Portal tumor thrombus due to gastrointestinal cancer

METHODS

We studied the clinical data of seven patients with portal tumor thrombus (PTT) due to gastrointestinal (GI) cancer to determine the radiologic patterns and clinical implications of this rare complication.

RESULTS

(a) PTT was located along the entire splenic vein in three cases, at the splenomesenteric confluence in one case, and in the superior mesenteric vein in one case. Intrahepatic PTT occurred in two of four cases with liver metastasis. (b) One cirrhotic case was complicated by the occurrence of colon cancer associated with PTT in the splenic vein; the esophageal varices became rapidly enlarged and poorly controlled, and the patient died due to repeated variceal rupture. (c) In all patients, abdominal sonography (US) detected PTT and color Doppler sonography confirmed the US findings.

CONCLUSIONS

The splenic vein should be meticulously observed by color Doppler sonography to check for PTT in patients with GI cancer to improve patient care.

Multinodular fatty change in the liver in patients with chronic hepatic porphyria

We present five cases of chronic hepatic porphyria (CHP) without skin lesions, in whom a multinodular fatty change in the liver was incidentally detected by ultrasound. Discovery prompted further examinations, leading to the diagnosis of CHP. Although relatively rare, the possibility of CHP must be considered when encountering patients with irregular (multinodular) fatty infiltration of the liver of unknown cause. We also discuss the differential diagnosis.

Splenic lymphangioma: US and CT diagnosis and clinical manifestations

BACKGROUND AND METHODS

We tried to determine the role and problems of gray-scale sonography (US), computed tomography (CT), and color Doppler sonography in the diagnosis of splenic lymphangioma on the basis of our experience with seven adult cases with this relatively rare tumor.

RESULTS

(1) The whole spleen was replaced by a collection of cysts of different sizes with or without calcifications in six patients. In these patients, color Doppler sonography showed the intrasplenic arteries and veins running along the cyst walls. (2) The enlarged spleen occupied the whole upper abdomen and contained numerous small cysts in one patient. The patient was initially diagnosed as having a pancreatic tumor because of the location, but color Doppler sonography clearly demonstrated two vessels (artery and vein) running parallel from the center of the mass. This characteristic vascular structure led to the determination that the mass was the markedly enlarged spleen. (3) The splenic lesion was isolated in six patients but was associated with mesenteric and pleural lymphangioma in one symptomatic patient.

CONCLUSIONS

(1) When US shows multiple cysts of different sizes in the spleen, the diagnosis of splenic lymphangioma is not difficult to make with US and CT alone. (2) Color Doppler sonography is a very useful tool to increase diagnostic confidence because it demonstrates the vasculature of the mass. (3) When examining patients with splenic lymphangioma, one should consider the possibility of multiorgan involvement.

Gastrointestinal bleeding due to ruptured pseudoaneurysm in patients with pancreatitis

We present the medical imaging results and clinical data of four pancreatitis cases with gastrointestinal bleeding due to rupture of a pseudoaneurysm to determine in which situations a rupture should be suspected. Our observations suggest that the possibility of such a rupture must be kept in mind when encountering not only patients with hematemesis or melena associated with acute severe abdominal symptoms but also patients with severe anemia. Color Doppler sonography and computed tomography are very useful as first-line diagnostic tools and should be performed promptly to prevent a delay in patient management.

Determination of norepinephrine in microdialysis samples by microbore column liquid chromatography with fluorescence detection following derivatization with benzylamine

A microbore column liquid chromatographic method is described for the determination of norepinephrine (NE) in microdialysis samples from rat brain. The method is based on precolumn derivatization of NE with benzylamine in the presence of potassium hexacyanoferrate(III) resulting in a highly fluorescent and stable benzoxazole derivative. Typically, a 10-microl sample was mixed with 10 microl derivatization reagent containing 0.45 M Caps buffer (pH 12.0), 0.2 M benzylamine, 10 mM potassium hexacyanoferrate(III), and N,N-dimethylformamide (1:1:1:15, v/v). The derivatization was carried out at 50 degrees C for 20 min. Under these conditions only NE and epinephrine produced high fluorescence yields at excitation and emission wavelengths of 345 and 480 nm, respectively, while fluorescence of other catechols and 5-hydroxyindoles was quenched by 10-100 times. The NE derivative was separated on a reversed-phase column (100 x 1.0 mm i.d., packed with C18 silica, 5 microm) within 10 min with no late eluting peaks. The mobile phase consisted of 40 mM Britton-Robinson buffer (pH 7.5) containing 1 mM didodecyldimethylammonium bromide and acetonitrile (34%, v/v), the flow rate was 40 microl/min. The limit of detection (signal-to-noise ratio of 3) for NE was 90 amol in 10 microl sample injected. Microdialysis samples were collected in 5-min intervals from the probes implanted in the hippocampus, frontal cortex, or hypothalamus of awake rats. The basal extracellular NE levels in the respective areas were 4.7 +/- 0.9, 1.8 +/- 0.3, and 0.8 +/- 0.2 fmol/10 microl (mean +/- SE, n = 7). Perfusion with a Ringer solution containing 100 mM K+ increased hippocampal NE levels by 700%, while NE uptake inhibitors maprotiline and amitriptyline administered orally or subcutaneously increased extracellular NE in the frontal cortex by about 300%. On the other hand, reserpine (5 mg/kg) reduced cortical NE levels by 40% 3 h after the administration. This new fluorescence derivatization method provides better selectivity, sensitivity, and speed for NE determination than the electrochemical detection since no late-eluting compounds such as dopamine, serotonin, and their metabolites are detectable in the chromatograms of the microdialysis samples.

