Relationship of 31P MR spectroscopy to the histopathological grading of chronic hepatitis and response to therapy.

PURPOSE: In vivo phosphorus-31 MR spectroscopy (31P MRS) was performed in the human liver in order to investigate the relation between: the ratios of phosphorus metabolites in the liver; the histopathological grading of chronic hepatitis; and the response to therapy. MATERIAL AND METHODS: Hepatic 31P MRS using the DRESS method (depth-resolved surface-coil spectroscopy) was carried out in 45 patients with chronic viral hepatitis or autoimmune hepatitis, and in 16 control subjects. We measured the ratios of the peak areas of phosphomonoesters (PME), inorganic phosphate (Pi), or phosphodiesters (PDE) to the peak area of beta-adenosine triphosphate (ATP). RESULTS: The PDE/ATP ratio of patients with chronic hepatitis or liver cirrhosis was lower than that of control subjects (liver cirrhosis = 0.74; chronic active hepatitis = 1.13-1.21; normal = 1.43); only a small difference was found in the PME/ATP and Pi/ATP ratios. There was no correlation between the spectra and histopathological grading or response to therapy, but the response to therapy was poor when a reduced PDE/ATP ratio was present. CONCLUSION: The PDE/ATP ratio measured by 31P MRS makes it possible to identify the transition of chronic active hepatitis into liver cirrhosis with a poor response to therapy.

Induction of a 26-kDa membrane-form tumor necrosis factor (TNF)-alpha in human alveolar macrophages.

The expressions of a membrane form of TNF (m-TNF) by human alveolar macrophages (AM) and autologous blood monocytes from healthy donors were examined. Upon lipopolysaccharide (LPS) stimulation, AM produced 26-kDa TNF-alpha on their cell surface. We designed a bioassay for measuring m-TNF in which macrophages were fixed with paraformaldehyde after stimulation for 18 h, then m-TNF activity was assessed as cytotoxicity of fixed macrophages on L929 cells. This assay was specific to m-TNF because: 1) no soluble factors were contributed to the cytotoxicity of fixed AM, 2) anti-TNF-alpha monoclonal antibody completely neutralized m-TNF activity, and 3) m-TNF activity was not altered after low-pH or high-salt treatment. On LPS stimulation, AM produced significant amounts of m-TNF earlier than TNF-alpha secretion. AM also expressed significant amounts of m-TNF when stimulated with other bacterial components and their derivatives. Interleukin (IL)-4 suppressed both m-TNF production and TNF-alpha secretion. p-Toluene-sulfonyl-L-arginine methyl ester (TAME) inhibited specifically TNF-alpha secretion and not m-TNF expression. Although blood monocytes produced small amounts of m-TNF, monocyte-derived macrophages showed enhanced m-TNF after cultivation with GM-CSF for 10 days. These findings indicate that m-TNF is expressed as a step in the TNF-alpha producing system, and suggest that m-TNF may play important roles in exhibition of macrophage function in situ.

Liver abscess as the initial manifestation of colonic Crohn's disease: report of a case.

Liver abscess is a rare complication of Crohn's disease and in most of the reported cases, the diagnosis of Crohn's disease preceded that of liver abscess. We report herein a case in which a liver abscess was the initial clinical manifestation of Crohn's disease in a 36 year old man who presented with high fever and weakness. The diagnosis of liver abscess was established by abdominal ultrasonography, computed tomography and an arterial blood culture. The abscess was resolved with antibiotic therapy alone and during the drug therapy, a barium enema examination was performed which revealed a stricture at the transverse colon. Resection of the transverse colon was performed and macroscopic and microscopic examination of the resected specimen established the diagnosis of Crohn's disease. The liver abscess was thus speculated to be secondary to the inflamed bowel. Although rare, Crohn's disease should be included in the differential diagnosis of diseases causing liver abscess.

Scintiscanning demonstration of thymoma: comparative study on scintiscans using 201Tl, 67Ga and 75Se.

Thymus scintigraphy was performed using 201Tl-chloride, 67Ga-citrate and 75Se-selenomethionine on 30 thymoma patients with or without myasthenia gravis. Mass negativity was observed in 6 out of 17 (35.3 per cent) and 3 out of 13 cases (23.1 per cent), respectively. A rate of 70 per cent (21 cases out of 30) of mass positivity was observed by thymus scan using 201Tl. With regard to the relation between thymus scan and cell type, 201Tl-scan exhibited a high rate of mass positivity, regardless of the cell type while the 75Se-scan showed a trend toward mass positivity in epithelial cell predominant cases. With 201Tl, mass positivity was observed when the CPM/g ratio for tumors and blood exceeded 3.0. This trend can serve as an index for the suitability of supplementary chemo- and radiotherapies, as well as for prognosis in cases of relapse, and in those for whom excision was not complete.