A rare case of paraovarian cancer coexisting with cancer of the fallopian tube: magnetic resonance appearance.

Primary paraovarian cancer is a rare tumor occurring in the female pelvis. Magnetic resonance imaging features of paraovarian cancer have not been previously reported. In the present report, we describe a case of paraovarian cancer coexisting with cancer of the fallopian tube and the magnetic resonance features.

Electromagnetic fields inhibit endothelin-1 production stimulated by thrombin in endothelial cells.

Electromagnetic field (EMF) radiation has been found to induce arteriolar dilatation, but the mechanism of action remains largely unknown. This study investigated the effect of EMF radiation on the production of endothelin-1 (ET-1), a potent vasoconstrictor, by cultured endothelial cells. EMF radiation reduced ET-1 basal levels in human umbilical vein and microvascular endothelial cells, but failed to reduce ET-1 basal levels in bovine and human aortic endothelial cells. EMF radiation significantly inhibited thrombin-stimulated ET-1 production in all four endothelial cell types in a dose-dependent manner. EMF radiation significantly inhibited thrombin-induced endothelin-1 mRNA expression in all four cell types. The inhibitory effect of EMF radiation on ET-1 production was abolished by the nitric oxide synthase inhibitor NG-monomethyl-L-arginine (10(-3) mol/1). These results demonstrate that EMF radiation modulates ET-1 production in cultured vascular endothelial cells and the inhibitory effect of EMF radiation is, at least partly, mediated through a nitric oxide-related pathway.

Preoperative assessment of anterolateral thigh flap cutaneous perforators by colour Doppler flowmetry.

An anterolateral thigh flap is very useful in head and neck reconstruction because of its long and large-caliber vascular pedicle, large skin territory and elevation simultaneous with tumour resection. However, the number and locations of cutaneous perforators vary individually, and thus, it is not widely used because flap elevation is often complicated and time-consuming owing to unexpected anatomical variations. To overcome this disadvantage, we assessed the number and locations of cutaneous perforators preoperatively by colour Doppler flowmetry. These data were compared with the intraoperative anatomical findings and their reliability evaluated. A total of 48 cutaneous perforators were found by preoperative colour Doppler flowmetry scanning of 17 anterolateral thigh flaps. All the perforators except two were found intraoperatively. Doppler scanning failed to detect four perforators. Colour Doppler flowmetry assessment therefore has a 92% true-positive rate and a 95.8% positive predictive value. All the flaps except one included multiple perforators, and sufficient blood circulation was observed in all cases. No flaps were unexpectedly changed to anteromedial thigh flaps or contralateral anterolateral thigh flaps because of inappropriate cutaneous perforators or the absence of perforators. Though this investigation is relatively time-consuming (30-40 min) and requires skill, it is very useful for preoperative flap planning and increases the reliability and safety of elevating an anterolateral thigh flap.

MR detection of iliac bone marrow involvement by malignant lymphoma with various MR sequences including diffusion-weighted echo-planar imaging.

OBJECTIVE: To assess the diagnostic accuracy of MR imaging for detecting bone marrow infiltration by malignant lymphoma. PATIENTS AND DESIGN: Fifty-three patients with malignant lymphoma underwent MR imaging and bone marrow biopsy. In 80 iliac crests of the 53 patients (13 positive specimens in 9 patients and 67 negative specimens in 44 patients), biopsy results and the signal intensity characteristics were compared. MR sequences included T1-weighted SE, T2-weighted FSE with fat suppression, FSE STIR, and diffusion-weighted EPI with fat suppression at 1.5 T. RESULTS AND CONCLUSIONS: To detect lymphoma infiltration, T1-weighted SE had the highest sensitivity (92%) and diffusion-weighted EPI with fat suppression and FSE STIR had the highest specificity (92.5% and 92%, respectively). A combination of T1-weighted SE and FSE STIR yielded the highest sensitivity and specificity (85% and 97%, respectively). A combination of T1-weighted SE and FSE STIR sequences seems to be the current choice of imaging protocol for detecting bone marrow infiltration by malignant lymphoma.

Functional evaluation with intravoxel incoherent motion echo-planar MRI in irradiated salivary glands: a correlative study with salivary gland scintigraphy.