Assessment of resectability of pancreatic carcinoma by color Doppler sonography

This study was undertaken to evaluate the role of color Doppler sonography in the preoperative assessment of vascular involvement in patients with pancreatic carcinoma. Twenty-six pancreatic carcinomas were investigated with color Doppler sonography and angiography, and the results of these examinations were compared with those of surgical findings. Color Doppler sonography was more sensitive than angiography in depicting vascular involvement of carcinoma. Thus, it seems rational to perform a preoperative assessment in suspected pancreatic carcinoma patients initially with color Doppler sonography to improve patient management.

Treatment of the nasal hump with preservation of the cartilaginous framework

Classically, nasal hump reduction is based on the partial resection of the cartilages and bones of the nose, as it was described by Joseph almost a century ago. The cartilaginous portion of the hump consists of a single unity formed by the two upper lateral cartilages and the septal cartilage. During hump reduction in the classic rhinoplasty, this structure is slashed in three pieces, which is the main cause of irregularities, shadows, and pinchings over the long-term results. Late follow-ups of the classical hump removal often show an inverted V-shaped shadow on the dorsum secondary to the destruction of the osseous-cartilaginous transition. The angle and relation between the septal and upper lateral cartilages are reduced, which may compromise the functional aspect. The destruction of the unique anatomy of the cartilaginous hump is one of the main causes of this functional and aesthetic sequela. Here, we present a technique that preserves the cartilaginous framework of the nasal hump by lowering it through the resection of a strip of septum, avoiding the problems described above.

[Angiotensin II and apoptosis]

Angiotensin II (AII), the effector octapeptide of the renin-angiotensin system, exerts a multitude of actions, including vascular contraction, aldosterone secretion, catecholamine release, glycogenolysis, and decreased renal filtration. These diverse actions are mediated through AII receptor subtypes present in a variety of target tissues. Molecular cloning studies have identified two major types of mammalian AII receptors, designated AT1 and AT2, which are classified as a typical family of seven transmembrane guanyl nucleotide-binding protein (G-protein) coupled receptors from hydropathy analyses. Mainly, if not all, of the actions of AII are mediated by AT1 that has been well characterized. Recently, AT2 is found to exert growth inhibitory and proapoptotic effects, but its physiological role is still unclear. The molecular mechanism and the physiological importance of signaling pathways via these receptors remain to be elucidated.

Expression and characterization of mouse angiotensin II type 1a receptor tagging hemagglutinin epitope in cultured cells

The octapeptide angiotensin II mediates the physiological actions of the renin-angiotensin system through activation of several angiotensin II receptor (AT) subtypes, in particular AT1 (AT1a and AT1b in the case of rodents). Although we and others have generated mutant mice in which the AT1a gene was disrupted, the function of mouse AT1 remains to be fully elucidated, due to the lack of effective tools involving antibodies against AT1 for detecting biological responses in cellular conditions. To avoid these problems, we constructed the hemagglutinin (HA)-tagged mouse AT1a, and stably introduced this recombinant receptor into human embryonic kidney 293-T cells. Radioligand binding of [(125)I] angiotensin II to AT1a was specific, saturable, and reversible. Scatchard analysis demonstrated that the transfected receptor had a dissociation constant of 1.7 nM with a density of 1.2 x 10(5) sites/cells. Angiotensin II stimulated a rapid increase in cytosolic free calcium, and angiotensin II-induced phosphorylation of extracellular signal-regulated kinases (Erk) was found in a dose-dependent manner. After solubilization, Western blot analysis showed specific interactions between an anti-HA antibody and HA-tagged mouse AT1a. Furthermore, a significant proportion of HA-tagged mouse AT1a was specifically immunoprecipitated with this antibody. In the immunocytochemical and electronmicroscopic studies, treatment of this cell line with angiotensin II resulted in decrease in signals of the surface receptors. Based on these results, the cell line established here provides an excellent tool for studying angiotensin II actions mediated through mouse AT1a, at sub-nanomolar concentrations.

