Influence of splenomegaly on aortic and liver parenchymal CT numbers during contrast-enhance CT in patients with cirrhosis.

INTRODUCTION: To compare CT (computed tomography) values for enhancement of the abdominal aorta and liver parenchyma during dynamic contrast enhancement (CE) CT in cirrhotic patients with and without splenomegaly (SM). METHODS: We considered 258 patients (83 males and 46 females for the splenomegaly group, and 83 males and 46 females for the control group) for this retrospective study. We measured CT values in the abdominal aorta and hepatic parenchyma during the hepatic arterial (HAP) and portal venous (PVP) phases. The aortic CE at HAP and the hepatic parenchymal CE at PVP were compared between the two groups. For success rate of scans, we also calculated the optimal CE rates (>280 HU in the abdominal aorta and >50 HU in the hepatic parenchyma) for each group. RESULTS: In the SM group, the CE for abdominal aorta was decreased during the aortic phase for a dynamic CE-CT (p < 0.05). When evaluating the success rates, they were found to be 65.1 % and 58.9 % in the SM group and 81.4 % and 72.3 % in the non-SM group (p < 0.05). CONCLUSION: The success rate of scans and CE for the abdominal aorta during the aortic phase exhibited a significant decrease during dynamic CE-CT scans on patients with SM. Patients with SM may have reduced diagnostic ability with typical contrast injection protocols. IMPLICATIONS FOR PRACTICE: It may be necessary to change the injection rates and contrast medium volume during CE-CT depending on the presence or absence of SM.

Rapid improvement of osseous sarcoidosis after the treatment of pulmonary aspergillosis by itraconazole.

Osseous sarcoidosis is relatively uncommon, and treatment with corticosteroids is not always effective. Moreover, patients with an advanced stage of pulmonary sarcoidosis are sometimes infected with aspergillus in the cavities of the pulmonary lesions, and long-term use of corticosteroids should be prohibited to prevent the development of fatal invasive pulmonary aspergillosis. Here, we described a unique case of osseous sarcoidosis with pulmonary aspergillosis, showing a rapid improvement of the osseous symptoms just after the administration of the antifungal agent, itraconazole. Itraconazole is likely to become a candidate among new therapeutic agents for osseous sarcoidosis.

Morphologic changes in hepatitis virus-related liver cirrhosis: Relationship to hemodynamics of portal vein on dynamic contrast-enhanced CT.

INTRODUCTION: The morphologic changes in the compensated stage of liver cirrhosis (cLC) are not diffuse atrophic changes. With cLC lobar or segmental changes combined with atrophy of the right lobe and medial segment together with hypertrophy of the caudate lobe and lateral segment are commonly seen. The purpose of this study was to evaluate the morphologic changes in hepatitis virus-related liver cirrhosis in relationship to haemodynamics of the portal vein on dynamic contrast-enhanced computed tomography (DCE-CT) METHODS: This study included 72 patients, 46 with hepatitis virus-related cirrhosis and 26 with a normally functioning liver, who underwent DCE-CT. In cirrhosis patients, the morphologic change index (MCI) of the liver was calculated and categorised into two groups, high-MCI (MCI ≥ 0.4) (n = 21) and low-MCI (MCI < 0.4) (n = 25). Cross-sectional areas of the main, right and left portal veins and the intra-portal distribution from splenic venous flow were evaluated for their relationships with the MCI and compared among three groups (normal-control, low MCI and high MCI). RESULTS: There was a significant difference in the cross-sectional area of the left portal vein between the high-MCI group and the low-MCI group (p = 0.013) and the control group (p = 0.008). A significant correlation was identified between the cross-sectional area of the left portal vein and the MCI (r = 0.508, p < 0.001). CONCLUSION: Cross-sectional area of the left portal vein may be a factor related to morphologic changes in hepatitis virus-related liver cirrhosis and could be a possible index of the left portal venous flow volume. IMPLICATIONS FOR PRACTICE: This study may be useful for predicting the degree of hepatic morphologic changes and the condition of cirrhosis in association with regional hepatic morphologic changes.

