Osteoprotegerin is secreted into the coronary circulation: a possible association with the renin-angiotensin system and cardiac hypertrophy.

The circulating osteoprotegerin (OPG) level reflects a series of cardiovascular diseases; however, the source(s) of circulating OPG remain(s) to be determined. This study explored whether OPG is released in the coronary circulation and whether it is associated with cardiac structure and function. Fifty-six patients (67±10 years old, male 57%, hypertension 73%, coronary artery disease 50%) were enrolled, and blood samples were collected simultaneously from the orifice of the left coronary artery (CA) and the coronary sinus (CS) after angiography. The concentration of OPG was higher in the CS than in the CA (7.7±4.1 vs. 6.7±3.6 pmol/l, p<0.001). The trans-cardiac OPG concentration was significantly (p=0.019) decreased in patients who have been prescribed either an angiotensin converting enzyme inhibitor or an angiotensin II type 1 receptor blocker (ACEI/ARB). In patients subgroup who did not take an ACEI/ARB (n=27), the trans-cardiac OPG level was positively correlated with age (r=0.396, p=0.041) and relative wall thickness of left ventricle (r=0.534, p=0.004). In multivariate linear regression analysis, relative wall thickness remained to be the independent variable for the trans-cardiac OPG level (p=0.004). Moreover, trans-cardiac OPG was significantly (p=0.021) increased in patients with relative wall thickness greater than 0.45 but it did not differ if the left ventricular mass index was increased (≥116 for males, or ≥ 104 for females, g/m(2)) or not (p=0.627). This study suggests that OPG is secreted into the coronary circulation and is associated with concentric remodeling/hypertrophy of LV, possibly in interactions with the renin-angiotensin system.

Posttranscatheter embolization computed tomography in hepatocellular carcinoma. Evaluation of embolization effects.

The postcontrast CT scans and angiography of 26 lesions in 23 patients with hepatomas who underwent transcatheter arterial embolization therapy were reviewed. Newly developed low density and high density areas and gas were noted on CT scans of the tumors after embolization in 100, 8 and 58% of the lesions, respectively. The CT findings of residual tumors correlated well with those of follow-up angiography. When discrete smooth round low density zones were observed on CT, there was no residual neovascularity on follow-up arteriography. When there were nodular or thick septum-like structures in low density lesions, arteriography revealed residual tumor vascularity in the lesions. CT proved useful not only in evaluating the effects of embolization, but also in providing important information about residual tumors.

Differentiation of central lung tumor from postobstructive lobar collapse by rapid sequence computed tomography.

When central lung tumor is associated with lobar collapse, discrimination of tumor from atelectasis is important for determining operability or for field planning should radiation therapy be utilized. Because tumor and collapsed lung have similar attenuation values, they cannot always be distinguished with usual contrast-enhanced CT. The article describes separation of tumor from collapsed lung by means of RSCT with bolus injection of nonionic contrast medium. With this technique collapsed lung is appreciably enhanced, but tumor enhancement is slow and minimal. The difference is most marked from 40 seconds to 2 minutes after scanning begins. This phenomenon is probably related to the marked increase in blood flow per unit area of collapsed lung due to crowding of relatively large pulmonary arteries compared to tumor blood supply through small bronchial arteries. Tumor can also be delineated from atelectasis by differences in internal structure with this technique.

An infantile case of infiltrating lipoma in the buttock.

This paper presents a rare case of infantile infiltrating lipoma in the buttock. The usefulness of magnetic resonance imaging of the tumor in the follow-up study is discussed.

Retroaortic left renal vein with renal vein hypertension causing hematuria.

We describe a case of retroaortic left renal vein with hematuria. In this case, pullback pressure from the retroaortic left renal vein to the inferior vena cava revealed left renal vein hypertension according to criteria of the "nutcracker phenomenon." We stress that left renal vein anomaly including retroaortic left renal vein can cause clinical symptoms such as hematuria.

Histopathologic correlation of two-phased dynamic incremental CT in hepatocellular carcinomas using multivariate analysis.

In order to grade pathologic factors that influence CT findings in hepatocellular carcinomas (HCCs), the CT-pathologic correlation was assessed statistically using univariate and multivariate analyses of 75 lesions. CT findings of early and delayed phase scans using two-phase dynamic incremental CT (TDICT) were compared with pathologic findings in resected specimens to calculate a category score for each pathologic finding. According to category scores, histopathologic differentiation and growth pattern were the major determinants of tumor density. Determinants of the internal structure of tumors were cytological variants, histologic differentiation, and macroscopic classification, in that order. Macroscopic classification, histologic differentiation, fibrous capsule characteristics, and growth pattern were important in descending order for tumor margins. Histologic differentiation was the most important factor for determining TDICT findings in HCCs. The CT findings were modified by parenchymal liver disease and cytologic variants.

