCCs occurred. The concept revealed in this study can apply to diagnoses made on the basis of Doppler sonography, dynamic CT, and MR imaging.

Giant hyperplasia of the caudate lobe of the cirrhotic liver: correlation with an anomaly of the caudate portal branch

Different imaging appearances of giant hyperplastic change of the caudate lobe of the liver are presented in a patient with liver cirrhosis. The mass like caudate lobe was isoechoic on ultrasound, hypodense on postcontrast computed tomography (CT), hyperintense on T1-weighted magnetic resonance, images and isointense on T2-weighted images. These imaging findings are similar to those of dysplastic nodule in cirrhotic liver. The caudate lobe received normal portal flow on CT during arterial portography, but superior mesenteric arteriography showed precocious or early division of the caudate portal branch. We suspect that caudate hyperplastic change may be correlated to anomalous caudate portal vein branch.

[Causative organisms of acute otitis media and acute sinusitis in children and their susceptibility of oral beta-lactam antibiotics]

The clinical efficacy of cefditoren pivoxil (CDTR-PI) was evaluated for 43 pediatric patients with acute otitis media or acute sinusitis. The causative organisms were identified and their susceptibilities to 6 oral beta-lactam antibiotics were measured; ampicillin (ABPC), cefaclor (CCL), cefdinir (CFDN), cefditoren pivoxil (CDTR-PI), cefteram pivoxil (CFTM-PI) and cefpodoxime proxetil (CPDX-PR). The ages of 43 patients were distributed from 4 months to 10 years and 7 months, and especially children under 4 years accounted for 72% (31 cases). In 22 cases (51%), Haemophilus influenzae or Streptococcus pneumoniae were identified as the pathogens, but in 18 cases, no causative organisms were defined. Treatment by CDTR-PI was successful in 12 cases out of 15 evaluable cases in which H. influenzae or S. pneumoniae were identified as the main causative organisms. From the susceptibility testing of them, some strains of H. influenzae were found to be ABPC-resistant and some strains of S. pneumoniae were benzylpenicillin (PCG)-resistant. To support above clinical evaluation of CDTR-PI, susceptibility testings on clinically isolated H. influenzae (81 strains) and S. pneumoniae (79 strains) were performed using above mentioned 6 oral beta-lactam antibiotics. The MIC80s against H. influenzae were; CDTR-PI 0.06 microgram/ml, CCL 2 micrograms/ml, CPDX-PR 0.125 microgram/ml, CFTM-PI 0.03 microgram/ml, CFDN 1 microgram/ml and ABPC 1 microgram/ml. Those against S. pneumoniae were; CDTR-PI 0.5 microgram/ml, CCL > 4 micrograms/ml, CPDX-PR 2 micrograms/ml, CFTM-PI 1 microgram/ml, CFDN 2 micrograms/ml and ABPC 1 microgram/ml. From those results, it was concluded that CDTR-PI or CFTM-PI may be preferable for the treatment of acute otitis media and acute sinusitis in children.

Biochemical modulation therapy for pancreatic cancer

It is well known that the clinical course in most patients with advanced pancreatic cancer is not influenced substantially by chemotherapy and/or radiotherapy. However, new chemotherapy, based on the synergistic antitumor activities of 5-fluorouracil (5-FU) and cisplatin (CDDP) producing biochemical modulation in solid cancers diagnosed as adenocarcinoma, has recently been reported to be effective. In gastrointestinal cancers, the optimal concentrations of each drug and the duration of the anticancer effects, as well as adverse effects have been confirmed in pharmacodynamic studies. Our experience of this treatment for advanced pancreatic cancer (stage IV) indicates the usefulness of the antitumor effect in terms of both effect on the tumor size in unresectable patients and prognosis in resectable patients. These results were remarkable in patients diagnosed as stage IV b and/or curability C. Although there were adverse effects, none were severe. However, anything compromising the patient's quality of life must be prevented. Randomized prospective studies of the combination of 5-FU and CDDP are expected in the near future.