Management of De Novo Mycobacterial Infection After Lung Transplantation Without Rifampicin: Case Series of a Single Institution.

BACKGROUND AND OBJECTIVES: To treat organ transplant patients with mycobacterial infection, physicians need to pay attention to interaction between drugs used against mycobacteria and immunosuppressants. The purpose of this report is to describe the clinical features of and treatment for mycobacterial infection in lung transplant (LTx) recipients. METHODS: To investigate the incidence, treatment, and outcome for mycobacterial infection, we retrospectively reviewed 100 LTx recipients in our program since 2000. RESULTS: Four recipients (4.0%) developed mycobacterial infection. Three recipients took tacrolimus, and 1 received cyclosporine with mycophenolate mofetil and a steroid for immunosuppression. Tuberculosis (TB) was isolated from 2 recipients, and non-tuberculous mycobacteriosis (NTM) was detected in the other 2. We treated the patients with levofloxacin + isoniazid + pyrazinamide + ethambutol (EB) for TB and clarithromycin (CLM) + EB for NTM to avoid interaction of calcineurin inhibitors (CNI: 8-10 ng/mL in trough level) with rifampicin (RFP). In treating the patients with NTM, we were able to maintain an adequate blood concentration of CNI by decreasing the dosage from one-half to one-quarter. All mycobacterial infections were controlled with treatment. In 1 patient with chronic obstructive pulmonary disease (COPD) infected with TB in the native lung, the forced expiratory volume in 1 second (FEV1) unexpectedly increased from 1890 mL before infection to 2320 mL possibly due to organization of the native lung. CONCLUSIONS: We were able to manage the mycobacterial infections using drugs other than RFP without any cases of acute rejection under adequate immunosuppression. Organization of the native lung with TB infection unexpectedly resulted in improvement of FEV1 in a COPD patient.

What and when: parallel and convergent processing in motor control.

Successful motor behavior requires making appropriate response (response selection) at the right time (timing adjustment). Earlier psychological studies have suggested that the response selection and timing adjustment processes are performed serially in separate stages. We tested this hypothesis using functional magnetic resonance imaging. The subjects performed a choice reaction time task in four conditions: two (on-line response selection required or not) by two (on-line timing adjustment required or not). We found that the neural correlates for the two processes were indeed separate: the anterior medial premotor cortex (presupplementary motor area) was selectively active in response selection, whereas the cerebellar posterior lobe was selectively active in timing adjustment. However, the functional separation was only partial in that the lateral premotor cortex and the intraparietal sulcus were active equally for response selection and timing adjustment. The lateral premotor cortex was most active when both processes were required, suggesting that it integrates the information on response selection and the information on timing adjustment; alternatively, it might contribute to the allocation of attentional resources during dual information processing. The intraparietal sulcus was equally active when either response selection or timing adjustment was required, suggesting that it modifies, rather than integrates, these processes. Furthermore, our results suggest that these activations related to response selection and timing adjustment were distinct from sensory or motor processes.

Neural representation of a rhythm depends on its interval ratio.

Rhythm is determined solely by the relationship between the time intervals of a series of events. Psychological studies have proposed two types of rhythm representation depending on the interval ratio of the rhythm: metrical and nonmetrical representation for rhythms formed with small integer ratios and noninteger ratios, respectively. We used functional magnetic resonance imaging to test whether there are two neural representations of rhythm depending on the interval ratio. The subjects performed a short-term memory task for a seven-tone rhythm sequence, which was formed with 1:2:4, 1:2:3, or 1:2.5:3.5 ratios. The brain activities during the memory delay period were measured and compared with those during the retention of a control tone sequence, which had constant intertone intervals. The results showed two patterns of brain activations; the left premotor and parietal areas and right cerebellar anterior lobe were active for 1:2:4 and 1:2:3 rhythms, whereas the right prefrontal, premotor, and parietal areas together with the bilateral cerebellar posterior lobe were active for 1:2.5:3.5 rhythm. Analysis on individual subjects revealed that these activation patterns depended on the ratio of the rhythms that were produced by the subjects rather than the ratio of the presented rhythms, suggesting that the observed activations reflected the internal representation of rhythm. These results suggested that there are two neural representations for rhythm depending on the interval ratio, which correspond to metrical and nonmetrical representations.

