Signal intensity of the motor cortex on phase-weighted imaging at 3T.

BACKGROUND AND PURPOSE: It is known that the motor cortex shows hypointensity on T2-weighted images in older patients. The goal of this study was to assess the signal intensity of the motor cortices on the phase-weighted imaging performed with a Windows-based software program that we developed ourselves. MATERIALS AND METHODS: All studies were performed at 3T MR imaging. First, the TE for the phase-weighted image was optimized; the best contrast between the motor and other cortices was obtained with a TE of 40 ms. The study population consisted of 45 healthy subjects (23 females, 22 males; mean age, 32.1 years). The signal intensity of the motor cortices was divided into 3 grades by 2 neuroradiologists in comparison with that of the superior frontal cortex (SFC): In grade I, the motor cortex was isointense to the SFC; in grade II, the motor cortex was slightly hypointense to the SFC; and in grade III, the motor cortex was markedly hypointense to the SFC. RESULTS: The motor cortex was classified as either grade II or III in all subjects older than 20 years of age on the phase-weighted images. Even at 10-19 years of age, the grade II or III appearance was found in 14 (88%) of 16 motor cortices (8 subjects) on the phase-weighted images. CONCLUSION: In adolescents, the motor cortex is hypointense to other cerebral cortices on phase-weighted MR imaging, which probably reflects differences in the concentration of nonheme iron and/or in the tissue architecture.

Treatment of acute right coronary artery occlusion during anesthesia.

PURPOSE: Perioperative coronary artery occlusion is a potentially dangerous complication causing myocardial infarction and circulatory collapse. We report a case showing severe ST segment depression in leads II and V5 during anesthesia. Diltiazem and nifedipine, but not nitroglycerine, partially improved the ST changes which were normalized by a percutaneous cardiopulmonary system (PCPS). CLINICAL FEATURES: A 71-yr-old man with cerebrovascular disease was scheduled for coronary artery bypass grafting (CABG). Past medical history included myocardial infarction due to right coronary artery (RCA) occlusion. Both the femoral artery and vein were cannulated percutaneously before operation and the PCPS was prepared as a back-up system. Depression of the ST segments in leads V5 and II was observed following heparinization. Although hemodynamic stability was maintained with continuous infusion of catecholamines, the ST changes were not improved by intravenous nitroglycerine. Intravenous diltiazem followed by nasal nifedipine partially improved the ST changes. The changes were normalized after induction of PCPS. No neurological complications were observed. The postoperative coronary angiography confirmed the total occlusion of RCA. CONCLUSION: Calcium channel blockers were more effective than nitroglycerine in treating perioperative ST depression. However, none of them produced complete reversal of the ischemic changes which were normalized with PCPS.

[Electroejaculation and assisted reproductive techniques in the patients with spinal cord injury].

BACKGROUND: Most of the patients with spinal cord injury (SCI) have fertility problems by an ejaculation and a poor fertility of the ejaculate. The objective of this paper is to evaluate the clinical effectiveness of electroejaculation (EE) and combined use of EE and assisted reproductive techniques for the patients with SCI. PATIENTS AND METHODS: Using a Seager Model, EE was attempted on 69 patients with SCI. Of the 69 patients 14 (20%) had cervical, 49 (71%) thoracic and 6 (9%) lumbar paraplegia. Mean patient age was 30 years (range 19 to 47 years) and the mean interval from spinal injury to the first EE was 9 years (range 1 to 38 years). Artificial insemination of husband (AIH), in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) were used to achieve a pregnancy. RESULTS: Antegrade ejaculation was obtained in 60 patients (86.9%). Patients with under-active bladder showed low induction rate (58.3%). Volume of ejaculate was ranged from 0.05 to 5.2 ml (average 1.0 ml) and sperm concentration was ranged from 0 to 546 x 10(6)/ml (average 40.3 x 10(6)/ml), but sperm motility was poor (range 0 to 70%, average 9.4%). Assisted reproductive techniques was attempted on 87 occasions (AIH 80, IVF 2, ICSI 5) on 15 couples. To date, there have been 4 pregnancies (AIH 2, ICSI 2) resulting in 3 healthy live births. CONCLUSION: Combined use of EE and assisted reproductive techniques is excellent management for the patients with SCI who wish to father children.

Alendronate modulates osteogenesis of human osteoblastic cells in vitro.

The bisphosphonates, which are carbon-substituted pyrophosphates, have been studied extensively both in vivo and in vitro to elucidate their effects on bone tissues and cells. However, because these agents were shown to have a potent inhibitory effect on bone resorption, the majority of studies have focused on only this aspect of bone metabolism. There appears to be less information regarding the direct effect of bisphosphonates on bone formation, so thus we undertook experiments to investigate the effects of bisphosphonates, especially alendronate, on the mineralization and matrix protein synthesis of human osteoblastic cells in vitro. The data show that the bisphosphonates, alendronate, etidronate and pamidronate, suppressed 1,25-dihydroxycholecalciferol (1,25(OH)2D3)-stimulated mineralization of human osteoblastic cells at high concentrations, while relatively lower concentrations of alendronate and etidronate potentiated mineralization of the cells in the presence of 1,25(OH)2D3. The potentiation of mineralization with alendronate was accompanied by increased synthesis of bone matrix proteins, osteocalcin and collagen, and the mRNA of pro alpha(I) collagen. These findings show that in addition to their well-known effects on bone resorption, bisphosphonates have significant and direct effects on osteogenesis in osteoblasts in vitro. The actual mechanism remains to be further investigated.

