Global untargeted and individual targeted plasma metabolomics of breast cancer recurrence modified by hormone receptors

BACKGROUND

Breast cancer is a heterogeneous and complex etiological disease. Understanding perturbations of circulating metabolites could improve prognosis.

METHODS

We recruited breast cancer patients from Kaohsiung Medical University (KMU) to perform untargeted (case-control design) and targeted (patient cohort) metabolomics analyses in the discovery and validation phases to evaluate interaction effects between clinical factors and plasma metabolites using multivariable Cox proportional hazards model.

RESULTS

In the discovery phase, partial least squares-discriminant analysis (PLS-DA) showed that plasma metabolites were significantly different between recurrent and non-recurrent breast cancer patients. Metabolite set enrichment analysis (MSEA) and metabolomic pathway analysis (MetPA) showed that valine, leucine, and isoleucine degradation was the significant pathway, and volcano plot showed significant ten upregulated and two downregulated metabolites between recurrent and non-recurrent cases. Combined with receiver operating characteristic (ROC) curve and biological significance, creatine, valine, methionine, and mannose were selected for the validation phase. In this patient cohort with 41 new-recurrent vs. 248 non-recurrent breast cancer cases, followed for 720.49 person-years, compared with low level of valine, high valine level was significantly negatively associated with recurrent breast cancer (aHR: 0.36, 95% CI: 0.18-0.72, P = 0.004), especially in ER-negative and PR-negative status. There were interaction effects between valine and ER (Pinteraction = 0.006) as well as PR (Pinteraction = 0.002) on recurrent breast cancer. After Bonferroni correction, stratification effects between valine and hormone receptors were still significant.

CONCLUSION

Our study revealed that plasma metabolites were significantly different between recurrent and non-recurrent patients, proposing therapeutic insights for breast cancer prognosis.

Association of early-onset breast cancer with body mass index, menarche, and menopause in Taiwan

Background

The trend of women suffering from early-onset breast cancer is increasing in Taiwan. The association of early-onset breast cancer with body mass index (BMI), menarche, and menopausal status has focused interest on the field of cancer epidemiology; however, few studies have explored the interaction of these factors on early-onset risk. This study aimed to estimate the interaction effects of BMI, menarche, and menopausal status on 40-year-old early-onset breast cancer.

Methods

Breast cancer patients were recruited from Kaohsiung Medical University Chung-Ho Memorial Hospital from 2013 to 2020. Multivariable logistic regression was used to estimate odds ratios (ORs) for early-onset breast cancer risk associated with menarcheal age stratified by sociodemographic factors and for the interaction between BMI and menopausal status on early-onset risk.

Results

A total of 775 participants were divided into 131 early-onset cases (≤ 40 years) and 644 late-onset cases (> 40 years). Compared to the age of 13 years at menarche, the age ≤ 11 years was significantly positively associated (OR: 2.62, 95% CI: 1.38–4.97) and ≥ 16 years was negatively associated (OR: 0.13, 95% CI: 0.03–0.53) with 40-year-old early-onset breast cancer respectively. In an adjusted model, the status of BMI < 24 and premenopause had 1.76- and 4.59-fold risk of early-onset breast cancer respectively. Especially in BMI < 24 status, premenopause also had a 6.47-fold early-onset risk and the early-onset risk increased by a significant amount per one year younger at menarche (aOR: 1.26, 95% CI: 1.03–1.55). There was also a positive interaction effect on an additive scale between BMI and menopausal status on early-onset breast cancer (RERI_OR = 4.62, P_interaction = 0.057). Compared to both BMI ≥ 24 and peri-/postmenopausal status, both the status of BMI < 24 and premenopause were associated with early-onset breast cancer (aOR: 7.16, 95% CI: 3.87–13.25).

Conclusions

This study suggests that the status of BMI < 24 and premenopause were associated with an increased risk of early-onset breast cancer and there was a positive interaction on an additive scale. Understanding how obesity and menopausal status affect early-onset breast cancer is important for drafting preventive measures for early-onset breast cancer in Taiwan.

