Congenital masses of the lung: prenatal and postnatal imaging evaluation.

Congenital masses of the lung are a spectrum of interrelated abnormalities that includes congenital lobar overinflation, bronchogenic cyst, congenital cystic adenomatoid malformation (CCAM) and sequestration. The prenatal and postnatal imaging features of these lesions are reviewed, emphasizing the importance of serial prenatal sonograms and postnatal imaging studies, including radiography and computed tomography. Masses that become inconspicuous, or disappear on serial prenatal sonograms are discussed, as well as the importance of postnatal imaging studies in the evaluation of these lesions. Finally, the management of congenital masses of the lung is reviewed, emphasizing the importance of imaging studies in the preoperative evaluation.

Dilation of the ventriculus terminalis: sonographic findings.

A newborn term male infant was found to have the stigmata of VACTERL syndrome, including cervical and thoracic hemivertebra, partial sacral agenesis, 13 pairs of ribs, high imperforate anus with rectovesical fistula, and tracheoesophageal fistula with proximal esophageal atresia. No open spinal dysraphism or skin dimpling was seen. Ultrasonography of the spinal cord was performed to screen for occult anomalies. The examination revealed a lipoma of the filum terminalis and a low-lying conus medullaris at the L3-L4 level with a large central cystic structure in the terminal cord, which was continuous with the central canal (Fig. 1). This was thought to most likely represent a dilated ventriculus terminalis, and the diagnosis was confirmed on a subsequent MR image (Fig. 2). Fluid in the cyst followed cerebrospinal fluid signal in all sequences. We observed no abnormal signal in the adjacent parenchyma or enhancement associated with the cystic mass. A cranial ultrasonogram did not reveal any intracranial anomalies. The patient demonstrated no neurologic deficits in the lower extremities. Bowel and urinary continence was not assessable in this infant.

Congenital masses of the lung: changes in cross-sectional area during gestation.

PURPOSE: We assessed the growth of congenital masses of the lung during gestation using computer-assisted planimetry. METHODS: The prenatal sonograms of 8 fetuses with congenital masses of the lung were reviewed. RESULTS: The cross-sectional area of the mass and chest were measured on the same transverse image using computer-assisted planimetry, and the percentage of the chest occupied by the mass was determined for each study. Four masses had pathologic features of type II congenital cystic adenomatoid malformation and intralobar sequestration (CCAM/ILS), 2 were type II CCAM, 1 was type I CCAM, and 1 was bronchial atresia with bronchiectasis. Four masses increased in cross-sectional area during gestation, 1 decreased, 2 were essentially unchanged, and 1 showed an initial increase in cross-sectional area followed by a decrease later in gestation. No consistent growth pattern was seen among masses with similar histologic characteristics. The percentage of the cross-sectional area of the chest occupied by the mass decreased in 7 fetuses and was virtually unchanged in 1 during gestation. All the fetuses survived to term; the infants had an uncomplicated postnatal course and underwent surgical resection of the mass during the first year of life. CONCLUSIONS: This study showed that in a fetus with a congenital mass of the lung and a favorable clinical outcome, growth of the chest exceeds any growth of the mass that may occur and masses with the same pathologic diagnosis have different patterns of growth in utero.

Bilateral cystic neuroblastoma: imaging features and differential diagnoses.

Neuroblastoma is one of the most common malignant tumors of childhood, with 40 % arising in the adrenal glands. Bilateral adrenal involvement from synchronous development or metastatic spread of the tumor is seen in less than 10 % of children with neuroblastoma [1]. Neuroblastoma rarely presents as a cystic suprarenal mass that is difficult to differentiate from adrenal hemorrhage, extralobar sequestration, or dilated upper-pole renal calyces. To our knowledge, bilateral cystic neuroblastoma has not been previously reported. We present a case of bilateral cystic adrenal neuroblastoma to demonstrate the imaging features of this unusual entity, and to expand the differential diagnosis of bilateral cystic suprarenal masses in an infant.

Humoral hypercalcemia due to an occult renal adenoma.