Involvement of NAD in induced synthesis of colicin E1.

Escherichia coli K-12 nadC13 (ColE1) was starved for nicotinic acid and cellular NAD levels decreased to less than 10% of the normal. Under these conditions, induction of colicin E1 synthesis decreased to about 1% of the normal value, while 30% of the total protein synthesis remained intact. Addition of nicotinic acid reversed both the ability of the colicin induction and cellular NAD level. Induced replication of colicin E1 DNA was greatly reduced in the NAD-deprived cells.

Crystallization and preliminary X-ray diffraction studies of photolyase (photoreactivating enzyme) from the cyanobacterium Anacystis nidulans.

Photolyase (photoreactivating enzyme) from the cyanobacterium Anacystis nidulans was crystallized by the hanging drop vapor diffusion procedure using ammonium sulfate as a precipitant. The pale-yellow crystals were grown to a size of 0.4 mm in length and 0.1 mm in diameter. They belong to the tetragonal space group P4(1)2(1)2 or P4(3)2(1)2 with unit cell dimensions of a = b = 90.7 A and c = 135 A. Assuming that the asymmetric unit contains one molecule, the Vm value is calculated as 2.6 A3/dalton. The crystals are stable towards X-ray exposure and diffract beyond 2.5 A resolution.

Crystal structure of glycosyltrehalose trehalohydrolase from the hyperthermophilic archaeum Sulfolobus solfataricus.

The crystal structure of glycosyltrehalose trehalohydrolase from the hyperthermophilic archaeum Sulfolobus solfataricus KM1 has been solved by multiple isomorphous replacement. The enzyme is an alpha-amylase (family 13) with unique exo-amylolytic activity for glycosyltrehalosides. It cleaves the alpha-1,4 glycosidic bond adjacent to the trehalose moiety to release trehalose and maltooligo saccharide. Unlike most other family 13 glycosidases, the enzyme does not require Ca(2+) for activity, and it contains an N-terminal extension of approximately 100 amino acid residues that is homologous to N-terminal domains found in many glycosidases that recognize branched oligosaccharides. Crystallography revealed the enzyme to exist as a homodimer covalently linked by an intermolecular disulfide bond at residue C298. The existence of the intermolecular disulfide bond was confirmed by biochemical analysis and mutagenesis. The N-terminal extension forms an independent domain connected to the catalytic domain by an extended linker. The functionally essential Ca(2+) binding site found in the B domain of alpha-amylases and many other family 13 glycosidases was found to be replaced by hydrophobic packing interactions. The enzyme also contains a very unusual excursion in the (beta/alpha)(8) barrel structure of the catalytic domain. This excursion originates from the bottom of the (beta/alpha)(8) barrel between helix 6 and strand 7, but folds upward in a distorted alpha-hairpin structure to form a part of the substrate binding cleft wall that is possibly critical for the enzyme's unique substrate selectivity. Participation of an alpha-beta loop in the formation of the substrate binding cleft is a novel feature that is not observed in other known (beta/alpha)(8) enzymes.

Morphological and endocrinological studies on follicular development during the human menstrual cycle.