Clinical value of MRA analysis of the vertebrobasilar system in vertiginous patients

Vertebrobasilar haemodynamics correlate closely with syndromal vertigo. The aim of this study is to examine the clinical value of MRA for evaluation of vertebrobasilar haemodynamics in vertiginous patients. We examined 40 individuals (20 with vertebrobasilar insufficiency and 20 diagnosed with other vestibular disorders). MRA results were quantified on the basis of the severity of vascular stenosis in the major arteries of the vertebrobasilar system and we analysed the relationship of these results with otoneurological diagnoses, eye-tracking tests (ETT) and optokinetic nystagmus (OKN). MRA results correlated well with otoneurological diagnoses and ETT results. Consequently, MRA can be used as a screening examination to evaluate vertebrobasilar haemodynamics and ETT may be a sensitive functional parameter of vertebrobasilar insufficiency.

Quantitative analysis of correlation between smooth pursuit and vertebrobasilar hemodynamics

The cerebellar arterial system is derived from the vertebrobasilar system. However, the relation between cerebellar function and vertebrobasilar hemodynamics remains poorly understood. In this study on patients with vertebrobasilar insufficiency symptoms we examined the relation between magnetic resonance angiography (MRA) abnormalities in the vertebrobasilar system and smooth pursuit function, which is a sensitive parameter of cerebellar function. MRA abnormality was quantitatively assessed on the basis of the severity of stenosis in the vertebral arteries and basilar artery, and on the visualization of the superior cerebellar arteries. Smooth pursuit dysfunction was quantified by the combined amplitude of spikes on an electronystagmograph. A significant correlation was found between MRA abnormality and smooth pursuit dysfunction. This suggests that smooth pursuit dysfunction is closely related to static factors of dysregulation of vertebrobasilar blood flow. Therefore, smooth pursuit can be valued as a sensitive parameter to dysfunction of vertebrobasilar blood flow.

Evaluation of the vertebrobasilar artery system by magnetic resonance angiography in the diagnosis of vertebrobasilar insufficiency

To evaluate the advantages of magnetic resonance angiography (MRA) in assessing the vertebrobasilar artery system for diagnosing vertebrobasilar insufficiency (VBI), we compared the MRA results of middle-aged and older VBI cases with those of age-matched peripheral disorder cases. There were no significant differences in the rate of complications associated with atherosclerosis between VBI cases and peripheral disorder cases. The MRA results were quantitatively assessed by scores determined on the basis of the severity of stenosis in the vertebral arteries and basilar artery. The MRA score was defined as the total score of these three arteries. The severity of stenosis and the MRA score of VBI cases were significantly higher than those of peripheral cases. MRA can therefore be of value as a screening examination for estimating vertebrobasilar blood flow and can provide helpful information for diagnosing VBI.

Comparative assessment of cell proliferation and accumulation of extracellular matrix in nasal polyps

In nasal polyps constantly associated with chronic inflammation, a dysregulation of epithelial cell proliferation has been described. Involvement of extracellular matrix accumulation is also suggested in the formation and growth of nasal polyps. In this study, we attempted to evaluate the activity of the proliferation of epithelial cells and fibroblasts and the relation between fibronectin accumulation and these cell proliferations in nasal polyps. The pathological specimens of 30 patients were examined which manifested proliferating cell nuclear antigen (PCNA) expression in epithelial cells and fibroblasts and in fibronectin expression. PCNA expression was quantified by calculating the index for each sample. No significant difference in PCNA index was found between epithelial cells and fibroblasts. However, a significant correlation was found between the epithelial and fibroblastic PCNA index. In addition, fibronectin immunopositivity was well correlated with the activity of proliferation of fibroblasts. Therefore, proliferation of fibroblasts is also an important factor in the growth of nasal polyps, and its relationship with fibronectin accumulation may play a role in the pathogenesis of nasal polyposis.

