Brain parenchyma motion: measurement with cine echo-planar MR imaging. With echo-planar magnetic resonance (MR) imaging, the authors measured the intrinsic pulsatile motion of brain parenchyma. Phase-sensitive, electrocardiography-gated, two-dimensional cine images were acquired throughout the cardiac cycle by using a spin-echo, blipped echo-planar MR pulse sequence. Transverse and coronal planes were obtained in 14 healthy volunteers. Corrections were made for gross head motion. Brain motion consisted of a rapid displacement in systole, with a slow diastolic recovery. The motion occurred chiefly in the cephalocaudal and lateral directions; the anteroposterior motions were relatively small. Cephalocaudal velocities increase with proximity to the foramen magnum. The lateral motion is mainly a compressive motion of the thalami. Brain parenchymal velocities were as high as 2 mm/sec caudally in the brain stem and 1.5 mm/sec medially in the thalami. Net parenchymal excursions were at most 0.5 mm. Phase-based echo-planar velocity measurements agreed well with echo-planar Fourier velocity zeugmatography measurements and were consistent with reported values. Velocity mapping with echo-planar imaging offers a rapid and flexible method of assessing the pulsation velocities of the human brain.


Brain motion: measurement with phase-contrast MR imaging. Brain motion during the cardiac cycle was measured prospectively in 10 healthy volunteers by using a phase-contrast cine magnetic resonance (MR) pulse sequence. The major cerebral lobes, diencephalon, brain stem, cerebellum, cerebellar tonsils, and spinal cord were studied. The overall pattern of brain motion showed caudal motion of the central structures (diencephalon, brain stem, and cerebellar tonsils) shortly after carotid systole, with concurrent cephalic motion of the major cerebral lobes and posterior cerebellar hemisphere. Peak brain displacement was in the range of 0.1-0.5 mm for all the structures except the cerebellar tonsils, which had greater displacement (0.4 mm +/- 0.16 [mean +/- standard error of mean]). Caudal motion of the central structures did not occur simultaneously but progressed in a caudal-to-rostral and posterior-to-anterior sequence, being seen first in the cerebellar tonsils and then later in the diencephalon (hypothalamus). Caudal motion of the low brain stem and cerebellar tonsil was simultaneous with caudal motion of cerebrospinal fluid in the cervical subarachnoid space. Oscillatory flow in the aqueduct was delayed compared with brain stem motion.


Intracerebral lesion contrast with spin-echo and fast spin-echo pulse sequences. Fast spin-echo (FSE) magnetic resonance (MR) imaging was compared with conventional, peripherally gated T2-weighted spin-echo (SE) imaging in the detection of high- and low-signal-intensity lesions in the central nervous system. Lesion detectability was determined with percentage of contrast measurements and contrast-to-noise ratios with two different measurements for noise. All three measures of lesion detectability were similar. FSE and SE sequences were quantitatively equivalent in the detection of high-signal-intensity lesions. The SE sequence, however, was superior to the FSE sequence in the detection of small, low-signal-intensity lesions in the central nervous system caused by magnetic susceptibility effects.


Intracranial vascular stenosis and occlusion: evaluation with three-dimensional time-of-flight MR angiography. To assess the usefulness of magnetic resonance (MR) angiography in the characterization of intracranial arterial stenosis and occlusion, a three-dimensional time-of-flight method was compared with conventional angiography in 214 vessels in 29 patients. Studies were independently interpreted by two neuroradiologists who scored each vessel as normal, narrowed, or occluded. Overall, 97% of normal vessels and 100% of occlusions were correctly graded. Sixty-one percent of stenoses were graded correctly; the remainder were graded as normal. The portions of the intracranial vessels near the skull base and especially the paracavernous and supraclinoid segments of the internal carotid arteries were areas of frequent over- and underestimation of stenosis due to the presence of dephasing artifacts. In patients with stenosis or occlusion, MR angiography also provided information regarding the presence of collateral flow in the circle of Willis. When used in conjunction with MR imaging of the brain and MR angiography of the extracranial carotid arteries, intracranial MR angiography allows a more complete evaluation of the patient with symptoms of cerebral ischemia or infarction.


Mapping of brain tumor metabolites with proton MR spectroscopic imaging: clinical relevance. Brain tumor metabolism was studied with hydrogen-1 magnetic resonance spectroscopy and positron emission tomography with fluorine-18 fluorodeoxyglucose in 50 patients. N-acetylaspartate (NAA) was generally decreased in tumors and radiation necrosis but was somewhat preserved at neoplasm margins. Choline was increased in most solid tumors. Solid high-grade gliomas had higher normalized choline values than did solid low-grade gliomas (P < .02), but the normalized choline value was not a discriminator of tumor grade, since necrotic high-grade lesions had reduced choline values. Serial studies in one case showed an increase in choline as the glioma underwent malignant degeneration. Choline values were lower in chronic radiation necrosis than in solid anaplastic tumors (P < .001). In two cases studied before and after treatment, clinical improvement and a reduction in choline followed therapy. Lactate is more likely to be found in high-grade gliomas, but its presence is not a reliable indicator of malignancy.


Cytotoxic brain edema: assessment with diffusion-weighted MR imaging. To determine whether cytotoxic brain edema is associated with a decrease in diffusion, it was induced in rats, in the absence of ischemia, with an established model of acute hyponatremic encephalopathy. Cytotoxic brain edema secondary to acute hyponatremia was induced with intraperitoneal injections of 2.5% dextrose in water and subcutaneous injection of arginine-vasopressin. Coronal spin-echo magnetic resonance (MR) images were obtained with and without strong diffusion-sensitizing gradients before and after induction of acute hyponatremia. The apparent diffusion coefficient (ADC) was measured at two coronal section locations. In hyponatremic rats, the brain ADC was significantly reduced (P = .0153 and .0001) and was positively correlated with increased total brain water content (P = .0011). Plots of ADC versus total brain water showed a statistically significant inverse linear relationship between ADC and increasing brain water at the anterior coronal section location. The results indicate that the ADC may be a sensitive indicator of cytotoxic brain edema and thus may enable quantitative evaluation of such edema with diffusion-weighted MR imaging.


Malignant parotid tumors: clinical use of MR imaging and histologic correlation. Magnetic resonance (MR) imaging was performed in 116 patients in whom a parotid mass lesion was clinically suspected. Eighty-six patients had benign disease. The 30 patients in whom a malignant tumor was found were further evaluated. To determine which features are characteristic of malignant parotid tumors, spin-echo T1- and T2-weighted images of malignant lesions in the parotid gland were compared with those of benign disease. In our series, tumor margins, homogeneity, or signal intensity were not discriminative factors to correctly predict benign or malignant disease. Infiltration into deep structures (eg, the parapharyngeal space, muscles, and bone) was observed only in malignant tumors. Infiltration into subcutaneous fat was noticed in malignant as well as in inflammatory disease. No statistically significant correlation was found between tumor grade and MR imaging features in malignant disease. MR imaging is useful in delineating malignant tumors but is unreliable in correctly predicting the histologic nature of a mass lesion in the parotid gland.


Increased corneal temperature caused by MR imaging of the eye with a dedicated local coil. To determine the existence of tissue heating-associated risks to the eye with magnetic resonance (MR) imaging performed at high specific absorption rates (SARs), corneal temperature was measured in 14 patients immediately before and after MR imaging performed with a 1.5-T, 64-MHz unit and a quadrature-driven body coil for radio-frequency transmission and a receive-only local coil designed for eye imaging. Fast spin-echo pulse sequences were used predominantly. Estimated peak SARs ranged from 3.3 to 8.4 W/kg. A statistically significant (P < .001) increase in average corneal temperature (32.2 degrees C +/- 0.7 before imaging, 33.1 degrees C +/- 0.6 after) was associated with MR imaging of the eye. The changes in corneal temperature ranged from 0.2 degrees to 1.8 degrees C (average, 0.9 degrees C). The highest corneal temperature measured after MR imaging was 35.1 degrees C. MR imaging performed with a dedicated local coil at the SARs studied produced elevations in corneal temperature that were physiologically inconsequential and below the temperature threshold (41 degrees to 55 degrees C) for radio-frequency radiation-induced cataractogenesis.


Disparities in reimbursement to radiologists and nonradiologists for 65 common outpatient imaging studies. The authors examined global charges (incorporating both technical and professional components) and global reimbursement allowances for all radiographic and ultrasound (US) examinations performed on Pennsylvania Blue Shield subscribers in the Lehigh Valley area of Pennsylvania during 1990. Data for radiologists and nonradiologists were compared with respect to all procedure codes for which at least 25 claims were submitted, yielding a sample of 40,619 radiographic examinations (54 procedure codes) and 9,761 US examinations (11 procedure codes). Radiologists' mean charges were higher than those of nonradiologists for 38 of the 54 radiographic codes. However, nonradiologists received higher mean reimbursement allowances for 39 of the 54 codes. Among the 11 US codes, nonradiologists' mean charges were higher for 10 and they received higher mean reimbursement allowances for seven. The averages of the mean reimbursement allowances for individual codes were higher for nonradiologists in both the radiographic and US categories. Pennsylvania Blue Shield has begun steps to eliminate disparities in reimbursements to providers who submit claims for imaging examinations.


Mammographic features of 455 invasive lobular carcinomas. Of 6,009 cases of breast cancer studied, 455 (7.6%) were invasive lobular carcinoma (ILC); 341 of these (75%) were pure ILC and 114 (25%) were ILC mixed with ductal forms. The mammographic features were compared with those of the 5,554 other breast carcinomas. Pure ILCs were less frequently round (1% vs 11%) and more frequently spicular (28% vs 23%) or with architectural distortion (18% vs 6%) than the other breast carcinomas. Microcalcifications were less common (24% vs 41%) and retraction of the skin (25% vs 21%) and nipple (26% vs 17%) was more common in pure ILC than in the other breast carcinomas. When complementary magnification views were obtained, only 50% were helpful in diagnosis of ILC while 75% were helpful in diagnosis of other breast carcinomas. Malignancy was less frequently diagnosed in ILC (57%) than in the other breast carcinomas (64%). The results were intermediate in the mixed ILC group.


Effects of fine-needle aspiration on the US appearance of the breast. Fine-needle aspiration (FNA) of normal breast tissue or benign lesions can cause changes that suggest malignancy at ultrasound (US) examination. Serial US studies showed that three of 17 patients developed signs mimicking malignancy following FNA of palpable breast lumps. A second group of 14 patients had US signs of malignancy in palpable lumps following recent FNA. Nine patients with benign lesions were unnecessarily worried, since the appearance was probably due to FNA. Diagnosis of malignancy was delayed in one of five patients because the US appearance was attributed to the FNA in the presence of false-negative cytologic findings. FNA of normal breast tissue or benign masses produced tissue changes in 18% of cases that altered the US appearance from normal or benign to possibly malignant. The changes took up to 4 months to subside. If US is clinically indicated, it should be performed before FNA.