Humoral hypercalcemia refers to the elevated blood calcium levels caused by neoplasms which release a bone resorptive substance into the circulation. Previously reported infants with malignant and benign solid tumors causing humoral hypercalcemia have presented with large abdominal masses. The case we describe, a hypercalcemic infant due to an occult parathyroid hormone-related protein-containing metanephric adenoma of the kidney, shows that radionuclide bone scanning can be a useful test to identify humoral hypercalcemia. Humoral hypercalcemia stemming from a soft tissue neoplasm should be ruled out, even in the absence of clinical signs of a tumor, if bone scans show generalized uptake in the absence of hypervitaminosis D or radiological signs of bone lesions, and serum parathyroid hormone is low.

Disappearing fetal lung masses: importance of postnatal imaging studies.

BACKGROUND: The "disappearance" of congenital masses of the lung on prenatal sonograms has been described, but the importance of postnatal imaging studies in these children is unknown. OBJECTIVE: The objective of this work was to study the utility of radiographs and CT scans in asymptomatic infants with congenital masses of the lung that partially or completely resolve on prenatal sonograms performed late in gestation. MATERIALS AND METHODS: The prenatal sonograms, postnatal imaging studies, surgical findings, and pathologic diagnoses of seven children with an echogenic mass of the lung that improved or disappeared on prenatal sonograms were reviewed. RESULTS: All masses were type II congenital cystic adenomatoid malformation, with features of intralobar sequestration also being found in four. An unsuspected extralobar sequestration adjacent to a left lower lobe mass was found at surgery in one patient. All masses were hyperechoic compared with normal lung on sonograms prior to 32 weeks of gestation, with cysts being seen in four. On scans after 32 weeks, four of the masses had resolved completely and three showed subtle increased echogenicity compared with normal lung. Cysts completely resolved in two of four cases. Postnatal radiographs showed subtle abnormalities in four infants, a hyperlucent lobe in one, a soft tissue mass with adjacent hyperlucency in one, and normal findings in one. CT scans were abnormal in all cases, with air-filled cysts and soft tissue in six and a hyperinflated lobe in one. CONCLUSION: Children with "disappearing" fetal lung masses have persistent abnormalities after birth that are often subtle on radiographs but are well demonstrated with CT.

CT of intussusception in the pediatric patient: diagnosis and pitfalls.

Intussusception in the pediatric patient may have a varied clinical presentation depending on its location, presence of lead point, intermittent occurrence, or underlying systemic disease. Computed tomography (CT) may be used at times in the evaluation of children with complicated presentations. The purpose of this investigation was to review the findings of CT images obtained in children with intussusception. Five patients with intussusception were diagnosed by CT at our institution between 1989 and 1994. An intraluminal mass was found in all patients. Intraluminal eccentrically located fat, as well as the target sign of alternating layers of high and low attenuation, was seen in most patients. In patients with a more long-standing process, fluid-distended loops, inflammation, and loss of tissue planes were seen and corresponded with necrosis and areas of nonviable bowel found at surgery. Finally, potential pitfalls with the layered or target appearance are discussed in the form of two patients who were initially felt to have intussusception at CT, but in whom the target appearance was later found to be due to other processes.

Nontraumatic pediatric musculoskeletal MR imaging: comparison of conventional and fast-spin-echo short inversion time inversion-recovery technique.

PURPOSE: To compare conventional short inversion time inversion-recovery (STIR) with fast spin-echo (FSE) STIR techniques to evaluate suspected nontraumatic musculoskeletal abnormalities. MATERIALS AND METHODS: Thirty STIR and FSE-STIR examinations in 26 pediatric patients with suspected nontraumatic musculoskeletal abnormalities were prospectively evaluated. Qualitative (subjective) and quantitative (five-point rank score) analyses of the images were performed. RESULTS: FSE-STIR was faster than STIR (mean, 2 minutes 25 seconds and 6 minutes 35 seconds, respectively). Fat suppression was slightly better with STIR. Image degradation due to motion was judged similar. Lesion contrast to muscle was slightly better with STIR than FSE-STIR, and lesion contrast to fat was equivalent. Qualitatively, lesion conspicuity was similar: All lesions were seen with both techniques. CONCLUSION: FSE-STIR can replace STIR when an inversion-recovery fat-suppression sequence is desired. Considerable imaging time is saved.