Primary leiomyosarcoma of the greater omentum

We report a case of primary greater omental leiomyosarcoma successfully resected by omentectomy. Palpation of a painless abdominal mass at physical examination motivated medical imaging examination. Ultrasound visualized accurately the internal structure of the lesion but failed to determine the site of origin. Computed tomography and angiography determined the greater omental origin of the tumor before surgery. A review of the literature is also presented.

Hepatic hemangioma with arterioportal shunts

Color Doppler sonograms and angiographic findings in 23 hepatic hemangioma patients were compared to clarify how arterioportal shunts influence color Doppler findings of hepatic hemangiomas. The results of our study showed that the presence of arterioportal shunts (six cases) gave rise to large feeding arteries (five cases), multiple intratumoral flows (six cases), and reversal of portal flow within (five cases) or around (four cases) the tumor. These color Doppler findings mimicked hypervascular malignant tumors. Knowledge of such unusual color Doppler findings in hepatic hemangiomas may help in avoiding misinterpretations of color Doppler sonograms.

Primary tumours of the greater omentum

Primary tumours of the greater omentum are very rare. Ultrasound allows the detection and characterization of such lesions, but determination of their precise anatomical location is usually difficult by US. Computed tomography determines the omental origin of the tumour. Thus, when US reveals an abdominal tumour of unknown origin, the possibility of an omental tumour, although rare, must be kept in mind and CT should be performed.

Abdominal wall closure after selective aponeurotic incision and undermining

The tension required to pull the anterior and the posterior rectus sheaths toward the midline was studied in 20 fresh cadavers at two levels: 3 cm above and 2 cm below the umbilicus. The quotient of the force used to mobilize the aponeurotic site to the midline and its resulting displacement was called the traction index. These indices were compared in three situations: (1) prior to any aponeurotic undermining, (2) after the incision of the anterior rectus sheath and the undermining of the rectus muscle from its posterior sheath, and (3) after additionally releasing and undermining the external oblique muscle. A significant decrease in aponeurotic resistance was observed after each dissection. The anterior sheath showed higher resistance to traction compared with the posterior sheath on both levels. No statistical difference was noted in the comparison of the values of the aponeurosis above and below the umbilicus. These results suggest that these procedures are effective in assisting in the closure of abdominal wall defects because these maneuvers decrease substantially the tension required for advancement of the aponeurotic edges.

Rescue of angiotensinogen-knockout mice

Angiotensinogen, the precursor of angiotensins I and II, is a critical component of the renin-angiotensin system that plays an important role in regulating blood pressure and electrolyte homeostasis. Genetically altered mice lacking angiotensinogen (Agt-KO) showed an expected phenotype, such as marked hypotension, but unexpected ones including abnormal kidney morphology, reduced survival rates of newborns, and impaired blood-brain barrier function after cold injury. To examine whether disruption of the angiotensinogen gene is responsible for the observed phenotypes, we generated a line of mice heterozygous for the mouse angiotensinogen gene under the control of a mouse metallothionein-I promoter (MT-Agt) and crossmated transgenic mice with Agt-KO mice. The resulting mice (MT-Agt(+/-)/Agt(-/-):MT-Agt/KO) produced the plasma level of angiotensin I comparable to that of wild-type mice, and the mutant phenotypes were rescued. These results indicated that the resultant phenotypes due to the genetic deficiency of mouse angiotensinogen can be corrected by restoring angiotensinogen and angiotensin I in the circulation.

Sonographic and color Doppler findings of rupture of liver tumors

We present six cases of ruptured liver tumor (hepatocellular carcinoma, five cases; liver metastasis, one case) in which gray-scale sonography revealed an ascites containing constantly moving dense high-echo spots, leading to a high suspicion of acutely developing hemoperitoneum. Color Doppler sonography helped in detecting the rupture site by demonstrating a high-velocity jet flow from it. Although four of six patients were dead within 3 months, detection of the rupture site by color Doppler sonography made the initial transarterial embolization therapy easy and prompt.

Splenic artery aneurysm: value of color Doppler and the limitation of gray-scale ultrasonography

BACKGROUND

To reevaluate the advantages and limitations of gray-scale and color Doppler sonography in the diagnosis of splenic artery (Sp-A) aneurysm.

METHODS

We reviewed the gray-scale and color Doppler sonograms of five cases with Sp-A aneurysm (four patients with portal hypertension and one patient without portal hypertension). Color Doppler sonography was performed in all five patients, and power Doppler sonography was performed in three.