Shifting pneumothorax after heart-lung transplantation. Heart-lung transplantation involves the total replacement of two of the most complex organs of the thoracic cavity. This procedure is usually reserved for patients with failure of both systems, such as in primary pulmonary hypertension or chronic Eisenmenger physiology. The en bloc replacement of the heart and lungs leaves an open communication between the two sides of the thorax that may allow air or fluid to shift from one side to the other. To evaluate this possibility, the authors reviewed the chest radiographs of 25 heart-lung transplant recipients for signs of rapidly changing pneumothoraces that could not be explained by the conventional dynamics of pleural physiology. A series of postoperative radiographs showed unusual shifting or apparently rapid disappearance of pneumothoraces in eight patients. Decompression of a pneumothorax with a contralateral chest tube was a phenomenon observed in six of these patients.


AMBER and conventional chest radiography: comparison of radiation dose and image quality. The authors compared the radiation dose to the patient and the image quality in advanced multiple-beam equalization radiography (AMBER) with those in conventional chest radiography. Organ doses were estimated for an anthropomorphic phantom from measurements with thermoluminescence dosimeters. These measurements were supplemented with area-air kerma products obtained during chest examinations of 223 patients. Image quality was determined by means of a contrast-detail image evaluation test. An improvement in image quality in regions of high absorption and an increased dose to the patient were found for the AMBER technique compared with the conventional technique. However, for both techniques, the radiation exposure was relatively low compared with other reported values of patient dose during chest radiography. The estimated effective dose for an average-size patient during chest radiography with posteroanterior and lateral projections is 0.085 mSv for the conventional and 0.14 mSv for the AMBER technique.


Junctional parenchyma: revised definition of hypertrophic column of Bertin. The so-called hypertrophic column of Bertin is a normal variation and simply represents unresorbed polar parenchyma of one or both of the two subkidneys that fuse to form a normal kidney. It contains renal cortex, pyramids, and columns (septa) of Bertin. (Since all elements of the tissue are normal, that is, neither hypertrophic nor a displaced or embryonic rest, it is referred to as "junctional parenchyma.") When a masslike lesion is suspected at sonography or excretory urography, diagnosis of junctional parenchyma can be made with a high degree of certainty when sonography shows that the structure (a) is located between the overlapping portion of two renal sinus systems, (b) is bordered by a junctional parenchymal line and defect, (c) contains renal cortex, pyramids, and columns of Bertin, and (d) contains renal cortex that is continuous with the adjacent renal cortex of the same subkidney.


Testicular tumors: findings with color Doppler US. A study of 28 patients with surgically proved testicular tumors was performed to determine the appearance at color Doppler ultrasound (US) scanning. There was a general correlation of tumor size and vascularity. Twenty of 21 (95%) tumors larger than 1.6 cm were hypervascular. Six of seven (86%) tumors smaller than 1.6 cm were hypovascular. One small, 1.1-cm-diameter seminoma was hypervascular, and one 2.8-cm-diameter seminoma was hypovascular. The histologic findings of the tumor did not correlate with the vascularity of the lesion as seen at color Doppler US. Resistive indexes ranged from .476 to 1.0 (mean, 0.70). Peak systolic velocities ranged from 8.4 cm/sec to 64.9 cm/sec (mean, 9.8 cm/sec). Venous flow was detected in eight tumors. The gray-scale findings, as well as history and physical examination findings, correctly suggested a neoplasm in all cases. The findings at color Doppler US were prospectively interpreted as indicative of neoplasm in 27 cases and as indicative of inflammation in one case. The authors conclude that color Doppler US scanning has only a limited role in the evaluation of testicular tumors.


Renal US findings in sulfadiazine-induced crystalluria. The authors report two cases of sulfadiazine-induced obstructive nephropathy that were diagnosed with ultrasound (US). Renal US demonstrated layered clusters of echogenic shadowing material--presumed to be sulfa crystals--which cleared when the crystalluria resolved. The authors conclude that renal US is helpful in diagnosing sulfa calculi and subsequent obstructive nephropathy.


Bladder tumor staging: comparison of conventional and gadolinium-enhanced dynamic MR imaging and CT. With computed tomography (CT) and unenhanced magnetic resonance (MR) imaging, stage pT3b extravesical extension and beyond can be diagnosed, but tumors confined to the bladder wall (stages pT1-pT3a) are poorly delineated. To determine whether visualization of such tumors could be improved with gadolinium-enhanced MR imaging, dynamic breath-hold T1-weighted MR images were obtained after intravenous infusion of 0.1 mmol/kg gadopentetate dimeglumine in 79 patients (86 tumors). Conventional MR images, CT scans, and histologic correlation were available in all cases. With dynamic gadolinium-enhanced MR imaging, the mucosa could be distinguished from the muscular layers of the bladder wall. Staging accuracy with this technique was 85% (73 of 86), which was significantly better than with CT (55%; 47 of 86) (P < .005) or conventional MR imaging (58%; 50 of 86) (P < .05). The accuracy of staging the intramural extent (pT1-pT3a) of bladder tumors was thus improved with gadolinium-enhanced dynamic MR imaging.


Dandy-Walker variant: prenatal sonographic features and clinical outcome. The Dandy-Walker variant is a less severe posterior fossa anomaly than the classic Dandy-Walker malformation. In 17 consecutive fetuses, the Dandy-Walker variant was diagnosed at sonography, and associated defects, karyotypic anomalies, and outcomes were evaluated. Four of the 17 fetuses (24%) had mild ventriculomegaly. Eight of the 17 (47%) had concurrent non-central nervous system (CNS) anomalies. Five fetuses (29%) had an abnormal karyotype (two with trisomy 18, one each with trisomy 13, 21, and 11q+) and associated sonographic anomalies. Six of the 17 fetuses (35%) died in utero or during the neonatal period, two are severely handicapped, and the other nine are developing normally at ages 4 months to 4 years. Six of the nine normally developing infants (53%) lacked non-CNS sonographic findings. Because the prognosis is uncertain for an infant born with the prenatal diagnosis of Dandy-Walker variant, prenatal recognition of the anomaly allows for the option of fetal karyotyping and for arrangement for postnatal follow-up.


Twin pregnancies: accuracy of first-trimester abdominal US in predicting chorionicity and amnionicity. A first-trimester transabdominal ultrasound (US) study was performed on twin pregnancies to determine the utility of US in predicting chorionicity and amnionicity. Among 85 dichorionic-diamniotic (DC-DA) twin pairs, a thick membrane was present in 78 (92%). Four of the DC-DA cases without a thick membrane had two distinct placental sites, allowing 82 DC-DA pregnancies (96%) to be predicted. Among 16 monochorionic-diamniotic (MC-DA) twin pairs, a thin membrane was present in 14 (88%). None of the four monochorionic-monoamniotic (MC-MA) cases had an identifiable membrane. The lambda sign had no value in this evaluation and was actually misleading, while a thick membrane or the identification of two separate placentas was always predictive of DC-DA twinning. However, a thin membrane, while usually predictive of an MC-DA pregnancy, did not exclude a DC-DA gestation. When no membrane is present, an MC-MA gestation is probable; however, a diamniotic pregnancy may still be present, and further evaluation is suggested.


Effect of scanning pressure on intracranial hemodynamics during transfontanellar duplex US. The purpose of this study was to determine the effect of transducer scanning pressure during duplex ultrasonographic evaluation of intracranial hemodynamics in newborns. Doppler spectra were obtained from the anterior cerebral artery with use of light and firm scanning pressure over the anterior fontanelle in 23 healthy infants and 20 infants with reduced cranial compliance due to ventricular dilatation, intracranial hemorrhage, diffuse cerebral edema, and extraaxial fluid. In healthy infants, the mean resistive index (RI) increased from 69.9 +/- 3 to 74.8 +/- 3 (P < .005), and mean time average velocity (TAV) decreased from 11.1 cm/sec +/- 1.3 to 8.6 cm/sec +/- 1.3 (P < .0001) with firm scanning pressure. In infants with decreased cranial compliance, mean RI increased from 67.8 +/- 4 to 85 +/- 5, and mean TAV decreased from 16.3 cm/sec +/- 2 to 10.7 cm/sec +/- 2 (P < .0001 for both comparisons). A significant alteration in RI with firm technique (> or = 20% increase in RI, or reversal of diastolic flow) was observed in 12 of 28 examinations in infants with decreased cranial compliance and in only one of 23 healthy infants (P < .005). These data show that scanning pressures during duplex ultrasonography can significantly affect intracranial hemodynamics, especially in infants with altered cranial compliance.


Urethral stones: US for identification in boys with hematuria and dysuria. There are multiple causes for hematuria in infants and children. When hematuria is accompanied by dysuria, however, one should focus attention on the lower urinary tract. Although ultrasound (US) is a well-established method for assessing the kidneys and bladder, little attention has been focused on its use for evaluating urethral abnormalities, since voiding cystourethrography or retrograde urethrography usually is used. In the cases of two young boys, sonography aided in the identification of clinically unsuspected urethral stones. US evaluation of the urethra is now included as an integral part of urinary tract sonography in male patients with hematuria accompanied by dysuria.


Closed-loop and strangulating intestinal obstruction: CT signs. In 19 patients with closed-loop intestinal obstruction, including 16 patients with strangulating obstruction, the findings at examination with computed tomography (CT) were retrospectively correlated with the surgical and pathologic findings and evaluated by two radiologists. Signs of closed-loop obstruction, present in 15 patients, were associated with the configuration of the incarcerated loop of small bowel, abnormalities detected at the site of obstruction, or both. These abnormalities were the following: a U-shaped, distended, fluid-filled bowel loop; the whirl sign; the beak sign; a triangular loop; two adjacent collapsed loops of bowel at the site of obstruction; or all of these. CT signs of strangulation, seen in 10 of the 16 patients with ischemic or infarcted bowel, were associated with the appearance of the bowel wall (thickening, high attenuation, and the target sign), abnormalities in the attached mesentery, or both. In mechanical obstruction of the small bowel, detection of ischemic changes in the bowel wall or mesentery with CT indicates strangulation. Absence of CT findings of ischemia or infarction does not rule out strangulation.


High-attenuation lymphadenopathy in AIDS patients: significance of findings at CT. A retrospective evaluation was performed of the location and attenuation characteristics of abdominal and pelvic lymphadenopathy, identified at dynamic sequential bolus computed tomography (CT) in 69 patients with acquired immunodeficiency syndrome (AIDS). Lymph node appearance at CT was characterized as hyperattenuating, isoattenuating, or hypoattenuating relative to the iliopsoas muscle. The significance of finding hyperattenuating adenopathy in the patient population was evaluated. Thirty-three patients had hyperattenuating adenopathy, including 26 with the epidemic form of Kaposi sarcoma (KS). Of 38 patients with epidemic KS, 26 had hyperattenuating, 11 had isoattenuating, and one had hypoattenuating lymphadenopathy. The positive predictive value of hyperattenuating adenopathy for epidemic KS was 79%. These findings were statistically significant at the 95% confidence interval (P < .005). Hyperattenuating lymphadenopathy, identified on dynamic sequential bolus CT scans in AIDS patients, was seen with disseminated KS in approximately 80% of cases.