Surgical treatment for recurrent tumors of primary malignant melanoma of the esophagus: a case report and review of the literature

The purpose of this communication is to present a case of resection performed for local recurrent tumors of primary malignant melanoma of the esophagus (PMME) and to review the relevant literature. The patient was a 54 year-old man who had received an intraabdominal esophagectomy with a total gastrectomy for primary malignant melanoma of the abdominal esophagus in another hospital, in November 1995. After the initial operation, he was treated as an outpatient. In August 1997, computed tomography and ultrasonography revealed recurrent tumors in the dorsal pancreatic lymph node and in the right adrenal gland. The recurrent tumor of the dorsal pancreas directly invaded the dorsal pancreas parenchyma and occluded the superior mesenteric vein and splenic vein, and the other metastatic tumor in the right adrenal gland existed in the absence of circumference invasion. Metastases of the PMME were confirmed in the dorsal pancreas, the superior mesenteric vein, splenic vein, and right adrenal gland, and were removed by a total pancreatectomy on October 7, 1997. By immunohistochemical staining, we found that the focal areas expressed S-100 protein and HMB-45 antibody. Currently (February 1998), the patient is alive and disease-free. PMME is an extremely rare tumor with a poor prognosis for survival. Only 2 cases of removal of recurrent tumors, including the present case, have been reported. The treatment of choice is surgical resection, even in cases of recurrence, because radiotherapy and/or chemotherapy have not been proven to be beneficial; however, they may play a palliative role if surgery is not possible.

Olivary degeneration after intracranial haemorrhage or trauma: follow-up MRI

We studied serial MRI appearances of transneuronal degeneration in the inferior olives, retrospectively analysing follow-up images of five patients, three with head injury and two with brain stem haemorrhage. We performed 13 MRI studies 4 days to 2 years 7 months after the accident. All but one of the patients exhibited bilateral olivary high signal on T2-weighted images. The interval between causal event and appearance of olivary changes was 2-4 months, images 4 days to 1.5 months after the accidents revealing no changes. Olivary enlargement was observed in four patients 2-4 months after ictus.

Pseudolesion in segment IV of the liver on MRI: prevalence and morphology in 250 cirrhotic livers compared with 250 normal livers

PURPOSE

The goal of our study was to assess the prevalence of pseudolesion in segment IV of the liver on MRI in patients with and without liver cirrhosis.

METHOD

Patients were divided into three groups: 10 patients with angiographically confirmed aberrant gastric venous drainage and liver cirrhosis (Group 1), 250 consecutively selected patients with liver cirrhosis (Group 2), and 250 with normal liver (Group 3). The signal intensity of pseudolesion in segment IV on T1- and T2-weighted MRI in the 510 patients was analyzed.

RESULTS

In Group 1, five pseudolesions were visible and hyperintense on T1-weighted images. On T2-weighted images, four were visible and hypointense. In Group 2, 11 were seen (4.4%). All were hyperintense on T1-weighted images. Five were hypointense on T2-weighted images. In Group 3, one pseudolesion was seen (0.4%).

CONCLUSION

The prevalence of pseudolesion in segment IV on MRI is higher in liver cirrhosis than in normal liver. The lesion is hyperintense on T1-weighted images when visible.

[What 100 HPN patients taught us]

Recently, Terumo Corporation has developed a new management system, 'Home-Joint', which helps hospitals discharge patients easily. Several hospitals have adopted this system for HPN (home parenteral nutrition) patients, as it can provide discharge program from the hospital and provide items required in alternate site care. This report gives an evaluation of 100 HPN patients who underwent 'Home-Joint' program in 1997. 1) Profiles of patients. Number: 100 (female 47, male 53) Age: 26-96 (61 patients over 70) DIAGNOSIS: cancer 57, others 21, unknown 22 Therapeutic periods: average 53 days (2-617) for terminated 84 patients. Infusion Devices: ambulatory pump 55, stationary pump 41, gravity 4. 2) Important factors for HPN support 1. Be reliable for patients and staff. 2. Train patients well before discharge. 3. The simpler the device the better. 4. Trial or short home-coming required. 3) Issues. 1. Compared with other home therapies, HPN blood access requires much care. 2. Therapeutic period too short. 3. Pay for HPN service too small for a business HPN is very useful for the hospital to discharge the patient comfortably, but requires a complete service system and suitable reimbursement for business.

