Experimental colitis in mice: effects of olsalazine on eicosanoid production in colonic tissue. In rodents colitis can be induced by adding 2% (w/v) carrageenan (CARR) for 4 weeks or 10% (w/v) dextran sulphate sodium (DSS) for 7 days to their drinking water. These models are suitable to test anti-inflammatory drugs used in inflammatory bowel disease in man. Mice were treated with olsalazine (400 mg/kg body wt) starting 7 days before the DSS or CARR administration. Colonic tissues were incubated with [1-14C]-arachidonic acid and stimulated with A23187 and, thereafter, the pattern of eicosanoids was determined by separation on HPLC. DSS and CARR produced a marked diffuse inflammatory response in the colon and a subsequent 5-fold increase of all eicosanoids after DSS, whereas after CARR only a 2-fold increase of PGs was observed. Olsalazine treatment decreased all cyclooxygenase and lipoxygenase products to baseline levels.


Anti-inflammatory and gastrointestinal effects of nabumetone or its active metabolite, 6MNA (6-methoxy-2-naphthylacetic acid): comparison with indomethacin. 6MNA, the active metabolite of the non-acidic anti-inflammatory drug nabumetone, was investigated using intravenous administration for effects on (a) carrageenan paw oedema and gastric irritancy compared to either oral nabumetone or both oral and intravenous indomethacin when given acutely and (b) gastrointestinal irritancy when given in repeat dosing studies. An oral dose of nabumetone or intravenous 6MNA produced effective anti-inflammatory activity together with significant inhibition of paw exudate PGE2. An anti-inflammatory oral dose of nabumetone or intravenous 6MNA produced minimal effects on gastric 6-keto-PGF1 alpha production, with an absence of gastric damage, in contrast to indomethacin. In repeat dose studies, 6MNA failed to induce gastrointestinal damage even at doses where general toxicity was evident. These results show that in the rat 6MNA, the active metabolite of nabumetone, is an effective anti-inflammatory drug but, even in very high intravenous doses, does not have the propensity to induce gastrointestinal damage.


EM 405: a new compound with analgesic and anti-inflammatory properties and no gastrointestinal side-effects. EM 405 has analgesic and antitussive effects, probably exerted by noradrenaline uptake inhibition and local anaesthetic actions. It showed anti-inflammatory, which may be due to anti-histaminic and indirect sympathomimetic properties. As oral application of EM 405 did not induce gastrointestinal side effects a possible ulcer preventing action was investigated. EM 405 reduced gastric ulcers induced by ethnology or indomethacin with ED50 values of 45 and 26 mg/kg p.o. Stress-induced ulcer was inhibited with an ED50 of 34 mg/kg. EM 405 reduced basal and stimulated gastric secretion by reducing volume as well as H(+)- and Cl(-)-production. Therefore ulcer prevention by EM 405 may be explained by its inhibitory effects on gastric secretion. The results characterise EM 405 as a novel anti-inflammatory compound with ulcer-protective action.


Gastrointestinal bleeding associated with the use of non-steroidal, anti-inflammatory drugs--symptomatology and clinical course. The symptoms associated with admission for gastrointestinal haemorrhage were studied in relation to the intake of non-steroidal, anti-inflammatory drugs (NSAIDs) within fourteen days prior to admission. In a prospective, two-year study we included only those with bleeding due to gastroduodenal ulcers or haemorrhagic erosive gastritis. In 94 patients with a median age of 74 years, NSAID use was stated in 54, but the symptoms in these subjects (degree of epigastric pain, nausea or heartburn) were no different from those without previous NSAID use. Correspondingly, no difference was seen as to the clinical course of the bleeding.


Effect of sulglycotide treatment on cell kinetics alterations induced by aspirin in humans. The effect on gastric epithelial cell proliferation of small doses of aspirin was evaluated in 9 healthy volunteers, with or without administration of sulglycotide, a sulfated glycopeptide with cytoprotective properties. Cell kinetics study was performed by incubation of gastric biopsies with bromodeoxyuridine (BrdU) and immunohistochemistry. A decrease of BrdU-labeling index and a shortening of the height of gastric columns were observed after treatment with aspirin and placebo. No variations were observed after treatment with aspirin and sulglycotide. A decrease of the epithelial cell renewal could be one of the damaging effects of aspirin on the gastric mucosa. The treatment with sulglycotide seems to be effective to prevent this alteration.


Influence of steroid treatment's duration in patients with active Crohn's disease. Steroids are very useful drugs in the treatment of active Crohn's disease (CD), but clinical relapses after steroid withdrawal may be very high. We investigated the efficacy of two steroid regimens of different duration in inducing remission and in maintaining it after drug suspension. Patients with active CD were randomly assigned to scheme A, lasting 7 weeks (27 patients), or to scheme B, lasting 15 weeks (27 patients). Remission rates at the end of the treatment were 81% for scheme A and 85% for scheme B. Relapse rates at 6 months after stopping the treatment were 50% (11 patients) and 52% (12 patients), respectively. Remission rates seem not to be influenced by the duration of the treatment, but patients recently treated with steroids showed a higher relapse rate if they received the short-duration treatment.


Vasodilator therapy enhances neutrophil tissue migration. Very little is known about the effect of vasoactive substances on migration of polymorphonuclear neutrophils in vivo. We evaluated the effect of oral treatment with isosorbide dinitrate on neutrophil migration into a sterile skin inflammatory focus in man with the use of "skin chamber technique". Isosorbide dinitrate increased the number of neutrophils harvested in the chamber as well as the "granulocyte clearance". Thus, vasoactive agent may increase neutrophil extravasation and subsequent tissue migration.


[Quantitative estimation of the relationship between amino acids and cataracts in rat lens]. The concentration of free amino acids and their related compounds has been determined in the lenses of ICR (f) strain rat and in the Wistar strain rat's lenses which were cultured with diethyl maleate. It was supposed that the decrease of cystathionine and the increase of serine in lenses of ICR with aging were related with development of senile cataracts. The increase of cystathionine in lenses cultured were suggested that synthesis of taurine is done by cystathionine pathway. Quantitative changes of amino acids were higher than normal of glutamine, glycine and aspartate in lenses cultured. It was supposed that the changes were the flow in lens from medium for synthesis of glutathione and glucose.


[Anticoagulant and fibrinolytic therapies for anterior chamber fibrin following cataract surgery in the rabbit eye]. Effects of anticoagulant or fibrinolytic therapy on anterior chamber fibrin following cataract surgery was evaluated. In one series of experiment, various amounts of antithrombin III (ATIII), an anticoagulant, were injected into the anterior chamber of the rabbit eye immediately after phacoemulsification of the lens. In another series, various amounts of tissue plasminogen activator (TPA), a fibrinolytic agent, were injected into the anterior chamber 24 hours after phacoemulsification when it was filled with fibrin. The extent of the fibrin clot was graded using a slit lamp microscope, and the aqueous flare intensity was determined with a laser cell-flare meter for 2 weeks after operation. The eyes treated with TPA was also examined with light and electron microscopy. ATIII showed an inhibitory effect on fibrin formation, but complete inhibition was not obtained even with the highest concentration used. In contrast, the fibrin clot was completely resolved even with the lowest dose of TPA used, while no side effect such as inflammation or bleeding was seen. Histological examinations revealed no pathological changes in eyes treated with TPA. TPA may be a promising agent for fibrin resolution after cataract surgery.


[Changes in retinal blood flow volume in experimental retinal vein compression]. The authors quantitated the retinal blood flow volume during and immediately after experimental compression of the temporal retinal vein in 5 Macaca fuscata monkey eyes. The hydrogen clearance method was used to quantitate the retinal blood flow volume. After placing a microelectrode on the retinal surface, we measured the blood flow volume 4 times at a 15-minute interval. This value served as a baseline for the experiments. Next we compressed the temporal retinal vein near the disc with a 25-gauge needle with a rounded tip under guidance by an indirect ophthalmoscope. We measured the blood flow volume during compression. The compression was maintained for 3 minutes. Further blood flow determination was performed 7 minutes after release of compression and was repeated 4 times at a 15-minute interval. During compression of the temporal retinal vein, the retinal blood flow volume in the area served by the vein decreased by an average of 35%. The flow volume recovered rapidly and remained stable after release of compression. There was no reactive hyperemia. This model appears useful to elucidate the retinal circulation of branch retinal vein occlusion.


[Retinal toxicity of intravitreally injected steroids on the rabbit eye]. The retinal toxicity of intravitreally injected steroids, fluorometholone and tetrahydrocortisol, was examined. The concentration of the steroids was 20 mg/ml, and 0.05 ml of each solution were injected into the rabbit vitreous cavity. An equal volume of saline solution was injected as a control. In addition to ophthalmoscopy, intraocular pressure was measured and electroretinography, light microscopy and electron microscopy were performed. The results showed no remarkable changes in all eyes. Fluorometholone and tetrahydrocortisol seem to have neither toxicity to the retina nor adverse effect of elevating intraocular pressure when intravitreally injected with this amount.


[Ocular effects of topical instillation of UF-021 ophthalmic solution in healthy volunteers]. Phase I studies, as divided into two stages, were conducted in healthy volunteers with the ophthalmic solution of UF-021, a novel prostaglandin metabolite-related compound, that was reported to exhibit potent intraocular pressure (IOP)-reducing activity in various species of animals. In the first stage, the vehicle as well as UF-021 ophthalmic solutions at concentration of 0.03%, 0.06% and 0.09% were applied topically to the eyes of 8 healthy volunteers to determine their respective effects through observations on the IOP, and local ocular and systemic side effects. In the second stage, 2 dosages of UF-021 ophthalmic solution, 0.06% and 0.12%, were applied topically to 11 healthy volunteers to investigate the IOP-reducing activities and local ocular side effects. The results revealed that ophthalmic solutions of UF-021 at concentrations ranging from 0.03% to 0.12% reduced IOP in a dose-dependent manner with neither systemic nor local ocular controversial side effects at those dosage levels. In summary, UF-021 ophthalmic solutions, when administered to healthy volunteers through single instillation, reduced IOP significantly without causing any side effects.


