Usefulness of cell block cytology for preoperative grading and typing of intraductal papillary mucinous neoplasms.

BACKGROUND: Precise histological diagnosis is important for the successful management of intraductal papillary mucinous neoplasms (IPMNs). OBJECT: The object of this study was to determine whether cell block cytology is useful for preoperative cytomorphological grading and typing of IPMNs. METHODS: The subjects were 23 patients with IPMN from whom pancreatic juice was collected via a pancreatic catheter and who subsequently underwent pancreatic resection. RESULTS: In 20 of the 23 cases, the quantity of cells collected for cell block cytology was sufficient to enable typing and grading of the IPMN. The rates of consistency between the results of typing and grading by cell block cytology and histological examination of the surgical specimen were 95% and 80%, respectively. Typing of the 10 main-duct/mixed-duct-type IPMNs by cell block cytology yielded 5 gastric types, 3 intestinal types, 1 oncocytic type, and 1 pancreatobiliary type, and the typing was consistent with the surgical diagnosis in all 10 cases. The results of typing of the branch-duct-type IPMNs by cell block cytology were identical to the results of histological typing in the surgical specimens in every case but one. However, the specificity of cell block cytology for grading IPMNs was 55.6%. CONCLUSIONS: The cell block cytological findings were fairly consistent with the histopathological features of the surgical specimens, thereby indicating that cell block cytology may be useful for preoperative and typing of IPMNs, but only play a supplementary role in grading IPMNs.

Evaluation of MRI criteria (1.5 T) for the diagnosis of hippocampal sclerosis in healthy subjects.

PURPOSE: The presence of hippocampal sclerosis (HS) on MRI has a great impact on the clinical evaluation and counselling of patients with temporal lobe epilepsy (TLE) and is considered as a key criterion for the decision to recommend epilepsy surgery. However, neuropathological studies describe evidence of HS in up to 10% of non-epileptic individuals, questioning the impact of this MRI finding in patients with TLE. We evaluated the prevalence of HS on MRI in the general population. METHODS: 100 healthy subjects and 10 patients with TLE due to HS were investigated in a prospective study using a specific protocol for the detection of hippocampal pathology (coronal FLAIR, coronal T2 TSE and a T1 weighted 3D SPGR sequence). RESULTS: HS was detected in none of the healthy subjects (95% confidence interval=0-3.6%), but in all patients. Inter-rater agreement was perfect for presence of HS. Thirty-three subjects had an unilaterally enlarged temporal horn as an isolated secondary criterion for HS and inter-rater agreement was slight for this point. Incidental pathological findings were detected in two patients (2%): one had a low grade astrocytoma (1%), one an aneurysm of the posterior communicating artery (1%). CONCLUSIONS: HS was not diagnosed in healthy subjects, supporting its impact on the evaluation of patients with temporal lobe epilepsy. An unilateral enlarged temporal horn that occurred in one third of the healthy subjects should not be considered as a pathologic finding or even as a marker for HS.

EXTL3 promoter methylation down-regulates EXTL3 and heparan sulphate expression in mucinous colorectal cancers.

Exostoses like-3 (EXTL3) is a putative tumour suppressor gene but its involvement in colorectal cancer (CRC) is unclear. We have investigated the role of methylation of the EXTL3 promoter as a mechanism for EXTL3 regulation and tested the hypothesis that loss of EXTL3 expression is associated with mucinous differentiation and alteration of glycoprotein expression in CRC cells. The methylation status of the EXTL3 gene promoter was analysed by methylation-specific PCR following bisulphite modification in CRC cell lines and microdissected primary CRC tissues and their corresponding adjacent normal colorectal mucosa. EXTL3 promoter methylation was detected in seven of 11 mucinous CRCs (63.6%) but in none of 26 non-mucinous CRCs examined. EXTL3 promoter methylation was also detected in the normal colonic mucosa of three patients with mucinous CRC but not in the normal colonic mucosa of any patients with non-mucinous CRC. The presence of EXTL3 methylation was significantly associated with the partial loss of HS expression in mucinous CRC lesions. The mucinous CRC cell lines, Colo201 and Colo205, showed EXTL3 promoter methylation and loss of EXTL3 mRNA expression. However 5-aza-2'-deoxycytidine treatment demethylated the EXTL3 gene promoter and restored its mRNA expression. Furthermore, the basal expression of HS in CRC cells was abolished by treatment with EXTL3-siRNA. We conclude that EXTL3 promoter methylation and its related loss of EXTL3 expression are involved in the loss of HS expression in mucinous CRCs.

[Mitral valvuloplasty utilizing a posterior leaflet patch for healed infective endocarditis; report of a case].

A 63-year-old man was diagnosed as having grade IV mitral regurgitation (MR). Intraoperative examination revealed perforation (13x7 mm) of the anterior mitral leaflet (AML) and prolapse of the posterior mitral leaflet (PML). The prolapsing part of the PML was resected as a rectangle and the AML perforation was covered with this resected PML patch. A Carpentier-Edwards rigid ring (30 mm) was used to secure the mitral valve annulus after suturing the PML. The patient had an uneventful course after surgery and postoperative echocardiography showed no regurgitation.