In order to clarify the morphological dynamics of follicular development and its correlation with ovarian endocrine activity, the present studies were performed in 45 regularly menstruating women who underwent gynecological surgery. Ovarian venous blood was collected from 35 women during the follicular phase. Thirteen of these 35 women were ovariectomized. In addition, 11 pairs of ovaries were obtained from women during the luteal phase. The ovaries were sectioned serially at 2.5 micron and every 13th stained slice was examined to assess the sizes and numbers of atretic and nonatretic follicles. The follicles were divided into five stages: 0.4 less than or equal to approximately less than 1.0 mm, 1.0 less than or equal to approximately less than 2.0 mm, 2.0 less than or equal to approximately less than 4.0 mm, 4.0 less than or equal to approximately less than 6.0 mm, and 6.0 mm less than or equal to approximately in follicular diameter. Estradiol concentrations in ovarian venous plasma were low on both sides on days 1 and 3 of the cycle, whereas a clear asymmetry was found on day 5 before morphological recognition of the dominant follicle. Thereafter, estradiol increased proportionally to the growth of the dominant follicle, followed by a sudden drop when ovulation was imminent. An asymmetrical rise of progesterone occurred on day 10 and later which was sustained up to ovulation. A dominant follicle was recognized in 8 of 11 women between days 6 and 14. All dominant follicles were invariably associated with higher estradiol concentrations in the ipsilateral ovarian blood. Seven of 8 dominant follicles were on the side contralateral to the preceding corpus luteum. The mean diameters of the largest nonatretic follicles were 5.4 +/- 0.3 (SE) mm during the luteal phase as a whole and 4.7 +/- 0.7 mm during the late luteal phase. The mean diameters of the largest nonatretic follicles were not significantly different between the groups with or without the corpus luteum in the luteal phase. In terms of number and atretic rate, follicles of less than 4.0 mm in diameter did not change throughout the cycle in the presence or absence of the corpus luteum. In contrast, cyclic changes of growth and atresia occurred in the larger antral follicles.(ABSTRACT TRUNCATED AT 400 WORDS)

Effect of hydergine in hyperprolactinemia.

The PRL-inhibiting and ovulation-inducing effects of hydergine were studied in 18 patients with hyperprolactinemic ovulatory disturbances. The women were divided into 2 groups of 9 each. Those in group A had basal serum PRL levels higher than 100 micrograms/L, and those in group B had basal serum PRL levels lower than 100 micrograms/L. Serum PRL levels in both groups were determined before and hourly for 8 h after a single oral dose of either 2 mg hydergine or placebo. Hydergine induced a significant (P less than 0.01) decrease in the serum PRL level, compared with placebo, in both groups. The fall in mean serum PRL in group A was significant (P less than 0.05) 300 min after hydergine administration, and the concentration remained low at 480 min, at 45.5% of the mean baseline value. However, the serum PRL concentration did not reach the normal PRL range in any group A patient. Chronic treatment with this drug (2 mg, 3 times daily, for 4-12 weeks) in 5 patients from group A normalized the serum PRL concentration in only 1 patient and did not induce ovulation in any patient. In group B, also, hydergine administration significantly (P less than 0.01) reduced the mean serum PRL concentration within 240 min, and it declined further to within the normal range. The mean maximal reduction was to 56.4% of the baseline value at 360 min. All of the group B women received chronic treatment (2 mg, 3 times daily, for 4-104 weeks); repeated ovulation was induced in 7 (78%). Seven pregnancies ensued in 6 of the women in whom ovulation had been induced, and 4 normal infants were delivered. There were no side-effects, such as nausea and vomiting, during these trials. These data indicate that hydergine has PRL inhibitory activity and is useful in the treatment of hyperprolactinemic anovulatory patients whose basal serum PRL concentrations are below 100 micrograms/L.

Aromatization by skeletal muscle.

Because peripheral aromatization is the major source of circulating estrogens in men and postmenopausal women, we studied the aromatase activity in muscle tissue from both men and postmenopausal women. To do so, the in vitro conversion of tritiated androstenedione to estrogen in homogenates of skeletal muscles obtained at autopsy was studied. Samples from lower limb muscles of both men and postmenopausal women produced estrogen, ranging from 8.5-39.8 pg/g wet wt. The conversion was almost the same as that reported for human adipose tissue, suggesting that the contributions of muscle and fat to the extraglandular production of estrogens in these subjects might be similar. This is the first direct confirmation of muscle aromatase activity and indicates the possible importance of muscle as an extragonadal source of estrogen in both men and postmenopausal women.

Reduction in pituitary desensitization and prolongation of gonadotropin release by estrogen during continuous administration of gonadotropin-releasing hormone in women: its antagonism by progesterone.