Mucin-producing tumor of the pancreas--intraluminal ultrasonography

BACKGROUND/AIMS

Many patients with mucin-producing pancreatic tumor, characterized by dilatation of the pancreatic duct, are diagnosed by conventional ultrasonography in a mass ultrasonographic survey in Japan. It is a necessary and reliable method for making a precise diagnosis and for deciding on the treatment approach. Endoscopic ultrasonography (EUS) is appreciated as a useful method for precise diagnosis of pancreatic tumors. Intraductal ultrasonography (IDUS) is expected to be a new modality for the more detailed diagnosis of pancreatic tumors.

METHODOLOGY

Endoscopic ultrasonography and intraductal ultrasonography were performed in 23 patients with mucin-producing pancreatic tumor. The differences in ultrasonographic findings between benign and malignant tumors were studied.

RESULTS

Ultrasonographic findings of mucin-producing pancreatic tumor revealed by EUS and IDUS were: cystic lesion, mural nodule in the cystic lesion, wall thickness of the cyst, mucus echoes, and solid tumor with a mixed echo pattern. Seven out of 11 patients with mural nodule were diagnosed as carcinomas and another 4 patients had adenoma. Seven of 8 patients with mucus echoes were diagnosed as carcinoma. Three of 4 patients with solid tumor were diagnosed as invasive carcinoma. The ultrasonographic findings suggesting malignancy were: mural nodule, irregular wall thickness, mucus echoes, and solid tumor with a mixed pattern. Solid tumor indicated invasive carcinoma exclusively.

CONCLUSIONS

Intraluminal ultrasonography, EUS and IDUS are very useful in making a differential diagnosis between benign and malignant tumors in mucin-producing pancreatic tumors.

[Usefulness of T2-weighted images using single shot fast spin echo (SSFSE) pulse sequence for the evaluation of pancreatobiliary diseases: comparison with MRCP using SSFSE]

Single shot fast spin echo (SSFSE) pulse sequence provides us with a thick single-slice MR cholangiopancreatography (MRCP) as well as thin multi-slice MRCP, and T2-weighted images are also obtained with SSFSE sequences. In comparison with conventional spin-echo and fast spin-echo sequences, T2-weighted image using SSFSE sequence has the advantages of the abscence of motion artifacts and the extremely short acquisition times. MRCP using SSFSE sequence is useful in the conspicuity of bile duct, pancreatic duct, and cystic lesions. However, T2 weighted image using SSFSE is superior to MRCP not only for the differentiation between solid and cystic lesions but also for the visualization of contour of different organs and lesions.

Differentiation of hypervascular hepatic pseudolesions from hepatocellular carcinoma: value of single-level dynamic CT during hepatic arteriography

PURPOSE

The purpose of our study was to assess the efficacy of single-level dynamic CT during hepatic arteriography (D-CTA) in the differentiation between hypervascular hepatocellular carcinoma (HCC) and hypervascular pseudolesion.

METHOD

D-CTA was performed in nine cases with HCC and nine cases with pseudolesion. Findings on D-CTA were retrospectively analyzed.

RESULTS

The transition of the stain of pseudolesion on D-CTA was divided into three phases: (1) inflow of the contrast material into the portal vein within the lesion, (2) lesion staining, and (3) fading out of the stain; that of HCC was divided into four phases: (1) inflow of CM into tumor, (2) tumor staining, (3) inflow of CM into the adjacent liver, and (4) coronal stain of adjacent liver. The coronal stain was seen in all HCCs but not in any pseudolesions.

