The correlation between spontaneous and radiation-induced apoptosis in T3B bladder cancer (histological grade G3), and the precedence between the two kinds of apoptosis for predicting clinical prognosis.

PURPOSE: The correlation between the frequency of spontaneous and radiation-induced apoptosis, and the precedence between those for predicting prognosis were studied at clinical level. METHODS AND MATERIALS: Twenty-one patients (mean age, 65.8 years; 16 men and 5 women) with bladder cancer (transitional cell carcinoma Grade 3, T3bN0M0, Stage IIIb) underwent intraoperative radiotherapy: single 30-Gy 12-MV electron beam irradiation to bladder, followed by total cystectomy 6 h after irradiation. The specimens of pretreatment and irradiated bladder cancer were assayed for apoptosis, using TUNEL staining with counter staining of hematoxylin. The apoptotic index (AI) was calculated by dividing the number of apoptotic cells by the total number of cells and multiplying by 100. The Pearson's linear fitting was used to test the correlation between spontaneous and radiation-induced apoptosis. The Kaplan-Meier product-limit estimation was used for overall survival (OS) and freedom from recurrence (FFR). The precedence between spontaneous and radiation-induced apoptosis for predicting the clinical prognosis was estimated using the proportional hazard regression. RESULTS: The mean AI of spontaneous and radiation-induced apoptosis was 1.18 +/- 0.16 and 2.63 +/- 0.45, respectively, which was significantly different. There was strong correlation between spontaneous and radiation-induced apoptosis (r(2) = 0.864, adjusted r(2) = 0.857). Radiation-induced apoptosis was estimated by equation: y (radiation-induced apoptosis) = 2.67 x (spontaneous apoptosis) -0.52. However, the proportional hazard regression test indicated that only spontaneous apoptosis was significant for predicting OS and FFR (&z.sfnc;t&z.sfnc; > 0.2), but radiation-induced apoptosis was not. CONCLUSION: Estimating AI in radiation-induced apoptosis from AI in spontaneous apoptosis is possible. However, spontaneous apoptosis is more accurate in predicting clinical prognosis.

MR anatomy of the substantia innominata and findings in Alzheimer disease: a preliminary report.

PURPOSE: To demonstrate normal MR anatomy of the substantia innominata and its changes in Alzheimer disease on MR imaging. METHODS: Using a 1.5-T superconductive MR unit, thickness of the substantia innominata was measured on coronal thin-section images obtained in 22 patients with Alzheimer disease and 14 age-matched control subjects. Comparison of these images with postmortem specimens of human brain was also performed. RESULTS: On T2-weighted images through the anterior commissure, the substantia innominata was clearly identified between the globus pallidus and the anterior perforated substance. In Alzheimer disease, thinning of the substantia innominata was more frequently observed than in the age-matched controls. CONCLUSION: Thin-section T2-weighted coronal MR images can demonstrate shrinkage of the substantia innominata, a finding that may aid in the diagnosis of Alzheimer disease.

Superselective continuous arterial infusion chemotherapy through the superficial temporal artery for oral cavity tumors.

BACKGROUND AND PURPOSE: High-dose intraarterial chemotherapy with repeated one-shot infusion may be useful for treating head and neck tumors. We evaluated the efficacy of superselective continuous arterial infusion chemotherapy administered via a coaxial catheter system and compared the results with those of subselective catheterization for treatment of oral cavity tumors. METHODS: Forty-nine consecutive patients with tumors of the oral cavity (clinical stage I, 12 cases; stage II, 19 cases; stage III, six cases; stage IV, 12 cases) were treated by arterial infusion chemotherapy. After a guiding catheter was advanced into the superficial temporal artery, superselective catheterization was performed using a coaxial system microcatheter. Superselective catheterization was accomplished in 34 cases, and was unsuccessful in 15, owing to difficulties in performing catheterization or to multiple feeding arteries. In the latter cases, the tip of the catheter was placed near the origin of the feeding arteries (subselective catheterization). RESULTS: Thirty (88%) of 34 patients had a complete response to superselective arterial infusion chemotherapy and two (6%) had a partial response. Twelve (80%) of 15 patients had a complete response to subselective arterial infusion chemotherapy and three (20%) had a partial response. Local recurrence was more frequent after subselective treatment (13%) than after superselective (6%) treatment. CONCLUSION: Superselective continuous arterial infusion chemotherapy may be suitable for local control of oral cavity tumors, with a low rate of recurrence.