[Accommodative resting position and the effect of viewing distance on after-effects of accommodation and the pupil]. The resting position of accommodation is determined by the equilibrium established between sympathetic and parasympathetic tone. To accommodate for near objects is brought about by excitation of the parasympathetic, and distant objects call for excitation of the sympathetic system. To investigate accommodation and pupil after-effects following the 10 min visual task with stereoscopic three dimensional image, the measurements of the dynamic responses of accommodation and pupil were made. When the subjects worked at 0.4 m (closer than their resting state) and at 1 m corresponded to their resting positions, the response delay in accommodative relaxation occurred in each condition. When they worked at outside their resting position (1.5 m and 3 m viewing distances), the significant response delay in contraction in the groups of 1.5 m and 3 m, and the increases of accommodation error and the area of miosis were shown. There was a fact that the after-effect on accommodation and pupillary function was different between in the case of tasks given inside and outside their resting positions.


[Intraocular lens implantation after glaucoma filtering surgery--time course of changes in intraocular pressure control and filtering blebs]. Cataract extraction and intraocular lens (IOL) implantation were carried out in 45 glaucomatous eyes that had undergone glaucoma filtering surgery. Of these, 37 eyes had primary glaucoma, 2 eyes capsular glaucoma, and 6 eyes secondary glaucoma. The visual acuity after IOL implantation was 0.5 or more in 29 eyes (64%) but in 10 eyes (22%) acuity was 0.1 or less because of advanced optic nerve head damage. To analyze affects of IOL implantation on intraocular pressure (IOP) control and functioning of the filtration bleb in 39 eyes of primary or capsular glaucoma, a life-table analysis with the Kaplan-Meier method was performed. The probability that IOP control does not worsen at 2 years was 43 +/- 7% (SE) in 21 eyes without pre-operative ocular hypotensive medication, 56 +/- 16% in 18 eyes with pre-operative ocular hypotensive medication, 47 +/- 12% in 26 eyes where functioning filtering bleb existed pre-operatively. The probability that the filtering bleb survives 2 years post-operatively was 44 +/- 11%. The present results imply that intensive management of post-operative inflammation and careful IOP follow up are imperative in eyes in which IOL implantation was indicated after undergoing filtration surgery.


[Enhanced production of in vitro tumor necrosis factor-alpha from monocytes in Behçet's disease]. In vitro tumor necrosis factor-alpha (TNF-alpha) production from peripheral blood monocytes (PBMC) was investigated among 12 patients (male: 7, female: 5) with uveoretinitis of Behçet's disease and 6 age-matched healthy controls. TNF-alpha production of PBMC after the stimulation with lipopolysaccharides (LPS) was significantly enhanced in Behçet's disease patients with active uveoretinitis (21.5 +/- 2.8 U/ml) compared with both controls (5.7 +/- 1.8 U/ml) (p < 0.01) and inactive cases (5.1 +/- 1.4 U/ml) (p < 0.01). In the cases with active uveoretinitis, TNF-alpha production in the period of ocular attack (7.2 +/- 6.2 U/ml) was significantly lower than that of the post-attack period (24.4 +/- 13.9 U/ml) (p < 0.02). These results may indicate that TNF-alpha plays an important role in the immunopathogenesis of uveoretinitis in Behçet's disease.


[Antibody titer to streptococcal and staphylococcal L-form in Behçet's disease and other uveitis]. The antibody titer in serum to Streptococcus pyogenes L-form and Staphylococcus aureus L-form were determined by enzyme-linked immunosorbent assay in 28 patients with Behçet's disease, 31 patients with other uveitis (sarcoidosis: 10, Harada's disease: 5, tuberculosis: 4, rheumatoid arthritis: 4, lues: 2, juvenile rheumatoid arthritis: 2, herpes simplex: 2, trauma: 2) and 16 healthy normal controls. All L-forms were induced by the penicillin disk method. The antibody titer to Streptococcus pyogenes L-form in Behçet's disease was lower than that of other cases of uveitis and controls, and showed significant differences between controls, rheumatoid arthritis, sarcoidosis, tuberculosis and Harada's disease by the Student's t-test. The antibody titer to Staphylococcus aureus L-form in Behçet's disease showed no difference between controls and other cases of uveitis. In each uveitis and controls, and between active and inactive stages of all uveitis, there were no differences between titers. In Behçet's disease, antibody formation to Streptococcus pyogenes L-form may be specifically disturbed.


[Low dose cyclosporin treatment for ocular lesions of Behçet's disease]. Cyclosporin is an immunosuppressant that has recently been used for the treatment of Behçet's disease. We evaluated the clinical effect of low doses of cyclosporin (5 mg/kg/day) on 20 patients of Behçet's disease with refractory ocular involvement. The therapeutic effect of cyclosporin was judged by the frequency of ocular inflammatory attacks. It was effective in more than 70% of the patients. On the other hand, it had some adverse side effects such as renal dysfunction, indigestion, and neurological disorders. Most side effects were mild with low dose treatment, but neurological side effects were similar in frequency and severity to those seen with 10 mg/kg/day usage. These findings indicate that low dose cyclosporin (5 mg/kg/day) administration may be acceptable as a standard plan for treatment of Behçet's disease, but that we have to use cyclosporin with great attention to its side effects, especially neurological symptoms.


[pO2, pCO2 and acid-base balance in the human vitreous sample]. In order to clarify the physiological profile in vitreous cavity undergoing vitrectomy, both human vitreous and venous blood samples were obtained to measure pO2, pCO2, acid-base balance and potassium. A new collection system was employed to obtain vitreous samples from 15 eyes under local or general anesthesia. The mean vitreous pO2 was higher than that of venous blood, and was affected by irrigative air more than breathed oxygen. Irrigating air was considered to be one of the best methods to supply enough oxygen concentration to the inner retina during the vitrectomy. Although the vitreous pH showed alkalosis during the air irrigation, it was suggested that to protecting the retina, the vitreous bicarbonate buffer was not enough to compensate for the decrease in the vitreous pH.


[Postoperative anterior chamber inflammation after posterior chamber intraocular lens implantation concurrent with pars plana vitrectomy and lensectomy]. The authors compared postoperative anterior chamber inflammation of triple procedure; diabetic pars plana vitrectomy, lensectomy with anterior capsule left intact and posterior chamber intraocular lens implantation anterior to anterior capsule, to those of various cataract surgeries with posterior chamber intraocular lens implantation and vitrectomies in diabetic retinopathy eyes. The inflammation was evaluated in terms of the incidence of inflammatory complications (fibrin reaction and posterior synechia of iris), and by periodical measurement of flare counts for postoperative 6 months using a laser flare-cell meter. The inflammation was more intense than those after the following 3 surgeries; phacoemulsification and in the bag intraocular lens implantation after continuous curvilinear capsulorhexis, extracapsular extraction and in the bag intraocular lens implantation after can opener capsulotomy, and vitrectomy alone. The inflammation, however, was less intense compared with that of another method of triple procedure; pars plana vitrectomy, phacoemulsification and in the bag intraocular lens implantation after continuous curvilinear capsulorhexis or can opener capsulotomy, and development of posterior synechia was rarely observed.


[Clinical study of venous abnormalities in diabetic retinopathy]. The authors studied 304 eyes (248 cases) affected by diabetic retinopathy in relation to venous abnormalities by ophthalmoscopy, slit lamp examination with contact lens and fluorescein angiography. The posterior pole and surrounding mid-peripheral area were examined. The subjects consisted of 225 eyes with pre-proliferative and 79 eyes with proliferative retinopathy. Fifty-six eyes (18%) had venous abnormalities: 17 of the 225 eyes (8%) with pre-proliferative retinopathy and 39 of the 79 eyes (49%) with proliferative retinopathy. In the 56 eyes with venous abnormalities. 39 (96%) showed beading. 14 (25%) showed looping and 2 (4%) showed duplication. All eyes which showed looping or duplication had proliferative retinopathy. The locations of the venous abnormalities were analyzed: 42% were in secondary branches, 27% in tertiary branches, 18% in primary branches, 10% in fourth branches and 3% in fifth branches. The portion of the fundus affected was upper temporal, lower temporal, upper nasal and lower nasal in 28%, 22%, 29% and 21%, respectively. Based on our results, eyes with looping or duplication on ophthalmoscopic or slit lamp examination, have an extremely high probability of being in some stage of proliferative retinopathy. Retinopathy should be confirmed by fluorescein angiography and photocoagulation should be performed as quickly as possible.


[Analysis of optic nerve head circulation in diabetics using a laser Doppler technique]. The authors measured the red blood cell speed distributions in the capillaries of the optic nerve head using a laser Doppler technique. We calculated the widths of Doppler-broadened frequency spectra of laser light scattered from temporal sites on the optic nerve head in 34 Type I diabetic patients (mean age, 29.5 years; 12 patients having no retinopathy; 22 having background retinopathy) and in 29 age- and sex-matched normal controls. Doppler broadening proportional to the red blood speed was 763 +/- 113 Hz (mean +/- SD) in the diabetics and 912 +/- 167 Hz in the controls. The difference was statistically significant. Mean blood pressure and intraocular pressure in the diabetics were not significantly different compared to controls. Our finding of abnormally low capillary blood speeds suggests that pathologic alterations occur in the microvasculature of the optic nerve head in the early stages of diabetic retinopathy.


[Age-related changes in the normal visual field using colored targets]. The authors evaluated the influence of aging on the normal visual field sensitivity and the color visual field sensitivity. The central 5 degrees visual field of 259 normal subjects (ages 10 to 79) was evaluated with Program Macula of the Humphrey Field Analyzer. Visual field sensitivity remained constant, irrespective of age, until 40 years. In contrast, sensitivity decreased linearly with aging after 40 years. The age-related decline of visual field sensitivity was most remarkable using a blue target. Visual field sensitivity gradually decreased toward the peripheral retina measured by white, red and green targets. However, using a blue target, at 1 degree-2 degrees locations from the fovea, sensitivity was the same as foveal sensitivity. There were no statistically significant differences of visual field sensitivity between the lower half of visual field and the upper half, and between the temporal half and the nasal half. At all test locations, the ordering of visual field sensitivity was white > red > blue > green target.