Uterine leiomyoma: correlation between signal intensity on magnetic resonance imaging and pathologic characteristics.

To correlate the signal intensity of uterine leiomyoma with its pathologic characteristics, with particular emphasis on the fibrous component, 33 magnetic resonance (MR) examinations that revealed 93 leiomyomas were prospectively studied. All patients were imaged in axial and sagittal planes with different spin-echo pulse sequences to obtain T1-, T2-weighted, and proton density images. Nondegenerative leiomyomas (n = 62) showing a homogeneous signal of low intensity, and degenerative leiomyomas (n = 31) with a heterogeneous signal of variable intensity on T2-weighted images could be correlated. Histopathological assessment of fiber constitution and degeneration, and MR intensity were interpreted by independent observers. There was excellent accord between the averages for MR intensity, T2 relaxation time and fiber content, although the intensity values in each fiber grade showed a wide range. The greater the fiber content the lower the MR intensity on T2-weighted images, and the shorter the T2 relaxation time (p < 0.0001). In addition, the manner in which fiber distribution affected MR appearance was also elucidated. These data contribute guidelines for precise tissue differentiation of myogenic tumors on MR images, and for MR imaging tissue diagnosis of any lesion with a considerable fibrous element.

Chronic liver disease: value of volumetry of liver and spleen with computed tomography.

Volumetric comparisons of portions of liver and spleen were performed in patients with chronic liver diseases to determine their diagnostic value. Volumetric ratios of liver and spleen were determined by CT examination in 34 normal subjects and 125 consecutive patients with histologically proved liver cirrhosis, chronic active hepatitis, chronic persistent hepatitis, acute hepatitis, or fatty liver. Ratios of caudate lobe, spleen, and lateral segment of the left lobe of the liver to the remainder of the liver, right lobe and medial segment of the left lobe (RL+LM), were calculated. The product of caudate lobe/RL+LM and spleen/RL+LM was of value in differentiating liver cirrhosis from other liver disease, with a sensitivity of 60%, specificity of 98%, and accuracy of 86%. The same ratios differentiated liver cirrhosis and chronic active hepatitis from other liver diseases with a sensitivity of 79%, specificity of 100%, and accuracy of 90%. Volumetric ratio measurements are useful in the diagnosis of cirrhosis and chronic active hepatitis.

Computed tomographic evaluation of adrenal glands in patients with bronchogenic carcinoma.

One hundred thirty-four patients with histo-pathologically proven bronchogenic carcinoma underwent computed tomography (CT) of the thorax and adrenal glands. Prospectively, 23 of the 134 patients had adrenal metastasis, based on CT criteria for enlargement of the gland. Retrospectively, however, some proved to be false positives. In addition, the diagnosis of adrenal metastasis frequently altered the initial staging and the treatment modality. We suggest that valid diagnoses of adrenal metastases on CT scan be made on the basis of altered shape as well as on altered size of the gland.

Computed tomography of accessory spleens.

Computed tomography's (CT) ability to detect accessory spleens was assessed using histopathologically proven cases. CT proved to be a sensitive procedure for detecting accessory spleens that were 10 mm or larger in diameter and located in the left upper quadrant.

Angiotensin II stimulates cardiac adrenomedullin production and causes accumulation of mature adrenomedullin independently of hemodynamic stress in vivo.

Adrenomedullin is a potent hypotensive peptide that may act on myocytes to inhibit hypertrophy and on fibroblasts to inhibit growth in vitro induced by mechanical stretching and angiotensin II. Adrenomedullin is processed from the inactive intermediate adrenomedullin precursor with a glycine extension, which is subsequently converted to biologically active mature adrenomedullin by enzymatic amidation. Total adrenomedullin is the sum of intermediate and mature adrenomedullin. We examined the effect of a subpressor dose of angiotensin II on the production of left ventricular adrenomedullin and on protein levels of mature adrenomedullin in the left ventricle in vivo. We also investigated whether the effect is mediated by the angiotensin II type 1 receptor. Concentrations of total and mature adrenomedullin in the left ventricle and mature adrenomedullin-to-intermediate adrenomedullin ratio were significantly increased by angiotensin II infusion, regardless of pressure overload. Total and mature adrenomedullin concentrations significantly correlated with the weight of the left ventricle. Furthermore, increased adrenomedullin gene expression and protein levels were completely suppressed by a subdepressor dose of angiotensin II type 1 receptor blocker. In conclusion, angiotensin II stimulates the production of cardiac adrenomedullin and accumulates mature adrenomedullin in the left ventricle independently of hemodynamic stress. These processes are partially regulated through the angiotensin II type 1 receptor in vivo.