DEHP mediates drug resistance by directly targeting AhR in human breast cancer

Resistance to chemotherapy and hormonal therapy is a major clinical problem in breast cancer medicine, especially for cancer metastasis and recurrence. Di(2-ethylhexyl)phthalate (DEHP) affects drug resistance by an unknown mechanism of action. Here we analyzed breast cancer patients (N = 457) and found that Σ₄MEHP (the sum of MEHP, MEHHP, MECPP and MEOHP concentrations) in urine was significantly higher (P = 0.018) in the recurrent breast cancer group compared with non-recurrent patients. Σ₄MEHP-High was positively and significantly correlated with tumor stage (P = 0.005), lymph node status (P = 0.001), estrogen receptor status (P = 0.010), Her2/Neu status (P = 0.004), recurrence (P = 0.000) and tumor size (P = 0.002), as well as an independent prognostic marker (OR = 1.868; 95% CI = 1.424-2.451; P < 0.000) associated with poor survival rates based on a positive Her2/Neu status (P = 0.035). In addition, we found that DEHP inhibited paclitaxel and doxorubicin effects in breast cancer cell lines MCF-7 and MDA-MB-231 and in zebrafish and mouse tumor initiation models. DEHP induced trefoil factor 3 (TFF3) expression through the vinculin/aryl hydrocarbon receptor (AhR)/ERK signaling pathway and induced CYP2D6, CYP2C8 and CYP3A4 expression through the AhR genomic pathway to increase the epithelial-mesenchymal transition (EMT) and doxorubicin metabolism, respectably. DEHP mediated AhR-related alterations in estrogen receptor expression through the ubiquitination system, which decreased tamoxifen effects in AhR knockout mice. These findings suggest a novel therapeutic avenue by targeting AhR in drug-resistant and recurrent breast cancer.

Visceral obesity and cell cycle pathways serve as links in the association between bisphenol A exposure and breast cancer

It has been identified that bisphenol A (BPA) exposure causes developmental toxicity in breast cells. However, the exact molecular mechanisms underlying the association between exposure to BPA and breast cancer remain unclear. The aim of the present study was to investigate the BPA-regulated signaling pathways associated with the aggressiveness and the development of breast cancer. Microarray technology and functional gene set analyses were used to evaluate BPA and breast cancer-associated biomarkers and pathways in a discovery-driven manner. Using individual dataset analyses, it was indicated that two BPA-associated gene sets, the visceral obesity pathway, involved in visceral fat deposits and the metabolic syndrome, and the cell cycle pathway, involved in cyclins and cell cycle regulation, were significantly associated with a high grade of aggressiveness and the development of estrogen receptor (ER)-positive breast cancer (between P<0.05 and 0.0001). The pooled analysis indicated that the most significant pathway was G₁/S checkpoint regulation, and the cyclin and cell cycle regulation pathway for BPA-associated ER-positive cancer. Cancer cell signaling pathways were associated with healthy breast cells developing into breast cancer. The visceral obesity and the cell cycle pathways were indicated to link BPA exposure to breast cancer. The results of the present study demonstrate a significant association between breast cancer and BPA-regulated gene pathways.

Breast cancer is associated with methylation and expression of the a disintegrin and metalloproteinase domain 33 (ADAM33) gene affected by endocrine‑disrupting chemicals

A disintegrin and metalloproteinase domain 33 (ADAM33) gene is a transmembrane glycoprotein that mediates changes in cell adhesion and plays an important role in cancer progression. Since bisphenol A (BPA) and phthalates are epigenetically toxic, the purpose of this study was to examine whether BPA and phthalate metabolites, including monoethyl phthalate (MEP), mono‑n‑butyl phthalate (MBP), mono‑isobutyl phthalate (MIBP), mono(2‑ethylhexyl) phthalate (MEHP), mono(2‑ethyl‑5‑hydroxyhexyl) phthalate (MEHHP), mono(2‑ethyl‑5‑carboxypentyl) phthalate (MECPP), and mono(2‑ethyl‑5‑oxohexyl) phthalate (MEOHP), have an epigenetic impact on ADAM33 and the incidence of breast cancer. CpG islands of breast cancer microarray datasets obtained from the Gene Expression Omnibus (GEO) were used to assess the ADAM33 methylation profile. We designed a case‑control study including 44 cases and 22 age‑matched controls to detect the methylation status of intron 1 in ADAM33 from peripheral blood mononuclear cells (PBMCs) in blood, using BSP, nested PCR, and bisulfite sequencing, and measured the in vivo gene expression of ADAM33 and the urinary concentrations of endocrine‑disrupting chemicals (EDCs), using real‑time PCR, high‑performance liquid chromatography (HPLC) and liquid chromatography-mass spectrometry (LC‑MS). Only one dataset, GSE32393, reached significance (P=0.016). ADAM33 expression and methylation frequencies at CpG site 3 in intron 1 were higher in the control group. We found a positive association between intron 1 methylation level and ADAM33 expression as well as urinary concentrations of MEHHP, MECPP, MEOHP and Σ4MEHP (the sum of MEHP, MECPP, MEHHP, and MEOHP) in the cases. This study suggests that metabolites of phthalate such as MEHHP, MECPP, MEOHP and Σ4MEHP may increase the intron 1 methylation level to elevate ADAM33 gene expression and have a protective effect on reducing the risk of breast cancer.