[A telescopic system for distance consisting of contact lens and spectacle lens for low vision patients]. A telescopic system for distance consisting of a negative contact lens (-10.0 - -20.0 D) as the eye piece and a positive spectacle lens (+8.0 - +16.0 D) as the objective, a modification of the Galilean telescope was examined. First the system was tried in 15 normal subjects, whose visual acuity was reduced to 20/200 or less by providing several occlusion membranes, and results were compared with customary full correction for distance. The best improvement of their vision by this system was achieved when the dioptric power of the spectacle was between +11.0 D and +13.75 D. This system was then applied to 78 eyes (61 patients) with visual acuity of 20/100 or less. Subjective improvement of vision was found in 55% of those patients' eyes. Eight patients out of 26 patients whose better eye acuity was 20/100 or less wanted to use this system and received prescription to result in the visual improvement, as evidenced by their continued use. This system can provide aid for low vision correction for distance.


[Auto recording system for the Goldmann perimeter]. In order to develop a method for converting the Goldmann perimeter data directly for computer storage and evaluation, a recording instrument was designed as a modification of the Goldmann perimeter. By installing the two potentiometers on the pantographic arm and electrical switches, the position of the test target and the setting of the four levers which defines the size and the brightness of the test target were transferred directly to the computer. Accuracy of this recording system is better than 1.3 degree over the entire surface of the chart. This system will make it possible to easily follow changes in the visual fields of the same patient, i.e. shape change, numerical value.


[A case of metastatic carcinoma to the retina]. The authors report a case of metastatic carcinoma to the retina. The patient was a 61-year-old man who had an operation for a well-differentiated adenocarcinoma of the rectum. Ophthalmoscopic examination disclosed a single, white, elevated mass lesion surrounded by serous retinal detachment located in the upper part of the macula of the right eye. A few retinal hemorrhages existed around the lesion. Fluorescein angiography revealed partially obscured retinal vessels due to compression by the tumor and arteriovenous anastomosis. Postmortem pathologic examination confirmed metastases to the brain, lung and retina. Microscopic examination showed a retinal lesion and tumor cells in the right eye. Tumor cells, similar to the carcinoma of the rectum, were present only in the neurosensory retina and did not invade the pigmented epithelium or choroid.


[Ocular manifestations in a case of infantile cystinosis]. A case of infantile cystinosis was reported. The diagnosis of cystinosis was made by the renal Fanconi syndrome and the ocular findings. The patient showed typical corneal and fundus changes associated with cystinosis. Corneal crystals and fundus pigmentary change were found early in life. The deposition of corneal crystals increased in the course of the disease, especially in the nasal and the temporal sides close to the limbus. By specular microscopy, the corneal crystals were needle-shaped and were larger and more numerous in the superficial layer of the stroma. The same shape of crystals ere found in the corneal endothelium, and the size of endothelial cells was markedly increased. There were also small crystals on the surface of the iris. The entire fundus showed a mottled appearance characterized by mixture of fine granular pigmentation and depigmentation associated with patchy depigmentation in the periphery. On the anterior surface of the retina, a glistening crystal appeared. As the crystal deposition in ocular tissues increases, even after successful peritoneal dialysis, eventual impairment of visual function may be expected.


Effects on testosterone, LH and cortisol concentrations, and on testicular ultrasonographic appearance of induced testicular degeneration in bulls. It is well known that heat stress has a detrimental effect on testicular functions. In addition to the alteration of semen quality and testicular damage, reproductive hormone secretion can be altered. The objective of this study was to describe changes in plasma concentrations of testosterone, LH and cortisol, as well as in testicular ultrasonographic appearance after induced testicular degeneration. Four Swedish Red and White bulls, aged 3 years, were used. They were fed according to Swedish standards. The scrotum was covered with an insulation device during 96 h. Semen was collected weekly 3 times before and up to 4 months after insulation. Testicular ultrasonography and clinical genital examination were performed with the same intervals. Heparinized blood samples were taken from the jugular vein at 2 h interval during 24 h every 2 weeks during the study. Blood samples were tested for the content of testosterone, LH and cortisol. Data were analysed, using one way analysis of variance of seminal data, clinical examination data as well as 24 h hormonal output data as percentage of mean individual pretreatment values. The use of a 5 MHz B-mode ultrasound unit did not contribute with an objective estimation of the degree of testicular degeneration. In 3 of the bulls testosterone levels had a tendency to decrease and LH to increase during the time of severe degeneration, whereas an opposite trend was seen during the regenerative phase, changes becoming significant 15 weeks after scrotal insulation. Variation between animals was big. Cortisol levels had a decreasing trend, changes being significant only in individual bulls at 10 and 15 weeks after scrotal insulation.(ABSTRACT TRUNCATED AT 250 WORDS)


Colostral growth factors. Possible role in bovine udder epithelial cell regeneration. Growth of the secretory epithelium during prepartum time, and for a short period after calving, is under hormonal control by estrogen, progesterone and prolactin. The mechanism(s) by which these hormones act is not known but colostrum and milk have been shown to contain different growth promoting substances. In an attempt to unravel these relationships the effect of bovine colostrum on cellular proliferation in vitro have been characterized. Colostral thermostable factors not present in milk nor associated with fat, potently induce the proliferation associated enzyme, ornithine decarboxylase, in fibroblast cell lines. However, mammary epithelial cells appear to proliferate in response to different colostral heat sensitive factor(s) that await further characterization.


Mycoplasma hyosynoviae in joints with arthritis in abattoir baconers. The occurrence of Mycoplasma hyosynoviae in synovial fluid of baconers with chronic arthritis was studied at an abattoir. Cultural examination of synovial fluid samples from diseased tarsal joints of 50 animals from 42 herds yielded M. hyosynoviae in 10 cases from 8 herds. Streptococci were found in 6 cases from 6 other herds. M. hyosynoviae antigen was found in 1 of 47 of the samples, and antibody to the mycoplasma was found in 14 of 40 of the samples by ELISA test. The presence of M. hyosynoviae in a joint was usually accompanied by the corresponding antibody. In joints with streptococcal infection antibody to M. hyosynoviae could not be found.


Critical difference of some bovine haematological parameters. The purpose of the present study was to calculate the critical difference between 2 analytical results for the red blood cell count (RBC), the white blood cell count (WBC), the haemoglobin concentration (Hb), and the haematocrit (PCV) in blood from Red Danish Dairy cows. The critical difference can help to judge whether the difference between 2 consecutive analytical results from the same animal may be safely ascribed to natural variation or not. To calculate the critical differences, blood samples from 20 clinically healthy lactating cows were collected once daily for 5 consecutive days. The total variance of the analytical results was divided into the component of variance between cows (S2Inter), the component of variance for days within cows (S2Intra), and the component of variance for measurements (S2Anal) using nested analysis of variance. The critical difference was then calculated from S2Intra and S2Anal as 0.61 x 10(12)/l for RBC, 2.2 x 10(9)/l for WBC, 0.79 mmol/l for Hb, and 0.07 for PCV. The critical differences may be used as guidelines to indicate potentially important changes in the parameters. However, the analytical results should not be assessed by the critical differences alone, but should also be compared to the corresponding reference intervals.


The use of isophane insulin for the control of diabetes mellitus in dogs. For this study 54 dogs with diabetes mellitus verified by anamnesis, clinical examinations and laboratory analyses were selected in 13 Danish and Swedish small animal clinics. After instruction the owners gave isophane insulin ("Insulin Protaphan Human") injections to the dogs morning and evening followed by a commercial or homemade meal rich in fibers. The veterinarians examined the treated dogs 5 times or more in the 90 day treatment period, preferably in the morning before injection and meal. In all 54 dogs the clinical symptoms disappeared a few days after isophane insulin injections, and 54% of the dogs were clinically healthy within 8 days. Within a month 96% of the dogs were normalized after therapy. Simultaneously the blood glucose levels were normalized in 64% of the dogs within 14 days and in further 21% within 30 days. The urine glucose levels were normalized in 64% of the dogs within 14 days and for further 19% within 30 days. At the end of the study 48 out of the 54 diabetic dogs were clinically healthy, alert and free from symptoms of diabetes. The average dose of isophane insulin was for greater dogs 0.44 units per kg bw twice a day, for small dogs 0.79. Six dogs had been destroyed in the trial period for various reasons. One owner had injection troubles. Another owner was hospitalized and had to get rid of the dog. One dog developed advanced breast cancer, 1 went fierce and 2 developed cataracts. Four dogs had by 1 or 2 occasions shown hypoglycemic symptoms, which quickly disappeared after appropriate adjustments of insulin dosing, feeding schedule and exercise programme.(ABSTRACT TRUNCATED AT 250 WORDS)


Experimental infections with Cooperia oncophora in calves. A study with two different larval dose levels and dosing regimens. The effect of different larval dose level and dosing regimens on the course of Cooperia oncophora infection in calves was studied. Four groups each of 4 calves were experimentally infected either with 50,000 or 200,000 C. oncophora larvae (L3) given either as single infections or as daily trickle infections. An additional group of calves remained as uninfected controls. The animals were necropsied on week 4 after infection. Mild to moderate clinical signs of parasitic gastroenteritis developed among calves given high doses of larvae, but liveweight gains were not significantly different from those of the uninfected controls. Serum pepsinogen levels of dosed animals were within normal ranges but rose slightly, and on day 14 p.i. they differed significantly from those of the controls. On that occasion, the levels of serum pepsinogen in the trickle infected groups significantly exhibited the levels of the single infected groups. Hypoalbuminaemia was not a feature on any occasion. The various groups did not differ significantly with regard to total worm counts and adult worm counts, but the groups receiving high larval dose harboured significantly more fourth stage larvae than the group receiving low doses of larvae, both in terms of absolute counts and in terms of percentages of total worm burdens. Within the same dose level, there was a tendency of a more even distribution of worms along the small intestine when the infections was given as a single infection compared with a trickle infection. The results indicate that C. oncophora larval dose and dosing regimens may influence the pathogenic effects and to some extent the distribution of the parasite in the small intestine.


Coculture of bovine demiembryos prior to freezing. Pregnancy rates after transfer of frozen/thawed bisected embryos, demiembryos, have until now been very low. In the present study it was attempted to improve the freezability rate of demiembryos by culturing them on a monolayer of bovine oviduct epithelial cells (BOEC) prior to freezing. The cultured frozen/thawed demiembryos showed a lower developmental rate than intact embryos. The pregnancy rate (23%) following transfer was not different from the pregnancy rate after transfer of unfrozen demiembryos (26%). The calving rate (4%), however, was significantly lower than the calving rate after transfer of fresh demiembryos (23%). Although the overall pregnancy rate achieved in this study was low, it can be concluded that a co-culture period upon BOEC prior to freezing does not improve the viability of frozen demiembryos.


