Balloon-occluded retrograde transvenous obliteration for gastric varices: a feasibility study.

PURPOSE: To evaluate the clinical feasibility of balloon-occluded retrograde transvenous obliteration (BORTO) for gastric varices. METHODS: BORTO was performed in 14 patients with gastric varices due to liver cirrhosis. The gastric varices were confirmed by endoscopy, and their feeding and draining veins were identified by contrast-enhanced computed tomography (CT) and angiography. A 6 Fr Simmons-shaped balloon catheter was inserted into the gastrorenal shunt. The balloon was inflated, and 5% ethanolamine oleate iopamidol was infused slowly through the catheter. Patients were followed up with endoscopy and enhanced CT at 1 week, 1, 3, and 6 months after the procedure and every 6 months thereafter. RESULTS: The gastric varices completely disappeared in 12 of 14 patients and was partially resolved in the remaining 2 patients. Neither a recurrence nor an aggravation of gastric varices were found. No major complications were experienced. CONCLUSION: BORTO is a safe and effective treatment for gastric varices.

"Oblique path"--the optimal needle path for computed tomography-guided biopsy of small subpleural lesions.

PURPOSE: To determine the optimal needle path for computed tomography (CT)-guided biopsy of small lesions just beneath the pleura. METHODS: A biopsy of 61 subpleural lesions measuring less than 2.5 cm was done prospectively with regard to the approach and the results. One of two needle paths was randomly chosen: a nearly right angle path (n = 30) or an "oblique path" in which the needle was sharply inclined within the slice, using a course nearly parallel to the pleura (n = 32). One lesion was sampled twice. The procedures were considered successful when diagnostic samples were obtained. RESULTS: The success rate of the oblique path was 81.2% and that of the near 90 degrees path was 43.3% (p < 0.05). CONCLUSION: For percutaneous biopsy of small subpleural lesions under CT guidance, the oblique path is better than the perpendicular path.

Supraophthalmic chemotherapy with long tapered catheter: distribution evaluated with intraarterial and intravenous Tc-99m HMPAO.

Supraophthalmic intraarterial chemotherapy has not become popular due to a high incidence of damage to the normal brain and eye. This damage is due to inhomogeneous distribution of the agent secondary to streaming and other flow-related phenomena. To try to minimize this complication, the authors developed a catheter and studied different infusion techniques. A 4.5-F catheter tapered to 2.5 F was used to perform supraophthalmic intraarterial chemotherapy in 26 patients with malignant gliomas. Forty-one of 45 catheterizations were successful. In 17 patients (20 procedures), technetium-99m hexamethyl-propyleneamine oxime (HMPAO) was then injected through the catheter and single photon emission computed tomography was performed to assess the cerebral distribution of the radiopharmaceutical with either a pulsatile or continuous infusion technique. Diffuse and relatively homogeneous distribution of Tc-99m HMPAO was observed with fast pulsatile infusion (10 of 10 procedures); however, inhomogeneous distribution was mostly seen with slow continuous infusion (eight of 10 procedures).

Abnormal excretion of urinary phospholipids and sulfatide in patients with mitochondrial encephalomyopathies.

We found that patients with mitochondrial encephalomyopathies excreted urinary phosphatidylethanolamine, cardiolipin, and phosphatidylserine most likely derived from mitochondria and sulfatide which is specific to myelin or the kidney. It is of interest that four patients with myoclonus epilepsy with ragged-red fibers and one patient with chronic progressive external ophthalmoplegia all showed qualitatively similar abnormal excretion of such urinary lipids. It is conceivable that the urinary acidic phospholipids reflect abnormalities in the mitochondrial phospholipids, which are very important for mitochondrial enzymatic activities.

Anticoagulant activity of sulfatide and its anti-thrombotic effect in rabbit.

The mechanism of anticoagulant activity of sulfatide (galactosylceramide I3-sulfate), which exists in serum lipoproteins of various mammals except rodents, was investigated, together with the pharmacological effects of the glycolipid on the blood coagulation system in rabbits. The sulfatide was shown to be an effective anticoagulant when it was added in vitro in the form of pure micelle without auxiliary lipids such as phosphatidylcholine and/or cholesterol. The anticoagulant activity of synthetic galactosylceramide I6-sulfate, a positional isomer with respect to the sulfate group, was stronger than that of the sulfatide. The anticoagulant activity was specifically inhibited by anti-sulfatide antibody. The study on the pharmacological effects of sulfatide showed that the fibrin-precipitation time after single injection of the lipid (10 mg/kg body weight) into rabbits increased 2.5-fold compared with the normal level, and the maximum effect was observed 1 h after the injection. The half-life of anticoagulant activity was 5 h. These results suggest that sulfatide may be effective for the prevention of thrombosis. Sulfatide may be safer than other anticoagulant drugs, because it is a natural component of serum lipoproteins. Further, it may well play an essential role as an endogenous anticoagulant in mammals. Unlike heparin, sulfatide failed to inhibit thrombin and coagulation factor Xa activities in the presence of antithrombin III, indicating that the anticoagulant mechanism of sulfatide is independent of antithrombin III. These results indicate that the anticoagulant activity of sulfatide is potent and specific, and the lipid may be available as a useful and safe antithrombotic drug.