Importance of prenatal detection of hydronephrosis of the upper pole.

To determine the impact of prenatal detection on neonates with hydronephrosis of the upper pole of a duplex collecting system, we reviewed 40 such cases seen between June 1982 and April 1989. This six-per-year rate contrasts with fewer than one case per year that was seen at our hospital from 1947 to 1977. Nineteen patients had an ectopic ureterocele, and 21 had an ectopic ureter without a ureterocele. Thirty-three (83%) were girls. Thirty-three cases were discovered because of abnormal findings on a prenatal sonogram, and 20 of those infants were asymptomatic. In the 33 patients whose prenatal sonographic findings were abnormal, the sonogram was diagnostically precise for hydronephrosis of the upper pole of a duplex collecting system in only 39%. This imprecision did not adversely affect management or outcome. Postnatal sonography modified the prenatal diagnosis in 75% of these 33 patients. Voiding cystourethrography was the most sensitive and precise imaging technique for detecting both ureterocele and reflux. Lower pole reflux was almost twice as common when an ectopic ureterocele was present (63%) than when one was not (33%). Prenatal sonographic detection of hydronephrosis of the upper pole of a duplex collecting system decreased the proportion of neonates presenting with urinary tract infection and urosepsis because of prophylactic antibiotics initiated at birth and continued until surgical correction. Precise prenatal diagnosis was not needed for effective surgical treatment.

Urinoma drainage for neonatal respiratory insufficiency.

This report describes two newborn males with posterior urethral valves, perirenal urinomas and respiratory distress. A 400 cc urinoma was drained percutaneously with resolution of respiratory symptoms in the first case. A 120 cc urinoma was drained in the second case but the infant died of pulmonary hypoplasia at 22 h of age. This report emphasizes the importance of aspirating or draining the urinoma in an attempt to treat the newborn's respiratory insufficiency.

In vitro immune monitoring of antibody response in dogs given chemoimmunotherapy for lymphoma.

Clinical remission in 30 dogs with lymphoma was induced with a combination of vincristine, L-asparaginase, cyclophosphamide, and doxorubicin HCl, administered sequentially, and then an autochthonous tumor cell vaccine, given intralymphatically, as maintenance therapy. Humoral antibody amounts were monitored in 11 dogs, using a solid-phase bead-type radioimmunoassay. The median survival of the 30 dogs was 13 months from the start of chemotherapy (range, 7 to 25 months; mean, 13.8). The median remission duration was 16 weeks (range, 9 to 98 weeks; mean, 26.8). Correlation between increase in amount of humoral antibody was significant (P = 0.0001 to 0.012), before and after chemoimmunotherapy, in dogs responding to therapy, compared with that in dogs not responding to therapy.

Effect of radiofrequency radiation on mRNA expression in cultured rodent cells.

Four rodent cell lines were exposed to 2450 MHz microwave radiation at a Specific Absorption Rate (SAR) of 103.5 +/- 4.2 W/kg for varying lengths of time at 37 degrees, 40 degrees, 42 degrees and 45 degrees C. mRNA was extracted from microwave-exposed and sham-exposed cells and dot blotted or Northern blotted to nitrocellulose. Radioisotope labelled DNA probes of oncogenes, heat shock protein or long terminal repeat sequences were hybridized to the mRNA, and the resulting autoradiographs analyzed for differences in levels of mRNA expression between exposed and nonexposed samples. With the cell lines and probes used in this study no significant differences in mRNA expression were observed after microwave exposure.

Ketamine- and morphine-induced analgesia and catalepsy. I. Tolerance, cross-tolerance, potentiation, residual morphine levels and naloxone action in the rat.