The purpose of this study was to determine the relationship between the apparent diffusion coefficient (ADC) measured on intravoxel incoherent motion (IVIM) echo-planar magnetic resonance imaging (MRI) and salivary gland function. Twenty-one patients with head and neck malignancies underwent MRI and salivary gland scintigraphy before and after radiotherapy. Based on the scintigraphic results, each major salivary gland was classified into two groups (dysfunctional and functional) and ADCs measured on IVIM MRI were compared between the two groups. Furthermore, the relationship of ADC to scintigraphic parameters, maximum accumulation (MA), and the uptake ratio (UR), were analyzed. ADCs of the dysfunctional group decreased significantly after radiotherapy (P <.01), whereas those of the functional group showed no significant change. Furthermore, positive correlations were found between the ADC ratio and both MA (P <.005) and UR (P <.001). ADC measurement on IVIM echo-planar MRI is a potentially useful means of evaluating salivary gland function.

Relationship between bone marrow cellularity and apparent diffusion coefficient.

This study was performed to determine if there is a relationship between apparent diffusion coefficient (ADC) and cellularity of bone marrow of the posterior ilium. Four groups of various marrow cellularity underwent diffusion-weighted echo-planar imaging: 1) adults with normal hypocellularity (21 patients); 2) adults with normal normocellularity (13 patients); 3) young children with normal hypercellularity (5 patients); and 4) adults with lymphoma-related hypercellularity (3 patients). In all adults, marrow cellularity was confirmed by uni-or bilateral bone marrow biopsies. In children, the iliac marrow was presumed hypercellular because of their ages. A total of 66 ADC values of bone marrow calculated from diffusion-weighted images with b-values of 30 and 300 seconds/mm(2) was evaluated. Hypercellular marrow (normal and lymphoma-related) showed the highest mean ADC, and hypocellular the lowest ADC. Statistically significant differences were found between three groups of normal marrow: hypocellular, normocellular, and hypercellular. There is a positive correlation between ADC and cellularity of bone marrow. J. Magn. Reson. Imaging 2001;13:757-760.

Simple and low-cost tele-nuclear medicine conference system with the e-mail protocol.

PURPOSE: Because of the recent innovative growth in computer technology, digital imaging, and the Internet, we can take advantage of these facilities for education and clinical work in nuclear medicine. We developed a tele-nuclear medicine conference system with electronic mail (e-mail) on the Internet. METHODS: Twenty-one physicians (20 radiologists, 1 neurologist), 6 technologists and 2 medical students in six university hospitals (Japan 5, Canada 1), 5 local hospitals in Japan participated in this project. We used digital still cameras (330 k pixels) equipped with a floppy disk drive and 10 x optical zoom to digitize images with JPEG compression (640 x 480 matrix). The images were attached to e-mail messages (containing a brief description of each case). The mail was sent simultaneously to all members on the mailing list. Scintigram and SPECT images as well as other radiological images were sent by e-mail. Reply mails about each case were sent to all members via the mailing list. RESULTS: During a period of 6 months, 18 cases (tumor/infection: 7, bone: 6, cardiovascular: 1, neurology; 3, endocrine: 1) with 144 e-mails (average 5.6/case) were submitted to the conference. The average period of discussion was 15.6 days. The number of attached images was 1 to 9 (average, 4.2/e-mails). JPEG compression rate was 1/10 to 1/20. The quality of the images was good enough for discussion. Some cases required additional images for further discussion. CONCLUSION: Our tele-nuclear medicine conference with an electronic mailing list and digital camera was simple and low-cost. The conference system was useful for education and clinical work.

Aberrant left gastric vein demonstrated by helical CT.

PURPOSE: Our goal was to describe the CT findings of aberrant left gastric vein (ALGV) and to evaluate the clinical significance of this vein. METHOD: Four patients in whom ALGVs were demonstrated by helical CT were examined. Each patient had either intrahepatic cholangiocarcinoma, cirrhosis with gastric varices, chronic hepatitis, or nonspecific abdominal pain. All patients underwent two phase helical CT, and the patient with cholangiocarcinoma underwent CT during arterial portography, and 3D images of the abdominal veins were obtained. RESULTS: In all patients, the ALGVs ran along the hepatogastric ligament and were directly connected with the left portal branch. In the patient with cholangiocarcinoma, the portal vein had severe stenosis by tumor invasion, and both the ALGV and the aberrant right gastric vein functioned as a collateral pathway of the portal flow into the liver. In the patient with cirrhosis, dilated ALGV with hepatofugal flow caused gastric varices. CONCLUSION: The ALGV is directly connected with the left portal branch and may play an important role in the collateral pathway of the portal system.

Differential diagnosis of early homogeneously enhancing hepatocellular carcinoma and hemangioma by two-phase CT.