RESULTS

Gray-scale sonography failed to detect the aneurysm in four of five cases because of a surrounding splenorenal (Sp-R) shunt in three patients and marked calcification of the aneurysmal wall in one patient. Pulsed Doppler sonography showed a slightly turbulent pulsatile flow along the aneurysmal wall, which immediately led to the diagnosis in four cases, including the three cases with Sp-R shunt. In one case, color Doppler sonography failed to detect the aneurysm because of a markedly calcified aneurysmal wall, although power Doppler sonography could visualize the aneurysm.

CONCLUSIONS

Gray-scale sonography is not a useful diagnostic tool for Sp-A aneurysm. Clinicians should use color Doppler sonography in the evaluation of the splenic hilus in patients with Sp-R shunt to find a small Sp-A aneurysm. The addition of power Doppler sonography is helpful in visualizing calcified Sp-A aneurysms.

Sonographic and color Doppler findings of gastrointestinal myogenic tumors with a marked extraluminal growth

We present five cases with gastro (four cases) and intestinal (one case) myogenic tumors with a marked extraluminal growth. In all cases, incidental discovery of an asymptomatic mass prompted further examination. One of three cases with a pedunculated growth mimicked a gallbladder cancer. The mass of a jejunal leiomyoma case changed markedly in location under probe compression. Color Doppler sonography confirmed not only the hypervascular nature of the mass but also feeding and draining vessels.

Anterior abdominal wall pathologies detected by high-frequency annular array

AIM AND METHODS

In 1850 patients, high-frequency (HF: 7.5-10 MHz) annular array US examination was performed to evaluate the value of HF annular US in the detection of pathologies of the anterior abdominal wall.

RESULTS

HF annular US revealed pathological lesions (metastasis, benign tumor, lymphoma, hematoma, fistula, hernia, abscess) in 37 patients. The lesions were detected by conventional medium-frequency (3.5-3.75 MHz) US in only 8 of 37 cases (21.6%). HF annular US added information that altered clinical management in 19 cases (51.4%), predominantly in cases with tumors and fistulas.

CONCLUSION

The addition of HF annular US to a conventional US examination increases the detectability of small, but clinically important pathologies in the anterior abdominal wall.

Small bowel varices: report of two cases

Two cases of small bowel (S-B) varices associated with portal hypertension, one with liver cirrhosis and one with portal thrombus, are reported. Detection of S-B varices has been a challenging task and several invasive diagnostic techniques have been used for this purpose. However, in our cases, color Doppler sonography revealed the S-B varices supplied by the superior mesenteric vein and draining to the iliac (one case) or ovarian vein (other case), which helped to establish an early appropriate diagnostic and treatment plan.

Intrahepatic venous collaterals

BACKGROUND

The aim of this study was to reevaluate the causes and sites of intrahepatic venous collaterals and to determine the role of color Doppler sonography in the diagnosis of this relatively rare vascular abnormality.

METHODS

Real-time color Doppler sonography was used to study 21 patients with intrahepatic venous collaterals. The cause, distribution, and clinical manifestations of collaterals were determined, and Doppler waveforms obtained from the collaterals were also analyzed.

RESULTS

First, the causes of intrahepatic venous collaterals were divided roughly into two groups according to the presence or absence of veno-occlusions. The former group included liver tumors (six cases), primary Budd-Chiari syndrome (five cases), and metastatic adrenal tumors invading the inferior vena cava (two cases). The latter group consisted of diaphragmatic hernia (three cases), Osler-Weber-Rendu disease (two cases), and congestive liver (one case). The cause was not determined in two cases. Second, venous collaterals were distributed throughout the entire liver in primary Budd-Chiari syndrome but localized in the other cases. Third, Doppler waveforms of the collaterals were divided into two patterns: flat flow and multiphasic flow. Flat flow pattern was seen in patients with veno-occlusive diseases, and multiphasic flow pattern was seen in patients without veno-occlusive disease.

CONCLUSION

The relationship between intrahepatic venous collaterals and veno-occlusive diseases has been emphasized in the literature, but the results of our series showed that they occurred under a wide variety of conditions, even without veno-occlusive diseases, including diaphragmatic hernia and Osler-Weber-Rendu disease. The analysis of the Doppler waveforms of the collaterals was useful in differentiating those due to veno-occlusive diseases and those not.