Cellulose as a gastrointestinal US contrast agent. Ultrasound (US) imaging of the abdomen often is compromised by artifacts due to adjacent bowel gas. In an attempt to decrease gas artifacts and improve US image quality, the authors evaluated the use of cellulose preparations as gastrointestinal US contrast agents. Optimal homogeneity and reflectivity were evaluated in phantom solutions, and two suitable agents were selected for clinical trial. Ten volunteers underwent abdominal US imaging before and after contrast agent administration on three separate occasions. The volunteers drank 800 mL of freshly degassed water and two different gastrointestinal US contrast agents. US images obtained before and after administration of contrast material were evaluated by five radiologists and scored for bowel marking, visualization of abdominal anatomy, and image degradation by bowel gas. Compared with water, the orally administered US contrast agents improved visualization of bowel and abdominal anatomy, with diminished gas artifact.


Intestinal anisakiasis: US in diagnosis. Eighteen consecutive patients with intestinal anisakiasis were studied with high-resolution ultrasound (US) and barium studies. US showed markedly thickened bowel loops associated with luminal narrowing, swelling of Kerckring folds, and decreased peristalsis. A small amount of ascitic fluid around the bowel loops was found, and cytologic examinations of the ascites revealed a dense infiltration of eosinophils. Barium studies demonstrated segmental mucosal edema of the small intestine: The most common site was the distal ileum, and the mean length of the edematous lesion was 19 cm. All patients underwent treatment of symptoms without laparotomy, and their symptoms disappeared by the eighth day after onset. Patients with acute abdominal symptoms should be asked about the intake of raw or undercooked fish. If the above US features are found, the diagnosis of intestinal anisakiasis must be seriously considered to avoid unnecessary surgical treatment.


Evaluation of myocardial perfusion abnormalities with gadolinium-enhanced snapshot MR imaging in humans. Work in progress. To determine whether myocardial perfusion abnormalities could be detected in patients with coronary artery disease by means of contrast material-enhanced magnetic resonance (MR) images, a snapshot imaging technique was used in six patients with coronary artery disease and four healthy subjects in conjunction with pharmacologic stress (dipyridamole infusion) and bolus injection of gadopentetate dimeglumine. MR images from all patients and healthy subjects were quantitatively analyzed to define spatial changes in signal intensity after administration of dipyridamole and gadopentetate dimeglumine. The resultant findings were compared with findings on thallium-201 scintigrams obtained after administration of dipyridamole and on coronary arteriograms in all patients. Nine myocardial regions supplied by stenosed arteries showed diminished levels of signal intensity after infusion of the contrast agent compared with those of normally perfused regions. These findings were in agreement with those obtained with T1-201 scintigraphy (in eight of nine regions) and arteriography. Thus, contrast-enhanced high-speed MR imaging with use of dipyridamole enabled detection of regional perfusion abnormalities in humans.


The Groshong catheter: initial experience and early results of imaging-guided placement. Fifty Groshong catheters were placed in 50 patients with use of ultrasound (US) and fluoroscopic guidance in the radiology suite: 49 were placed via the subclavian vein and one was placed via the left internal jugular vein. All (100%) attempts at catheter placement were successful. Imaging guidance affected the placement of catheters in 12 cases (24%), including four patients (8%) in whom vascular access would not have been possible with blinded percutaneous venipuncture or surgical cutdown. After a four-case learning curve period, during which one pneumothorax (2%) and two arterial punctures (4%) occurred, there were no further venipuncture-related complications. One catheter was removed because of infection (2%) and one because of allergic reaction (2%) to the antimicrobial cuff. Four patients with cutaneous infections and one with catheter-related sepsis were successfully treated with antibiotics. Results demonstrate the initial promise of imaging-guided placement of central venous access catheters when performed in the radiology suite.


Arterial and venous blood flow: noninvasive quantitation with MR imaging. Quantitative measurements of arterial and venous blood flow were obtained with phase-contrast cine magnetic resonance (MR) imaging and compared with such measurements obtained by means of implanted ultrasound (US) blood flow probes in anesthetized dogs. The US flowmeter was enabled during a portion of each MR imaging sequence to allow virtually simultaneous data acquisition with the two techniques. MR imaging data were gated by means of electrocardiography and divided into 16 phases per cardiac cycle. The rates of portal venous blood flow measured with MR imaging and averaged across the cardiac cycle (710 mL/min +/- 230 [standard deviation]) correlated well with those measured with the flowmeter and averaged in like fashion (751 mL/min +/- 238) (r = .995, slope = 1.053). The correspondence in arterial blood flow was almost as good. No statistically significant difference existed between the paired measurements of blood flow obtained with MR imaging and the implanted probe. It is concluded that, as a noninvasive means of accurate quantification of blood flow, phase-contrast MR imaging may be especially useful in deep blood vessels in humans.


Role of parallel transjugular intrahepatic portosystemic shunts in patients with persistent portal hypertension. Transjugular intrahepatic portosystemic shunts (TIPS) were placed in 93 patients between June 1990 and January 1992 for treatment of variceal hemorrhage. In each case, a Wallstent (Schneider USA, Minneapolis) was used to support the hepatic parenchymal tract between the hepatic and portal veins. Currently, these stents have a maximal diameter of 10 mm. In eight of 93 patients, major portal hypertension persisted after placement of a 10-mm-diameter shunt, manifested by continued rapid variceal filling and elevated portosystemic gradients. A second TIPS was placed parallel to the first in these patients to allow further portal decompression. In two other patients, a second TIPS was placed because the initial shunt functioned suboptimally. The mean postprocedural portosystemic gradient in the patients who received one TIPS was 10.2 mm Hg +/- 3.7. In patients who received two TIPS, the mean postprocedural gradient was 19.1 mm Hg +/- 3.8 after placement of the first TIPS and 12.5 mm Hg +/- 3.5 after placement of the second. Two patients developed their first episode of encephalopathy after placement of two TIPS. The methods and indications for placing two TIPS in this select population are discussed.


Fine-needle aspiration biopsy for cytopathologic analysis: utility of syringe handles, automated guns, and the nonsuction method. The performances of seven techniques and devices used with 22-gauge needles to obtain biopsy specimens for cytologic analysis were compared by means of single-blinded evaluation with an objective, previously published grading scheme. A total of 420 specimens were obtained from 10 fresh human cadavers (42 specimens per cadaver), including 30 hepatic, 20 renal, and 10 pancreatic specimens per technique or device. No statistical differences existed in the liver, kidney, or pancreas or in the combined data in the performance of the aspirator gun, syringe holders, vacuum needle, and end-cut gun versus the manual aspiration biopsy technique performed with a 22-gauge Chiba needle. However, nonaspiration, fine-needle capillary biopsy (FNCB) performed statistically significantly worse than any other technique or device in the kidney and pancreas and in comparison with the overall combined data. In the liver, no statistically significant difference existed in the overall performance of FNCB versus conventional aspiration biopsy, but the amount of cellular material obtained with FNCB was statistically significantly less.


Deep pelvic abscesses: transrectal drainage with radiologic guidance. Transrectal catheter drainage was performed under radiologic guidance in eight patients with deep pelvic abscesses during a 7-month period. One patient underwent two procedures. In five patients, the abscess could not be palpated at rectal examination. Seven procedures were performed with fluoroscopic guidance. Transrectal ultrasound was performed in conjunction with fluoroscopy for two procedures. Medium to large (8-14-F) locking catheters were used in seven procedures, and small (5-F) nonlocking pigtail catheters were used in two. The catheter was left in place for 3 days or less in all but one patient, in whom the catheter was left in place for 20 days. Five abscesses were drained through the anterior or anterolateral rectal wall and four, including one repeat drainage, through the posterior rectal wall. No complications occurred as a direct result of transrectal drainage. Successful initial drainage was established with clinical improvement in all cases. Two patients eventually required surgery, one for continued bleeding into an infected hematoma and one for abscess recurrence after tube dislodgment. Transrectal drainage performed with radiologic guidance is a safe, feasible procedure; is well tolerated by patients; and is relatively easy to perform with the techniques described.


Percutaneous recanalization of a renal artery in aortic dissection. Chronic renal failure acutely worsened in a patient with a type B aortic dissection. Aortography revealed an occlusion of the left renal artery without renal intimal tear. Percutaneous recanalization, performed with a self-expandable stent, resulted in improvement in the renal function. This technique offers a new therapeutic choice in patients with visceral complications of aortic dissection.


Multiple myeloma: spinal MR imaging in patients with untreated newly diagnosed disease. Spinal magnetic resonance (MR) imaging was performed in 29 patients with newly diagnosed, untreated multiple myeloma. Nineteen (66%) patients were asymptomatic. Sagittal pre- and postcontrast T1-weighted spin-echo images and gradient-recalled-echo images of the thoracic and lumbosacral spine were obtained. Marrow involvement was identified in 20 (69%) patients. There were three MR patterns: focal lesions in nine patients (31%), diffuse involvement in seven (24%), and an inhomogeneous pattern of tiny lesions on a background of normal marrow in four (14%). A statistically significant correlation between MR imaging patterns of marrow involvement and serum hemoglobin values (one-way, P = .0899; Kruskal-Wallis, P = .0620) and between MR imaging patterns and percentage of marrow plasmacytosis (Kruskal-Wallis, P = .0314) was noted, with patterns of diffuse and focal marrow involvement associated with more abnormal values. Spinal MR imaging in patients with early myeloma may reveal marrow involvement in both symptomatic and asymptomatic patients. Some correlation was found between MR imaging patterns and laboratory indexes of disease.


Quantitative imaging of Gaucher disease. Twenty-three patients with type 1 Gaucher disease were evaluated with a battery of quantitative imaging techniques. Plain radiographs were used to measure cortical thickness and Erlenmeyer flask deformity. Xenon-133 uptake was measured in scans of the lower extremities. Dual-energy quantitative computed tomography was used for calculation of trabecular bone and bone marrow fat content in the spine and long bones. Magnetic resonance (MR) imaging was performed to evaluate disease extent and three-dimensional splenic volume. MR images were also used to provide quantitative measurements of each vertebral fat fraction. Each imaging modality was correlated with the others as well as with the clinical history of skeletal complications and the hematocrit and acid phosphatase activity. There was a strong relationship between splenic volume and disease severity as measured clinically and with laboratory testing. The spinal fat fraction also correlated with these measures of disease severity and with the femoral fat fraction and xenon uptake. No measurement allowed discrimination of patients with from those without skeletal complications.