The present study was designed to elucidate gonadal steroid influences on gonadotropin release and subsequent pituitary desensitization to GnRH. Sixteen women, 10 of whom were normal and 6 of whom had hypogonadism, were infused with GnRH at rates ranging from 0.313-10 micrograms/h via an indwelling iv catheter for 66 h. Blood samples obtained throughout the GnRH infusion were analyzed for LH, FSH, estradiol, and progesterone. A prompt and substantial release of gonadotropin occurred in women with ovarian failure or during the luteal phase in normal women compared with that during the follicular phase of the menstrual cycle. Thereafter, a gradual decrease in gonadotropin secretion occurred due to pituitary desensitization, which was slower in the follicular phase than in other groups. A dose-related increase in integrated LH release occurred during GnRH infusion, but this response tapered off with administration of large doses of GnRH to women with ovarian failure or during the luteal phase. In contrast, it increased linearly up to the maximum dose of GnRH in the follicular phase. These data suggest that 1) basal levels of estrogen suppress the early rapid release of gonadotropin in response to GnRH and reduce subsequent pituitary desensitization, resulting in the prolonged release of LH; 2) estrogen widens the range of dose-related increases in gonadotropin in response to GnRH; and 3) these effects of estrogen are antagonized by progesterone.

In vivo measurement of spatial dose distribution with thermoluminescent sheet around high dose-rate intracavitary source: application to rectal cancer.

For intracavitary high dose-rate radiation therapy, a thermoluminescent [TL] sheet for in vivo measurement of spatial dose distribution around source has been recently developed. The TL sheet was found to have a linear response with a very wide dynamic range from at least 0.002 cGy to 5000 cGy for 60Co gamma-rays. This TL sheet (40 cm x 50 cm x 200 microns), which is composed of Teflon mixed with BaSO4:Eu doped powder, is very flexible and can be cut to the desired size. In addition, this sheet is easy to handle because of its insensitivity to room light. The spatial dose distribution is displayed in a color mode by using a newly developed TL sheet readout system. For a clinical application, the TL sheet was wrapped on an applicator for intracavitary radiation therapy of a rectal cancer and was inserted into the rectum. The location of the TL sheet could be confirmed with diagnostic X ray film. After irradiation with high dose-rate 60Co source, the in vivo relative dose distribution on the surface of the rectum was determined. This TL sheet provided a convenient means of measuring the relative dose distributions around 60Co sources of various patterns in intracavitary radiation therapy.

Aging and salt-loading modulate blood pressure QTLs in rats.

To evaluate the effects of nongenetic factors, aging, and salt-loading on the quantitative trait loci (QTLs) for blood pressure (BP), we conducted a genome-wide linkage analysis using multiple sets of BP measurements in 125 male F2 generation cross derived from stroke-prone spontaneously hypertensive rats and normotensive Wistar-Kyoto rats. The experiment was arranged in two stages. In the first stage, corresponding to the developing period of the rats, BP was measured repeatedly without loading of salt; this continued until the rats were 5 months of age. In the second stage, after the baseline BP leveled off, 1% salt water was given to the rats and BP was monitored for the subsequent 7 months. Genome scanning was performed using 201 markers. In the developing period, three QTLs were identified on chromosomes 1, 3, and 4 (logarithmic odds [LOD] scores of 5.6, 3.1, and 3.2, respectively), which had peaks at 8 or 10 weeks of age. In the latter salt-loading stage, QTLs for BP were detected on chromosomes 1 and 10 (LOD scores 4.6 and 4.5, respectively). When the BP increase during salt-loading was analyzed as a phenotype, however, only the region on chromosome 10 showed linkage at a suggestive level (LOD score 3.2). The present study provides experimental evidence that QTLs for BP could be modulated by nongenetic factors, such as aging and salt-loading.

Cerebro-cerebellar functional connectivity revealed by the laterality index in tool-use learning.

The function of the lateral part of the human cerebellum was investigated through cerebro-cerebellar functional connectivity. We propose a laterality index method to reveal a functional and possibly anatomical pathway between the cerebral cortex and the cerebellum. The brain activity involved in learning a visually-guided tracking skill using a novel computer mouse was measured by functional magnetic resonance imaging. The imaging data analyzed using the method suggest that the simple lobule and semilunar lobule of the lateral cerebellum have connections with the pars opercularis and pars triangularis in the inferior frontal gyrus. A possible function of this cerebro-cerebellar communication loop is tool usage, which is in-between the cognitive and motor functions of the human cerebellum.