Surgical resolution of accidental intramuscular injection of Gudair® vaccine in a mare

This case report describes the accidental intramuscular administration of 20 mL Gudair® vaccine to a 7-year-old Standardbred mare and successful treatment of the resulting inflammatory reaction by radical surgical resection.

The methylation patterns of a disintegrin and metalloproteinase 33 gene (ADAM33) in adult asthma

BACKGROUND

Asthma is a common chronic inflammatory respiratory disease. Previous studies have suggested that the pathogenesis of asthma may be affected by epigenetic regulation. The purpose of this study is to characterize the effect of the methylation of each CpG site in the ADAM33 (a disintegrin and metalloproteinase 33) gene in adult asthma.

METHODS

A human CpG island microarray was used to examine 4 asthmatic cases and 4 healthy controls, and the results suggested that there might be differences in methylation within exon 9 of the ADAM33 gene. Therefore, we designed a case-control study with 50 asthmatic patients and 50 age- and sex-matched healthy controls to examine the relationship between the CpG methylation of the ADAM33 gene and asthma using bisulfite deoxyribonucleic acid modification and sequencing.

RESULTS

Bisulfite sequencing experiments showed that the 14 CpG sites in exon 9 of the ADAM33 gene were highly methylated (100%) in all individuals. The proportions of methylation of the 14 CpG sites in ADAM33 in the case group were not different from those of the control group. The methylation of exon 9 of this locus was not associated with age, sex, IgE levels, or lung function. This study found no association between the methylation of CpG sites in exon 9 of the ADAM33 gene and adult asthma.

CONCLUSIONS

The 14 CpG sites were highly methylated in the case and control groups. Further investigation of exon 9 in ADAM33 in a larger population is needed to evaluate its role in asthma.

Acute lobar nephronia in a renal allograft: a case report and literature review

We report a diabetic renal transplant recipient who presented with fever and right lower quadrant abdominal pain. Acute appendicitis was considered initially and she underwent emergent appendectomy. However, persistent symptoms postoperatively made us perform an imaging study to identify the problems. Abdominal and pelvic computed tomography disclosed several focal wedge-shaped lesions of low attenuation in the renal allograft. Acute lobar nephronia was successfully managed with parenteral antibiotics. The patient recovered without any sequela. A renal allograft in the right iliac fossa complicates the diagnosis among acute renal infection, malignancy, acute rejection, and even acute appendicitis. Biopsy of the renal allograft is sometimes needed due to clinically ambiguous imaging results. In this report, we not only detail the clinical course of such a rare case, but also review the previous 3 cases of acute lobar nephronia in renal allografts in the literature.

Repair of oroantral communications in the third molar region by random palatal flap

Various palatal flap procedures based on the greater palatine vessels have been advocated for the repair of oroantral communications (OACs). However, when the defect is located in the third molar region, difficulty is encountered in using the palatal flap because rotation is hindered by the vascular pedicle. In this study, we used random palatal flaps to repair OACs in the third molar area in 21 patients. The vascular pedicles were ligated and severed in all cases in order to evaluate whether it was necessary to preserve the greater palatine vessels when using the palatal rotation flap (PRF). The repair was successful in 16 cases (76.2%). The length/width ratio of the flap was the most important factor determining the outcome. The ratios were 2.23 +/- 0.12 and 2.40 +/- 0.14 in the success and failure groups, respectively and their difference was statistically significant (P<0.05). Other clinical parameters such as age, gender, antral infection, tooth displacement into the sinus and duration of the communication had no influence on the outcome (P>0.05). The study showed that the PRF with the appropriate length/width ratio can safely be used in a random fashion. This provided another option in the repair of oroantral communications of difficult locations such as in the tuberosity area.