The effects of ketamine and morphine on pain perception and catalepsy were compared in rats. Analgesia, as measured by the latency to withdrawal of the tail from a 55 degrees C water bath (tail-flick latency difference, TFLD), was produced by both ketamine and morphine, but at widely different doses, and in each case the effect was reversed by naloxone. Catalepsy, measured by the duration of loss of righting reflex (DLRR) in catatonic animals, was induced by larger doses of both ketamine and morphine and in each case was reduced by a larger dose of naloxone. DLRR and TFLD tolerance developed rapidly and with a similar time course after daily doses of ketamine or morphine. Rats tolerant to the DLRR effect of ketamine showed cross-tolerance to morphine. Rats tolerant to the DLRR effect of morphine did not show cross-tolerance to ketamine when administered the following day; instead, these rats showed potentiation of the ketamine-induced DLRR. The degree of potentiation noted 24 hr after a single or multiple daily doses of 45 mg/kg of morphine is the same as that seen when 2 mg/kg of morphine is given simultaneously with ketamine. The residual brain level of morphine 24 hr after 45 mg/kg is similar to the level 1 hr after a 2-mg/kg dose. The augmented ketamine response in morphine-tolerant rats is postulated to be a result of residual morphine still present in the brain 24 hr after the last DLRR-inducing dose of morphine.(ABSTRACT TRUNCATED AT 250 WORDS)

In vitro exposure to electromagnetic fields: changes in tumour cell properties.

Two human colon cancer cell lines, Colo 205 and Colo 320 DM, have been studied for their responses to 60 Hz-generated electromagnetic fields (EMF) using soft agar cloning and monoclonal antibody binding assays to assess exposure-induced changes. Cellular responses have been studied after 24 h continuous exposure of cells concurrently to four experimental conditions; i.e. no EMF (E-M-), magnetic field only (M+, 1.0 G rms), electric field only (E+, 300 mA/m2 rms), and combined electric plus magnetic fields at these intensities (E+M+). Under these conditions, both cell lines demonstrated significantly increased colony formation in soft agar and increased expression of tumor associated antigens after exposure to E+M+ and to M+ as compared to unexposed controls.

Transferrin binding to two human colon carcinoma cell lines: characterization and effect of 60-Hz electromagnetic fields.

125I-Labeled human transferrin was used to study the binding of transferrin to Colo 320 DM and Colo 205 human cell lines derived from adenocarcinomas of the colon. Although transferrin uptake was greater in both cases at 37 degrees than at 4 degrees it was found that slightly greater than two-thirds of the transferrin associated with the cells at 37 degrees was not bound to surface receptors but rather had been internalized by the cells. Subsequent analysis of true surface binding at 4 degrees by Scatchard analysis allowed determination of the number of transferrin receptors as well as association constants for the interaction. The number of transferrin receptors per cell was found to be inversely related to the cell density of the cultures from which cells were removed for study. Association constants were unaffected by cell density, with average values of 1.2 and 5.4 X 10(8) M-1 obtained for Colo 320 DM and Colo 205, respectively. Additionally, maximum theoretical numbers of receptors of 1.05 X 10(5)/cell for Colo 320 DM and 1.39 X 10(5)/cell for Colo 205 were determined. Furthermore, exposure of Colo 205 cells to three different experimental situations, i.e., 60 Hz-generated electric field only (E+, 300 mA/m2rms), magnetic field only (M+, 1.0 gauss rms), and combined electric + magnetic fields at these intensities (E+M+), altered the expression of transferrin receptors as compared to a concurrently run unexposed control population of cells (E-M-). In three separate experiments the number of transferrin receptors quantitated on both M+ and E+M+ cells was independent of cell culture density and was close to or exceeded the maximum theoretical number of receptors determined for this cell line. In contrast, E+ cells expressed fewer transferrin receptors than was predicted on the basis of cell culture density.

Effects of 6-methoxy-2-benzoxazolinone on the pineal melatonin generating system.