Intraosseous neurilemmoma of the mandible.

We report a rare case of intraosseous neurilemmoma of the mandible, with an emphasis on radiographic findings. The tumor, located mainly in the premolar region, presented as an expansive, unilocular, well-defined, radiolucent lesion on plain radiography. No dilatation of the mandibular canal was identified. MR imaging helped to identify the solid nature of the tumor. A biopsy was necessary to make the final diagnosis because of the relatively nonspecific nature of the lesion.

Disk-cathode flash X-ray tube driven by a repetitive two-stage Marx pulser.

Fundamental studies of a repetitive flash X-ray generator using a disk-cathode radiation tube are described. The high-voltage pulser employed a modified two-stage surge-Marx circuit. The two condensers in the pulser were charged from 40 to 60 kV, and the electric charges were discharged to the X-ray tube repetitively to generate flash X-rays. The total capacity during the main discharge was 425 pF, and the maximum output voltage from the pulser was about 1.9 times the charged voltage. The flash X-ray tube was of the demountable-diode type and was composed of a rod-shaped anode tip made of tungsten, a disk cathode made of graphite and a tube body made of polymethylmethacrylate. The peak tube voltage was primarily determined by the anode-cathode (A-C) space, and the peak tube current was less than 0.5 kA. Thus the maximum photon energy could be easily controlled by varying the A-C space, and the tube current roughly increased according to increases in the charged voltage. The pulse width ranged from 40 to 100 ns, and the X-ray intensity was less than 1.1 microC kg-1 at 0.5 m per pulse. The repetition rate was less than 50 Hz, and the effective focal spot size was equivalent to the anode diameter.

Sub-kilohertz flash X-ray generator utilising a glass-enclosed cold-cathode triode.

The construction and fundamental studies are described for a sub-kilohertz X-ray generator for producing low-dose rate flash X-rays. The X-ray tube was a glass-enclosed cold-cathode triode, composed of a tungsten plate target, a rod-shaped graphite cathode, a mesh-type trigger electrode made of tungsten wires, and a glass tube body. The coaxial condenser was charged up to 60 kV by a power supply, and the electric charges in the condenser were discharged to the X-ray tube repetitively when a negative high-voltage pulse was applied to the trigger electrode. The maximum tube voltage before the discharging was equivalent to the initial charged voltage of the condenser, and the maximum tube current was about 0.3 kA with a charged voltage of 60 kV. The X-ray durations were about 1 microsecond, and the X-ray intensity was about 0.47 microC kg-1 at 0.5 m per pulse with a charged voltage of 60 kV. The maximum repetition rate of the X-rays was about 0.4 kHz, and high-speed radiography was performed.

10 kHz microsecond pulsed X-ray generator utilising a hot-cathode triode with variable durations for biomedical radiography.

A 10 kHz pulsed X-ray generator utilising a hot-cathode triode in conjunction with a new type of grid control device for controlling X-ray duration is described. The energy-storage condenser was charged up to 70 kV by a power supply, and the electric charges in the condenser were discharged to the X-ray tube repetitively by the grid control device. The maximum values of the grid voltage (negative value), the tube voltage, and the tube current were -1.5 kV, 70 kV, and 0.4 A, respectively. The duration of the flash X-ray pulse was primarily determined by the time constant of the grid control device and the cut-off voltage of thermoelectrons. The X-ray duration was controlled within a region of less than 1 ms; the X-ray intensity with a pulse width of 0.27 ms, a charged voltage of 70 kV, and a peak tube current of 0.4 A was 0.92 microC kg-1 at 0.5 m per pulse. The maximum repetition rate was about 10 kHz, and the size of the focal spot was about 3.5 x 3.5 mm.

Spondylolysis of the upper lumbar spine. Radiological features.

To elucidate the radiological features of spondylolysis of the three upper lumbar vertebrae, review of radiology reports during an 8-year period was performed. Among 17 levels of defects in 14 patients, nine were unilateral. Among 25 defects, nine had an atypical course. In eight of nine atypical defects, the direction was vertical at the inferolateral aspect, and horizontal at the superomedial aspect. The spondylolysis of the upper lumbar spine is often unilateral and the course of the defect is frequently atypical.

MRI of myositis ossificans circumscripta.