Evaluation of peribulbar anesthesia in encircling scleral buckle surgery and its postoperative pain course

BACKGROUND

Retrobulbar anesthesia is considered effective in ocular surgery but it can give rise to serious complications. We used peribulbar anesthesia with sub-Tenon's irrigation to perform encircling scleral buckling for retinal detachment, as it could reduce the complications caused by retrobulbar anesthesia. We also recorded the course of pain for 72 hours after surgery.

METHODS

Thirty patients who were diagnosed with rhegmatogenous retinal detachment were treated with an encircling scleral buckle. The surgery was performed with peribulbar anesthesia with occasional sub-Tenon's irrigation. We evaluated the patient's pain with a visual analogue scale after surgery at 30 minutes, 1 hour, 2 hours, 4 hours, 6 hours, 12 hours, 24 hours, 48 hours, and 72 hours.

RESULTS

In 24 cases (80%), the anesthesia was complete with the peribulbar block. Only 6 patients (20%) needed sub-Tenon's irrigation and four of them felt no pain after augmentation. Although all the surgical procedures proceeded without problem, two of the patients felt pain and were uncomfortable during the surgery. No serious complications occurred. The course of pain peaked 6 hours after surgery when 26 patients (86.7%) felt pain and 12 patients (40%) were uncomfortable (pain score > or = 5). Forty-eight hours after surgery, 9 patients (30%) still felt pain but no one felt uncomfortable.

CONCLUSION

Peribulbar anesthesia can be used safely in encircling scleral buckling for retinal detachment. The postoperative pain is maximal 6 hours after surgery and becomes mild (pain score < or = 4) after 48 hours.

Arecoline cytotoxicity on human oral mucosal fibroblasts related to cellular thiol and esterase activities

Betel quid (BQ) chewing is associated with an increased risk of oral submucous fibrosis (OSF) and oral cancer in India and many south-east Asian countries. Recently, we have shown that arecoline is cytotoxic to cultured human oral mucosal fibroblasts. This study investigated protective effects of various agents against the cytotoxicity of arecoline and its mechanisms. Arecoline, at concentrations of 0.2 and 0.4 mM, decreased the cell numbers by 38% and 63%, respectively. At a concentration of 2 mM, N-acetyl-L-cysteine [a glutathione (GSH) synthesis precursor] could prevent arecoline-induced cytotoxicity. The decrease in cell numbers was reduced to 17% relative to control. Extracellular addition of esterase at a concentration of 0.1 U/ml could almost completely protect the oral mucosal fibroblast (OMF) from arecoline-induced cytotoxicity. Arecoline is a muscarinic receptor agonist. However, atropine, a muscarinic receptor antagonist was unable to protect the cells from arecoline cytotoxicity at a concentration of 10 microM. Pretreatment of OMF with 50 microM buthionine sulfoximine (a cellular GSH synthesis inhibitor) or 0.5 mM diethylmaleate (a cellular GSH depleting agent) potentiated the cytotoxic effects of arecoline. These results indicate that cytotoxicity of arecoline on OMF is associated with cellular GSH levels and esterase activities. Factors that induce the GSH synthesis or esterase activity of oral mucosal cells can be used for future chemoprevention of BQ chewing-related lesions.