CONCLUSION

The present study suggest that D-CTA is a helpful option in the differentiation between HCC and pseudolesion.

Effect of lipo-pro-prostaglandin E1, AS-013 on rat inner ear microcirculatory thrombosis

We investigated effects of lipo-pro-prostaglandin E1 (lipo-[11alpha, 13E, 15S]-11,15-dihydroxy-9-[1-oxobutoxy]-prosta-8, 13-dien-1-oic acid butyl ester), AS-013 in two models of hearing disturbance and equilibrium dysfunction induced by rat inner ear microcirculatory thrombosis. Inner ear microcirculatory thrombosis was induced by photochemical reaction between systemic injection of Rose Bengal and irradiation of green light to the cochlea and vestibule. Photochemical reaction causes endothelial injury followed by platelet adhesion, aggregation and formation of a platelet- and fibrin-rich thrombus. In the hearing disturbance model, a compound cochlear nerve action potential was recorded by electrocochleography every minute. Photochemical reaction induced inner ear microcirculatory thrombosis, followed by disappearance of the action potential. AS-013 significantly (P<0.05) prolonged time to disappearance of the action potential compared with control group. In the equilibrium dysfunction model, the irradiation to the vestibule was applied for 10 min after Rose Bengal injection. The behavior of rats in the swimming test and nystagmus were observed 24 h after the completion of irradiation. In the swimming test, two of 12 animals treated with AS-013 showed no rotating about their longitudinal axes, which indicates equilibrium dysfunction and the duration of well-balanced swimming prolonged. AS-013 suppressed the appearance of nystagmus. These results suggest that lipo-pro-prostaglandin E1, AS-013 may prevent hearing disturbance and equilibrium dysfunction due to inner ear microcirculatory disorders.

Endoscopy and intraductal ultrasonography

Because the prognosis in pancreatic carcinoma is so poor, a reliable method for early detection of tumors is needed. Endoscopic ultrasonography (EUS) is a useful method for precise diagnosis of pancreatic tumors. Recently, peroral pancreatoscopy (POPS) and intraductal ultrasonography (IDUS) have been introduced to make a more detailed diagnosis of pancreatic tumors. These three techniques were performed in 48 patients with pancreatic carcinoma. The ultrasonographic and endoscopic findings of pancreatic carcinoma were studied. EUS, IDUS, and POPS are very useful for differentiating between benign and malignant pancreatic tumors.

Subsegmental transcatheter arterial embolization for hepatocellular carcinoma in the caudate lobe

PURPOSE

To clarify the effectiveness of transcatheter arterial embolization (TAE) for hepatocellular carcinoma (HCC) in the caudate lobe of the liver.

MATERIALS AND METHODS

Thirteen patients with HCC in the caudate lobe underwent TAE. TAE was performed by injection of the mixture of anticancer drugs (mitomycin C and doxorubicin or epirubicin) and iodized oil, followed by gelatin sponge particles. Arterial anatomy of the caudate branch, local recurrence rate, and survival rate were evaluated.

RESULTS

From 31 TAEs for the caudate lobe, 22 subsegmental TAEs were successfully performed (71%). Local recurrence in the caudate lobe was seen in 10 patients (77%). Subsegmental TAE for the caudate lobe was repeated one to five times. Cumulative local recurrence rates were 33% and 75% within 3 and 6 months, respectively. Survival rates after first TAE for HCC in the caudate lobe were 89% and 74% for 1 and 3 years, respectively.

CONCLUSION

Local recurrence rate after subsegmental TAE for HCC in the caudate lobe was high. However, repeated subsegmental TAE possibly improves the prognosis of HCC in the caudate lobe.