Lobar atrophy of the liver

Lobar atrophy of the liver due to causes other than liver tumor or liver cirrhosis is a relatively rare pathological condition, and there are only a few reports in the literature. We report six such cases and try to evaluate the relationship between lobar atrophy and portal flow disturbance. The patients could be divided into two groups according to the site of the atrophy: those with atrophy of the left lobe (two cases) and those with atrophy of the right lobe (four cases). The two cases with atrophy of the right lobe had hepatholithiasis in the involved segments, but the cause was not determined in the remaining four cases. In all six cases, portal flow disturbance was noted, including invisibility of the portal vein in four cases, narrowing in one case, and portal thrombus in one case. Collateral circulation was not recognized in any of our cases. Of interest is the mode of lobar atrophy. Atrophy of the right lobe was always associated with marked enlargement of the left lobe, but that of the left lobe did not induce an enlargement of the right lobe.

Simultaneous determination of urinary catecholamines and 5-hydroxyindoleamines by high-performance liquid chromatography with fluorescence detection

A simple, selective and sensitive high-performance liquid chromatographic method with fluorescence detection is described for the simultaneous determination of catecholamines and 5-hydroxyindoleamines. The method is based on the derivatization of the amines with benzylamine in the presence of potassium hexacyanoferrate(III) under mild conditions. The resulting fluorescent derivatives are separated on a reversed-phase column, Cosmosil 5C18, using a mixture of acetonitrile and 10 mmol l-1 acetate buffer (pH 6.0) (35 + 65 v/v) as mobile phase, and are detected spectrofluorimetrically at 480 nm with excitation at 345 nm. The detection limits (signal-to-noise ratio = 3) for the amines are 2.8-236.0 fmol for an injection volume of 50 microliters. The method was successfully applied to the determination of 5-hydroxyindol-3-ylacetic acid, serotonin, norepinephrine and epinephrine in human urine. The method is simple and does not require clean-up of urine samples.

Sonographic findings of anomalous position of the gallbladder

Anomalous position of the gallbladder is relatively rare and has been reported only in isolated case reports. We tried to determine its ultrasound (US) findings on the basis of 18 such patients. In the left-side gallbladder group (nine patients), the gallbladder was imaged as an oval cystic mass in front of the pancreas. In all patients, the narrow neck of the gallbladder was clearly detected by US in the usual location before the main portal vein. Four of nine patients had small gallbladder stones. The retrohepatic gallbladder group (four patients) showed marked atrophy of the right lobe of the liver. Two patients had multiple gallstones in the bile ducts of the right lobe. All patients in the suprahepatic retrohepatic gallbladder group (four patients) were cirrhotic, and the anterior segment of the right lobe was markedly atrophied. In the intercostal scan, the gallbladder mimicked a perihepatic fluid. In the floating gallbladder group (one patient), the gallbladder was imaged as a cystic mass in the anterior abdominal wall. Surgical intervention showed a severely inflamed gallbladder, with small stones adhered into the anterior abdominal wall and partially ruptured. Knowledge of the wide range of US findings of malposition of the gallbladder helps in avoiding misdiagnosis.

Radiometric Measurement Comparison Using the Ocean Color Temperature Scanner (OCTS) Visible and Near Infrared Integrating Sphere

As a part of the pre-flight calibration and validation activities for the Ocean Color and Temperature Scanner (OCTS) and the Sea-viewing Wide Field-of-view Sensor (SeaWiFS) ocean color satellite instruments, a radiometric measurement comparison was held in February 1995 at the NEC Corporation in Yokohama, Japan. Researchers from the National Institute of Standards and Technology (NIST), the National Aeronautics and Space Administration/Goddard Space Flight Center (NASA/GSFC), the University of Arizona Optical Sciences Center (UA), and the National Research Laboratory of Metrology (NRLM) in Tsukuba, Japan used their portable radiometers to measure the spectral radiance of the OCTS visible and near-infrared integrating sphere at four radiance levels. These four levels corresponded to the configuration of the OCTS integrating sphere when the calibration coefficients for five of the eight spectral channels, or bands, of the OCTS instrument were determined. The measurements of the four radiometers differed by -2.7 % to 3.9 % when compared to the NEC calibration of the sphere and the overall agreement was within the combined measurement uncertainties. A comparison of the measurements from the participating radiometers also resulted in agreement within the combined measurement uncertainties. These results are encouraging and demonstrate the utility of comparisons using laboratory calibration integrating sphere sources. Other comparisons will focus on instruments that are scheduled for spacecraft in the NASA study of climate change, the Earth Observing System (EOS).

Isolated splenic metastases

We analyzed the primary tumors, sonographic findings, clinical manifestations, and prognosis in five cases of isolated splenic metastases to determine in what situations these rare metastases should be suspected. The metastases were detected by ultrasonography in all five patients, and the primary tumors were colonic cancer in four patients and renal cancer in one patient. Splenectomy was performed and the postoperative course was uneventful in all patients. We conclude that preoperative and follow-up examinations must be performed with special attention given to the spleen in colonic or renal cancer patients.