[67Ga citrate imaging in AIDS-related Pneumocystis carinii pneumonia in Japan].

Six AIDS patients with Pneumocystis carinii pneumonia (PCP) underwent 67Ga scan as part of their evaluation. Only one patient of them showed the characteristic 67Ga distribution pattern for PCP, that is, diffuse, increased, bilateral lung activity greater than liver activity. Two patients who were receiving therapy for PCP and one patient with recurrent PCP showed focal or uneven 67Ga lung uptake. In the four patients, the scan showed more extensive lesion than the chest radiograph. The other two patients who died 2 months later of cellular immunodeficiency showed no or very slight lung uptake of 67Ga. In summary, 67Ga scanning is useful diagnostic procedure in evaluation of PCP in patients with AIDS.

New approach for characterization of lysosulfatide by TLC, fast atom bombardment mass spectrometry and NMR spectroscopy.

Thin layer chromatography of lysosulfatide showed anomalous Rf-values in contrast with such lysosphingolipids as glucopsychosine and galactopsychosine with neutral, acidic, and alkaline developing solvents. This was thought to be due to the presence of oppositely charged sulfate and amino groups in the lysosulfatide. In the negative mode of fast atom bombardment mass spectrometry, the lysosulfatide showed the pseudo molecular ion (M-H)- peak at m/z 540 and sulfate ion peak at m/z 97, whereas in the positive mode, it showed not only the pseudo molecular ion (M+H)+ peak at m/z 542, but also the major peaks of protonated psychosine at m/z 462 and fragment ions of dehydrated sphingosine at m/z 282 and 264, 13C-NMR signals of all carbons of lysosulfatide were determined by using distortionless enhancement by polarization transfer. The difference in chemical shifts of ring carbons of galactose residue between lysosulfatide and galactopsychosine was largest at C-3 (downfield shift), thereby indicating the location of the sulfate group to be at C-3 of galactose. This conclusion is supported by the 1H-NMR spectra of the lysosulfatide and galactopsychosine. Thus, the chemical structure of lysosulfatide was confirmed by fast atom bombardment mass spectrometry and 13C- and 1H-NMR spectroscopy. Furthermore, 13C-NMR signals of C-1 to C-5 of the sphingosine moiety showed significantly different chemical shifts between the lysosulfatide and galactopsychosine. These differences suggested that C-1 to C-5 of sphingosine might be influenced by intramolecular or intermolecular interaction between the sulfate group of the galactose residue and the amino group of sphingosine.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical investigation of the branching formation of the bronchial arteries in the Japanese].

It is imperative to be familiar with anatomical variation in the branching formation of the bronchial artery for radiologists attempting an interventional angiography to the pulmonary diseases such as hemoptysis or pulmonary carcinoma. The anatomy of the bronchial arteries reported by Cauldwell et al. is the most frequently quoted literature in the world as well as in Japan. However, we had noticed that some discrepancies exist between our clinical experience and those in Cauldwell's report regarding anatomical variation of the bronchial arteries. Then, we reviewed the bronchial arteriograms in 640 patients. We included 412 patients in investigation, in which it was possible to identify the branches supplying all pulmonary lobes. In 50 out of 640 patients, catheterization of the branches supplying the lesion was failed. Branching formation of the bronchial arteries is extremely variable and complicated by presence of the accessory bronchial arteries and anastomosing branches from the systemic arteries, which may be enlarged in various pathological conditions. Our results showed that the most common branching type was single artery on each side (50.0%), followed by common trunk (14.1%). The incidence of single on the right and dual on the left, most common in Cauldwell's series, was only 12.9%. Kasai and Chiba also pointed out these differences in their detail report investigating 100 cadavers. These discrepancies between the data may be due to differences of methodology or due to differences between the races. The authors feel that Cauldwell's data should not be referred to the anatomical variation of the bronchial artery in Japanese.