Once-a-month treatment with a combination of mifepristone and the prostaglandin analogue misoprostol

In this two centre study, the efficacy of 200 mg mifepristone orally followed 48 h later by 0.4 mg misoprostol orally for menstrual regulation was investigated. The dose of mifepristone was taken the day before the expected day of menstruation. Each volunteer was planned to participate for up to 6 months. A plasma beta human chorionic gonadotrophin (HCG) was measured on the day of mifepristone intake. The study was disrupted prematurely due to low efficacy. In 125 treatment cycles the overall pregnancy rate was 17.6% (22 pregnancies) and the rate of continuing pregnancies (failure) was 4.0%. Eight women discontinued the study due to bleeding irregularities which were seen in 15 cycles (12%). These effects on bleeding pattern made the timing of treatment day difficult. Late luteal phase treatment with a combination of mifepristone and misoprostol is not adequately effective for menstrual regulation.

Cytotoxic and cytostatic effects of arecoline on oral mucosal fibroblasts

Betel quid (BQ) chewing shows strong correlation to the incidence of oral submucous fibrosis and oral cancer in Taiwan. Arecoline, the main areca alkaloid, is considered to be one of the etiologic factors in BQ. To elucidate the role(s) of arecoline in the pathogenesis of BQ chewing related oral mucosal lesions, we used oral mucosal fibroblasts to study the effects of serum concentration, cell density, and incubation time on the cytotoxic response to arecoline. At a concentration less than 0.2 mM, arecoline was not cytotoxic to oral mucosal cells after 1, 3, and 6 days of incubation. After 3 days of incubation, the cytotoxic and cytostatic effects of arecoline became evident when the cells were exposed to higher concentrations of arecoline (0.2 mM) and serum (10% FCS). Exposure of cells (1 x 10(4) cells/well) to 0.2 mM of arecoline in 0.5% FCS for 3 and 6 days led to a 20% and 23% decrease, respectively, in the cell number, whereas exposure of cells (1 x 10(4) cells/well) to 0.2 mM arecoline in 10% FCS led to a 38% and 53% decrease, respectively, in cell number. At a higher cell density (5 x 10(4) and 1 x 10(5) cells/well), 0.2 mM arecoline led to less cytotoxicity (38% and 21% of decreasing in cell number, respectively) after 6 days of incubation. Our results indicated that arecoline was not mitogenic to oral mucosal fibroblasts, and that the cytotoxic and cytostatic effects of arecoline on oral mucosal fibroblasts could be modulated by the changes in the cell density, serum concentrations, and incubation time.

[A study on the relation between cerebral lesion and cognitive defect in multi-infarct patients]

240 cases of multi-infarct patients with more than two cerebral infarct lesions in CT findings were collected successively from 1991 to 1992. 42.92% of them were shown to have cognitive defect with a series of neuropsychological tests. Correlation of the occurrence of cognitive defect with the CT findings such as the location and extent of focal lesions as well as the presence of cerebral atrophy or subcortical degeneration were carried out. According to the results by multiple regression and factor analysis, the location and extent of the focal infarct lesions were not the primary determining factor for the occurrence of cognitive defect. It is, therefore, suggested that the term of ischemic or vascular dementia be used clinically instead of the so-called multi-infarct dementia.

Effects of different doses of norethisterone on ovarian function, serum sex hormone binding globulin and high density lipoprotein-cholesterol

The ovarian effects of different doses of norethisterone (NET) were compared in 45 normally menstruating women in order to find the lowest effective dose of the Chinese NET "visiting pill". Subjects were randomly divided into 3 groups. Each subject in each group was taking 0.5, 1.5 or 3.0 mg per day from days 5 to day 18 of the cycle. Blood samples were taken on days 5, 8, 11, 14, 17, 20, 23, 26 and 29 of the cycle. Serum oestradiol (E2), progesterone (P), sex hormone binding globulin (SHBG), high density-lipoprotein cholesterol (HDL-C), and NET concentrations were measured. Ovulation, delayed ovulation, ovulation inhibition and follicular activity were classified by the analysis of the peripheral serum levels of sex hormones. Ovulation occurred in 7 women in the 0.5 mg group, in 2 women in the 1.5 mg group and in none of the 3.0 mg group. Mean serum SHBG levels were reduced progressively by 6.6% (Group 0.5), 15.5% (Group 1.5) and 23.4% (Group 3.0). There were no significant changes in HDL-C levels in any group. There was a significant correlation of mean serum NET concentrations with dose. The lack of complete inhibition of ovulation in most women in the 1.5 mg and 0.5 mg groups might suggest that the dose of NET required when used as a visiting pill could not be reduced below 3.0 mg.