George W. Holmes Lecture. Deep venous thrombosis and pulmonary embolism: correlative evaluation and therapeutic implications. Deep venous thrombosis and pulmonary embolism are significant causes of morbidity and mortality in the United States; estimates range from 120,000 to 150,000 deaths annually. Although usually symptomatic, deep venous thrombosis can be clinically occult, in part due to incomplete obstruction or in part related to duplication, triplication, and fenestration anomalies, primarily of the superficial femoral or popliteal vein. Additionally, pulmonary emboli caused by deep venous thrombosis may be clinically silent. Because of therapeutic implications, especially indications for insertion of inferior vena caval filters, comprehensive assessments of both the disease process (i.e., deep venous thrombosis) and the complication (i.e., pulmonary emboli) are important. Thus, when a pulmonary embolus is the presenting process, correlative assessment of deep venous thrombosis, even in the absence of symptoms or signs in the lower extremity, may be of therapeutic significance. Conversely, when deep venous thrombosis of the lower extremities involving the popliteal or superficial femoral vein is the presenting process, correlative assessment of the pulmonary circulation, even when no pulmonary symptoms or signs are present, may be of therapeutic significance. Relative to the diagnosis of pulmonary embolism, the roles of assays of D-dimer, ventilation-perfusion lung scans, and segmental occlusion studies of the pulmonary circulation are discussed. Finally, the indications for insertion of inferior vena caval filters above the renal veins are presented and examples are shown.


Epilepsy: the role of MR imaging.

Epilepsy: the role of MR imaging. MR is the imaging technique of choice when examining a patient who is having seizures. Detection, localization, and differentiation of structural epileptogenic abnormalities are much better with MR imaging than with CT. MR imaging has a high success rate in identifying hippocampal sclerosis, a common cause of surgically treatable temporal lobe epilepsy. The affected hippocampus is atrophic and hyperintense on long TR images. Functional imaging with single-photon emission computed tomography and positron emission tomography is complementary to MR imaging but is not as widely available. In summary, MR imaging has dramatically changed the workup of epilepsy, especially for the patient with medically uncontrollable seizures. As surgical treatment of epilepsy becomes more available, the need for preoperative evaluation with MR imaging will increase.


CT appearance of pulmonary tuberculosis in diabetic and immunocompromised patients: comparison with patients who had no underlying disease. It has been stated, but not adequately assessed, that pulmonary tuberculosis in diabetic or immunocompromised patients often has an atypical pattern and distribution. To evaluate the CT features of pulmonary tuberculosis in diabetic or immunocompromised patients compared with patients without underlying disease, we performed this retrospective study. We reviewed conventional CT scans (n = 100) and high-resolution CT scans (n = 16) of the chest in 110 adult patients with active postprimary tuberculosis. Seventy-one patients had no underlying disease, 31 had diabetes mellitus, and eight were immunocompromised. In patients who had no underlying disease, 44 had nodular opacities, 11 had consolidation, and 13 had consolidation with associated loss of volume. Characteristic features of tuberculosis in this group of patients included segmental distribution (97%), satellite lesions (93%), single cavity within any given lesion (95%), and tendency toward architectural distortion and loss of volume. In diabetic and immunocompromised patients, 15 had nodular opacities, seven had consolidation, and 15 had consolidation with associated loss of volume. Diabetic and immunocompromised patients had a high prevalence of nonsegmental distribution (30%) and multiple small cavities within any given lesion (44%). Unusual localization of tuberculosis, including disease confined to the basal segments of the lower lobes, anterior segment of the upper lobes, or right middle lobe, occurred equally in both groups (17% and 18%). We conclude that diabetic and immunocompromised patients have a higher prevalence of multiple cavities within any given lesion (p < .01) and of nonsegmental distribution (p < .01) than do patients without underlying disease.


Reversed or absent hepatic arterial diastolic flow in liver transplants shown by duplex sonography: a poor predictor of subsequent hepatic artery thrombosis. We studied the value of absent or reversed diastolic flow in the hepatic artery, shown by duplex sonography of recently transplanted livers, in predicting subsequent hepatic artery thrombosis. We retrospectively reviewed the records of liver transplantations performed in adults during a 3-year period at our institution. Duplex Doppler studies were done within 24 hr after transplantation and subsequently reviewed. The clinical course of all patients with absent or reversed diastolic flow in the hepatic artery immediately after transplantation was evaluated. Of the 160 liver transplants included in this study, 30 had aberrant diastolic flow in the hepatic artery immediately after transplantation. Twenty had reversed flow, and 10 showed no flow in diastole. In this group of 30 transplants, complications developed in six; two were vascular in origin. One of these complications was thrombosis of the hepatic artery 12 months after transplantation. This 3% thrombosis rate is similar to the 4.6% thrombosis rate of the 130 patients who had antegrade diastolic flow in the hepatic artery immediately after transplantation. Reversed or absent diastolic flow in the hepatic artery of a recently transplanted liver has no correlation with subsequent hepatic artery thrombosis.


Filling defects in the pancreatic duct on endoscopic retrograde pancreatography. Filling defects in the pancreatic duct are a frequent finding during endoscopic retrograde pancreatography (ERP) and have a variety of causes. Some filling defects may be artifactual or related to technical factors and, once their origin is recognized, can be disregarded. Others may be due to acute changes of pancreatitis and should prompt more careful injection of contrast material into the duct. Intraluminal masses may represent calculi or a neoplasm, either of which may require surgery or endoscopic intervention. The exact nature of these filling defects may not be apparent on radiographs, and other studies may be needed. This article reviews our approach to the evaluation of filling defects in the pancreatic duct.


Spiral CT of the pancreas with multiplanar display. This essay illustrates the findings obtained with spiral CT imaging in pancreatic disease. Features of spiral CT--fast scanning, dynamic injection of contrast material allowing optimal vessel opacification, and supplemental multiplanar imaging--promise to provide increased accuracy in the diagnosis and staging of pancreatic disease. With further development of continuous (spiral/helical) scanning technology, this technology should expand to cover a wider range of applications.


Rupture of the bowel after blunt abdominal trauma: diagnosis with CT. The accuracy of CT in the detection of injuries of the solid viscera after blunt trauma is well established, but the value of CT in diagnosing bowel rupture resulting from blunt trauma is controversial. This study was conducted to determine the sensitivity of CT in diagnosing posttraumatic bowel rupture. During a 51-month period, 17 preoperative CT scans were obtained in 16 patients who subsequently had bowel ruptures verified surgically. Both preoperative (prospective) and retrospective CT findings were analyzed in these patients. Retrospective interpretation was made by consensus of two radiologists. Surgically confirmed bowel ruptures occurred in the duodenum (five), ileum (four), jejunum (four), colon (four), and stomach (two). CT findings considered diagnostic of bowel perforation were detected prospectively on 10 (59%) of 17 scans; these included pneumoperitoneum without prior peritoneal lavage (six), mesenteric, intramural, or retroperitoneal free air (six), or direct visualization of discontinuity of the bowel wall or extravasation of luminal contents (four). Prospective CT findings considered suggestive of bowel rupture were present on five (29%) of the 17 scans; these included intraperitoneal fluid of unknown source (three), thickened (> 4-5 mm) bowel wall (two), gross anterior pararenal fluid without a recognized source (one), and a mesenteric-bowel wall hematoma (one). On two of 17 scans, findings were seen in retrospect only; these included free intraperitoneal blood without a source (findings on a second CT scan were diagnostic) and pneumoperitoneum. CT findings diagnostic or suggestive of bowel injury were detected prospectively on 15 (88%) of 17 scans and were noted in all retrospectively. CT is sensitive for the diagnosis of bowel rupture resulting from blunt trauma, but careful inspection and technique are required to detect often subtle findings.


The natural history of renal lesions in von Hippel-Lindau disease: a serial CT study in 28 patients. Von Hippel-Lindau disease is a multisystem disorder predisposing to renal cysts and cancer. The growth and development of these renal lesions have not been documented previously. We reviewed serial CT scans to determine the rates and patterns of growth of renal lesions associated with von Hippel-Lindau disease. Twenty-eight patients with von Hippel-Lindau disease and renal involvement, including the spectrum from simple cysts to solid masses, had follow-up examinations for at least 1 year (mean, 2.4 years; range, 1-12 years) with serial contrast-enhanced abdominal CT. Renal lesions were measured and characterized. Surgical correlation was available in 12 patients. Two hundred twenty-eight lesions (eight lesions per patient) were detected. On the basis of their CT appearance, 168 lesions (74%) were classified as cysts, 18 (8%) as cysts with solid components, and 42 (18%) as solid masses. Among 12 patients with pathologic confirmation, the solid components of cystic lesions and solid lesions almost always contained renal carcinoma. The majority of cysts remained the same size (71%) or enlarged (20%); 9% became smaller or entirely involuted during the follow-up period. Although it is generally presumed that renal cysts are precursors to cancers, the transformation of a simple cyst to a solid lesion was observed in only two patients. Among the 42 solid lesions, all but two enlarged with time, with a mean doubling time of 10 months. The renal lesions associated with von Hippel-Lindau disease exhibited wide differences in growth. The majority of renal cysts grew slowly but some involuted. Transition to solid renal cancer was rare among cysts. Complex cystic and solid lesions contained neoplastic tissue that uniformly enlarged. These data may be used to help predict the progression of renal lesions in von Hippel-Lindau disease.


Sonographic findings after surgical ablation of the endometrium. Endometrial ablation is a new surgical technique that is an alternative to hysterectomy in women with dysfunctional uterine bleeding. The endometrium is either coagulated or resected in an attempt to render the patient amenorrheic. Because of the newness of the procedure, no report of radiologic findings after endometrial ablation has been published. Accordingly, the sonographic appearance of the uterus after endometrial ablation is described. Using transvaginal sonography, we examined a select group of 16 women, seven of whom were symptomatic after endometrial ablation. All patients had a preoperative diagnosis of menorrhagia not responsive to conventional hormonal therapy and no evidence of cancer. In the seven symptomatic patients, sonography showed that postoperatively two had hematometra, one had a nonviable intrauterine pregnancy, and four had residual islands of functioning endometrial tissue alone or in combination with hematometra. In nine asymptomatic patients, postoperative sonography showed seven had normal findings except for leiomyomata and two had residual islands of functioning endometrial tissue. Sonographic examination of the uterus after endometrial ablation provides a method for evaluating symptomatic patients and for identifying any remaining endometrium that could later become symptomatic.