PURPOSE: Our goal was to differentiate between early homogeneously enhancing hepatocellular carcinoma (HCC) and hemangioma by two-phase CT. METHOD: Two phase images of 51 HCCs and 28 hemangiomas showing homogeneous high attenuation in the first series (arterial dominant phase) were reviewed. Enhancement patterns of the lesions in the second series (parenchymal phase) were classified as homogeneous high, peripheral high, iso-, and low attenuation. The attenuation values of all and the enhancement values of some (21 HCCs and 18 hemangiomas) in the first series were calculated. RESULTS: Although low and peripheral high attenuation patterns were seen during the second series only in HCCs (n = 35), which could be used to correctly diagnose HCC, other nonspecific patterns were demonstrated in both HCCs (n = 16) and hemangiomas (n = 28). The attenuation values of 49 of the 51 HCCs and 5 of the 28 hemangiomas were below 130 HU on the first series. The enhancement values of all 21 HCCs and 3 of 18 hemangiomas were below 70 HU. Combining the enhancement patterns with a borderline attenuation value of 130 HU or borderline enhancement value of 70 HU yielded overall accuracies of 94 and 92%, respectively. CONCLUSION: The combined criteria (enhancement pattern plus attenuation or enhancement value) were useful for differentiating between early homogeneously enhancing HCCs and hemangiomas.

Segmental anatomy of the liver under the right diaphragmatic dome: evaluation with axial CT.

PURPOSE: To evaluate the segmental anatomy of the liver under the right side of the diaphragm with axial computed tomography (CT). MATERIALS AND METHODS: Forty-six patients underwent CT arteriography with selective catheterization of the right hepatic artery in 25 cases, the left hepatic artery in 12, the anterior branch of the right hepatic artery in six, the posterior branch of the right hepatic artery in five, the superior anterior branch of the right hepatic artery in 10, and the superior posterior branch of the right hepatic artery in eight. RESULTS: The boundary between the right and left lobes shifted by 16.2 degrees +/- 16.8 anteriorly, and the boundary between the anterior and posterior segments shifted by 43.9 degrees +/- 14.0 posteriorly to the line through the middle or right hepatic vein from the inferior vena cava. The top of the liver consisted of both lobes in 22 patients, only the right lobe in 17, and only the left lobe in two. Participation of segment 7 in the top was not demonstrated. CONCLUSION: The line that extends beyond the middle or right hepatic vein from the inferior vena cava does not coincide with the main or right longitudinal scissura on axial images of the upper portion of the liver.

Isoflurane preserves adenosine triphosphate levels in anoxic isolated rat hepatocytes by stimulating glycolytic adenosine triphosphate formation.

The hypothesis that general anesthetics protect energy reserves by decreasing energy demand is widely accepted but poorly substantiated. Isoflurane at clinical doses preserved adenosine triphosphate (ATP) levels in anoxic isolated hepatocytes. Specific inhibitors were used to block mitochondrial and/or glycolytic ATP formation to ascertain whether pathways of energy supply or demand, or both, were involved in ATP preservation by isoflurane. Hepatocytes were isolated from fed adult male rats after perfusing livers with Krebs buffer containing collagenase. Cells were incubated in Krebs buffer for 0-30 min at 25 degrees C under N2/CO2 (95%/5%) +/- isoflurane 0.63 mM in liquid phase. Oligomycin, iodoacetate, or fasting were used to block mitochondrial and glycolytic ATP formation. Under anoxia alone, ATP levels declined more slowly in the presence than in the absence of isoflurane, confirming the ATP-protective effect of isoflurane reported previously. With oligomycin plus iodoacetate blocking all ATP formation, ATP decline (representing pure ATP consumption) was not slowed by isoflurane. Isoflurane's protective effect recurred when glycolytic ATP supply was restored by incubating with oligomycin only. The protective effect was accompanied by increased lactate accumulation, and both effects-ATP preservation and lactate formation-were similarly dependent on isoflurane concentration. We conclude that the protective effect of isoflurane on energy status in anoxic isolated hepatocytes was not associated with reduced ATP demand but with enhanced ATP supply via stimulation of glycolysis.

Hepatic hemangioma: findings with two-phase CT.