A cross-over study of three oral contraceptives containing ethinyloestradiol and either desogestrel or levonorgestrel

A randomised cross-over trial was performed to compare the pharmacodynamic actions of three low-dose oral contraceptives (OCs): Marvelon (150 micrograms desogestrel (DSG)+ 30 micrograms ethinyloestradiol (EE)), Mercilon (150 micrograms DSG + 20 micrograms EE) and Microgynon (150 micrograms levonorgestrel (LNG) + 30 micrograms EE). None of the OCs produced any significant changes in serum cholesterol, LDL-C and apoprotein B. Triglycerides were increased by the desogestrel OCs but not by Microgynon. The latter however increased the glucose and insulin responses to a glucose tolerance test whereas Marvelon and Mercilon had no effect. HDL-C increased with Marvelon, was unchanged with Mercilon and was decreased with Microgynon. Apoprotein AII was increased by all three OCs but only the DSG OCs increased apoprotein AI. All OCs produced similar increases in caeruloplasmin but the increase in SHBG was much greater with Marvelon and Mercilon than with Microgynon. Testosterone was reduced more with Microgynon than with the DSG OCs. Many of the changes reflect the strong anti-oestrogenic action of LNG on metabolic parameters compared to DSG. Except for the effect on HDL-C, there was little difference between Marvelon and Mercilon on metabolic parameters and this complements the findings from large-scale clinical trials of the two OCs. Mercilon, therefore provides a very satisfactory alternative to Marvelon.

Ni-Ti memory alloy clamp plate for fracture of short tubular bone

The clamp shape implant has a special memorial function. It consists of one main rod and 3 or 4 pairs of curved short arms located at both sides of the rod. Each pair of arms rolls into a circle, which can embrace 2/3 of the circumference of the fractured bone shaft, thus fixing fragmental bones at multiple points more securely without any limitation to the motion of adjacent joints. Therefore, clamp implant is especially useful for comminuted fracture of the short tubular bone, which is difficult to fix by other methods.

A pharmacodynamic and pharmacokinetic study of the Chinese No. 1 pill

A pharmacodynamic and pharmacokinetic study of the Chinese No. 1 pill, a combined oral contraceptive containing 35 micrograms ethynyloestradiol (EE) and 600 micrograms norethisterone (NET), was performed in 29 women over a period of six months. Blood samples for analysis were taken during a pretreatment cycle, the first and 6th treatment cycles and post-treatment. Minor changes in carbohydrate metabolism occurred and these were particularly noticeable when the incremental areas under the serum concentration-time curves for both glucose and insulin in response to a glucose tolerance test were calculated. No changes occurred in the serum glycosylated haemoglobin levels. The serum concentrations of all the lipids measured (total cholesterol, triglycerides, LDL-C, HDL-C and apolipoproteins AI, AII and B) were significantly increased on treatment as were levels of Factor X, SHBG and caeruloplasmin whereas antithrombin III decreased. In 38 of the 40 treatment cycles, ovulation was suppressed. In one cycle serum oestradiol and progesterone levels showed a typical ovulatory pattern and in another there was evidence of follicular activity without ovulation. Serum EE concentrations showed a similar pattern in both treatment cycles showing that co-administration of NET did not affect EE metabolism. Serum NET levels were higher in the 6th than in the first treatment cycles. On comparing pharmacodynamic and pharmacokinetic parameters, the only statistically significant correlations were between the percentage change in triglycerides and SHBG and serum NET, but not EE concentrations, and between apolipoproteins AI and serum EE.

Spinal cord compression due to metastatic disease: diagnosis with MR imaging versus myelography

To determine the efficacy of magnetic resonance (MR) imaging and myelography for the diagnosis of spinal cord compression due to metastatic disease, the authors prospectively examined 70 patients who had known or suspected spinal involvement by malignancy. Most MR examinations consisted of T1-weighted sagittal imaging of the entire spine, with additional sequences as needed for clarification. Extradural masses were found in 46 patients, 25 of whom had cord compression. For extradural masses causing cord compression, the sensitivity and specificity of MR imaging was .92 and .90, respectively, compared with .95 and .88 for myelography. For extradural masses without cord compression the sensitivity and specificity of MR imaging was .73 and .90, versus .49 and .88 for myelography. MR imaging was much more sensitive for metastases to bone (.90 vs .49), as expected. MR imaging is an acceptable alternative to myelography for diagnosing spinal cord compression and is preferable as a first study because it is noninvasive and better tolerated.