Peroxisome proliferator-activated receptor gamma ligand prevents the development of chronic pancreatitis through modulating NF-kappaB-dependent proinflammatory cytokine production and pancreatic stellate cell activation.

PURPOSE: Thiazolidinedione derivatives (TZDs) are known to be ligands of peroxisome proliferator-activated receptor gamma (PPARgamma). In this study, we investigated the effect of a TZD, troglitazone, on inflammation and fibrogenesis in the pancreas of an experimental model of chronic pancreatitis. MATERIAL AND METHODS: Male WBN/Kob rats with spontaneous chronic pancreatitis were fed rat chow containing 0.2% troglitazone from 1 to 4 months of age. Immunohistochemical studies of rat pancreas were carried out with monoclonal mouse antibody against human alpha-smooth muscle actin (alpha-SMA) or rabbit polyclonal antibody against collagen type I, collagen type III, or fibronectin. Cytokine production was measured by enzyme-linked immunosorbent assay. The inhibitory action of troglitazone on nuclear factor-kappaB (NF-kappaB) binding activity in activated macrophages was also investigated. RESULTS: Long-term administration of troglitazone reduced inflammatory cell infiltration and fibrosis in the pancreas of WBN/Kob rats, and expression of alpha-SMA, procollagen I, III, and fibronectin was significantly reduced by troglitazone. The increase in TNF-alpha production by activated macrophages was significantly decreased by troglitazone. Peritoneal macrophages isolated from WBN/Kob rats produced a large amount of TNF-alpha, whereas those from troglitazone-treated WBN/Kob rats produced only a marginal amount of TNF-alpha. Lipopolysaccharide-induced NF-kappaB binding activity in peritoneal macrophages was also significantly reduced by troglitazone. CONCLUSIONS: Troglitazone prevented the progression of chronic pancreatitis via inhibition of ECM synthesis and proinflammatory cytokine production mediated by the inhibition of NF-kappaB activity.

[Multiple myxoma in the left ventricle and the left atrium].

Left ventricular myxoma is particulary rare. Our case is a 77-year-old female. Transesophageal echocardiography showed a giant tumor in the left atrium. An urgent operation was performed. A giant mass was excised en bloc via a transinteratrial septal approach. Histopathologically it was myxoma. As a transthoracic echocardiography at 1-year postoperation showed a tumor in the left ventricle. A mass was excised en bloc via a vertical approach. Histopathologically it was diagnosed again as myxoma. We looked at the earliest transesophageal echocardiogram again, and found the small tumor on the same area under the posterior mitral leaflet. At the diagnose of cardiac tumor, possibility of multiple formation should be always considered.

Activation of nuclear factor-kappa B in the conjunctiva with the epithelial scraping of the mouse cornea and human epidemic keratoconjunctivitis.

AIM: To examine the expression of p65, one of nuclear factor-kappa B (NF-kappa B), in the conjunctival epithelium of the C57Bl6 mouse and a patient with epidemic keratoconjunctivitis (EKC). METHODS: Normal and epithelial scraped cornea obtained 6 hours after the injury were processed for paraffin section. Samples of a normal and an EKC conjunctival epithelium were obtained using impression cytology. Both samples were analysed by immunocytochemistry using anti-p65 antibody. RESULTS: Immunocytochemistry with the anti-NF-kappa B p65 antibody revealed that p65 was localised in the cytoplasm of the conjunctival epithelium in the C57Bl6 mouse without the treatment. Six hours after the scraping of the cornea, p65 protein was expressed in the nuclei of the conjunctival epithelium. p65 was localised in the cytoplasm of the conjunctival epithelium in the human normal eye. p65 protein was expressed in the nuclei of the conjunctival epithelial cells in the EKC patient. CONCLUSION: These findings suggest that NF-kappa B was activated in the conjunctiva in the epithelial scraping of the mouse cornea and in human EKC.

Auricular chondritis in young ear-tagged Crj:CD(SD)IGS rats.

Gross and histopathological features of auricular chondritis in young Crj:CD(SD)IGS rats were examined. Although the rats were identified with metallic ear tags on the right pinnae, auricular chondritis was also observed on the contralateral (left) ear in some animals. Histopathologically, the lesions were characterized by granulomatous inflammation with destruction of the normal cartilaginous plate, formation of new cartilaginous nodules and osseous metaplasia. Proliferative cell nuclear antigen (PCNA) positive cells were present predominantly in chondrocytes found in the centre of the newly-formed cartilaginous nodules. The results suggest that the newly-formed cartilaginous nodules were due to interstitial proliferation of chondrocytes.

Intraspinal pannus formation at C6 in a patient with rheumatoid arthritis causing severe cervical cord compression. A case report.

We report a rare case of cervical cord compression caused by intraspinal pannus formation at C6 in a patient with long-term rheumatoid arthritis. No atlantoaxial abnormalities were seen. The imaging findings are presented and the pathology discussed.

Extreme, unilateral widening of Virchow-Robin spaces: case report.