3,4-Dimethoxybenzylamine as a sensitive pre-column fluorescence derivatization reagent for the determination of serotonin in human platelet-poor plasma

3,4-Dimethoxybenzylamine is shown to be a highly sensitive pre-column fluorescence derivatization reagent for the determination of serotonin in plasma by high-performance liquid chromatography. The reagent reacts selectively with 5-hydroxyindoles including serotonin in slightly alkaline media in the presence of potassium hexacyanoferrate(III) to give highly fluorescent derivatives. The derivatives of six standard 5-hydroxyindoles (5-hydroxytryptophan, 5-hydroxyindole-3-acetic acid, serotonin, 5-hydroxyindole-3-acetamide, N-acetyl-5-hydroxytryptamine and 5-hydroxytryptophol) are separated within 18 min by isocratic elution using acetonitrile-10 mM phosphate buffer (pH 6.0)-50 mM 1-hexanesulfonic acid on a Wakosil II 5C18RS reversed-phase column. The detection limits (signal-to-noise ratio=3) for the indoles were 1.0-5.7 fmol in a 100-microl injection volume. The method was applied to the measurement of serotonin in human platelet-poor plasma.

Hypertension induced in pregnant mice by placental renin and maternal angiotensinogen

Maternal hypertension is a common complication of pregnancy and its pathophysiology is poorly understood. This phenomenon was studied in an animal model by mating transgenic mice expressing components of the human renin-angiotensin system. When transgenic females expressing angiotensinogen were mated with transgenic males expressing renin, the pregnant females displayed a transient elevation of blood pressure in late pregnancy, due to secretion of placental human renin into the maternal circulation. Blood pressure returned to normal levels after delivery of the pups. Histopathologic examination revealed uniform enlargement of glomeruli associated with an increase in urinary protein excretion, myocardial hypertrophy, and necrosis and edema in the placenta. These mice may provide molecular insights into pregnancy-associated hypertension in humans.

High-performance liquid chromatographic determination of human serum albumin in plasma and urine by post-column fluorescence enhancement detection using 8-anilino-1-naphthalenesulfonic acid

A method for the quantitative determination of human serum albumin in plasma and urine by post-column high-performance liquid chromatography with fluorescence detection is presented. Human serum albumin in plasma and urine is separated by gel-permeation column chromatography, which is followed by fluorescence detection. The detection uses the fluorescence enhancement observed when 8-anilino-1-naphthalenesulfonic acid binds to human serum albumin. The method is rapid to perform and is highly sensitive (detection limit is 2.5 ng/injection volume at a signal-to-noise ratio of three.

Chromosomal mapping of human angiotensinogen gene and human renin gene by fluorescence in situ hybridization (FISH) in transgenic mice

We attempted to apply FISH to chromosomal mapping of the human angiotensinogen (hAG) and human renin (hRN) transgenes which are carried by the parental strains of the Tsukuba hypertensive mouse. We report here that the hAG gene is mapped in the C2 region of Chr 19 and the hRN gene in the A1 region of Chr 6.

Assay for tryptophan hydroxylase activity in rat brain by high-performance liquid chromatography with fluorescence detection

A highly sensitive and selective liquid chromatographic (HPLC) method with post-column fluorescence detection has been developed for the determination of tryptophan 5-monooxygenase activity in rat brain tissue homogenate. 5-Hydroxytryptophan, formed enzymatically from tryptophan (incubation time, 20 min), is extracted with perchloric acid and determined by HPLC. Detection is performed fluorometrically after post-column derivatization by a reaction with benzylamine in the presence of potassium hexacyanoferrate (III). The lower limit of detection for 5-hydroxytryptophan formed enzymatically is 100 fmol at a signal-to-noise ratio of three.

Determination of maprotiline in plasma by high-performance liquid chromatography with chemiluminescence detection

A simple and sensitive high-performance liquid chromatographic method is described for the determination of maprotiline, an antidepressant, in plasma. After a single-step extraction from plasma (100 microliters) with n-hexaneisoamylalcohol (19:1, v/v), the drug and desipramine (internal standard) are converted into their chemiluminescent derivatives by reaction with 6-isothiocyanatobenzo[g]phthalazine-1,4(2H,3H)-dione, a new chemiluminescence derivatization reagent for amines. The derivatives are separated within 60 min on a reversed-phase column, TSKgel ODS-80, using isocratic elution with acetonitrile-100 mM acetate buffer (pH 3.2), and produced chemiluminescence by reaction with hydrogen peroxide in the presence of potassium hexacyanoferrate(III) in alkaline medium. The detection limit for maprotiline added to plasma is 0.36 pmol (0.1 ng)/ml plasma (1.5 fmol on column), at a signal-to-noise ratio of 3.