MR imaging of pelvic masses in women: contrast-enhanced vs unenhanced images. We compared the value of contrast-enhanced MR images with that of T2-weighted MR images in the diagnosis and staging of pelvic masses in women. The findings on preoperative MR studies of 97 patients with a total of 124 surgically proved lesions were retrospectively analyzed. Unenhanced T1- and T2-weighted spin-echo images were compared with contrast-enhanced T1-weighted images. The final diagnosis included benign (36 patients), borderline (six patients), and malignant (15 patients) ovarian masses, fallopian tube masses (15 patients), endometrial tumors (seven patients), cervical carcinomas (32 patients), subserous leiomyomas (11 patients), and two masses of extragenital origin. In the depiction of pelvic lesions, the sensitivity of contrast-enhanced MR imaging (96%) was equal to that of unenhanced T2-weighted imaging (97%). Contrast-enhanced images were useful in the definition of intratumoral architecture and tumor borders of 72 adnexal masses, resulting in better determination of malignancy (accuracy, 95%) than on T2-weighted images (85%). Size of viable tumor, differentiation of tumor from retained fluid, and depth of myometrial invasion of six endometrial carcinomas were most reliably shown on contrast-enhanced images. In the evaluation of cervical carcinoma, overall staging accuracy of contrast-enhanced imaging (80%) was slightly inferior to that of T2-weighted imaging (83%). However, contrast-enhanced images improved assessment of parametrial and organ invasion in seven cases in which findings on T2-weighted MR images were equivocal. Administration of contrast material was not helpful in the evaluation of subserous leiomyomas or masses of extragenital origin. The findings suggest that when results of unenhanced T1- and T2-weighted MR imaging of pelvic masses are equivocal, contrast-enhanced MR images should be used as supportive and complementary pulse sequences to (1) improve definition of intratumoral architecture and prediction of malignancy in adnexal tumors, (2) stage endometrial carcinoma, and (3) determine tumor extension in cervical carcinoma.


Detection of acute avascular necrosis of the femoral head in dogs: dynamic contrast-enhanced MR imaging vs spin-echo and STIR sequences. Spin-echo MR imaging has been shown to be highly sensitive in the detection of avascular necrosis. Very early avascular necrosis can, however, appear normal on MR images. We compared dynamic contrast-enhanced MR imaging with conventional spin-echo and short Tl inversion-recovery (STIR) sequences for detecting acute osteonecrosis in an animal model. Avascular necrosis was induced unilaterally in the femoral heads of five dogs that were imaged with a 1.5-T system within 3 hr of devascularization. After standard T1-weighted, T2-weighted, and STIR images, gradient-recalled echo images, 28/5 (TR/TE) with a 45 degrees flip angle, were obtained at 6-sec intervals for 90 sec synchronous with the IV administration of 0.2 mmol of gadoteridol per kilogram of body weight at a rate of 2 ml/sec via an automated injector. Two animals were reimaged after 7 days. Spin-echo and STIR images did not show any acute changes in the ischemic femoral heads. In contrast, significant differences were present in the enhancement profiles of the marrow spaces in the normal and ischemic femoral heads (p = .005). Normal marrow was characterized by rapid enhancement, with an average signal intensity increase of 83% peaking at 36 sec; no measurable enhancement was seen in the marrow of the ischemic femoral head. Spin-echo images, obtained 7 days after devascularization (n = 2), showed changes characteristic of avascular necrosis. Dynamic contrast-enhanced MR images showed persistent lack of enhancement in the avascular marrow of the ischemic femoral head. A junctional zone, characterized by rapid contrast enhancement in excess of 120% without early washout, was identified at the interface between normal and avascular marrow. In this experimental model, dynamic contrast-enhanced MR imaging proved significantly more sensitive than conventional spin-echo and STIR imaging in the detection of acute avascular necrosis.


Acute appendicitis in children: value of sonography in detecting perforation. We determined the sonographic features of perforating appendicitis in children in order to determine the best criteria for establishing the diagnosis. Sonograms of the right lower quadrants of 71 children with proved appendicitis were reviewed to determine the value of sonography in distinguishing between nonperforating and perforating appendicitis. The sonographic signs evaluated included the presence or absence of an appendix, an echogenic submucosal layer, increased periappendiceal echogenicity, free or loculated periappendiceal or pelvic fluid collections, and appendicoliths. The sonographic findings were correlated with the surgical and pathologic findings. Forty-five patients had nonperforating appendicitis, and 26 had perforating appendicitis. A sonographically visible appendix was present in all patients with nonperforating appendicitis and in 10 (38%) of 26 patients with perforation. An echogenic submucosa was noted in 27 (60%) of 45 patients with uncomplicated appendicitis but in only three (30%) of 10 patients with a visible appendix and perforating appendicitis (p < .05). In 19 of 26 patients with perforating appendicitis, sonography showed loculated periappendiceal or pelvic fluid collections; no patient with nonperforating appendicitis had a loculated fluid collection (p < .05). No statistically significant association was found between the presence or absence of perforation and free pelvic fluid, prominent periappendiceal fat, or an appendicolith. Our results indicate that sonography can be helpful in the diagnosis of perforating appendicitis. The best predictors of perforation are absence of the echogenic submucosal layer and the presence of a loculated fluid collection.


Congenital subglottic hemangioma: frequency of symmetric subglottic narrowing on frontal radiographs of the neck. This study was undertaken to determine how often symmetric subglottic airway narrowing is present in cases of infantile subglottic stenosis and to determine if the radiographic finding has any association with the anatomic location of the hemangioma. All cases (n = 12) of endoscopically proved subglottic hemangioma from 1976 to 1991 were collected from the records at Children's Hospital of Michigan. In 10 cases, high-kilovoltage magnification studies or frontal radiographs of the neck were available for review by two observers who classified the subglottic narrowing as either symmetric or asymmetric. The radiographic findings in these 10 cases were then compared with the location and extent of the lesion as described endoscopically. In 50% of cases (n = 5), narrowing of the subglottic airway was symmetric. In four of these the hemangioma was either situated on the posterior wall or was circumferential, and in the remaining one an associated marked fibrotic reaction to a lateral wall lesion was present. All other lesions were on the lateral wall, and asymmetric subglottic airway narrowing was consistently shown on radiographs. Our results show that subglottic hemangioma often manifests as a symmetric subglottic airway narrowing and that the anatomic location of the hemangioma appears to be associated with the appearance on radiographs.


Determination of magnetization transfer contrast in tissue: an MR imaging study of brain tumors. In this study, the magnetization transfer contrast (MTC) on MR images of several brain tumors and the correlation between MTC and tumors' histologic features were investigated. MTC depends on the extent of magnetization transfer, or cross-relaxation, from tissue water protons to macromolecular protons. On the basis of the known increase of the cross-relaxation rate with increasing molecular weight of protein in protein solutions, the hypothesis that changes in MTC correlate directly with the macromolecular composition of various tumors was tested. Preoperative MR images were obtained with a 0.1-T MR system in 40 patients with brain tumors. MTC was correlated with the histologic features and the dry weight of the tumors. The tumors studied included astrocytomas (10), acoustic schwannomas (three), meningiomas (12), pituitary adenomas (10), craniopharyngiomas (two), and hemangioblastomas (three). MTC was 0.43 in normal white matter and 0.42 in normal gray matter, and varied from 0.11 to 0.37 in the tumors. The mean MTC in astrocytomas (0.21 +/- 0.09) was smaller than the mean MTC in the gray matter (p = .0001) or in the other solid tumors (0.34 +/- 0.07 to 0.37 +/- 0.09, p < .002). MTC was larger in high-grade than in low-grade astrocytomas (0.28 +/- 0.05 vs 0.14 +/- 0.04, p = .0005). In meningiomas, MTC correlated with the collagen content of the tumor tissue (r = .95, p = .01). The differences in contents of solids between the solid tumor groups were not significant (p > or = .1, NS). When the previously demonstrated correlations between solid content and 1/T1 of the types of tumors studied are taken into consideration, the present results suggest a larger relative contribution from hydrodynamic vs cross-relaxation effects in astrocytomas than in benign tumors or in gray matter. The twofold difference in MTC between low- and high-grade astrocytomas probably reflects the amount of nuclear material in the tumor cells. Collagen content determined the differences in MTC among meningiomas. These results indicate that the major determinant of differences in MTC within these tumor groups is the high-molecular-weight tissue macromolecules, suggesting higher specificity for MTC than for T1 in discriminating between tissues on MR images.


Pleomorphic xanthoastrocytoma of the brain: MR findings in six patients. Pleomorphic xanthoastrocytoma is a rare, usually benign brain tumor. This pleomorphic supratentorial tumor involves the leptomeninges and superficial cortex in young patients with seizures. The MR imaging features of this distinct tumor have not been reported. We describe the MR imaging findings in six patients with pathologically proved pleomorphic xanthoastrocytoma. We retrospectively reviewed the MR images of six patients with pathologically proved pleomorphic xanthoastrocytoma. MR images were reviewed by two neuroradiologists. The pathologic slides of the tumors were reviewed by two neuropathologists. We also analyzed the patients' clinical features. Most of the tumors were cortical based and isointense with gray matter on T1-weighted images and mildly hyperintense on T2-weighted images. All the masses enhanced with contrast material. Cystic components and gyriform and leptomeningeal enhancement were seen occasionally. The tumors occurred in the temporal lobes in four of the six patients. Three patients had seizures, and the other three had headaches. Pleomorphic xanthoastrocytoma is a rare, usually benign, cortical-based mass that often enhances intensely with contrast material. The most common location is in the temporal lobes. Seizures and headaches are common clinical features. Familiarity with this lesion is important in the differential diagnosis of enhancing cortical-based masses.