Endoscopic ultrasonography in the assessment of colonic wall invasion by adjacent diseases.

For assessing the direct invasion of the colonic wall by pelvic or abdominal tumors, endoscopic ultrasonography was performed prospectively in patients who were suspected of having colonic wall invasion by barium enema. Three patients with ovarian cancer, two with endometriosis, and one with pancreatic cancer were included in this study. Preoperative endoscopic ultrasonography (EUS) revealed the relationship between the tumor and the colon in all cases. A surgical procedure was performed in all patients: resection of the tumor and a portion of the invaded colon (4) and removal of the tumor (only adhesion) (2). A correct preoperative diagnosis of the depth of tumor invasion was obtained in five of the six (83%) cases. In patients with pelvic or abdominal tumors, preoperative EUS may be useful for evaluating the presence and the degree of invasion of the colonic wall by the tumor.

Colonic submucosal tumors: a new classification based on radiologic characteristics.

OBJECTIVE: Despite advances in gastrointestinal radiologic techniques, findings from barium enema studies cannot be used reliably to predict the histologic nature of a colonic submucosal tumor. Therefore, we generated a new and comprehensive classification system for all colonic submucosal tumors based on a correlation between their radiologic characteristics and their histopathologic features. MATERIALS AND METHODS: Between 1978 and 1990, 89 patients had 95 colonic submucosal tumors diagnosed on the basis of barium enema studies and confirmed by biopsy or surgery. Of these, 39 patients (44%) were symptomatic and 50 patients (56%) were asymptomatic. Single lesions (82 cases) and multiple lesions (12 cases of lymphoma and one case of blue rubber bleb nevus) were observed. The 95 lesions included 21 carcinoids, 27 malignant lymphomas, 17 lipomas, 10 lymphangiomas, six leiomyosarcomas, five leiomyomas, and nine others. We analyzed the radiologic findings and classified these lesions according to their appearance. RESULTS: All tumors were classified on the basis of their morphologic appearance into five types: (1) wide-based sessile lesion with gradually sloping margin and smooth surface (17 cases); (2) wide-based sessile lesion, more polypoid than the first type, with a smooth surface, with or without a central depression (49 cases); (3) wide-based sessile lesion with lobulated surface (six cases); (4) pedunculated lesion with smooth or granular surface (17 cases); (5) unclassified, not any of the previously mentioned types, may be diffusely stenotic or aneurysmal (six cases). The most common finding was the wide-based sessile lesion with a smooth surface and a possible central depression; next most common was the wide-based sessile lesion with gradually sloping margin and smooth surface; next was the pedunculated lesion with a smooth or granular surface. Eighty-six percent of the lesions were single; 14% were multiple. Histologic confirmation revealed mainly lymphoma (29%) and carcinoid (22%), of which the most common finding was a wide-based sessile lesion with a smooth surface, with or without a central depression. CONCLUSION: This new classification based on radiologic characteristics covers all varieties of colonic submucosal tumors. It can serve as a guideline for predicting a specific diagnosis of a colonic submucosal tumor on the basis of radiologic findings.

Salmonella colitis: assessment with double-contrast barium enema examination in seven patients.

To completely rule out the possibility of ulcerative colitis, Crohn disease, and other diseases, the authors analyzed the radiographic findings at double-contrast barium enema examination performed in seven patients with colitis caused by Salmonella organisms. In all patients, bacteriologic confirmation of nontyphoid Salmonella infection and radiographs of the upper gastrointestinal tract were obtained. Total colonoscopy was performed in five patients and sigmoidoscopy in one patient. In all patients, the radiographic findings were retrospectively analyzed. The descending colon and sigmoid colon were affected in six patients, whereas the rectum was affected in none. The findings included fine mucosal granularity (seven patients), loss of haustration (six patients), many fine ulcerations (five patients), and multiple ulcers (two patients). The radiographic features simulated those of ulcerative colitis, except for absence of rectal abnormality. It is concluded that double-contrast barium enema examination is useful for detection of fine mucosal changes.

[Diagnosis of colon cancer (depth of invasion) by barium enema examination; present condition].

Accuracy of the barium enema examinations in diagnosis of the depth of invasion of the small carcinomas of the colon was reviewed. The materials included 101 sessile carcinomas and 12 small advanced carcinomas that were 20 mm or less in diameter. The carcinomas with stalks and the depressed type early carcinomas (Type IIc) were excluded from the study, because the former were impossible to the nature by X-ray examinations and the latter were extremely rare. Presence of the depressed portions on the surface of the elevated lesions observed in the frontal views and the degree of the deformity observed in the profile views of the lesions were correlated with the pathological specimen and the accuracy of the radiological diagnosis of the depth of invasion was estimated. The cases with gross malignant cell invasion into the submucosal or the deeper layers were diagnosed correctly with present radiological diagnostic criteria. But, those with a small amount of malignant cell invasion into the submucosal layer or the cases with malignant cell invasion limited to the mucosal layer (intramural cancer) were not always correctly diagnosed and there was a variety in diagnosis of the depth of invasion in this group. With the current radiological techniques, proper profile views of the lesions were not obtained in quite a few cases, nor the surface characteristics of the small elevated lesions were well documented. It would probably be possible to improve these techniques and to improve diagnostic accuracy to some extent, but with certain limitations.