PURPOSE: To characterize the appearance of hemagiomas at two-phase dynamic incremental computed tomography (CT) and to determine the cause of contrast material enhancement of adjacent parenchyma in the first series. MATERIALS AND METHODS: Contrast-enhanced CT images of 51 hemangiomas in 20 patients were reviewed. Enhancement patterns of hemangiomas in the first series were classified as homogeneous high, peripheral high, and low attenuation; in the second series, as homogeneous high, peripheral high, iso-, and low attenuation. Correlations between arterioportal shunts and early parenchymal enhancement were evaluated in 45 hemangiomas in the 17 patients who underwent angiography. RESULTS: Thirty-two hemangiomas progressively became enhanced. Four had low and eight had homogeneous high attenuation in both series. Seven changed from homogeneous high to isoattenuation. Early parenchymal enhancement was well correlated with presence of arterioportal shunt. CONCLUSION: Low-attenuation hemangiomas and those that changed from homogeneous high to isoattenuation are atypical and difficult to differentiate from other neoplasms. Most early parenchymal enhancement is caused by associated arterioportal shunts.

Hepatic pseudolesion in the left lobe around the falciform ligament at helical CT.

PURPOSE: To determine the prevalence and possible cause of pseudolesions in the left hepatic lobe around the falciform ligament at hepatic helical computed tomography (CT). MATERIALS AND METHODS: Portal venous-dominant CT scans of 472 consecutive patients were reviewed. CT of the left hepatic lobe was performed after injection of contrast material into the portal vein in 73 patients, the hepatic artery in 32, and the internal thoracic artery in four. The scans were compared with those obtained at helical CT, and the findings were analyzed. RESULTS: Pseudolesions were seen on 64 (14%) of 472 helical CT scans and correlated well (accuracy, 96%) with portal perfusion defects. They were not more enhanced than the surrounding liver parenchyma at CT arteriography with hepatic artery injection but were enhanced in two patients at CT arteriography with internal thoracic artery injection. CONCLUSION: Pseudolesions are caused by portal perfusion defects and may receive an aberrant blood supply.

Changes in serum granulocyte colony-stimulating factor (G-CSF) and interleukin 6 (IL-6) after surgical intervention.

To evaluate the physiological role of G-CSF following surgery, we measured the serum levels of immunoreactive IL-6 and G-CSF sequentially in nine patients after major elective thoracoabdominal surgery for esophageal carcinoma. Both G-CSF and IL-6 levels reached their maxima at the first postoperative day and decreased thereafter. There was a significant correlation between serum G-CSF (y) and IL-6 (x) levels (y = 3.273x + 3.991; r = 0.787, n = 78, p < 0.001). In the case that developed aspiration pneumonia and ARDS at the second postoperative day, the measured G-CSF level was less than half the predicted value. The relationship between serum G-CSF and IL-6 levels supports the central role of G-CSF as the host defense response modifier and, thus, low G-CSF levels in the circulation is one reason for the immunodeficient state after major surgery.

The prognostic significance of surgical margin in liver resection of patients with hepatocellular carcinoma.

OBJECTIVE: To evaluate the prognostic significance of surgical margin in liver resection of patients with hepatocellular carcinoma. DESIGN: Retrospective study. SETTING: The Center for Adult Diseases, Osaka, Japan, between 1980 and 1989. PATIENTS: One hundred eighty-five patients with hepatocellular carcinoma who underwent liver resection with complete extirpation. MAIN OUTCOME MEASURE: Cumulative survival rate. RESULTS: The patients were divided into a wide surgical margin group, in which the lesion was excised with a margin of 1.0 cm or more, and a narrow surgical margin group, in which the margin was less than 1.0 cm. No significant differences could be detected in survival rates for 3 years or longer. Mean +/- SE tumor sizes were 3.4 +/- 0.4 cm and 4.4 +/- 0.3 cm, respectively, in the wide and narrow surgical margin groups. The patients were divided into three groups according to tumor size: group 1, 2.0 cm or less in diameter; group 2, greater than 2.0 cm but 5.0 cm or less in diameter; and group 3, greater than 5.0 cm in diameter. In groups 2 and 3, no significant differences in survival rates were found between the wide and narrow surgical margin groups. In group 1, the survival rate was significantly higher in the wide surgical margin group than in the narrow surgical margin group (P < .05). CONCLUSIONS: Small hepatocellular carcinomas of 2.0 cm or less in diameter should be resected with an adequate surgical margin. However, surgical margin was not a significant factor in the resection of hepatocellular carcinomas larger than 2.0 cm.

Effect of granulocyte-macrophage colony-stimulating factor on sepsis-induced organ injury in rats.