Development of a novel luminol-related compound, 3-propyl-7,8-dihydropyridazino-[4,5-g]quinoxaline-2,6,9(1H)- trione, and its application to hydrogen peroxide and serum glucose assays

Manual and flow injection methods with chemiluminescence detection were developed for the determination of hydrogen peroxide (H2O2) using a novel luminol-related compound, 3-propyl-7,8-dihydropyridazino[4,5-g]quinoxaline-2,6,9(1H)-trione (PDIQ), having a higher efficiency than luminol. The methods are based on the chemiluminescence produced by the reaction of H2O2 with PDIQ in the presence of microperoxidase in alkaline media. Detection limits for manual and flow injection methods are 13 pmol per 100 microliter of test solution and 1.3 pmol per 100 microliter injection volume, respectively, at a ratio of chemiluminescence intensities (or peak heights) of test to blank of 2. The manual method was applied to the determination of glucose in human serum. The method correlated well with the conventional spectrophotometric method (4 = 0.998).

A study of cysts in the oral region. Cysts of the jaw

Clinical cases of cysts of the jaw treated in the Department of Oral Surgery of our university during the 10 y between 1980 and 1989 were studied clinically. Patients with radicular cyst, dentigerous cyst, odontogenic keratocyst and postoperative maxillary cyst, which were found at relatively high frequencies, were further analyzed with regard to age, sex and anatomical distribution. A diagnosis of cyst was established in 1,444 patients during the above period, and 1,234 (85.5%) of them had cysts of the jaw. According to a pathological classification by Ishikawa's method, these patients included 509 (41.2%) with radicular cyst, 259 (27.0%) with dentigerous cyst, 95 (7.7%) with odontogenic keratocyst and 267 (21.6%) with postoperative maxillary cyst. The pattern of age distribution in cases of radicular cyst, odontogenic keratocyst and postoperative maxillary cyst was similar to that found in previous studies. Among patients with dentigerous cyst, those aged under 20 y accounted for about 60%. Radicular cyst occurred most frequently in the maxillary lateral incisors, dentigerous cyst in the mandibular wisdom teeth, and odontogenic keratocyst in the region between the mandibular molar and the ramus of the mandible.

[Reduction mammoplasty with shortened scars: surgical technique]

Reduction mammaplasty is nowadays one of the most frequently performed plastic surgeries. The main purpose is the reduction of the volume of breasts, but the resulting scars can jeopardize the result of the operation. The Division of Plastic Surgery follows the modern tendency of reducing the length of the incisions and thus the resulting scars. A technique that incorporates this principle was developed with good results. The technique is simple enough to be used in a training program.

Secondary rhinoplasty: reconstitution of the allar cartilage by a rhinoplasty with an external incision

Presentation of 62 cases of secondary nasal deformities treated by external incision. Several types of endonasal deformities were observed, properly classified and repaired. When excessive resection was observed, local cartilage graft, septonasal or conchal types were employed.

Angiotensinogen-deficient mice with hypotension

The renin-angiotensin system is an enzymatic cascade that produces a potent vasoconstrictor octapeptide angiotensin II, through its physiologically inactive intermediate decapeptide angiotensin I, from their precursor angiotensinogen. In the present study, we generated angiotensinogen-deficient mice by homologous recombination in mouse embryonic stem cells. These mice do not produce angiotensinogen in the liver, resulting in the complete loss of plasma immunoreactive angiotensin I. The systolic blood pressure of the homozygous mutant mice was 66.9 +/- 4.1 mm Hg, significantly lower than that of wild-type mice (100.4 +/- 4.4 mm Hg). This profound hypotension in angiotensinogen-deficient mice demonstrates an indispensable role for the renin-angiotensin system in maintaining blood pressure.

Simultaneous high-performance liquid chromatographic determination of 6 beta-hydroxycortisol and cortisol in urine with fluorescence detection and its application for estimating hepatic drug-metabolizing enzyme induction

A simple and sensitive high-performance liquid chromatographic method is described for the simultaneous determination of 6 beta-hydroxycortisol (6 beta-OHF) and cortisol (F) in urine. Urine (1 ml) containing fludrocortisone as the internal standard is extracted with ethyl acetate. The extract is washed successively with sodium hydroxide solution and water, and subsequently dried under a stream of nitrogen. The residue is redissolved in methanol. The 6 beta-OHF, F and fludrocortisone in the methanol solution are oxidized by cupric acetate and the resulting glyoxal compounds are converted into fluorescent derivatives with 1,2-diamino-4,5-methylenedioxybenzene (DMB). The DMB derivatives of the corticosteroids are separated within 70 min on a reversed-phase column, L-Column ODS, using stepwise elution with methanol-acetonitrile-0.5 M ammonium acetate and detected fluorimetrically at 350 nm (excitation) and 390 nm (emission). The lower limits of detection for 6 beta-OHF and F are 1.8 pmol (680 pg) and 2.4 pmol (950 pg)/ml urine (0.6 pmol and 0.8 pmol/100 microliters injection volume), respectively, at a signal-to-noise ratio of 3. This method can be applied to the determination of urinary 6 beta-OHF, and the ratio of 6 beta-OHF to F in humans and in rhesus monkeys treated orally with phenobarbital as a hepatic drug-metabolizing enzyme inducer.