6-Methoxy-2-benzoxazolinone (6-MBOA) at concentrations greater than 20 microM stimulates serotonin N-acetyltransferase (NAT) activity of rat pineal glands in 48-hr organ culture as well as of glands freshly cultured, indicating that 6-MBOA acts postsynaptically. The effects of 6-MBOA on NAT activity can be blocked by propranolol but not by prazosin, suggesting that 6-MBOA acts on the beta receptor. At the doses used 6-MBOA stimulation does not block or enhance NAT stimulation by norepinephrine, but is additive with vasoactive intestinal polypeptide which stimulates NAT activity at a site different than the beta receptor. This study demonstrates that 6-MBOA stimulates rather than inhibits melatonin biosynthesis and does not prevent stimulation of melatonin synthesis by norepinephrine. The progonadal association with eating plants containing 6-MBOA in the Montane vole may be due to over stimulation of melatonin receptor sites. Other possible explanations include an extrapineal action such as a blockade of melatonin receptors in the central nervous system, a blockade of receptors on the gonads or to a direct action of this agent on the gonads.

Retardation of embryogenesis by extremely low frequency 60 Hz electromagnetic fields.

Fertilized Medaka fish eggs were used to determine if electromagnetic fields, designed to simulate those beneath a high voltage power line, have biological effects on vertebrate embryo development. The newly fertilized eggs were exposed to a 60 Hz electrical field of 300 mA/m2 current density, a 60 Hz magnetic field of 1.0 gauss RMS, or to the combined electric plus magnetic fields for 48 hours. No gross abnormalities were observed in any of the embryos as they developed, but significant development delays were seen in those embryos exposed to either the magnetic or to the combined electromagnetic fields; delays were not seen in the embryos exposed to the electrical field. Thus, a 60 Hz magnetic field like that encountered in a man made powerline environment was shown to retard development of fish embryos.

Humoral immune responses to adenoviruses, herpes virus type 1, and Candida albicans in sera of dental patients with oral neoplastic and periodontal diseases.

Levels of immunoglobulin class-specific antibodies as determined by solid phase radioimmunoassays to herpes simplex virus type 1 (HSV-1), human adenovirus types 5, 21, and 31 and to Candida albicans in sera from untreated healthy dental patients were not significantly different from levels of these antibodies in sera from untreated dental patients with benign oral tumors, oral carcinoma, or periodontal disease. These results show that higher levels of immunoglobulin class-specific antibodies to HSV-1, the three adenoviruses, or Candida albicans are not a consistent finding in sera from patients with oral cancer when comparisons are made with healthy patients and patients with other oral diseases.

Effects of amine pretreatment on ketamine catatonia in pinealectomized or hypophysectomized animals.

The present studies were designed to clarify the role of catecholamines and pineal idolamines on ketamine-induced catatonia in the intact, pinealectomized or hypophysectomized chick and rat. In the pinealectomized chick, pretreatment with dopamine increased the duration of catatonia (DOC) after ketamine, but pretreatment with norepinephrine did not. The pineal indolamines exhibited mixed actions. Serotonin and N-acetyl serotonin which augmented ketamine DOC, did not do so in the absence of the pineal gland, whereas melatonin potentiated the ketamine DOC in both the intact and pinealectomized chick. Ketamine was more potent in the hypophysectomized chick and the circadian rhythm noted in the intact chick was absent; furthermore, melatonin did not augment the ketamine DOC whereas dopamine continued to do so. This study did not demonstrate a species difference regarding the role of the amines on the pineal in spite of the immature blood-brain barrier in the young chick and the intact barrier in the rat. In addition, these data indicate a direct role of the pituitary in the augmentation of ketamine DOC induced by melatonin. Furthermore, dopamine appeared to act on systems more closely involved with the induction of ketamine catatonia rather than directly on the pituitary.

New techniques for detecting tumor markers: a prospective.

The search continues for biomarkers in body fluids that can identify the presence of otherwise undetectable tumors. Presently tumor biomarkers can be useful in monitoring neoplastic disease during and after therapy, although their role in early diagnosis is less certain. The value of each tumor biomarker in each clinical situation can be estimated by its concentration in biofluids, the sensitivity of the detection techniques, and the specificity of its in vivo and in vitro activities. A wide range of new multidisciplinary biotechnologies applied to tumor biomarkers promises additional and improved assays for highly sensitive and specific detections of human neoplasia. These new assays will have the potential for making accurate estimations of initial tumor burden, micrometastasis, and residual and occult tumor cells remaining after surgery.