[Diagnosis of the wall-thickened lesions of the gallbladder with dynamic MRI]

We studied 32 patients with the thickened lesions of the wall of the gallbladder by using dynamic MRI. We tried the differential diagnosis of gallbladder lesions according to the time intensity curve (TIC) and enhanced pattern. TIC of carcinoma was elevated more seeply from plain to arterial phase than the inflammatory diseases. The Inflammatory diseases were keeping three-layer structures of the wall of the gallbladder, but gallbladder carcinoma destroys the wall-structure. We could diagnose as direct liver invasion of the carcinoma clearly. We could exactly diagnose adenomyomatosis in dynamic MRI by small low intensity spots within the wall of the gallbladder. In the patients with gall stones, the wall of the gallbladder were more clearly observed in dynamic MRI compared with US and EUS.

Delayed MR imaging of the liver: correlation of delayed enhancement of hepatic tumors and pathologic appearance

BACKGROUND

The value of delayed magnetic resonance (MR) imaging (6 min) and ultradelayed MR imaging (1-4 h) for differentiating of hepatic tumors was studied.

METHODS

Postcontrast delayed and ultradelayed MR images were obtained after administration of 0.1 mmol/kg of Gd-DTPA in 30 patients with various malignant hepatic tumors.

RESULTS

Delayed enhancement in the center of the tumors was seen in 13 patients on the delayed MR images and in 22 patients on the ultradelayed MR images. On the ultradelayed images, peripheral hypointense rim was seen in 12 patients and central focal hypointense area was seen in eight patients. Pathologically, the portion showing delayed enhancement corresponded to abundant fibrous stroma, the hypointense rim to rich proliferation of tumor cells, and the central hypointense areas to coagulative necrosis.

CONCLUSION

Ultradelayed MR imaging can characterize different tissue components within various hepatic tumors.

RF system of the SPring-8 storage ring

Construction of three RF stations in the storage ring of SPring-8 has been completed. The design concept concentrates on avoiding a coupled-bunch instability which limits the stored current or makes the synchrotron radiation beam unstable. The cavity is bell-shaped to reduce the coupling impedance of the higher-order modes. The cavity dimensions are trimmed systematically to distribute the higher-order mode frequencies. Each cavity has two movable tuners. The temperature of the cavity cooling water is controlled within 0.02 K and the water flow is kept constant. The construction and commissioning of the SPring-8 storage ring RF system is reported.

CTAP in budd-chiari syndrome: evaluation of intrahepatic portal flow

BACKGROUND

To assess the intrahepatic portal flow in patients with Budd-Chiari syndrome (BCS) by computed tomography (CT) during arterial portography (CTAP).

METHODS

Five patients with BCS [with (n = 3) and without (n = 2) inferior vena cava (IVC) obstruction] underwent both CTAP and postcontrast CT following CTAP. CTAP and postcontrast CT after angioplasty were also performed in one patient. Findings on CTAP and postcontrast CT were analyzed retrospectively.

RESULTS

Patients with IVC obstruction and a patent large hepatic vein showed homogeneous hepatic enhancement on CTAP. Patients without IVC obstruction and with no patent large hepatic veins showed heterogeneous hepatic enhancement, which consisted of patchy enhancement and more definite enhancement in the central part of the liver. On postcontrast CT, the patchy enhancement was enlarged compared with that on CTAP in these patients. The heterogeneous hepatic enhancement became homogeneous in the patient who underwent angioplasty.

CONCLUSION

We suggest that the more marked the blood congestion, the more heterogeneous the hepatic enhancement becomes on CTAP. Heterogeneous hepatic enhancement on CTAP is seen in such cases without any patent hepatic veins.