Hill-Sachs lesion: comparison of detection with MR imaging, radiography, and arthroscopy. Magnetic resonance (MR) imaging has proved to be a valuable method for documenting Hill-Sachs lesions. The authors retrospectively analyzed the diagnostic interpretations at plain film radiography, arthroscopy, and MR imaging in 76 patients. The analysis revealed that neither radiography nor arthroscopy displayed the lesion with sufficient accuracy to represent a true standard of reference for the evaluation of MR imaging in the diagnosis of the Hill-Sachs lesion. The data from the diagnostic interpretations were analyzed in three ways, each of which revealed that findings at MR imaging were more helpful than findings at radiography and/or arthroscopy in the diagnosis of the Hill-Sachs lesion. When the agreement of findings in two or three methods was used to assign a final diagnosis, MR imaging resulted in sensitivity of 97%, specificity of 91%, and accuracy of 94% in the detection of Hill-Sachs lesions.


Osgood-Schlatter lesion: fracture or tendinitis? Scintigraphic, CT, and MR imaging features. To determine whether the Osgood-Schlatter lesion (OS) is produced by avulsion fracture or injury to the patellar tendon, all images obtained in 28 cases of OS in 20 patients (16 scintigrams, 34 computed tomographic [CT] scans, and 27 magnetic resonance [MR] images) were retrospectively analyzed. In 21 cases, imaging was performed before and after treatment; in 20 cases, relief from pain was complete at the time of repeat examination. In all patients (100%), abnormal size of the tendon, decreased attenuation, and increase in signal intensity were compatible with the CT and MR imaging appearance of tendinitis. Distended deep infrapatellar bursa was a frequent finding, particularly on MR studies. These abnormalities had partially disappeared at follow-up examination. An ossicle was seen in only nine of 28 cases (32%); in three of seven cases with follow-up, the ossicle remained nonunited to the tibial tuberosity on follow-up studies despite relief from symptoms. This implies that healing of fracture is not essential for relief from symptoms. These results strengthen the argument that in most cases of OS, insult to the tendon and associated soft tissues, rather than avulsion fracture, causes OS.


Long patellar tendon: radiographic sign of patellofemoral pain syndrome--a prospective study. The position of the patella was studied prospectively in both knees of 45 consecutive patients (21 male and 24 female patients aged 16-48 years who were competitive [n = 17] or recreational [n = 28] athletes) who had unilateral patellofemoral pain syndrome without symptoms or signs of patellar instability at initial examination. In each knee, standardized anteroposterior, lateral, and tangential radiographs were obtained and six indexes of patellar position (the ratio of the patellar tendon to the greatest diagonal length of the patella, sulcus angles, lateral patellofemoral angle, lateral patellar displacement, patellofemoral index, and knee angle) were measured. When healthy and affected knees were compared, high riding of the patella due to long patellar tendon (patella alta) was the only definite finding in the affected knees. The shape of the intercondylar sulcus and the mediolateral position of the patella were identical in both knees, providing no evidence for patellofemoral incongruence or lateral patellar tilt. Results of this study strongly suggest that idiopathic retropatellar pain is closely associated with patella alta.


Comparison of helical and serial CT with regard to three-dimensional imaging of musculoskeletal anatomy. To test the hypothesis that helical computed tomographic (CT) scans provide three-dimensional images as good as or better than those provided by serial CT, two objects were used to study the effects of helical CT: an angled cylindrical bone phantom and a human cadaveric femur specimen with a simulated fracture 1 mm wide. Both objects were immersed in a water bath, and a series of helical and serial CT scans were obtained with various parameters. Volumetric rendering was applied to the resultant data sets to create three-dimensional images, which three radiologists reviewed in a blinded manner to rate their fidelity, accuracy, and diagnostic usefulness. As expected, the images obtained with thin collimation and small intersection spacing or slow table movement were considered superior. Helical and serial CT data acquired with similar parameters were similar in quality, but helical CT is approximately five times faster than serial CT; hence, it is possible to use thinner collimation and obtain more sectional data with helical CT.


Temperature changes induced in human muscle by radio-frequency H-1 decoupling: measurement with an MR imaging diffusion technique. Work in progress. To investigate temperature increases in tissues during magnetic resonance (MR) imaging or spectroscopy, the authors measured temperature changes in vitro and in vivo (leg of a volunteer) in a condition simulating hydrogen-1 decoupling in MR spectroscopy. Noninvasive measurements were obtained by using the temperature dependence of the translational diffusion coefficient of water. Temperature was measured at 0.5 T (86 MHz) by using a stimulated-echo sequence that included intense gradient pulses and a procedure reducing sensitivity to bulk tissue motion. Calibration curves of the diffusion coefficient against thermocouple-measured temperature were obtained for a gelatin phantom and bovine muscle. Temperature changes were 5.3 degrees C +/- 0.5 at 2.5 cm from the coil in gelatin and 7.7 degrees C +/- 0.5 at 0.7 cm in bovine muscle. The temperature changed by 4.9 degrees C +/- 1.9 at 2.2 cm from the coil in the calf muscle of a volunteer. The H-1 decoupling protocol can be adapted (modifications in transmission power, duty cycle) to reduce heating effects to below safety recommendations.


Proceedings of a National Cancer Institute workshop: MR spectroscopy and tumor cell biology. In December 1991, the National Cancer Institute held a workshop to evaluate the role of magnetic resonance (MR) spectroscopy in human cancer biology. The clinical and basic cancer research issues requiring use of MR spectroscopy, the advantages and limitations of MR spectroscopy, and future directions in MR spectroscopy of cancer were discussed. Consensus-building panels were formed on the following four topics: cell membrane biochemistry, tumor therapeutic response or drug resistance, appropriate model systems, and potential clinical applications of MR spectroscopy. The workshop members concluded that large prospective clinical studies as well as in vivo animal and human studies to define prognostic variables should be performed, with correlation between MR spectroscopic results and biochemical and physiologic features. Studies of phospholipid metabolism, the pharmacokinetics of anticancer agents, and effects of new cancer treatments on the tumor vasculature and normal tissues are needed.


Prostate cancer: arterial infusion chemotherapy and alteration of intrapelvic blood flow. Twenty-one patients with prostate cancer underwent intermittent arterial infusion chemotherapy with an implanted reservoir and alteration of the intrapelvic blood flow. One internal iliac artery was embolized with steel coils so that the drugs would perfuse throughout the tumor through a single tube. Angiography performed after embolization showed distinct tumor vessels. Intensive radioisotope accumulation was demonstrated in the prostate gland at scintigraphy performed with technetium-99m macroaggregated albumin. Ten milligrams each of cisplatin and doxorubicin were injected once a week by means of puncture of the implanted reservoir. All patients had more than a 50% reduction in tumor size. The response rate to this treatment was good; six patients experienced complete response, and 13 had partial response. Two patients had progressive disease. With this technique, small doses of the anticancer agents reached the tumor in high concentrations. Results were good, with few side effects.


Adjustable automated biopsy device.

Adjustable automated biopsy device. The authors describe a device for soft-tissue core biopsy with core length of 3-19 mm. Excellent results were obtained in combination with a new needle design in a series of 119 renal biopsies in pediatric and adolescent patients. With ultrasound guidance and adjustment of the core length in relation to kidney size, renal biopsy in pediatric patients can be safely performed with this device.


Impact of section doubling on MR angiography. To improve the quality of projection angiograms generated from three-dimensional magnetic resonance (MR) angiography data, the authors applied voxel shifting to create intermediate sections ("section doubling") prior to maximum intensity projection. To date, the authors have processed MR angiography studies with and without section doubling in 20 cases. Section doubling resulted in improved vessel contrast and delineation of continuity (especially of small vessels) in all cases.


Intraparenchymal anesthesia infiltration during transjugular intrahepatic portosystemic shunting. The authors describe a technique for administration of anesthetic to the area of the transparenchymal tract during transjugular percutaneous transhepatic portosystemic shunting. Seven of the eight patients in whom the technique was used did not experience pain during balloon dilation of the tract, and one patient experienced only minimal pain. The technique allows good pain control in patients with severe liver failure and resultant inability of the liver to metabolize pharmaceuticals.


Radiation-induced optic neuropathy: correlation of MR imaging and radiation dosimetry. The authors performed topographic correlation of dosimetric measurements with contrast medium-enhanced magnetic resonance (MR) imaging signal aberration in two cases of radiation optic neuropathy. The region of pathologic contrast enhancement in the optic nerve and chiasm had received 55-62 Gy, which supports the theory that the risk of injury to the optic nerve and chiasm increases steeply with radiation doses above the tolerance level of 50-55 Gy.


Marine oils as a source of omega-3 fatty acids in the diet: how to optimize the health benefits. Marine oils are receiving increasing attention as a source of C 20 and C 22 carbon omega-3 polyenoic fatty acids. The provision of preformed EPA and DHA from marine oils has profound implications for health and disease. Their role as precursors for the synthesis of eicosanoids and docosanoids explains many of the multisystemic effects observed when they are administered. Furthermore under some physiologic conditions such as preterm birth the evidence suggests that C 18 omega-3 fatty acids are not sufficiently converted to DHA to allow for biochemical and functional normalcy, thus DHA may be considered a conditionally essential nutrient for normal eye and brain development. Under disease conditions EPA plays a major role in modifying the balance between omega-6 and omega-3 derived eicosanoids thus modulating related functions. The use of marine oils has some potential risks that can be circumvented by careful processing, storing and preserving the unsaturated fatty acids. Technological procedures based on chemical and physical separation of the unsaturated fatty acids has permitted the elaboration of concentrated EPA and DHA for clinical testing. The development of structured lipids has allowed the synthesis of novel forms of EPA and DHA delivery. Further uses of marine oil to optimize health and prevent disease are predicted based on recent knowledge and technological developments.


Recent advances in methodology for analysis of phytate and inositol phosphates in foods. This review summarises the methods available for the analysis of phytate and structurally related molecules, i.e., inositol polyphosphates. Phytate has been determined by colorimetry, low pressure ion exchange column chromatography, phosphorus-31 fourier transform nuclear magnetic resonance spectroscopy (31P FT NMR), near-infrared reflectance spectroscopy and high performance liquid chromatography (HPLC). Among these techniques anion exchange column chromatography and HPLC were shown to be best suited for separation of inositol phosphates. Since inositol phosphates do not have a characteristic absorption spectrum, their detection in HPLC analysis is limited to methods employing monitoring of refractive index, post column reaction products, conductivity or indirect detection although other detection methods may be feasible. As refractive index detection under isocratic eluent conditions is relatively easy to manipulate, anion-exchange HPLC methods using a low capacity column or ion-pair HPLC methods are recommended for the analysis of inositol phosphates in nutritional studies.