Myositis ossificans circumscripta (or pseudomalignant osseous tumor of soft tissue) may be confused with malignant neoplasms if there is no clear history of trauma. Two cases are presented in which magnetic resonance imaging (MRI) clearly demonstrates disproportionally extensive abnormal signal intensity along the course of muscle fibers. Although the specificity of this finding is uncertain, MRI enhances the level of confidence in diagnosing myositis ossificans.

Virtual CT endoscopy of ossicles in the middle ear.

The purpose of this study is to evaluate how virtual computed tomography (CT) endoscopy may help in assessing ossicles in the middle ear. Our series consisted of 96 ears of 68 consecutive patients with conducting hearing loss. All examinations were performed with a high-resolution spiral CT using axial and direct coronal planes of the temporal bone. Perspective virtual endoscopy was processed using the virtual endoscopic software. Superstructure of the stapes was difficult to evaluate on the virtual endoscopy; however, virtual endoscopy of the middle ear provides further information on the pathological conditions including congenital anomaly, posttraumatic, and inflammatory processes.

Macrodystrophia lipomatosa: CT and MR findings.

Macrodystrophia lipomatosa is a congenital macrodactyly characterized by proliferation of all mesenchymal components, particularly fibroadipose tissue. We report imaging features of two such patients. MR imaging and CT scanning demonstrated proliferation of fatty tissue in the territory of the median nerve in the hands and forearms, characteristic of macrodystrophia lipomatosa.

New modality of radiation therapy under increased tumor oxygen tension with angiotensin II: a pilot study.

Elevation of the mean arterial blood pressure to approximately 150 mmHg by infusion of angiotensin II (AT II) resulted in a selective increase of blood flow in tumor tissue. A concomitant increase in tumor oxygen tension was also observed, suggesting the possibility of hyperbaric oxygenation radiation therapy. By controlling the infusion rate of AT II, mean blood pressure was increased up to 1.5-fold of normotension, and radiation was given (AT II-RT). Forty-one patients with recurrent tumors after intensive radiation therapy or with locally far advanced tumors were treated. Using an uneven dose fractionation scheme, total dose ranged from 5,100 to 7,800 cGy. The radiation response to the tumor was quite good. Including three complete responders, more than 50% tumor regression was obtained in 24 patients (58.5%), less than 50% in 13 (31.7%) and no effect in four (9.7%). On the other hand, damage to normal tissue was minimal, and no serious morbidity was experienced. For example, comparing the results in the two groups of lung cancer patients treated with or without AT II, superiority of AT II-RT was indicated. The curative ability of AT II-RT will be investigated further.

Diffuse mineralization of extraskeletal chondroma: a case report.

We report a case of extraskeletal chondroma involving diffuse hazy calcification of the chondroid matrix. T2-weighted magnetic resonance imaging showed a well-defined mass of low signal intensity, rather than of high signal intensity with a lobular configuration as typically seen in chondroma with hyaline cartilage. Knowledge of this type of mineralization may help in the diagnosis of extraskeletal chondroma.

Aggressive appearance of non-ossifying fibroma with pathologic fracture: a case report.

An 11-year-old boy presented with a lytic lesion in the proximal humeral metaphysis. In spite of an aggressively reactive appearance on plain radiography and MR imaging, this lesion proved to be a non-ossifying fibroma. Fracture of the cortical shell probably contributed to the relatively wide zone of transition and periosteal reaction on plain radiography and the reactive change on MR imaging.

Detection of paraumbilical or splenorenal shunts by intra-arterial-DSA in bleeding varices: another risk factor?

In six of 46 consecutive patients with liver cirrhosis and bleeding varices, selective intra-arterial digital subtraction angiography detected large spontaneous portosystemic shunts including three patent paraumbilical veins and three splenorenal shunts. Twenty-one patients died during a median 73-month follow up period after devascularization with (44 cases) or without (2 cases) esophageal transection. Univariate analysis of preoperative variables concerning hepatic reserve failed to show significant predictability on postoperative survival rate. Instead, the postoperative survival rate of patients with the decompressive shunts was significantly lower than that of patients without the shunt. In a subgroup of patients with well-compensated liver cirrhosis and bleeding varices, the coexistence of paraumbilical or splenorenal portosystemic shunt may be another potent variable predicting poor prognosis.

Tumor vascularity under angiotensin II-induced hypertension--angiographic observations.