The use of nickel-titanium alloy in orthopedic surgery in China

A new biomaterial made of nickel and titanium with its shape-memory characteristics has been manufactured, investigated, and used in Shanghai, China. Since 1981, this biomaterial has been used in 265 cases clinically, among which 71 involved orthopedic surgery. Results are satisfactory without failure in our short-term follow up. This preliminary report of the use of this new biomaterial with the unique characteristic of being able to recover to its original shape with particular transformation temperatures indicates its potential for opening a new field for investigation in surgery. Research to discover appropriate ratios of nickel and titanium for specific usage is underway. The interest and cooperation between the medical and engineering professions may eventually solve the problems through mutual efforts and result in improved shape-memory biomaterials.

Transvenous embolization of direct carotid cavernous fistulas

Of 165 cases of direct carotid cavernous fistula, 14 (8.5%) were treated from a transvenous approach. Twelve of these were treated through the inferior petrosal sinus and one through the superior ophthalmic vein. In one patient, both approaches were used. The embolic agents were as follows: five patients had balloons only, four patients had minicoils alone, three patients had coils and liquid adhesives, one had balloons and coils, and one had balloons and liquid adhesives. Among the patients who were treated from a transvenous approach, three had an occluded carotid artery caused by trauma, nine failed transarterial balloon attempts, and one had a prior trapping procedure. In the remaining patient, who had Ehlers-Danlos syndrome, a transarterial approach was judged to be too dangerous. This patient suffered a fatal pontine hemorrhage after subtotal transvenous occlusion of the carotid cavernous fistula with diversion of flow into cortical veins. Another complication occurred when the inferior petrosal sinus was perforated during catheterization, causing a small subarachnoid hemorrhage. The tear was immediately closed with minicoils, and surgical exposure and embolization resulted in complete cure. Of the remaining 12 patients treated, 11 were completely cured and one showed angiographic and clinical improvement. Transarterial balloon embolization remains the procedure of choice in the treatment of symptomatic carotid cavernous fistulas; however, transvenous embolization is an alternative when the arterial route fails.

Conventional vs computed radiography: evaluation of myelography

A prospective study was performed to compare the diagnostic efficacy of conventional film-screen (FS) imaging with computed radiography (CR) in myelography. Forty examinations were done with both methods. Digital myelography was found to have diagnostic accuracy equal to that of conventional film-screen examinations.

Platinum wire: a new transvascular embolic agent

Standard Gianturco and "mini" coils cannot be used with some of the present microcatheter systems. However, occasions arise in which metallic coils would be an ideal embolic agent in vascular structure accessible only to a tracker (2.2-French) catheter system. We performed nine embolization procedures in eight patients with arteriovenous fistulas using platinum coils as an embolic agent. Fistulas were completely occluded in six of the nine cases. In several cases, platinum wire embolization was augmented with other agents. Complications occurred in two cases, neither resulting in permanent neurologic deficits. Advantages of using platinum coils included availability, radioopacity, thrombogenicity, biocompatibility, and delivery through microcatheters, specifically the tracker catheter system.

Intracranial non-Hodgkin lymphoma occurring after treatment of Hodgkin disease

Patients with successfully treated Hodgkin disease are at increased risk for the development of second malignancies. We present two cases of intracranial non-Hodgkin lymphoma that appeared following successful treatment of Hodgkin disease. The appearance of the lymphomas on computed tomographic images is shown, and possible predisposing factors, differential diagnosis, and clinical implications are discussed.

Computed tomography in hematologic malignancies of paranasal sinuses

Hematologic malignancies of the paranasal sinuses are uncommon. Four young patients with ophthalmologic abnormalities as a chief complaint are presented. Lymphoma or leukemia should be considered in the differential diagnosis of destructive lesions in the paranasal sinuses, particularly in children and young adults.