Release of arachidonic acid metabolites from isolated human alveolar type II cells. Human alveolar type II cells are thought to play a role in the pathogenesis of lung injury. Patterns of mediator release of arachidonic acid metabolism by type II cells were therefore studied after challenge with calcium ionophore A23187, opsonized zymosan and hydrogen peroxide. A time- and concentration dependent release of cyclooxygenase products was observed, with release of PGE2 greater than 6-keto-PGF1 alpha greater than TxB2. Addition of glutathione or bicarbonate further increased the production of PGE2. N-ethylmaleimide, a sulfhydryl (SH) reactant, induced a dose-dependent increase in the release of TxB2 and 6-keto-PGF1 alpha, but not of PGE2. This relates most likely to the SH-dependency and glutathione requirement of the PGE2 isomerase and SH-independence of thromboxane and prostacyclin isomerase.


Lack of prostaglandin effect on sodium balance and hyperreninemia in adrenalectomized rats. Glucocorticoids are known inhibitors of prostaglandin production. Prostaglandin E2 (PGE2) and prostacyclin (PGI2) are promoters of natriuresis and renin release. Excessive prostaglandin production, therefore, might contribute to the altered sodium balance and renin release observed in primary adrenal insufficiency. To test this hypothesis, sodium balance and prostaglandin production were measured in adrenalectomized rats and in animals receiving prostaglandin inhibitors or replacement dexamethasone. Compared to sham-operated controls, adrenalectomized rats had decreased two-day sodium balance and elevated plasma renin concentration (PRC), renal PGE2 production, and renal 6-ketoprostaglandin F1 alpha (6kPGF1 alpha, the nonenzymatic metabolite of PGI2); however, no appreciable change in aortic 6kPGF1 alpha production was observed. Dexamethasone given to adrenalectomized rats normalized PRC but had no effect on sodium balance or prostaglandin production. Likewise, prostaglandin inhibitors did not alter the sodium balance or decrease the PRC post adrenalectomy. These data confirm renal prostaglandin production is increased in adrenalectomized rats, but suggest that the elevation is not due directly to glucocorticoid deficiency. Further, PRC levels in adrenal insufficiency do not appear to be prostaglandin mediated. In conclusion, excessive renal prostaglandin production does not contribute to altered sodium balance or increased PRC in adrenalectomized rats.


Fetal viability does not affect the onset of stretch-induced labor and the increase in amniotic fluid prostaglandin F2 alpha and plasma prostaglandin F2 alpha metabolite levels. The role of the fetus in the onset and progress of stretch-induced labor and in the change in amniotic fluid prostaglandin F2 alpha and plasma prostaglandin F2 alpha metabolite levels was evaluated in six normal pregnant women (group 1) and six women whose fetuses had been dead for more than one week (group 2). The uterus was distended by a balloon inflated with physiologic saline. Regular uterine contractions occurred, and increased in all patients. Within 21 hours, all patients delivered a normal baby in group 1 and a macerated fetus in group 2. There was no significant difference in induction-delivery interval between the two groups. Both groups showed a significant and similar range of increases in the levels of amniotic fluid prostaglandin F2 alpha and plasma prostaglandin F2 alpha metabolite during treatment (P less than 0.001). Thus, the fetus has no functional role in the onset and progress of stretch-induced labor or in the rise of amniotic fluid prostaglandin F2 alpha and plasma prostaglandin F2 alpha metabolite levels.


Incorporation of [14C] arachidonic acid into ovine conceptus and endometrial lipids. The purpose of this study was to quantitate conceptus and endometrial incorporation of [14C]arachidonic acid (AA) into individual neutral and polar lipids. Endometrium and conceptuses from pregnant ewes and endometrium from nonbred ewes were collected 14 and 16 d after onset of estrus (d 0). Tissues were incubated for 8 h at 37 degrees C in medium containing 1 microCi of [14C]AA. Thin-layer chromatographic procedures were used to separate 12 lipids. Radioactivity was measured in each lipid, and the amount (ng) of [14C]AA incorporated into each lipid was calculated. Conceptuses and endometrium incorporated more [14C]AA into triacylglycerols than into any other lipid. Day and tissue type affected differentially (i.e., day X tissue interaction) the incorporation of [14C]AA into several lipids; d-14 conceptuses incorporated [14C]AA more actively than did any other day-tissue combination. Results indicate that triacylglycerols may be an important reservoir for conceptus and endometrial AA. The remarkable ability of d-14 conceptuses to incorporate [14C]AA into various lipids may be important for their accelerated elongation and active prostaglandin synthetic system.


Receptor-mediated effect of a synthetic thromboxane-analogue on cytosolic calcium in isolated proximal tubules. The aims of this study were to measure cytosolic calcium concentration -[Ca2+]i- under resting conditions in isolated renal proximal tubules and to analyze the effect of U-46619 (stable analogue of thromboxane A2/PGH2 on [Ca2+]i in a mammalian epithelium. Proximal tubules were dissected out from male New Zealand rabbits (2.5 to 3.0 kg). After isolation they were washed twice and resuspended in 2 ml phosphate buffer solution (PBS). Tubules were loaded with Quin 2-AM (25 microM) for 15 min. After washing with PBS to eliminate the excess of extracellular Quin 2, fluorescence was measured at 340 nm excitation and 490 emission, under resting conditions and after stimulation. U 46619 (from 10 nm to 10 mM) increased [Ca2+]i in a concentration-dependent pattern. Exposure to an antagonist of the thromboxane receptor (S-145) blocked the response to U-46619. Removal of external calcium abolished the response to U-46619. Change of PBS for Ringer-choline blunted the response to thromboxane analogue. Our results indicate that U-46619 increases cytosolic calcium through a receptor-mediated mechanism that requires external calcium to operate. Blockade of the response in the absence of external sodium suggests that Na+/Ca2+ exchanger participates in this response.


The F2-isoprostane, 8-epi-prostaglandin F2 alpha, a potent agonist of the vascular thromboxane/endoperoxide receptor, is a platelet thromboxane/endoperoxide receptor antagonist. F2-isoprostanes are a recently discovered series of prostaglandin (PG)F2-like compounds that are produced in vivo in humans by nonenzymatic free radical catalyzed peroxidation of arachidonic acid. One of the compounds that can be produced in abundance by this mechanism is 8-epi-PGF2 alpha. 8-epi-PGF2 alpha is a potent vasoconstrictor in the rat, an effect that has been shown to be mediated via interaction with vascular thromboxane (TxA2)/endoperoxide (PGH2) receptors. In an effort to further understand the biological properties of this prostanoid in relation to its ability to interact with TxA2/PGH2 receptors, we examined its effects on human and rat platelets. At concentrations of 10(-6) M and 10(-5) M, 8-epi-PGF2 alpha induced only a shape change in human platelets and at higher concentrations (10(-4) M) induced reversible but not irreversible aggregation. Both the shape change and reversible aggregation were unaffected by indomethacin but were inhibited by the TxA2/PGH2 receptor antagonist SQ29548. Conversely, 8-epi-PGF2 alpha inhibited platelet aggregation induced by the TxA2/PGH2 receptor agonists U46619 (10(-6) M) and IBOP (3.3 x 10(-7) M) with an IC50 of 1.6 x 10(-6) M and 1.8 x 10(-6) M, respectively. 8-epi-PGF2 alpha also inhibited platelet aggregation induced by arachidonic acid. Similarly, in rat platelets, 8-epi-PGF2 alpha alone induced only modest reversible aggregation but completely inhibited U46619-induced aggregation.


DuP 753, the selective angiotensin II receptor blocker, is a competitive antagonist to human platelet thromboxane A2/prostaglandin H2 (TP) receptors. DuP 753 is a potent, selective angiotensin II type 1 (AT1) receptor antagonist. The possibility was investigated that DuP 753 may crossreact with thromboxane A2/prostaglandin H2 (TP) receptors. DuP 753 inhibited the specific binding of the TP receptor antagonist [3H]SQ 29,548 (5 nM) in human platelets with kd/slope factor values of 9.6 +/- 1.4 microM/1.1 +/- 0.02. The AT2-selective angiotensin receptor ligand, PD 123,177 was a very weak inhibitor of specific [3H]SQ 29,548 binding in platelets (Kd/slope factor:200 microM/0.86). [3H]SQ 29,548 saturation binding in the absence and presence of DuP 753 resulted in an increase in equilibrium affinity constant (Kd: 9.3, 22, 33 nM, respectively) without a concentration-dependent reduction in binding site maxima (Bmax: 3597, 4597, 3109 fmol/mg protein, respectively). Platelet aggregation induced by the TP receptor agonist U 46,619 was concentration-dependently inhibited by DuP 753 (IC50 = 46 microM). These data indicate for the first time that DuP 753 is a weak but competitive antagonist at human platelet TP receptors.


A possible role of prostaglandin E2 in reproduction of the male water frog, Rana esculenta. In vivo and in vitro studies. Plasma prostaglandin E2 (PGE2), prostaglandin F2 alpha (PGF2 alpha), androgens and estradiol-17 beta were measured in the male water frog, Rana esculenta, during the annual sexual cycle. In vivo experiments were carried out to study the effects of PGE2 and PGF2 alpha on plasma sex steroids during the following periods: prereproduction (April), reproduction (May), postreproduction (June) and recovery (October). In the same months, in vitro experiments were performed to evaluate the effects of these two prostaglandins (PGs) on testicular release of sex steroids. The PGE2 plasma levels peaked in April. PGE2 treatment in vivo increased androgens in April and October, while PGF2 alpha increased estradiol-17 beta in June and October. In in vitro experiments, PGE2 increased androgens in April, while PGF2 alpha increased estradiol-17 beta in October. These results suggest that PGE2 could induce the breeding activity, probably through androgens synthesis. PGF2 alpha could interrupt the breeding, through estradiol-17 beta secretion.


Molecular evolution of cyclooxygenase and lipoxygenase. Four oxygenases of the arachidonic acid cascade (cyclooxygenase, 5-lipoxygenase, 12-lipoxygenase and 15-lipoxygenase) were investigated by the method of computer-assisted sequence comparison. From the calculations, some aspects of evolution and function of these enzymes were revealed. (1) The evolutionary origin of cyclooxygenase was different from that of lipoxygenases. (2) Cyclooxygenase was a distantly related member of a peroxidase family. (3) Enzymes with 12-lipoxygenase activity were created independently twice by gene duplication.