Benign prostatic hyperplasia: value of MR imaging for determining histologic type

PURPOSE

To assess the value of magnetic resonance (MR) imaging for determining the histologic type of benign prostatic hyperplasia (BPH).

MATERIALS AND METHODS

Unenhanced T1- and T2-weighted images and gadolinium-enhanced T1-weighted images were obtained in the transverse plane at 1.5 T in 33 patients with BPH. Hyperphasia was classified as stromal or nonstromal. Nonstromal hyperplasia was diagnosed if (a) the nodules in the inner gland had heterogeneous high signal intensity on T2-weighted images and peripheral enhancement on gadolinium-enhanced images, (b) a surgical capsule was present, or (c) the inner gland volume to total volume ratio was greater than 0.75.

RESULTS

A correct diagnosis was made with MR imaging in 23 of 24 patients with nonstromal hyperplasia and eight of nine with stromal hyperplasia (94% accuracy). In nonstromal hyperplasia, nodular lesions were seen in 20 patients and a surgical capsule was seen in 19. Eighteen patients had a transition zone ratio greater than 0.75.

CONCLUSION

MR imaging appears to be useful for choosing the type of pharmacotherapy performed because accurate histologic assessment is possible.

Comparative metabolism and structure of BCKD-E2 in primary biliary cirrhosis

The identification and cloning of the mitochondrial autoantigens in primary biliary cirrhosis (PBC) have provided new clues in disease pathogenesis. The two major autoantigens are the E2 subunits of pyruvate dehydrogenase and branched-chain ketoacid dehydrogenase (BCKD). Interestingly, one of these complexes, BCKD-E2, is already well known to clinical medicine based on its association with genetic mutations in maple syrup urine disease (MSUD). Patients with this disease have an inability to metabolize branched-chain amino acids. In the present study, we have taken advantage of the known sequence of BCKD-E2 from normal humans, and addressed the issue of whether there is an altered autoantigen sequence in hepatocytes of individuals with primary biliary cirrhosis. In particular, we examined both the leader sequence and the B-cell immunodominant epitope, the lipoic acid domain. In addition, because patients with PBC have autoantibodies to the BCKD-E2 complex, we have quantitated plasma levels of alpha-ketoacids potentially affected in maple syrup urine disease. These include pyruvic acid (PY), phenylpyruvic acid (PP), alpha-ketoisocaproic acid (KIC) alpha-ketoisovalerate (KIV) and alpha-keto-beta-methylvaleric acid (KMV). The levels of these alpha-ketoacids were compared in patients with primary sclerosing cholangitis and normal volunteers. The sequence of BCKD-E2 obtained from PBC hepatocytes showed homology with normal BCKD. Further studies of autoantigen structure and sequence are clearly indicated, including those involved in mitochondrial transport and localization. Finally, we noted a statistically significant increase in all plasma alpha-ketoacids except alpha-keto-beta-methylvaleric acid in PBC patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[CT evaluation of the pelvic cavity after total cystectomy]

CT scans were performed 40 times in 28 postcystectomy patients to identify the type and location of tumor recurrence. Sixteen patients showed tumor recurrence. Patients without recurrence showed a complete symmetric pelvis and a thin string that looked like an operation scar. Cutaneous ureterostomy showed small tube-like structures, and ileal conduit looked like herniation of the ileum. Cases with recurrent tumors were divided into 3 patterns, 1) pelvic abscess recurrence, 2) anterior abdominal wall thickening, 3) pelvic lateral wall thickening, and combinations of these types. The abscess-recurrence type often showed air within the mass or a fuzzy contour that could not be differentiated from true inflammatory abscess. Anterior abdominal wall thickening was usually accompanied with abscess-type recurrence and appeared as thickening of the operation scar. Lateral wall thickening was usually seen at the site of the obturator internus muscle or obturator node. Patients without recurrence had no complaints except for two who had ileus. All patients with recurrence except one had complaints of pain, abnormal secretion, or a palpable mass. Because all patients with recurrence already had a relatively large tumor at the time of CT, routine follow-up CT is recommended even if the patient has no complaints.