The selective increase in tumor blood flow under angiotensin II-induced hypertension was observed to be the result of passive vascular beds irresponsive to angiotensin II. We investigated whether or not increased tumor blood flow resulting from angiotensin II-induced hypertension could be recognized on angiographic findings. Angiography under angiotensin II-induced hypertension was performed in 51 patients with various cancers, and angiographic findings indicating increased tumor vascularity were recognized in 40 (78.4%) of them. Based on the assumption that the increase in tumor oxygen tension was brought about by increased tumor blood flow, the possibility of utilizing this phenomenon in hyperbaric oxygenation radiotherapy was suggested.

[Clinical value of magnification cerebral angiography (author's transl)].

Magnification carotid and vertebral angiography was performed via femoral catheter with magnification factor of 2.5 to 3.0, utilizing 0.1 X 0.1 ultra fine focal spot, manufactured by Shimadzu Seisakusho, Ltd. The standard angiograms were compared with magnification angiograms in a group of 67 patients with brain tumors and vascular disorders. The magnification angiography was more valuable than conventional angiography in 12 of 17 vascular tumors, while it was rarely valuable for diagnosis of vascular tumors. Aneurysms, occlusive diseases, collateral vessels, and capillary blush were also visualized to better advantage on magnification angiograms. Magnification cerebral angiography is a useful tool for elucidating small vascular branches, but further refinement in the design of focal spots and angiographic techinques is required for further improvement of magnification cerebral angiography.

[Catheter cerebral angiography in little children. Review of 71 examinations on 59 children under the age of 7 years (author's transl)].

Although the role of the cerebral angiography in the diagnosis of the central nervous system disorders in children is well established, there exists some reluctance to perform angiography in little children, probably due to technical difficulties and possible occurrence of side effects. For the last several years, we have performed catheter cerebral angiography on children with various disorders of central nervous system utilizing Seldinger's transfemoral technique. Our technique has been described in detail with special reference to the dilator catheter and double replacement technique, and the results of 71 catheter angiographies on 59 patients under the age of 7 years have been reviewed. No neurological complication or systemic reaction to contrast medium was noted. Circulatory disturbance at the site of femoral puncture was occasionally noted. Transient circulatory disturbance of several hours' duration was not uncommon in this age group. There were three cases which developed thrombus formation at the puncture site with resultant successful thrombectomy utilizing balloon catheter. The causes of these complications were analysed, and the need for systemic heparinization or heparin coated catheter during catheterization in little children was stressed. Comparison was made with other methods of cerebral angiography applied to children. It has been pointed out that this is a relatively convenient and safe technique applicable to little children, in whom multivessel study is often needed.

[Spontaneously cured carotid-cavernous fistula verified by angiography--report of a case (author's transl)].

A case of spontaneously cured carotid-cavernous fistula has been reported in details with a review of literatures. Seven cases verified by angiography have been described so far in the literature. Spontaneous cure has been revealed within 6 months after the initial examination in 5 out of 7 cases by follow up angiography, and has occurred in five women of middle age. The presented case was a 45 year-old female who has suffered from the exophthalmos associated with disturbed eye movements of two months duration. On January 2, 1977, the carotid angiography demonstrated a c--c fistula and an oval aneurysm of the middle cerebral artery on the right side. The exopthalmos was slowly decreased with the conservative treatment after two months. The c--c fistula was not demonstrated by the angiography carried out on March 10, 1977, and was not revealed thereafter by follow up studies.

[An operated case of clivus chondroma (author's transl)].

A case of clivus chondroma was presented in detail with a review of twenty-four cases reported in Japan. A twenty-eight-year-old house wife was admitted to hospital with complaints of muscle weakness and numbness on the right side of the body. Neurological examination revealed the right hemiparesis and hemihypesthesia. Cranial nerve palsies were also disclosed on the right Vth and the left IXth, Xth and XIth nerves. Craniograms showed a ring-like calcified shadow localized in the clival region without definite bone destruction. Roentgenograms disclosed many well-demarcated radioluscent areas in the phalanges of both hands and feet. The marked separation between the basilar artery and the clivus was demonstrated on vertebal angiograms and pneumoventriculograms. CT scan showed an irregularly shaped low density area localized on the clivus, which turned out to be enhanced following contrast infusion. The tumor was partially removed by the subtemporal approach, and was histologically chondroma. The patient was discharged, gaining adequate muscle strength after operations.