The 5-HT3 receptor agonist attenuates the action of antidepressants in the forced swim test in rats

Involvement of 5-hydroxytryptamine (5-HT)3 receptors in action of antidepressants was examined in the forced swim test in rats. Rats were forced to swim in a cylinder for 15 min on day 1 and for 5 min on day 2. Imipramine, desipramine and mianserin, administered after the 15-min swim session on day 1 and before the 5-min swim test on day 2, dose-dependently decreased the duration of immobility in the swim test on day 2. 1-(m-Chlorophenyl)-biguanide (mCPBG) attenuated the decreased duration of immobility induced by imipramine, desipramine and mianserin, although mCPBG did not affect the duration of immobility when it was given alone. ICS205-930 dose-dependently decreased the duration of immobility in the swim test on day 2, and the effect of ICS205-930 was attenuated by mCPBG. These results suggest that the suppression of 5-HT3 receptor activity may contribute to the action of antidepressants.

Obstructive jaundice caused by lymphangitis carcinomatosa of bile duct wall from gastric carcinoma

We report a case of advanced gastric carcinoma presenting with obstructive jaundice. Computed tomography showed marked lymphadenopathy in the hepatoduodenal ligament and concentric bile duct wall thickening. Histologically, extrahepatic bile duct wall was thickened due to submucosal lymphangitic spread of gastric carcinoma (lymphangitis carcinomatosa). Lymphangitis carcinomatosa may be considered when extrahepatic bile duct wall thickening is seen in patients with obstructive jaundice.

Biliary cystadenoma with mesenchymal stroma of the liver: correlation between unusual MR appearance and pathologic findings

We reported a case of the biliary cystadenoma of the liver. The cystic mass had lobulation and septation and showed marked hyperintensity on T1-weighted images and hypointensity on T2-weighted images; MR findings were very unusual for cystadenoma. The content of the cystic mass was jelly-like, thick mucinous fluid without intracystic hemorrhage. We concluded that these unusual signal intensities of the cyst were due to hyperproteinous mucinous fluid.

A new complex translocation (15;20;17)(q22;p13;q21) in acute promyelocytic leukemia

We describe here a 39-year-old male with acute promyelocytic leukemia (APL) carrying a new complex translocation (15;20;17). A chromosomal analysis of the bone marrow cells showed 46, XY, t(15;20;17)(q22;p13;q21). Fluorescence in situ hybridization (FISH) analysis using plasmid DNA libraries of chromosomes 15, 17, and 20 revealed three derivative chromosomes, der(15)t(15;17), der(17)t(17;20), and der(20)t(15;20). Fluorescence in situ hybridization with cosmid DNA probes flanking the breakpoints of t(15;17) did not show the retinoic acid receptor alpha (RAR alpha)/PML fusion signal usually generated on the der(17)t(15;17). However, rearrangement of the RAR alpha gene and expression of the PML/RAR alpha chimeric transcript were identified by Southern blot and reverse-transcriptase polymerase chain reaction (RT-PCR) analyses, respectively. Our results confirmed that the PML/RAR alpha gene on the der(15)t(15;17), not the RAR alpha/PML gene, must be essential to leukemogenesis in APL. Furthermore, considering another reported case with a 20p13 aberration, it is possible that 20p13 is a nonrandom breakpoint in APL with a complex translocation.

Suppressive effect of simvastatin on intramural small coronary arterial lesions in cholesterol-fed rabbits

The aim of this study was to examine the suppressive effect of simvastatin on intramural coronary arterial lesions in cholesterol-fed rabbits. In one experiment, six groups of rabbits were fed laboratory chow alone or with added 0.1%, 0.2%, 0.3%, 0.5% or 1.0% cholesterol for 16 weeks. In another experiment, four groups of rabbits were fed a 0.5% cholesterol diet and treated with simvastatin at 1, 3, or 5 mg/kg/day or placebo. In each rabbit, the levels of serum total cholesterol (TC) were determined at 1-week intervals to calculate the integrated values. The lesion induction ratio was defined as the ratio of intramural coronary arteries 50-150 microm in diameter with arterial lipoidosis to the total number of arteries of the same diameter. In the two experiments, there were positive correlations between the lesion induction ratio and integrated TC (r=0.785, P<0.0001 and r=0.763, P<0.0001, respectively). The slopes of the regression lines for integrated TC obtained in the two experiments were similar, but the lesion induction ratio in the simvastatin-treated group was always lower, by about 14%, in comparison with that in the non-simvastatin-treated group. These findings suggest that simvastatin induces lesion reduction not only by reducing the levels of circulating cholesterol but also by directly suppressing the development of lipoidosis.