Cranial metastases from prostate cancer simulating meningioma: report of two cases and review of the literature

Two cases of prostatic carcinoma metastatic to the cranium that presented with clinical and radiographic features simulating meningioma are described. The literature was reviewed, and 13 similar cases were identified. From the data gathered, we conclude that metastatic prostate cancer should be considered in the differential diagnosis of elderly males who present with characteristic clinical and radiological features of meningioma and that the classical description of meningioma is not specific.

A pharmacokinetic and pharmacodynamic study of a 'visiting pill' containing norethisterone

The pharmacokinetics and pharmacodynamic effects of two doses of norethisterone (5mg and 3mg) used as a 'visiting pill' were investigated. There were no significant differences in the pharmacokinetics of the two doses except for the peak concentration achieved and the bioavailability as assessed by the area under the serum norethisterone concentration - time curve. Both doses were rapidly absorbed. Pharmacodynamic effects were minor. No change occurred in serum concentrations of total cholesterol, total triglycerides or HDL-cholesterol. The area under the serum glucose concentration--time curve and particularly the area under the serum insulin concentration--time curve were significantly increased as a result of treatment but no change occurred in the serum levels of glycosylated haemoglobin. SHBG concentrations in serum decreased on treatment whereas those of ceruloplasmin increased.

Vertical fracture of the odontoid: CT diagnosis

A patient with a vertically oriented fracture of the odontoid is described. We found no previous report of this type of fracture. In our patient CT was the best imaging modality for defining the anatomic extent of the fracture.

Dural infolding during C1-2 myelography

Inward buckling of the dura at C1-2 may occasionally occur with hyperextension of the neck and can result in a difficult or unsuccessful puncture when the posterior lateral C1-2 approach is used for cervical myelography. In this circumstance, placement of the head in a neutral or slightly flexed position may widen the posterior subarachnoid space and facilitate the needle puncture.

High-dose i.v. contrast in CT scanning of the postoperative lumbar spine

Evaluation of the postoperative lumbar spine is sometimes difficult because of obliteration of epidural fat by hypertrophic scarring. We examined 70 patients using a high-dose intravenous contrast technique in an attempt to distinguish hypertrophic scarring from herniated disk. The CT interpretation was confirmed in all 17 patients who had follow-up operations. Thirteen had herniated disk material associated with scar and four had hypertrophic scarring only. The latter four patients underwent reoperation because of concomitant foraminal or spinal canal stenosis seen on CT. Twelve of the herniated disks had the expected appearance of a nonenhancing mass surrounded by a rim of enhancing scar tissue. In the 13th patient, homogeneous enhancement of the herniated disk was seen. It is thought that chronically herniated disks, such as this one, may incite enough surrounding scar to give the CT appearance of an enhancing disk. Finally, marginal enhancement in the anulus fibrosus region was seen in over 90% of disk spaces examined. Although an anatomical explanation cannot be given at present, this phenomenon is thought to represent a normal finding.

Primary and secondary histiocytic lymphoma of the brain: CT features

The authors examined 19 patients with diffuse histiocytic lymphoma of the brain, including 8 with primary disease and 11 with secondary disease. Both primary disease and secondary disease involving the brainstem and deep nuclei exhibited the characteristic CT appearance, consisting of a large, solid, homogeneously enhanced mass with varying amounts of edema. However, most secondary lymphomas outside the brainstem and basal ganglia contained large areas of low attenuation consistent with necrosis. Multifocal lesions were seen only in patients with secondary lymphoma. Systemic chemotherapy for extracranial lymphoma had no effect on the CT appearance of intracranial lesions. The authors suggest that these "unusual" CT patterns are actually typical of a distinct subset of histiocytic lymphomas.

Iohexol versus metrizamide for cervical myelography: double-blind trial

Cervical myelography was performed by lateral C1-C2 puncture in 60 patients. Thirty patients received iohexol (an investigational aqueous contrast agent) and 30 received metrizamide in order to provide a prospective, randomized, double-blind trial comparing these contrast media. The two media produced radiographs of equal quality. Contrast-related morbidity was suffered by four patients (13%) in the iohexol group and by 11 patients (37%) in the metrizamide group. These features indicate that iohexol is superior to metrizamide as a contrast agent for cervical myelography.