Analysis of the eicosapentaenoic acid (EPA) metabolite delta 17-6-keto-PGF1 alpha in human plasma by GC/SIM using [18O] delta 17-6-keto-PGF1 alpha. A method of the microdetermination of delta 17-6-keto-PGF1 alpha, a hydrolyzed metabolite of PGI3, is described. An authentic delta 17-6-keto-PGF1 alpha (120 mg) was prepared from eicosapentaenoic acid (EPA) incubated with homogenate of bovine aortic intima. [18O]delta 17-6-Keto-PGF1 alpha was synthesized by repeating base-catalyzed hydrolysis of methyl ester derivatives in [18O]water, to obtain an internal standard in gas chromatography/selected ion monitoring (GC/SIM) of delta 17-6-keto-PGF1 alpha. Good linear response over the range of 10 pg-10ng was demonstrated. Chromatographic conditions using a MP-65HT column presented nearly baseline separation of delta 17-6-keto-PGF1 alpha and 6-keto-PGF1 alpha. We were able to detect delta 17-6-keto-PGF1 alpha in the range from 6 to 26 pg/ml of the human plasma. The present method can be applied to the determination of delta 17-6-keto-PGF1 alpha in the human urine and plasma.


Pharmacological modulation of prostacyclin and thromboxane production of rat and cat venous tissue slices. To reveal a potential modulating effect of vasoactive pharmacological agents on the prostanoid production of the venous wall, prostacyclin and thromboxane release from venous tissue slices was studied. Aortic and caval vein samples from 20 rats as well as from 21 cats were studied. Prostacyclin and thromboxane productions were determined by radioimmunoassay as 6-keto-PGF1 alpha and TxB2 released into the incubation medium. Venous tissue produced significantly less prostacyclin per unit weight than arterial tissue in rats (30.7 +/- 4.6 vs. 52.1 +/- 8.2 pg/mg/min), while in cats an opposite situation was found (16.6 +/- 3.2 vs. 7.06 +/- 1.9 pg/mg/min). Thromboxane production of venous tissue was consequently higher than corresponding values for aortic tissue (3.72 +/- 0.46 vs. 1.54 +/- 0.14 in rats and 3.4 +/- 0.6 vs. 1.33 +/- 0.19 in cats, all values in pg/mg/min). Norepinephrine and dopamine significantly increased both the prostacyclin and the thromboxane release from venous tissue, while isoproterenol had no effect. Vasopressin significantly increased thromboxane release and decreased the ratio of prostacyclin vs. thromboxane production (from 10.4 +/- 1.6 to 7.5 +/- 1.6, in acetylsalicylic acid pretreated cats). Angiotensin and thrombin had no significant effects. Bradykinin (0.5 microgram/ml) significantly augmented prostacyclin release from venous tissue (14.4 +/- 2.6 from 10.9 +/- 2.4 pg/mg/min) and decreased thromboxane release (0.65 +/- 0.18 from 1.35 +/- 0.22 pg/mg/min). Methionine-enkephalin (5 micrograms/ml) significantly reduced the thromboxane release from venous tissue slices. The presented material demonstrates that several vasoactive agents modulate the vasoactive prostanoid release of the venous wall. In some cases, the prostacyclin and the thromboxane productions are influenced separately, which in turn will have its impact on smooth muscle activity and thrombocyte aggregation.


Stimulated release of arachidonate and prostaglandins is vectorial in MDCK epithelial cells. The receptor mediated activation of phospholipase A2 by appropriate ligands results in the synthesis and release of eicosanoids, a class of potent bioregulatory molecules. Madin-Darby canine kidney cells (MDCK) are polarized epithelial cells, with structurally and functionally distinct plasma membrane domains separated by tight junctions. Using MDCK cells grown in dual sided chambers, we show in this report, that a) the receptor mediated release of prostaglandins and arachidonate into the extracellular medium is predominantly unidirectional, b) the direction of release is agonist specific, and c) the magnitude of the response due to a given agonist is cell-domain specific. These characteristics, if operative in vivo, would contribute towards the optimal function of trans-cellular metabolism of eicosanoids already demonstrated.


Serum concentrations of secretory IgA in pregnancies delivering at term or preterm. Secretory component (SC) is a phospholipase A2 inhibitor possibly associated with pregnancy maintenance and in serum is bound either to IgA (sIgA) or IgM (sIgM). To determine if serum secretory component levels a) increase during pregnancy, b) fall as term approaches, c) are low in women who will deliver prematurely, serum sIgA was measured at "booking in" and related to weeks of gestation and length of gestation at subsequent noninduced delivery. Levels of sIgA increased during pregnancy; sIgA increased from a non-pregnant value of 1.6 nM +/- 0.2 (mean +/- SEM) to 2.8 nM +/- 0.3 at the end of the second trimester, then fell significantly between 31-34 weeks. Delivery before 37 weeks was associated with significantly reduced serum sIgA levels, particularly in women who delivered before 32 weeks and in whom sIgA concentrations were similar to those of nonpregnant women.


[Archaeology of childhood. Psychoanalytic conditions for realizing childhood daydreams exemplified by Heinrich Schliemann]. The biographical value of Heinrich Schliemann's memories of his childhood has always been disrupted. Following W.G. Niederland, the author characterises the famous archaeologist's powers of recall as instances of hypermnesia and not as retrospective constructs. In addition he shows that ontogenetically the conditions governing the realisation of infant ambitions are bound up with original experiences of happiness, traumatic losses without destruction of psychic substance, attempts at reparation and the preservation of the balance between the reality principle and the pleasure principle. A further factor shown to be involved is the dialectic tension between eros and thanatos. With reference to Freud's concept of the archaic heritage, the phylogenetic conditions and their links with ontogenesis are then identified with a view to elucidating why Schliemann, whose childhood ambition it was to excavate Troy, was later able to realise this boyhood dream.


[Late complications in patients cured of neoplasms in childhood]. Various late complications of the chemotherapy or radiotherapy have been discussed with special reference to rare life-threatening side-effects. The long term strategy of patient's care and preliminary principles of prevention of above complications have also been presented. It has been emphasized that life-threatening complications occurring in a small percentage of patients are not indications for limited or ineffective therapy giving no chance of saving of numerous children.


[Subendocardial blood flow index in relation to selected parameters of left-ventricular function in patients with aortic valve stenosis]. The aim of our studies was to estimate the relation between the reduction of the subendocardial blood flow, expressed by DPTI/TTI ratio and the grade of aortic stenosis determined by the maximal systolic aortic gradient. Additionally the influence of subendocardial blood flow reduction of left ventricular function and ECG alterations was assessed. The analyzed data were obtained during the cardiac catheterizations in a group of 30 patients (average age 32 years). The mean value of DPTI/TTI ratio was decreased (0.49 +/- 0.2) and associated with the elevated mean value of AGmax (72.2 +/- 38.1 mmHg). Negative correlation between DPTI/TTI and AGmax (r = -0.73; p less than 0.003), DPTI/TTI and LVEDP (r = -0.53; p less than 0.005) occurred. Depression of ST-T segment in EEG and episodes of anginal pain accompanied the reduction of subendocardial blood flow. We concluded that reduction in subendocardial blood flow in patients with SA-may lead subendocardial ischaemia of the left ventricular wall with subsequent of its function.


[Status of pulmonary circulation and the presence of regurgitant wave from the left ventricle in primary dilated cardiomyopathy]. The purpose of the study was to analyse relationships between the presence and magnitude of a regurgitant wave from the left ventricle to the left atrium and the state of the pulmonary circulation in patients with primary dilated cardiomyopathy. The study population consisted of 97 patients divided into three subgroups I--41 patients without the regurgitant wave, II--31 patients with the first-degree regurgitant wave, III--25 patients with the second-degree regurgitant wave. Diagnosis was based upon non invasive studies, cardiac catheterization and left ventriculography. Average values of the left ventricular systolic and end-diastolic pressures were similar in all subgroups, whereas the cardiac index was the lowest in the subgroup of patients with a large regurgitant wave to the left atrium. There were no differences in mean values of the pulmonary artery pressures, total pulmonary resistance and pulmonary vascular resistance between the patients without the regurgitant wave (subgroup II). In contrast the patients with a large regurgitant wave (subgroup III) showed statistically significantly higher pulmonary artery pressures, higher total pulmonary resistance and pulmonary vascular resistance. In 64% of the patients of this subgroup the left atrium was said to be large. The results of the present study indicate that even not a large regurgitant wave (second-degree) from the left ventricle to the left atrium leads to secondary pulmonary hypertension in patients with primary dilated cardiomyopathy.


[Results of the treatment of acute renal failure in 3 selected dialysis units in southern Poland 1981-1990]. The results of the treatment of patients with acute renal failure (ARF) in dialysis units of Kraków, Nowy Sacz and Tarnów were estimated on the basis of prepared questionnaire. The increased number of patients treated because of ARF was demonstrated in the successive years of the study. The mortality rate in the tested group of patients remained about 27%. It depended on the cause of ARF and equalled to 26.7% in medical, 36.7% in surgical, 8% in obstetrical and 6.7 in urological patients, respectively.


[Comparison of the value of echocardiographic examination in relation to hemodynamic studies in atrial septal defect of the ostium secundum type]. The aim of the study was in comparative analysis of the results obtained using the cardiac catheterization and the echocardiographic parameters in patients with atrial septal defect of the ostium secundum type. The studies have been performed in the group of 31 patients aged 16 to 58 years (mean = 31.9) in whom the right heart catheterization of the two-dimensional or Doppler's echocardiography has been performed. The following parameters have been analysed: pulmonary flow (Qp), systemic flow (Qs), shunt size (S), the Qp/Qs ratio, the systolic gradient via tricuspidal valve (TPG). The highest correlation in the invasive and the not invasive examination has been shown for TPG (r = 0.93). Other parameters showed no statistically significant differences.


[Effect of recombinant human erythropoietin on the bone marrow picture in patients with chronic renal failure treated by hemodialysis]. The influence of recombinant human erythropoietin (rHu-EPO) on anaemia and bone marrow cells was investigated in 7 patients with terminal renal failure on maintenance haemodialysis. The examination was performed immediately prior to rHu-EPO treatment (mean hematocrit 20.3%) and after increase of hematocrit to 33%. An increased number of cells from the erythroblastic series and rejuvenation of this population were observed during the treatment. There was no significant influence of the treatment on the myeloblastic cells series. An increase in megakaryocyte activity was observed in 2 studied patients.


[Efficiency of the autonomic nervous system in patients with acute leukemia]. Autonomic nervous system function was examined by simple tests in 10 patients with acute myeloblastic leukemia and 10 patients with acute lymphoblastic leukemia. The results in both groups were related to the stage of the disease, clinical and hematological status and mode of chemotherapy. It was found that the functional capacity of the autonomic nervous system was significantly lower in patients with leukemias than in healthy subjects (control group). Functional abnormalities were most prominent in patients in poor clinical condition with marked anemia and during the acute phase of the disease.