Clinical evaluation of tumor-associated mucin-type glycoprotein CA 54/61 in ovarian cancers: comparison with CA 125.

Studies were conducted in 343 women on the clinical utility of the newly developed tumor-associated mucin-type glycoprotein, CA 54/61, as a tumor marker in serum for ovarian cancer. The overall positivity rate of the new marker was 60%, lower than the rate of 88% obtained with CA 125 measured concurrently. Concerning tumor histology, CA 54/61 had a positivity rate of 78% in mucinous adenocarcinoma, compared with 44% with CA 125. There was no correlation between the serum levels of CA 54/61 and CA 125 (r = 0.05). CA 54/61 showed a low rate of positivity in benign disease and only exceeded the cutoff value in one patient with an endometrial cyst, whereas CA 125 had a positivity rate of 60%. The false-positive rates for CA 125 during the first trimester of pregnancy and during menstruation were 57 and 16%, respectively, whereas the rates for CA 54/61 were only 11 and 5%, respectively. Assay of both CA 54/61 and CA 125 increased the success rate in diagnosing ovarian cancer to 95% (38 of 40 patients).

Macrophage colony-stimulating factor as a tumor marker for epithelial ovarian cancer.

OBJECTIVE: To determine the serum level of macrophage colony-stimulating factor in ovarian cancer patients in order to evaluate its role as a marker for ovarian cancer. METHODS: Serum macrophage colony-stimulating factor levels were assayed in 69 patients with epithelial ovarian cancer, 55 with benign ovarian tumors, and 634 healthy individuals, including 398 women, using an enzyme-linked immunosorbent assay. RESULTS: The average serum macrophage colony-stimulating factor level was 754.4 +/- 153.9 U/mL in healthy females; 1056 U/mL (mean plus 1.96 standard deviations) was considered to be the upper limit of normal. Serum macrophage colony-stimulating factor levels were significantly elevated in patients with ovarian cancer (average 1460.5 +/- 1006.2 U/mL; P < .001) and exceeded 1056 U/mL in 42 of the 69 patients with ovarian cancer (61%). No differences in levels were observed among the histologic types. No definite relationship was found between serum levels of macrophage colony-stimulating factor and those of CA 125. We found that 96% of the patients with ovarian cancer had high serum levels of macrophage colony-stimulating factor and/or CA 125 values. There was no significant difference in the levels of macrophage colony-stimulating factor between patients with benign ovarian tumors and healthy controls. Only 7.3% of the group with benign tumors had levels exceeding 1056 U/mL. CONCLUSION: Macrophage colony-stimulating factor is a marker for ovarian cancer. Determination of serum levels can be useful in detecting ovarian cancer, particularly in combination with CA 125.

Serum luteinizing hormone profile during the menstrual cycle in polycystic ovarian syndrome.

Thirty-three patients with PCO were studied, focusing on the serum LH profile appearing during their menstrual cycles. The elevated LH level declined gradually after ovulation to the normal or near-normal range at the end of the luteal phase and the early follicular phase. The once declined LH level gradually elevated again with the increasing days from the beginning of menstrual flow and remained at a high level until the next ovulation. The LH response to LH-RH increased with the elevating basal LH level. These results may suggest that the timing of hormonal analysis is important for correct diagnosis of PCO.

Arrest of follicular development in a patient with 17 alpha-hydroxylase deficiency: folliculogenesis in association with a lack of estrogen synthesis in the ovaries.

The degree of follicular development was examined in a patient with 17 alpha-hydroxylase deficiency that accounted for impairment of estrogen and androgen biosynthesis. The ovarian content of P was markedly higher than those of any other steroids requiring 17 alpha-hydroxylation for synthesis. The morphologic analysis of the ovaries demonstrated that normal follicles could not develop to more than 2.2 mm in diameter, and most follicles with diameters of 1.0 mm or more yielded to atresia. It is known that estrogen and FSH act synergistically on the growth of the follicles. Our data suggest that the follicles can develop up to the size of 2.2 mm in diameter at most with the sole stimulation of gonadotropin.