Ultimate observation of tungsten atoms and clusters adsorbed on single crystalline MgO films

Tungsten single atoms and clusters composed of four and five atoms deposited on MgO (001) thin films were observed by high-resolution transmission electron microscopy at R.T. The observation was realized by optimizing the thickness of the MgO films and by using special imaging techniques such as an off-Bragg HREM method. The multislice simulation for the interpretation of the image contrast showed a possibility of discrimination of the atomic configuration of clusters, such as "b.c.c.," "on-top," or "f.c.c." type clusters, from details of the image-contrast. The image intensity at the center of the clusters with the b.c.c. configuration was evidently smaller than that of the clusters with the f.c.c. configuration. The reason for the difference was clarified through the multislice image simulation, suggesting that the lattice mismatch between the clusters and the MgO lattice was a key factor in determining the intensity of the center of the clusters.

Hypervascular hepatocellular carcinoma: evaluation of hemodynamics with dynamic CT during hepatic arteriography

PURPOSE

To assess the hemodynamics and the main drainage vessel of hypervascular hepatocellular carcinoma.

MATERIALS AND METHODS

Single-level dynamic computed tomography during hepatic arteriography (CTHA) was performed in 32 patients with hepatocellular carcinoma. Carcinoma was confirmed with histologic (n = 9) or clinical (n = 23) examination results. Single-level CTHA findings were retrospectively analyzed. Histologic specimens from 40 livers with hepatocellular carcinoma were also examined, with special attention to vessels along the rim of the lesion.

RESULTS

Contrast material enhancement on single-level CTHA images occurred in four phases: (a) inflow of the contrast material into tumor, (b) tumor enhancement, (c) inflow of the contrast material into adjacent liver, and (d) corona enhancement of adjacent liver. Corona enhancement was seen in all lesions. A bright branching structure in the corona enhancement area, suggestive of a portal venule, was visible at the start of adjacent liver staining in 21 lesions. Continuity between a tumor sinusoid and a tiny vessel in the inner layer of the pseudocapsule was histologically confirmed in 10 of 40 specimens. Continuity between a tiny vessel in the inner layer and a portal vein in the outer layer of the pseudocapsule was confirmed with findings on serial sections from one liver.

CONCLUSION

The main drainage of hepatocellular carcinoma lesions may be a protal venule.

The antiatherogenic effect of nifedipine on intramural small coronary arterial lesions in cholesterol-fed rabbits

The objective of this study was to examine the suppressive effect of nifedipine on intramural coronary arterial lesions in cholesterol-fed rabbits. Each rabbit in Groups A (n=6) and B (n=5) was fed a 0.3% cholesterol diet and was orally administered nifedipine (40 mg/day) or placebo. Each rabbit in Groups C (n=5) and D (n=6) was fed a 0.5% cholesterol diet and was orally administered nifedipine (40 mg/day) or placebo. The serum concentrations of total cholesterol (TC) were determined at 1-week intervals to calculate the integrated values. The lesion induction ratio was defined as the ratio of intramural coronary arteries 50-150 microm in diameter with arterial lipoidosis to the total number of arteries of the same diameter. There were no significant differences between the nifedipine-treated and placebo groups in either the integrated TC or lesion induction ratio in either the 0.3% and 0.5% cholesterol-fed rabbits. This study demonstrates that nifedipine does not suppress atherogenesis in the intramural small coronary arteries of cholesterol-fed rabbits.