[Selenium and malondialdehyde levels in the blood serum of men with normo- and hypercholesterolemia]. Lipid peroxidation is a free radical-mediated process. Malonaldehyde (MDA) is one of the products of reduction in this process. Selenium (Se) is a physiological free radical scavenger. In this paper the research on serum selenium (Se), serum MDA (MDAp) and MDA in low density lipoprotein (MDA1) in 52 men (age 38-52 years) will be presented. Plasma total cholesterol (T-chol), free cholesterol (F-chol), esterified cholesterol (E-chol) and triglyceride (Tg) concentrations were estimated also. It was found a significant negative correlation between MDA1 and T-chol (r = -0.4140, p = 0.0023), E-chol (r = -0.3947, p = 0.0038), F-chol (r = 0.4104, p = 0025). The patients were divided according to T-chol level (group I: T-chol greater than 5.2 mmol/l, group II: T-chol less than 5.2 mmol/l). Statistically significant negative correlation were found between: Se and MDAp in both groups (I: r = -0.7734, p = 0.0002, II: r = -0.6695, p = 0.0012), Se and MDA1 only in II group (r = -0.4693, p = 00368). There was no apparent relation between MDAp and T-chol, E-chol, F-chol and Tg.


[Complications of liver biopsy in ultrasonic evaluation]. Ultrasound of the right upper quadrant was performed in 261 patients just before and 2-4 h after liver biopsy (Menghini needle 1.4 mm). Serious complications were not seen. 9 patients had ultrasound-detected small hepatic hematomas (1 x 1 cm - 4 x 3 cm) 2-4 h after liver puncture, clinically however irrelevant. Follow-up ultrasound at 24 h and 48 h showed complete resolution of hematomas that had been detected previously (5 patients and 4 patients resp.). The results of our study indicate that intrahepatic hematomas are uncommon after liver biopsy; lesions disappear spontaneously within 24-48 h and that is why ultrasound detection of all post-biopsy intrahepatic hematomas should be performed at 2-4 h. If major complications are not seen a 4 h length of post-biopsy bed rest seems us as sufficiently for all the patients.


[Effect of diabetes mellitus type 1 on electric resistance of the skin and galvanic skin response]. Basal electrical resistance of the skin and the galvanic skin response were determined in 102 patients with type I (insulin-dependent) controlled diabetes mellitus. The control group consisted of 121 healthy subjects of the same age and sex distribution. The results obtained imply that diabetes mellitus causes an increase of electrical resistance of the skin, a prolongation of the latency time and or even lacking of the galvanic skin response.


[Response of the cardiovascular system in elderly patients to intravenous infusion of isoproterenol and adrenaline]. The effect of gradually increasing doses of catecholamines on the heart rate, arterial pressure and the left heart ventricle systolic time intervals has been studied in the group of 30 aged subjects (70 to 95 years old) and the control group aged 23 to 30 years. The initial resting QS2I, LVETI, PEPI, heart rate and diastolic pressure were similar in both groups studied whereas the chronotropic and inotropic response as well as the vasodilatation were weaker in the aged. The disturbed mechanisms of adaptation in the aged could be caused by limited response of the circulatory system to adrenalin secreted during the stress states.


[Chlamydia trachomatis infection of the urogenital system in our clinical experience]. The increased number of the genitourinary system infection caused by Chlamydia trachomatis (Ch. Tr.), increased number of patients with dysuria or sterile leukocyturia gave stimulus to studies of 615 patients from Department of Nephrology and District Outpatient Nephrological Care Unit with regard to infections with that microbes. Material for investigations derived from urethra. Diagnostic examinations were performed using the Mc Coy cell culture and the immunofluorescence method. The infection was noted in 176 patients (119 women and 57 men) that is in 28.6% of cases studied. The mean age of patients was 42.7 +/- 12 years. Clinical symptoms such as dysuria or frequency were typical for that kind of infection. The most frequent abnormality was leukocyturia or leukocyturia accompanied by erythrocyturia noted in 66% of patients. Isolated erythrocyturia was observed in 24.4% of cases. It has been stated that anamnesis or routine laboratory examinations were not able to the identification of infection. In face of poorly characteristics of clinical picture of infection the infection with Ch.Tr. could be the cause of unsuccessful therapy in patients with signs of genitourinary tract infections.


[Estimation of the dialysis time based on a simplified algorithm for urea kinetics]. A simplified method of calculating the dialysis time based upon urea kinetic modeling equation: Ct = C0 e exp - (Kt/V) is presented together with a table of urea clearance values for most commonly used dialyzers. The method is handy and helpful to prescribe dialysis time either in chronic uraemics or in patients with acute renal failure on hemodialysis. Estimation of a patient's urea distribution volume equal to the total body water and blood flow through the dialyzer are the key points in the described calculations.


[Sensitivity of multiresistant bacterial strains to imipenem (Tienam)]. The susceptibility to imipenem of 213 clinical strains of Gram-negative rods resistant to six cephalosporins (cephradine, cefamandole, cefuroxime, cefotaxime, cefoperazone and ceftriaxone) has been studied. It was found that 93.9% of the strains were sensitive and 6.1% were resistant to imipenem. In the examined group 64 (30%) out of 213 strains were simultaneously resistant to four aminoglycosides (gentamycin, tobramycin, netilmicin and amikacin); among them 5 (7.8%) strains were resistant to imipenem. Sensitivity to imipenem 157 out of 213 examined strains as compared to that of ceftazidime was as follows: 29.3% of the strains were sensitive and 3.8% resistant to both of the antibiotics, whilst 64.3% were imipenem-sensitive and ceftazidime-resistant. In vitro imipenem proved to be very active antibiotic against over 90% of multiresistant Gram-negative rods.


[Gastric secretion in chronic erosive gastritis]. In 50 patients with erosive gastritis the basic and the post-pentagastrin secretion of hydrochloric acid or glycoproteids has been studied. The results obtained have been compared with that in healthy subjects. No significant differences between the both groups investigated have been noted. It has been stated that chronic erosive gastritis could be associated with normal, elevated or lowered hydrochloric acid secretion. The results are of value with regard to the choice of treatment but remain without significance for diagnostics.


[Effect of carbon dioxide (CO2) pressure on minute ventilation, parameters of gas exchange and blood gases during hemodialysis using fluid containing acetate and bicarbonate buffers]. In 20 patients with chronic renal failure on a hemodialysis with acetate-containing dialysing fluid gasometric, ventilation and breathing patterns disturbances were determined. The loss of CO2 in the dialysate is attributed the major cause of hypoxemia due to alveolar hypoventilation. Hemodialysis with bicarbonate-containing dialysate can be performed in the absence of any change in ventilation and PaO2 despite a systemic alkalosis. Hyperventilation during HD with high concentration of bicarbonate indicate that changes in CO2 tension in the pulmonary circulation can lead to a change in minute ventilation due to the presence of slowly adapting pulmonary chemoreceptors. In patients with low respiratory response, respiratory muscle weakness intensified additionally by hypercapnia may explain this phenomenon.


High dose rate gynecological applications--radiobiological considerations based on the alpha-beta model. We compare the relative efficacy of high dose rate (HDR) and low dose rate (LDR) irradiation in gynecological implants, using formulations based on the linear-quadratic (alpha-beta) model. We consider both acute reaction and late effect as endpoints in evaluating equivalence for HDR and LDR treatments, at Point A (as defined in the text) and at other locations. We define a therapeutic factor gamma as an index for relative efficacy, with gamma > 1 indicating a gain in substituting HDR for LDR. It is found that gamma < 1 for most clinical situations, although a modest decrease (of about 15%) in dose to critical organs for HDR would raise gamma above unity.


Electrolyte disturbances caused by intravenous contrast media. The changes in serum electrolytes (sodium, potassium, ionized calcium, and total calcium) produced by high-dose (3 ml/kg) intravenous contrast media were investigated in Japanese white rabbits. The test solutions included sodium/meglumine diatrizoate (370 mgI/ml), sodium/meglumine ioxaglate (320 mgI/ml), iohexol (350 mgI/ml), iopamidol (370 mgI/ml), 20% mannitol, and isotonic saline. The alterations in serum ionized calcium were relatively small and transient, and correlated with changes in the hematocrit. Diatrizoate caused a significant decrease in ionized calcium in comparison with other contrast media and mannitol. The ratio of ionized calcium to total calcium showed no significant decrease in any group. The changes in potassium did not correlate with those in hematocrit. Diatrizoate caused a smaller decrease in potassium than low-osmolality contrast media, which may suggest that diatrizoate caused a shift in potassium from extravascular space to intravascular space. In conclusion, intravenous infusion of high doses of low-osmolality contrast media did not cause clinically significant alterations in serum electrolytes.


In vivo dosimetry during pelvic treatment. High precision in vivo entrance and exit dose measurements have been performed with p-type diodes on patients during 8 MV X-ray irradiation of the pelvis, to investigate the accuracy of dose calculations in this region. Based on phantom measurements the accuracy of the p-type diode measuring system itself, i.e. the agreement with ionisation chamber dose measurements, was shown to be better than 0.7% while the reproducibility in the dose determination was 1.1%, 1.5% and 1.6% (1 S.D.) at the entrance point, isocentre and exit point, respectively, for the wedged lateral fields. Patient movement and the uncertainty in the diode position increased these values to 1.7%, 1.5% and 3.1% (1 S.D.) for dose determinations on patients. From the entrance and exit in vivo dose values the dose actually delivered to the isocentre was determined. For the anterior-posterior beams a good correspondence for most patients was observed at the entrance and exit point and at the isocentre between the in vivo and calculated dose values. For the wedged lateral beams a systematic deviation of about 3% was observed. In addition to the in vivo dose measurements phantom dose measurements have been performed to quantify the accuracy of the dose calculation algorithms including the computation of the number of monitor units. These measurements also served to quantify the effects of the actual patient on the dose delivery. The measurements showed that accurate calculation of the dose requires a separation of the head and phantom scatter contribution of the output of the treatment machine. The dependence of the wedge factor on field size, depth and source-skin-distance has also to be considered for accurate dose calculations. The effect of the patient on the dose calculation is mainly related to the actual electron densities of fat and bone structures compared to water: neglecting these densities in the dose computation could yield deviations up to 8.5% for the exit point in wedged beams. Based on these results, improvements in the dose calculation algorithms and monitor unit calculation including the use of the actual electron densities will be implemented in the treatment planning procedure.


MRI of anterior mediastinal tumors.

MRI of anterior mediastinal tumors. To compare the abilities of MRI (magnetic resonance imaging) and CT to provide information about anterior mediastinal tumors, we retrospectively evaluated the MR (n = 28) and CT images (n = 25) of patients with anterior mediastinal tumors. T1-weighted and T2-weighted images were obtained with spin echo sequences using cardiac gating. Six of 12 thymomas and seven of nine teratomas showed characteristic findings by MRI, while four of the 10 thymomas and five of the eight teratomas were correctly diagnosed by CT. The other tumors did not show a characteristic MR appearance. All nine malignant tumors were correctly diagnosed as malignant lesions on MR images, while one false positive case and one false negative case were recorded on CT images. We conclude that MRI and CT provide nearly the same information for the evaluation of anterior mediastinal tumors. However, in some cases, only MRI can provide information about malignancy or a specific diagnosis.