Calcification of the trochlear apparatus of the orbit: CT appearance and association with diabetes and age. Calcification can sometimes be observed on CT scans in the region of the trochlear apparatus of the orbit, the cartilaginous structure through which the superior oblique tendon and its sheath pass. We evaluated associations of trochlear calcifications with age and diabetes. We retrospectively reviewed CT scans of the orbit in 159 patients to identify the presence of trochlear calcifications. The presence or absence of diabetes, duration of diabetes, type of therapy, and presence or absence of neuropathy were determined from medical charts of 139 patients. We calculated the odds ratio of detecting a trochlear calcification and used logistic regression to evaluate the associations of age, sex, and diabetes with trochlear calcification. Trochlear calcifications were present in seven of the 24 diabetic patients and in 10 of the 115 nondiabetic patients. The odds ratio for detecting trochlear calcifications in diabetic vs nondiabetic patients was 4.3 (p < .01). Logistic regression showed univariate associations with trochlear calcification for both increasing age (p < .001) and diabetes mellitus (p < .01). The effect of diabetes on the prevalence of trochlear calcifications was seen predominantly in those less than 40 years old (odds ratio = 24.0, p = .014). Sex, duration of diabetes, insulin dependence, and neuropathy were not significantly associated with an increase in trochlear calcifications. The results show that a trochlear calcification seen on CT is a benign condition that may serve as a marker for diabetes in young patients. Trochlear calcifications are observed frequently (25-30%) in persons more than 50 years old. When it is present in patients younger than 40 years, it is strongly associated with diabetes.


Do abnormalities of the frontonasal duct cause frontal sinusitis? A CT study in 198 patients. The purpose of the study was to determine the correlation between frontonasal duct abnormalities (narrowing or obstruction caused by hypertrophic mucosa) and frontal sinusitis. This study was based on the hypothesis that abnormalities of the frontonasal duct cause frontal sinusitis by impairing normal drainage of the sinus. CT studies of 198 consecutive patients with clinical diagnoses of chronic sinusitis were reviewed retrospectively. Criteria for inclusion were (1) no history of sinus surgery or facial trauma and (2) absence of polyps at rhinoscopy. As 37 frontal sinuses were undeveloped, a total of 359 sinuses were evaluated. CT scans were obtained in oblique axial and coronal planes. The following CT features were assessed: (1) the frequency of detection of the frontonasal duct, (2) the appearance of the frontonasal duct: normal vs abnormal (narrowed or obstructed), and (3) the correlations between abnormalities of the frontonasal duct and frontal sinusitis. The frontonasal duct was detected in all 359 cases, either in both CT planes (81%) or only in the axial oblique plane (19%). In 267 (74%) of 359 cases, the duct appeared normal; among these, isolated frontal sinusitis was detected in five cases (2%). In 92 (26%) of 359 cases, the duct was abnormal; it was narrowed in 18 cases (5%) and obstructed in 74 cases (21%). Frontal sinusitis was noted in 78 (85%) of the 92 cases of frontonasal duct abnormalities. The sensitivity and specificity of the correlations between frontonasal duct abnormalities and frontal sinusitis were 98% and 85%, respectively. Because our results show a strong correlation between abnormalities of the frontonasal duct and frontal sinusitis, it seems highly probable that abnormalities of the frontonasal duct cause frontal sinusitis.


Normal anatomy of the hippocampus and adjacent temporal lobe: high-resolution fast spin-echo MR images in volunteers correlated with cadaveric histologic sections. This essay illustrates the appearances of sections of the normal hippocampus and adjacent temporal lobe on high-resolution heavily T2-weighted fast spin-echo MR images and correlates them with histologic sections. We found that this MR examination showed the detailed anatomy of the normal hippocampus in a much shorter time than is possible with conventional spin-echo techniques. The information provided in this essay can be used as a baseline for distinguishing between normal and abnormal hippocampi in a variety of disease states.


MR myelography using heavily T2-weighted fast spin-echo pulse sequences with fat presaturation. A new method for generating myelogramlike images of the thecal sac by MR imaging is presented. The method is based on suppressing background signal by using heavily T2-weighted fast spin-echo pulse sequences and obliterating fat signal by presaturation. The resulting slices are then projected into a composite image using a standard maximum intensity projection (MIP) algorithm. The technique is implemented with commercially available hardware and software and yields reproducible high-quality images of the lumbar thecal sac, which show excellent definition of the thecal margins, nerve roots, and nerve root sheaths. This method could replace conventional lumbar myelography and postmyelographic CT studies.


Assessment of a neuroradiology picture archiving and communication system in clinical practice. The goal of this study was to determine if our neuroradiology picture archiving and communication system (PACS) is capable of improving the efficiency and function of the management and review of neuroradiologic images. A neuroradiology PACS module developed in our department was evaluated in the clinical environment from February 1990 through July 1991. The overall evaluation focused on three aspects: (1) image delivery performance, (2) system availability, and (3) user acceptance. Image delivery performance was evaluated by analyzing the time spent on each modularized task with both the film-based system and the PACS system. The system availability was examined by observing the downtime occurrence and uptime probability of individual hardware components in the PACS module. User acceptance was evaluated through a survey done with the display workstation. Under regular operating conditions, the PACS outperforms the current film-based operation. The overall PACS module availability is more than 92%, with the display workstation available more than 99% of the time. The overall user acceptance of the system is 3.4 on a four-point ranking scale. This study has demonstrated the full functionality and clinical usefulness of our neuroradiology PACS. On the basis of the results of this study, a large-scale PACS has been designed and implemented in our department.


Integration of a personal computer workstation and radiology information system for obstetric sonography. A personal computer workstation has been developed for storage and analysis of obstetric sonographic examinations. The workstation also serves as an interactive data terminal for our radiology information system. A data-base management program locally stores quantitative and descriptive sonographic results. Algorithms are used to analyze growth parameters over serial examinations, plot growth curves, generate a radiologic report, and provide instantaneous diagnostic assistance and suggestions. A bibliographic data-base system containing more than 3000 references (with abstracts) in the obstetric sonographic literature is integrated with the software's analytical functions. A telecommunications software module performs dialogues, such as immediate automatic transcription of the sonographic report, with the radiology information system. An examination summary form, growth curves, and the radiologist's report can be printed or digitally faxed by the workstation after authorization by the radiologist. The workstation has improved the organization of sonographic data, facilitated serial quantitative analysis, supplemented educational resources for our staff radiologists and residents, reduced transcription errors and transcription delays, and shortened to minutes the time necessary to deliver precise examination results to clinicians. This model is suitable for use in many areas in a radiology department.


High performance liquid chromatography with multiwavelength detection: a technique for identification of iodinated x-ray contrast agents in human body fluids and brain tissue. Several cases of a severe adverse reaction, referred to as "ascending tonic-clonic seizure syndrome," have been reported after administration of water-soluble iodinated x-ray contrast agents for myelographic examinations. Because of the bizarre reactions, the identities of the causative contrast media were questioned. Analyses of biologic materials from four of these patients were performed by using reverse-phase high-performance liquid chromatography. The chromatographic system was equipped with a fast-scanning UV-visible detector for the analysis of the UV-spectra of the chromatographic peaks. The analyses revealed that the nonionic contrast agents iohexol or ioversol were not present in detectable amounts in any of the samples. On the other hand, the chromatographic analyses revealed peaks that cochromatographed with and showed the same UV-spectra as the ionic agents diatrizoate, metrizoate, and ioxitalamate. The results indicate inadvertent injection of ionic contrast medium in all four cases.


Inadvertent intrathecal use of ionic contrast media for myelography. To describe instances of inadvertent intrathecal injection of ionic contrast media and to consider treatment approaches, and diagnostic and medicolegal issues. Ten cases of inadvertent injection, of which nine were reported to the manufacturers/authors and one appeared in the literature, are related with emphasis on similarity of reactions. Six criteria are enumerated and used to coin the term "ascending tonic-clonic seizure syndrome." Therapeutic possibilities seem limited, but several methods for controlling seizures are suggested. The importance of identifying the contrast material is underscored. Awareness of the grave possibility of administering the wrong contrast material is the first step in avoiding this problem; awareness of the symptoms is the first step toward therapy.


MR proton spectroscopy in multiple sclerosis. To elucidate the natural history of visualized MR abnormalities in patients with multiple sclerosis using proton spectroscopy. MR imaging and proton spectroscopy (1H spectroscopy) were performed on 16 patients with clinically definite multiple sclerosis. All patients received gadopentetate dimeglumine (Gd-DTPA). Decreased levels of N-acetylaspartate (NAA) were demonstrated in 17 out of 21 lesions. No correlation was found between decreased NAA and Gd-DTPA enhancement. In five out of seven enhancing lesions, abnormal 1H spectra with extra peaks (termed marker peaks) at 2.1-2.6 ppm (ranging in absolute concentration from 10-50 mM protons) were observed. In nine out of 14 unenhancing lesions, no elevated marker peaks were observed. In the five other unenhancing lesions, the levels of these marker peaks were generally lower than the enhancing group. No correlation was found between the NAA levels and the levels of the marker peaks. We suggest two distinct biochemical processes: 1) decreased NAA reflecting neuronal cell loss, and 2) elevated marker peaks reflecting ongoing demyelination. Based upon these observations we infer that 1) the majority of enhancing lesions are demyelinating with extra peaks at 2.1-2.6 ppm representing a marker of this process, 2) enhancing lesions without this marker most likely represent edematous regions without significant demyelination, and 3) demyelination may be long in duration compared with transient blood-brain barrier disruption manifested by Gd-DTPA enhancement. Our results suggest that 1H spectroscopy has the ability to further categorize MR-demonstrated enhancing and unenhancing lesions in patients with multiple sclerosis and that it may be more sensitive than contrast enhancement in revealing the true time course of demyelination.


Computer-based tutorial in MR imaging.