The administration of granulocyte-macrophage colony-stimulating factor (GM-CSF) to patients with severe active infections has been questioned because activation of neutrophils may cause tissue injury. To identify the effect of GM-CSF administration on severe sepsis, we examined the survival rate and pathologic changes in vital organs using the rat lethal sepsis model. Rats received 20 micrograms of recombinant murine GM-CSF (rmGM-CSF) 3 hours after the onset of peritonitis induced by cecal ligation and puncture. After 48 hours, the survival rate did not improve, and earlier deaths than in the control group were observed. In addition, the inhibition of early leuko-sequestration in the peritoneal cavity was seen in animals treated with GM-CSF. These results suggested that the administration of rmGM-CSF after the onset of sepsis was not beneficial; thus, we concluded that care should be taken in the clinical use of GM-CSF in severe infection.

The frequency of a concomitant early esophageal cancer in male patients with oral and oropharyngeal cancer. Screening results using Lugol dye endoscopy.

BACKGROUND: Male patients with oral and oropharyngeal cancer are known to have high risk of concomitant esophageal cancer developing. Thus, mass screening programs are pursued to detect such esophageal cancer early, and in a mass screening trial of patients with early oral and oropharyngeal cancer, the efficacy of Lugol dye endoscopy for detecting concomitant esophageal cancers has been evaluated. METHODS: Lugol dye was used in an endoscopic screening of 101 patients with oral cancer and 26 with oropharyngeal cancer; all of the patients were men. RESULTS: Among these 127 patients, eight (6.3%) clinical asymptomatic concomitant esophageal cancers were detected, and four of these eight cancers were found in the patients with oropharyngeal cancer. Five of these eight superficial lesions could not be detected by ordinary endoscopy or barium study. CONCLUSION: Our results show that Lugol dye endoscopy is indispensable for monitoring male patients with oral or oropharyngeal cancer to detect an early concomitant esophageal cancer. In addition, a higher frequency of concomitant esophageal cancer was seen in the patients with oropharyngeal cancer than in the patients with oral cancer.

Fibromuscular disease of the brachial artery with digital emboli treated effectively by transluminal angioplasty.

We present a 45-year-old male with fibromuscular dysplasia (FMD) of the left brachial artery causing microemboli with digital ischemia. The angiographic diagnosis was medial fibroplasia. Treated with percutaneous transluminal angioplasty (PTA), the corrugated arterial wall was made smooth and production of new thrombi apparently stopped, as 3.5 years after PTA the patient has had no recurrence. Although FMD of the brachial artery is rarely encountered, PTA seems to be an effective treatment as an alternative to surgical interposition grafting.

Small hepatocellular carcinomas: two-phase dynamic incremental CT in detection and evaluation.

PURPOSE: To compare dynamic incremental computed tomography (CT) with other techniques in detecting and evaluating small hepatocellular carcinomas (HCCs). MATERIALS AND METHODS: Two-phase (early vascular and parenchymal) dynamic incremental CT of the entire liver and ultrasonography (US) were performed in 184 patients with chronic liver disease. Thirty patients had 36 small HCCs (less than 30 mm in diameter); 27 of these 30 patients also underwent CT after intraarterial injection of iodized oil, and the results were compared. RESULTS: The HCC detection rate was 92% with dynamic incremental CT, 69% with US, and 81% with iodized oil-enhanced CT. Of six well-differentiated HCCs, two were detected with the first dynamic incremental CT series and two with iodized oil-enhanced CT, whereas all were detected with the second dynamic incremental CT series and five with US. CONCLUSION: Two-phase dynamic incremental CT was superior to the other techniques and is a useful and easy procedure for routine follow-up of patients with chronic liver disease.

[Changes of serum interleukin 6 (IL6) and acute phase protein after hepatectomy in patients with chronic liver disease].

We examined the changes in serum levels of interleukin 6 (s-IL6) and acute phase protein (APP) during perioperative periods in patients with or without chronic liver disease (CLD) who underwent hepatectomy or other surgeries. The elevation of s-IL6 on the first postoperative day was only correlated with preoperative values of indocyanine green retention test (ICG-R15) (r = 0.56, p < 0.01), and not concerned with any operative factors. We divided the patients into the following three groups; the patients with CLD undergoing hepatectomy (n = 21, group A), the patients without CLD undergoing hepatectomy (n = 7, group B), and the patients without CLD undergoing surgeries other than hepatectomy (n = 7, group C). The values of s-IL6 on preoperative day, 1st, 4th, and 7th days after surgery in group A were significantly higher than the corresponding values in group C (p < 0.05). Among the hepatectomy groups, the serum levels of APP on the 4th day after surgery were significantly higher than those on preoperative day. We concluded that the changes in s-IL6 after hepatectomy were strongly concerned with preoperative liver function, especially with values of ICG-R15. However, it seemed that the induction of APP was negatively correlated with the preoperative liver function.