We report a case of extreme, largely unilateral dilatation of Virchow-Robin spaces. Fluid-attenuated inversion-recovery images revealed high-signal foci adjacent to the dilated spaces, possibly due to chronic ischaemia.

[Circumscribed median nerve compression caused by a leiomyoma. Preoperative localization with spiral CT]. / Punktuelle Läsion des Nervus medianus bei Einschnürung durch ein Leiomyom. Präoperative Lokalisation mittels Spiral-CT.

Dysfunction of the median nerve is quite common and mostly observed related to carpal tunnel and pronator syndromes. We report a rare case of median nerve compression caused by a leiomyoma in the distal forearm. Spiral CT with MPR (multiplanar reconstruction) clearly located the lesion preoperatively.

Quantitative assessment of harmonic power Doppler myocardial perfusion imaging with intravenous Levovist in patients with myocardial infarction: comparison with myocardial viability evaluated by thallium-201 single-photon emission computed tomography and coronary flow reserve.

BACKGROUND: Intravenous myocardial contrast echocardiography with harmonic power Doppler imaging is a novel technique for assessing myocardial perfusion. AIMS: The aim of this study was to quantitatively assess myocardial perfusion by harmonic power Doppler imaging in patients with a previous myocardial infarction and compare myocardial contrast echocardiography results with myocardial viability evaluated by thallium-201 single-photon emission computed tomography ((201)Tl-SPECT) and the results of Doppler flow measurement of coronary flow velocity reserve. METHODS: Twenty-three patients with anterior myocardial infarction who were scheduled for adenosine stress (201)Tl-SPECT underwent myocardial contrast echocardiography with harmonic power Doppler imaging. Harmonic power Doppler imaging was performed at rest and during adenosine infusion (0.15 mg/kg/min) using an intravenous infusion of Levovist. The peak colour pixel intensity ratios of the risk area to the control area were used for quantitative analysis of myocardial perfusion by harmonic power Doppler imaging. Coronary blood flow velocity was measured using Doppler-tipped guidewire in the distal portion of left anterior descending artery and coronary flow velocity reserve was calculated. RESULTS: In patients with myocardial viability assessed by (201)Tl-SPECT, pixel intensity ratios both at rest and during hyperaemia were significantly higher compared with those in patients without myocardial viability (at rest: 0.62 +/- 0.28 vs 0.37 +/- 0.17, P=0.038, during hyperaemia 0.72 +/- 0.19 vs 0.40 +/- 0.18, P=0.003). Coronary flow velocity reserve was significantly different between two groups (2.35 +/- 0.43 vs 1.49 +/- 0.53, P <0.01). CONCLUSIONS: Quantitative assessment of microvascular integrity by harmonic power Doppler imaging corresponds to the evaluation of the microcirculation by coronary flow velocity reserve.

[Lateralizing and localizing signs and symptoms of epileptic seizures: significance and application in clinical practice]. / Lateralisierende und lokalisierende Anfallssymptome. Bedeutung und Anwendung in der klinischen Praxis.

This report reviews the lateralising and localising signs of epileptic seizures in respect to the differential diagnosis of epilepsy. The lateralising value of epileptic signs and symptoms can frequently be derived from the neuroanatomy. Focal clonic, focal tonic, and versive seizures as well as ictal unilateral dystonia are associated with a seizure onset zone in the contralateral hemisphere. Postictal nose wiping is performed with the hand ipsilateral to the epileptogenic zone. Similarly, unilateral blinking points to an ipsilateral seizure onset. Automatisms with preserved consciousness, ictal speech, and vomiting correlate to an epileptogenic zone in the non-dominant hemisphere, while postictal dysphasia is produced by seizures arising from the dominant hemisphere. Lateralising and localising signs and symptoms of epileptic seizures are of great help in the differential diagnosis of epilepsy from the first diagnosis of epileptic events to presurgical video-EEG monitoring.

Identification of cardiac abnormal structures with harmonic power Doppler contrast echocardiography.

We describe two cases in which echocardiographic image enhancement with an intravenous contrast agent using harmonic power Doppler (HPD) imaging established the diagnosis of abnormal structures in the left ventricle (LV).

A case of MERRF associated with chronic pancreatitis.

We report the first case to our knowledge of chronic pancreatitis associated with mitochondrial encephalopathy with the A8344G mitochondrial DNA (mtDNA) mutation. This 10-year-old-girl had suffered from recurrent abdominal pain with elevated serum amylase and lipase since the age of 6, and easy fatigability, tremor and astatic seizures since the age of 8. A biopsy of quadriceps muscle revealed ragged-red-fibers and cytochrome c oxidase deficiency. Analysis of mtDNA in peripheral blood identified an A8344G mutation in the mitochondrial tRNA(Lys) gene. Taken together with physical signs of myoclonic seizures and cerebellar dysfunction, we diagnosed her as myoclonic epilepsy with ragged-red fibers associated with chronic pancreatitis. Although no association between mitochondrial disease and pancreatitis has yet been established, this case suggests it is necessary to consider the participation of mitochondrial abnormality in the pathogenesis of recurrent pancreatitis.