Computer-based tutorial in MR imaging. To test the effectiveness of customized software as a teaching tool to help the novice understand basic physics concepts underlying the creation of MR images via various pulse sequences. The authors have developed animating graphic and highly interactive electronic MR audiovisual software for the Macintosh computer in the C programming language, and have integrated it into the classroom setting for teaching MR imaging physics concepts such as T1, T2, T2*, proton density, RF excitation, TR, TE, TI, flip angle, static magnetic field strength, gradient magnetic fields, section thickness, number of phase-encoding gradients, number of excitations, field of view, intersection gap, receiver bandwidth, contrast agent(s), etc. The program interactively demonstrates the effects of these variables upon such imaging objectives as voxel dimensions, section quantity, total scanned volume, signal-to-noise ratio, contrast, contrast-to-noise ratios, resolving power, and scan acquisition time. Partial saturation, gradient echo, inversion recovery, and fat-saturation imaging techniques are included. Written posttests on the syllabus covered in our basic MR course were administered to three groups: 43 student professionals (technologist/physicist/radiologist) (control professional group) before, 149 student professionals (exposed professional group) after the addition of the tutorial software into the MR course as an integral part of the teaching process, and a group of 200 pharmaceutical sales staff with little to no prior MR or scientific background (exposed pharmaceutical group). The scores were then evaluated and compared among the groups. One hundred ten students exposed to this software also anonymously rated the software on a 1 to 5 scale (harmful to very helpful, respectively) as to their feeling regarding its role in their MR educational experience and the ease with which they were able to understand the material covered in the basic MR course curriculum. Mean test scores were statistically significantly lower in the Control Professional Group (60%, +/- 2.59 standard error of the mean (SEM)) than in either the Exposed Pharmaceutical (73% +/- 0.75 SEM) or Exposed Professional Groups (77% +/- 0.99 SEM). The mean subjective assessment score regarding the software was 4.8 (scale 1 to 5). This custom-developed interactive MR tutorial software is demonstrated to be effective in assisting even those new to MR imaging in understanding the concepts underlying MR imaging physics in a manner that is felt to be significantly more palatable than lectures, articles, and/or textbooks alone.


MR imaging in acute multiple sclerosis: ringlike appearance in plaques suggesting the presence of paramagnetic free radicals. MR studies in three patients with multiple sclerosis have shown clearly defined rings within plaques of demyelination, having signal characteristics consistent with the presence of paramagnetic material. It is suggested that these appearances represent the presence of free radicals in the macrophage layer forming the margin of an acute plaque.


Cranial hypertrophic interstitial neuropathy. The authors describe a patient with complex cranial neuropathy caused by pathologically proved hypertrophic interstitial neuropathy. Plain and contrast-enhanced MR studies were performed prior to surgical exploration. Surgical complications caused the patient's death and a complete pathology study was done. Though nonspecific, MR proved helpful in determining the extent of disease and areas of anatomic involvement.


Temporary balloon occlusion of the carotid artery combined with brain blood flow imaging as a test to predict tolerance prior to permanent carotid sacrifice. To describe the technique of using SPECT brain blood flow imaging to identify patients at risk for having strokes after balloon or surgical ligation of an internal carotid artery. 29 patients underwent temporary balloon occlusion of the internal carotid artery and blood flow imaging studies were obtained prior to sacrifice of the vessel; 11 internal carotid arteries were indeed sacrificed and form the basis of our study. Follow-up of these patients ranged from 3 to 65 days. Three groups emerged: group I, patients with symptoms during occlusion and an abnormal blood flow study (one patient); group II, patients with no symptoms during the occlusion but with an unequivocally abnormal blood flow study (two patients); group III, patients without symptoms during occlusion and a normal or slightly abnormal blood flow study (eight patients). Carotid sacrifice without initial and temporary balloon occlusion is unnecessarily risky. Imaging of blood flow in the brains of these patients can further improve the safety of occlusion procedures in the internal carotid artery.


Delayed venous occlusion following embolotherapy of vascular malformations in the brain. To describe the nature and features of delayed venous thrombosis following embolization of arteriovenous fistulae. Retrospective review of the available clinical history, details of embolization procedures, and results of follow-up angiography were carried out on all embolization procedures performed on high-flow vascular malformations of the brain done at our institution since 1987. Four patients were identified who had delayed (greater than 1 week) venous thrombosis/occlusion after embolization of the malformation associated with neurologic complications. Two patients had arteriovenous fistula and two had vein-of-Galen malformations. These patients had no untoward embolization of the venous outlet as a cause of the venous occlusion. It is postulated that thrombosis in the arteriovenous fistula group was induced by conversion (due to embolization) of a patulous high flow venous outlet into a slow flow system; in the vein-of-Galen group, the occlusion was thought to be due to high-flow venopathy.


Color-flow Doppler sonography in the identification of ulcerative plaques in patients with high-grade carotid artery stenosis. To assess the ability of color-flow Doppler sonography (CFDS) to detect plaque ulcerations in patients who had high-grade to thread-like carotid artery stenosis and who underwent carotid endarterectomy. CFDS is a noninvasive diagnostic technique that allows, in addition to spatial visualization of blood flow, the identification of abnormal blood flow patterns such as vortex formation. There is evidence that pathologic anatomic changes in the vascular wall (such as ulcerations) may result in characteristic hemodynamic alterations. Therefore, solely hemodynamic criteria (detection of vortices) were used to diagnose ulceration. The results of preoperative examinations were compared to the intraoperative findings in 89 patients in a prospective and blinded way. CFDS proved highly sensitive (95.3%), specific (93.5%), and accurate (94.0%) for demonstrating ulcerative plaques. CFDS may be of significant advantage for examining plaque morphology in patients who have high-grade internal carotid artery stenosis, and in whom accurate, noninvasive diagnosis of plaque ulceration was previously difficult, if not impossible.


Use of the delayed mask for improved demonstration of aneurysms on intraarterial DSA. We retrospectively explored the use of the delayed mask technique for intraarterial digital subtraction angiography (IADSA) to demonstrate the anatomy of aneurysm necks. The delayed mask technique was utilized in 22 patients who had craniotomies for aneurysms demonstrated at angiography. The operative notes were compared to the angiographic findings of both the traditionally masked IADSA and the delayed mask IADSA. In addition, an in vitro model was constructed to examine the relationship between the size of the aneurysm neck and the ability to indirectly define its anatomy by demonstrating the flow jet. In 12 of 22 cases, the delayed mask technique demonstrated a systolic jet that was not demonstrated by traditional subtraction techniques. In nine of 12 cases, the delayed mask technique gave more specific information regarding the size, location, and orientation of the aneurysm neck. The delayed mask technique can add important information regarding the anatomy of aneurysm without adding time or risk to the procedure.


Prediction of neurologic outcome in acute spinal cord injury: the role of CT and MR. 1) To determine whether MR appearances of the spinal cord in acute trauma correlate with clinical prognosis, and 2) to identify other MR and CT prognostic factors in acute spinal trauma. Retrospective evaluation of MR, CT, and clinical examinations in 32 acute spinal trauma patients examined between 1987 and 1990. All 21 patients with abnormal spinal cords on MR had complete motor paralysis at presentation, compared to only three of 11 patients with normal cords. Whereas cord transection and hemorrhagic contusion had poor prognoses, 73% of patients with cord edema and 100% of patients with normal cord had useful motor function at outcome. At follow-up MR, areas of cord contusion developed into cysts, while edema resolved, leaving residual areas of myelomalacia. Associated spinal fractures, ligament injury, and cord compression were associated (P < .05) with a worse prognosis. Spondylotic changes were a significant risk factor for spinal cord injury, mediated by cord compression. MR and CT are valuable techniques for quantifying injury and predicting prognosis in acute spinal trauma.


Internal carotid artery occlusion due to idiopathic cranial pachymeningitis. A 35-year-old black woman had a 6-month history of headaches and a 1-month history of abducens nerve palsy. MR showed a mass in the sella and cavernous sinuses with encasement of the carotid artery. The mass enhanced intensely and homogeneously with Gd-DTPA. Arteriography revealed complete occlusion of the left internal carotid artery and severe stenosis of the C5 and C6 segments of the right internal carotid artery. Transsphenoidal biopsy of the mass led to the diagnosis of idiopathic cranial pachymeningitis.


Unusual subcutaneous sarcoidosis of the face. Two unusual cases of sarcoidosis manifesting as subcutaneous masses of the face are reported: in the first, the lesion occurred at the site of an osteotomy for rhinoplasty and was the initial clinical manifestation of sarcoidosis; in the second, the skin lesion was part of a multisystemic disease. The cases were documented with CT. Sarcoidosis should be added to the differential of soft-tissue masses of the face.


Chordomas of the skull base: MR features. To characterize the MR features of skull base chordomas with regard to signal intensity, size, position, extension, and Gd-DTPA enhancement. The MR imaging studies of 28 patients with surgically proven chordomas of the skull base were retrospectively reviewed. Twenty-two of these patients received intravenous administration of Gd-DTPA. On short TR/short TE images, chordomas generally had low to intermediate signal. On long TR/long TE images, chordomas generally had very high signal that was heterogeneous in 79%. After Gd-DTPA administration, all chordomas demonstrated some degree of contrast enhancement. In most cases, enhancement was demonstrated throughout most of each tumor in a heterogeneous pattern. Chordomas were associated with MR findings of displacement and encasement of vessels, and frequent extension into adjacent structures such as the cavernous sinus, sella, nasopharynx, and hypoglossal canal. The MR characterization of the position and extent of these neoplasms played an important role in determining the optimal surgical approaches for gross total tumor resection.


Anomalous origin of the posterior inferior cerebellar artery from the internal carotid artery. A rare anomalous origin of the posterior inferior cerebellar artery arising from the internal carotid artery is described. The embryologic explanation postulated is the persistence of a primitive communicating vessel (presegmental artery) between the anterior and posterior circulation.


Perioptic cyst distal to optic nerve meningioma: MR demonstration. Dilation of the subarachnoid space between the distal edge of an optic nerve sheath meningioma and the eyeball has previously been observed during surgery and considered a rare finding. We observed such perioptic cysts in seven patients with optic nerve meningioma and describe the MR features of this finding.


Photorefractor for detection of treatable eye disorders in preverbal children. Abnormalities of the optical media or alignment of the eyes during the period of visual immaturity may produce pathologic changes in the brain resulting in the clinical entity of subnormal vision known as amblyopia. Efforts to prevent visual deterioration or restore normal acuity where amblyopia exists require early diagnosis and treatment. Although amblyopia affects between 1% and 5% of children, it is estimated that at most one-fourth of preschool children are screened for this major treatable eye disorder. Simultaneous photography of the corneal and fundus reflex from both eyes using an offaxis flash photorefractor appears to be a practical, efficient, and effective method of eye-screening in pre-verbal children. Previous studies of this modality have dealt with populations referred to ophthalmology centers. We report the results of a masked validation of a commercially available photorefractor in an unselected group of children between the ages of 6 months and 6 years.