Glass yttrium-90 microspheres for patients with colorectal liver metastases. Total calculated uniform liver doses of up to 150 Gy were achieved using glass yttrium-90 microspheres administered via the hepatic artery and targeted to tumour using angiotensin II in seven patients with colorectal liver metastases. No toxicity was observed. Hepatic metastatic progression was delayed in six patients. Median survival was 11 months (range 5-25 + months).


Quantitation of cerebral blood volume by 99mTc-DTPA-HSA SPECT. The characteristics of technetium-99m diethylenetriaminepentaacetic acid human serum albumin (99mTc-DTPA-HSA) as an agent for quantitation of cerebral blood volume (CBV) were examined. The radioactivity after decay correction as a percentage of the activity at 10 minutes was 84.3 +/- 1.3% at 120 minutes after the injection of 99mTc-DTPA-HSA. Radioactivity was found exclusively in plasma, with little in blood cells. The blood retention of 99mTc-DTPA-HSA is sufficient, and its use in the quantitation of CBV omits the need for centrifugation of the blood sample. CBV quantified using the tracer and a SPECT system with a single-head rotating gamma camera was 4.09 +/- 0.60 ml/100 g brain, similar to values reported previously. Two serial SPECT scans provided similar images, and the CBV values determined by the two scans were closely correlated (p < 0.001). The high reproducibility suggests that the method may be used to monitor the cerebrovascular response to drugs. It was concluded that 99mTc-DTPA-HSA has useful properties for quantitative CBV measurement and that quantitation of CBV by 99mTc-DTPA-HSA SPECT is feasible using a system with a single-head rotating gamma camera.


Tandem-vaginal cylinder applicator for radiation therapy of uterine adenocarcinoma. Preoperative radiotherapy for stage II adenocarcinoma of the endometrium was studied in 74 patients using the University of Kentucky tandem-vaginal cylinder applicator. The intrauterine tandem and vaginal cylinder were inserted and loaded at the same time or sequentially. Forty to 45 Gy of fractionated whole pelvis photon radiotherapy was combined with the single intracavitary insertion which gave 20 Gy to a parauterine isodose at 2 cm and to the vaginal surface. Treatment with this system gave a 5 year survival rate of 88% with a 4% complication rate for stage II corpus adenocarcinomas.


Radiation therapy for stage I and II laryngeal cancer using 10 MV X-rays or cobalt-60 gamma-rays. From 1970 to 1985, 117 patients with stage I and stage II carcinoma of the larynx (98 with glottic, 15 with supraglottic, and 4 with subglottic cancer) received radiation therapy. The patients were treated with (1) a 60Co machine equipped with 45-degree wedge filters, at a total dose of 6,000-7,000 cGy, 300 cGy per fraction, 3 days a week in the period from 1970-1974; (2) 10 MeV linear accelerator X-rays from 1975-1980, and (3) 10 MeV linear accelerator X-rays and/or the 60Co machine in the period from 1981-1985, at a total dose of 6,000-7,000 cGy, 5 days a week by parallel opposing portals without wedge filters. The 5-year local control rates by radiotherapy alone were 66%, 78%, and 83%, respectively, in the three periods, and the 5-year survival rates were 77%, 97%, and 96% following salvage surgery for recurrent disease. In the 1970-1974 period, four patients developed severe laryngeal edema, and two patients had total laryngectomy without local residual tumor. In the 1975-1985 period, 16 patients had local recurrence in five years, and in five of them the tumor exhibited verrucous-like histopathological findings. In the 1975-1980 period, local recurrence was considered to result from underdosing of lesions with 10 MV X-ray beams and split-course irradiation. In the last five years of the period, the 5-year local control rate for stage I and II carcinoma of the glottis, excluding verrucous-like carcinoma, reached 90% with 10 MV X-rays combined with 60Co gamma-rays.


Multilocular cystic hemangioma: CT and MR appearance. An atypical case of multilocular cystic hemangioma is presented. A 4.5 cm multilocular cystic mass was incidentally found in a 66-year-old healthy woman on ultrasound screening. CT, MR imaging, and angiography were performed: however, the features that are characteristic of cavernous hemangioma were not obtained. The final diagnosis could not be made until surgery.


Selective avoidance of lymphatic radiotherapy in the conservative management of early breast cancer. In view of the morbidity and potential mortality associated with routine post-operative lymph node radiotherapy in women with early stage breast cancer, an attempt has been made to select patients in whom radiotherapy can be withheld. Three hundred and forty-seven consecutive patients treated wide local excision plus or minus axillary surgery have been evaluated. Only 20% were subsequently given radiotherapy to regional nodes. Relapse in the axilla, the supraclavicular fossa or at both these sites have occurred in 16 patients so far, 12 of whom were successfully treated. Systemic relapse was seen in eight of these patients occurring with one exception before or within 3 months of node relapse. Only four have persisting symptoms as a result of nodal relapse. So far, a policy involving selective lymphatic radiotherapy in women treated for early breast cancer appears justified.


Prostate cancer treated by radiotherapy: a multivariate study. According to respective proportions of evolutive status groups, results of multivariate studies are difficult to interpret. Among the 1099 cases of local form of prostate cancer, treated by radiotherapy from 1975 to 1982 in 16 French Anticancer Institutes, we can observe two homogeneous status groups of patients: disease-free survivors (285 cases) and patients who died of prostate cancer (278 cases). These correspond to 51% of the whole population. Among other things, they are comparable in size, for age at the beginning of radiotherapy and for delay between histologic diagnostic and radiotherapy. We chose to analyse them using multivariate analysis. To take survival into account, we used a Cox model and Kaplan-Meier curves; the group deceased of prostate cancer was further analyzed by a tree-structured regression method. The Cox model and the Kaplan-Meier curves confirmed two main explicative factors: Stage (p < 0.0001) and tumor grade (p < 0.001). Poorer evolution occurs in extracapsular forms and grade I has better survival than others. The tree-structured regression method indicates two other pejorative factors: hormonotherapy prior to radiotherapy and the presence of cardiovascular pathology. Though the pelvic dose does not appear to be a main explicative factor, it seems to improve survival and delay between radiotherapy and recurrence or metastasis in some categories of cases. Other factors such as tumor dose, age and delay between diagnosis and radiotherapy were not found to be significant. These results cannot be extended to the whole population for which they do not constitute a predictive study. We consider them as "baseline data".(ABSTRACT TRUNCATED AT 250 WORDS)


Orchidectomy followed by radiotherapy in 176 stage I and II testicular seminoma patients: benefits of a 10-year follow-up study. Results are presented for 176 patients with stage I and II primary testicular seminoma treated at the Dr. Daniel den Hoed Cancer Center (DDHCC) between 1975 and 1985. The median follow-up time was 7 years and 4 months. One-hundred and seventy-four (99%) of these patients were treated primarily with radiotherapy after extensive staging. According to the Royal Marsden Staging Classification, 132 patients (75%) were stage I, 8 (5%) were stage IIA, 21 (12%) were stage IIB, 9 (5%) were stage IIC and for 6 stage II patients a further subdivision was not possible. At 5 years the actuarial relapse-free survival and the actuarial survival were 95 and 99%, respectively, for stage I, and 77 and 91% for stage II. Prophylactic irradiation of the mediastinum has not been performed for stage II patients. Five stage II patients relapsed in the mediastinum. Four out of these five relapses were cured with chemotherapy, and in one case, in combination with radiotherapy, at the time of relapse. These results indicated that prophylactic irradiation of the mediastinum appeared to be unnecessary for stage II patients. Tumour markers were not useful in the discovery of metastases. Five years after treatment no relapses were seen. Therefore, it is proposed that a maximum follow-up of 5 years is sufficient to measure disease-free survival.


Some effects of feeding Tribulus terrestris, Ipomoea lonchophylla and the seed of Abelmoschus ficulneus on fetal development and the outcome of pregnancy in sheep. Pregnant ewes and their fetuses were chronically catheterized using aseptic procedures under general anaesthesia, and the ewes were then fed either lucerne chaff alone, or lucerne mixed with dried plant material obtained from one of three forb species, Tribulus terrestris (caltrop), Abelmoschus ficulneus (native rosella) or Ipomoea lonchophylla (cowvine), from 103-112 days gestation until term. Ingestion of the forb material was not associated with changes in maternal blood gases, plasma glucose concentrations, or the length of gestation. However, ingestion of rosella seed was associated with a significantly greater fall of fetal arterial pO2 with advancing gestation, and ingestion of either rosella or cowvine was associated with significantly lower fetal mean arterial pressure at 127-131 days, compared with the Tribulus and lucerne groups. Also, the incidence of fetal breathing movements was significantly lower, and did not show a normal day-night variation, in each of the forb-fed groups compared with the lucerne-fed group. The results indicate that these forb plants may contain substances that affect the functional development of the fetal brain. Although ingestion of these plants did not appear to affect the outcome of pregnancy in this study, the possibility that these forbs have a greater impact in sheep populations with poor nutrition and in more extreme environmental conditions is discussed.


Gonadotrophin-induced oestrus and ovulation in the polyovulatory marsupial Sminthopsis crassicaudata. Sminthopsis crassicaudata is a small (approximately 16 g) polyovulatory dasyurid marsupial which has the potential to become an important model species. This study examined the use of exogenous hormone treatment to manipulate the breeding of S. crassicaudata and as a means to obtain timed developmental stages for further study. Two thirds (21/32) of the females treated with 1.0 or 5.0 I.U. of pregnant mare serum gonadotrophin (PMSG) had ovulated when the contents of their reproductive tracts were examined 5 or 6 days later. Only one of eight females treated with 0.2 I.U. PMSG had ovulated in the same period. Although a similar proportion of animals treated with 1.0 I.U. and 5.0 I.U. ovulated, the ovulation rate was significantly lower when the higher dose was administered (mean of 10.5 ovulations per female v. 3.8 ovulations per female). In addition, the ovaries of 6/8 of the animals treated with 5.0 I.U. PMSG had luteinized follicles with degenerating oocytes, evidence of over-stimulation. Follicular luteinization also occurred in 4/8 animals treated with 1 I.U. PMSG. Oocyte maturation and ovulation occurred following PMSG stimulation without injection of synthetic gonadotrophin releasing hormone (GnRH). Treatment with a 10-micrograms dose of GnRH following PMSG seemed to have no effect on the outcome. Of the females that had ovulated by Day 6, three quarters had mated and some had fertilized eggs and two-cell embryos in the oviducts and uteri. In a further series of experiments the subsequent development of embryos conceived after PMSG treatment was assessed. Two thirds of treated females mated within 7 days of treatment and 60% of these matings yielded embryos when examined 11 days after PMSG. However, full-term development was only achieved in one animal. Gonadotrophin treatment of S. crassicaudata thus may have application as a means to obtain mature or maturing oocytes, cleavage stage embryos and blastocysts, but at this stage it appears not to offer promise as a method to achieve full-term development.