Improvement of fog and exercise-induced bronchoconstriction after local and subcutaneous immunotherapy in mite asthma. We compared the changes of non-specific bronchial hyperreactivity to methacholine, UNDW and exercise in 2 groups of patients with mite asthma treated with local immunotherapy (LIT group: 12 patients) and subcutaneous immunotherapy (SIT group: 8 patients) for 1 year. Bronchial challenges were done 1 week before the beginning and 1 week after the end of 1 year of treatment. The results showed a reduction of bronchial hyperreactivity to methacholine in the LIT group (PD 20FEV1 before: 223 +/- 193, after: 434 +/- 548) but not in the SIT group (PD 20FEV1: before: 143 +/- 188, after: 125 +/- 121) but the difference was not statistically significant. Exercise-induced bronchoconstriction completely disappeared in all the patients of LIT group (8/8) although only in 2 out of 4 patients of SIT group. Water-induced bronchoconstriction improved in 66% of LIT group (4/6) compared with none of SIT group (0/4). We conclude that, with the protocol of the present study, LIT is able to improve, more than SIT, non-specific bronchial hyperreactivity evaluated with osmotic stimuli as exercise and UNDW but not with pharmacologic stimuli as methacholine.


[Epidemiological study of asthmatic crises in a maternal-child emergency service]. In our region, allergic respiratory diseases affects over 55% of the child up to 5 years. This could be attributed to some peculiarities of our region, such as consanguinity, climate and predominant sensitisation to dermatophagoides mite. We made an epidemiologic study on the bronchospasm urgent cases attended in the Urgency Unit of our Maternal-Child Hospital in Las Palmas. We took 935 patients with a mean age of 32.36 months with acute attacks of bronchospasm, and found no significant difference between patients from the Northern and Southern zones of the island. Bronchospasm cases were more frequently observed in Autumn and Winter. We discuss here about the possible causing agents involved and want to draw attention to the need of education for our patients' parents for them to learn antiasthmatic medication and how to use it, before going to the Urgency Unit of any Hospital.


Reduction in the oral doses of theophylline in asthmatic children during concomitant treatment with ketotifen. Sixteen children with moderate or severe bronchial asthma underwent a double-blind study receiving either ketotifen (K) or placebo (P) in order to verify the sparing effect of K on theophylline. The study lasted 18 weeks. Slow release theophylline was administered to all patients at a dose of 300 mg every 12 hours for the first six weeks of the study ("washout"). From the seventh week on, eight patients received K (1 mg, 2x/day) and the others P. The theophylline dose was maintained and reduced every 4 weeks to 200 mg and 100 mg. The initial clinical characteristics were identical in both groups. The serum levels of theophylline decreased below the ideal range (less than 10 mcg/ml) in groups K and P with a 100 mg dose of theophylline. However, in group K patients, fewer reported worsening of symptoms (number of days with cough and/or wheeze, altered daytime or nighttime peak expiratory flow rate and consumption of beta agonist) when compared to group P. Increased PC20 of methacholine only occurred in group K patients.


Evaluation of serum total IgE in Chinese allergic children using different assays. Since differences in HLA groups have been found in Chinese populations, as well as differences in the values of total IgE in China, Japan and Thailand, a study has been done in 44 Chinese children, all of them with a history of atopic conditions divided into five groups: asthma, rhinitis, conjunctivitis, allergic bronchitis and atopic dermatitis. 34 of them were positive against D. pteronyssimus, 8 against cats, 3 against dogs and 3 against fish. The only adult patient studied was positive against gramineal plants (all positivities were tested with the prick test). IVT ELISA Screen is performed against 10 allergens, as well as 3 M FAST-Test and 3 M Total IgE FAST Plus Test. The results show that the majority of children had an elevation of the total IgE in the three tests. There is quite a good agreement between FAST and IgE-IVT and a better correlation between IgE-IVT and IgE FAST Plus. The correlation between IgE FAST and IgE FAST Plus was excellent.


Parapneumonic empyema in children: diagnosis and management. Parapneumonic effusion can be a significant problem if it is not recognized and treated promptly. The amount of pleural fluid at presentation is usually small and may not be detected on physical examination. If pleural fluid is seen on radiographs, thoracentesis must be performed. Early, free-flowing parapneumonic effusions usually respond clinically to antibiotic therapy without the necessity of draining the pleural space. Distinguishing between exudative effusion and empyema is crucial. Failure of effusion or empyema to respond to the treatment is usually due to failure to adequately drain the pleural space or inappropriate antibiotic therapy. If chest tube drainage does not result in a lower temperature and an appropriate clinical response within a few days, further evaluation by computed tomographic scanning and surgical consultation are indicated. In patients with pleural effusion and empyema that responds poorly to medical and/or surgical therapy, underlying causes or associated debilitating disease should be excluded.


Sacroiliac sprain: an overlooked cause of back pain. Since sacroiliac sprain syndrome is not a common disorder, it may be overlooked as a cause of low back pain. Even though the sacroiliac joint is very strong, it can incur painful injury. The diagnosis of sacroiliac sprain syndrome requires more than just tenderness on palpation of the sacroiliac area. Certain maneuvers, such as Patrick's test and the sacroiliac compression test, are useful in establishing the diagnosis. Proper treatment consists of bed rest, heat, nonsteroidal anti-inflammatory drugs and muscle relaxants. Physical therapy and manipulation may also help. In recalcitrant cases, injection of the sacroiliac joint with a corticosteroid and a local anesthetic can be effective.


Adverse psychiatric effects of systemic glucocorticoid therapy. Glucocorticoid therapy causes psychiatric side effects in many patients. Although psychiatric side effects occur most commonly in women and middle-aged patients, no clinical features have been identified to predict which patients are at risk. The most frequent side effects are mood changes ranging from mild euphoria to hypomania, but other reactions, including depression, dementia and psychosis, are possible. The incidence of psychiatric side effects is directly related to dosage. The mechanism by which glucocorticoids produce psychiatric symptoms is probably multifactorial, including both direct and indirect effects on the brain. Psychiatric symptoms usually resolve with dosage reduction or controlled withdrawal of glucocorticoids, but antipsychotic medication may be indicated if symptoms are severe or prolonged.


Genodermatoses with malignant potential. Disease-associated malignancy may occur in several inherited conditions with dermatologic manifestations. These genodermatoses include nevoid basal cell carcinoma syndrome, Cowden's disease, multiple endocrine neoplasia syndromes, neurofibromatosis and Peutz-Jeghers syndrome. Although most of these genodermatoses are rare, recognition of their cutaneous features can facilitate early diagnosis of the systemic condition and surveillance for neoplasm. Appropriate evaluation of the patient's family, as well as genetic counseling, should be performed when the diagnosis of a genodermatosis with malignant potential is established.


Sequelae of minor traumatic brain injury. Minor traumatic brain injury is the most common type of traumatic encephalopathy, with approximately 290,000 to 325,000 new cases occurring each year. Recent research has suggested that both anatomic factors (acceleration-deceleration injury, contusions) and neurotransmitter factors (cholinergic systems) may contribute to the pathologic sequelae. Symptoms may be broadly categorized as physical, behavioral/affective, cognitive and integrative. Patients with mild brain injury may demonstrate significant attention and information-processing impairments in the absence of apparent neurologic problems. Most symptoms abate within the first few months, but a sizable subgroup of patients remain symptomatic up to one year or more. Evidence suggests that patients whose symptoms persist are not simply "neurotic." Rehabilitation efforts should focus on proper evaluation, reassurance, education, support and monitoring of progress.


Managing the difficult physician-patient relationship. A difficult physician-patient relationship can have significant consequences for both the physician and the patient. Difficult relationships can lead to frustrating, dissatisfying, adversarial and expensive medical care. The difficult relationship is often a consequence of a breakdown in communication between physician and patient. Specific causes include technical communication barriers, difficulty in discussing certain topics, unmet or violated norms and expectations (both the physician's and the patient's) and a mismatch between the physician's and the patient's personality styles. Management goals for the difficult relationship include maintaining professional self-esteem, maintaining physician-patient continuity, minimizing the "medicalization" of the problem by limiting the use of tests and procedures, and minimizing hospitalization and referral. It is also important to remember that although the relationship may continue to be frustrating or conflictual, it can be effectively managed with appropriate strategies.


Diagnostic hysteroscopy.

Diagnostic hysteroscopy. The hysteroscope is a valuable tool for selective viewing of the uterine cavity and the endocervical canal. With smaller-diameter scopes, hysteroscopy can be performed in the office setting, often without the need for cervical dilatation or local anesthesia. Controlled-rate CO2 insufflators allow safe distention of the uterine cavity with minimal side effects. Indications for office hysteroscopy include the evaluation of abnormal uterine bleeding, genital carcinoma and infertility and the investigation of a "lost" intrauterine device. Hysteroscopy is an adjunct to endometrial sampling, dilatation and curettage, hysterosalpingography and cervical cytology.


Expanding applications of the 12-lead ECG in suspected acute infarction. In the setting of acute myocardial infarction, the importance of the 12-lead electrocardiogram has increased tremendously. In addition to facilitating diagnosis of acute ischemic syndromes, including acute myocardial infarction, the 12-lead electrocardiogram may provide invaluable assistance in determining which patients are most suitable for thrombolytic therapy, and it may provide information that is useful in prognostic stratification.


The elimination diet as a diagnostic tool. Many family physicians overlook the role that food and food additives play in health problems. An elimination diet is a safe and cost-effective method of evaluating adverse reactions to foods in some patients with common medical problems. Patients whose symptoms improve or clear while they are on the diet are then challenged with the omitted foods one at a time to establish food-symptom relationships.


Update on hormone replacement therapy.

Update on hormone replacement therapy. The well-recognized benefits of hormone replacement therapy include relief of vasomotor symptoms, alleviation of psychogenic manifestations, prevention of atrophic vaginitis, prevention and treatment of osteoporosis, and prevention of cardiovascular disease. Risks can be minimized by proper evaluation and appropriate hormone replacement. When an adequate dosage of estrogen is given, the added progestogen does not adversely affect lipid levels. When progestogens are added to estrogen replacement therapy, the incidence of endometrial cancer is lower in postmenopausal women receiving this form of therapy than in untreated postmenopausal women. Although the risk of breast cancer is a matter of controversy, it does not seem to increase with estrogen therapy; the addition of progestogen may decrease the risk for some women. The prognosis for breast cancer is improved in women receiving hormone replacement therapy.