Dynamic contrast-enhanced ultrasound improves diagnostic performance in endometrial cancer staging.

OBJECTIVES: To compare the sensitivity and specificity of conventional two-dimensional transvaginal ultrasound/power Doppler (2D-TVU/PD) alone and 2D-TVU/PD combined with dynamic contrast-enhanced ultrasound (DCE-US) in diagnosing deep myometrial invasion (MI) and cervical stromal involvement (CSI) in women with endometrial cancer (EC), and to assess the association of DCE-US semiquantitative and qualitative variables with International Federation of Gynecology and Obstetrics (FIGO) Stage ≥ IB and 'high-risk' cancer. METHODS: This was a prospective study of 101 consecutive women with biopsy-confirmed EC, undergoing expert ultrasound examination at Karolinska University Hospital, a tertiary referral center. All consenting women underwent DCE-US using a 1.5-2.5-mL intravenous bolus of SonoVue contrast agent, as well as conventional 2D-TVU/PD examination. DCE-US videoclips were analyzed with regard to filling (global or focal), wash-in (prior, simultaneous or after) and wash-out (global or focal) patterns of the contrast agent in the tumor compared with the surrounding tissue, as well as semiquantitative DCE-US parameters (wash-in slope, time-to-peak, peak intensity and area under the time-intensity curve (TIC)) obtained from a TIC. The study cohort was compared with a control cohort of women with EC examined at our center according to the International Endometrial Tumor Analysis protocol using 2D-TVU/PD only, matched at a ratio of 3:1 for FIGO stage and grade. The sensitivity and specificity of 2D-TVU/PD alone in the control cohort and in combination with DCE-US in the study cohort in the diagnosis of deep MI, CSI and high-risk cancer (defined as FIGO Stage ≥ IB and/or Grade 3 endometrioid and/or non-endometrioid histology) were compared, using pathological evaluation after hysterectomy as the 'gold standard'. RESULTS: After exclusions, 93 women were included in the study cohort and were matched to 279 women in the control cohort. The prevalence of FIGO Stage IA, Grade 1-2 EC was 52% in both cohorts. The sensitivity of 2D-TVU/PD with DCE-US in the study cohort was higher than that of 2D-TVU/PD alone in the control cohort in diagnosing both deep MI (0.74 vs 0.62; P = 0.036) and CSI (0.75 vs 0.51; P < 0.001), whereas the specificity was not significantly different (0.87 vs 0.85 and 0.96 vs 0.95, respectively). Compared with 2D-TVU/PD alone, the specificity of 2D-TVU/PD with DCE-US was higher in detecting high-risk cancer (0.94 vs 0.85; P = 0.024) but the sensitivity did not differ (0.73 vs 0.71). High-risk cancer and FIGO Stage ≥ IB were characterized by a 'focal' filling pattern, with a 'prior' wash-in pattern and a 'focal' wash-out pattern on subjective assessment of DCE-US videoclips. All semiquantitative DCE-US parameters were significantly predictive of FIGO Stage ≥ IB but not of high-risk cancer, despite a clear trend. CONCLUSIONS: Compared with 2D-TVU/PD alone, combining 2D-TVU/PD with DCE-US can significantly improve the detection of deep MI and CSI in women with EC, without increasing the false-positive rate. It can also improve the correct classification of high-risk disease, mainly by increasing specificity, thereby possibly reducing the number of unnecessarily extensive surgeries by almost 10%. Semiquantitative DCE-US parameters, as well as a 'focal' filling pattern, endometrial wash-in prior to the myometrium and a 'focal' wash-out pattern, are all associated with more advanced disease. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

A review of portal screen-film technology and five radiologists' evaluations of some existing products.

Portal radiographs, radiographs made to document the accuracy of radiotherapy treatment fields, are typically of poor image contrast. Recently, a new portal film and screened-cassette system was marketed, the Kodak EC-L system, with the claim of greatly improved image contrast. This new EC-L system was tested on a canine cadaver exposed to Cobalt-60 teletherapy gamma radiation, and image quality was compared to earlier marketed Kodak portal film products. The EC-L system was found to provide portal images of improved contrast/quality.

Duodenal perforation in a cheetah (Acinonyx jubilatus).

An 11-yr-old female cheetah (Acinonyx jubilatus) from a privately owned breeding center for endangered species was referred for evaluation with a history of vomiting and depression of 10 days' duration. After anesthetic induction with tiletamine and zolazepam and anesthetic maintenance with isoflurane, a complete diagnostic workup was performed, including hematology, serum chemistry, and radiography. The clinical diagnosis was septic suppurative inflammation and hemorrhage in the abdomen, consistent with perforation or rupture of the gastrointestinal tract. An exploratory laparotomy showed a perforated duodenal ulcer, which was resected. Subsequent endoscopy revealed no further evidence of ulceration in the upper gastrointestinal tract. Biopsy of the ulcerated tissue collected from the duodenum revealed Gastrospirillum-like organisms. Histologic examination revealed widespread infiltration of lymphocytes and plasma cells into the lamina propria and submucosa. Intraepithelial leukocytes were present along with attenuation, erosion, and ulceration of the superficial epithelium. Fourteen days after surgery, this cheetah was returned to its breeding compound, and no subsequent vomiting has been observed for 4 yr.

Comparison of three methods for relief of pain after ear canal ablation in dogs.

This study compared three methods of pain relief in dogs that had total ear canal ablation with lateral bulla osteotomy. The hypothesis was that systemic opioids with preoperative local nerve blocks would provide superior pain relief. Thirty-one dogs with chronic otitis externa were included in the study. Dogs were randomly assigned to one of three protocols: systemic opioids alone (10 dogs, group 1), systemic opioids with bupivacaine splash block (11 dogs, group 2), and systemic opioids with preoperative local bupivacaine nerve blocks (10 dogs, group 3). Twenty-one dogs had bilateral ear ablation and 10 had unilateral ablation. Pain was assessed preoperatively, at extubation, 2 hours postextubation, and 1 day postoperatively by a single observer blinded to the analgesic protocol used. Pain scores were not significantly different within or between groups, nor did unilateral versus bilateral ablation have a significant effect on the score. Mean scores were less than 3 (scale 1 to 5) for all groups at all observation times. Rough recoveries were noted in 30% of group 1 dogs, 0% of group 2, and 20% of group 3 dogs. Ninety-four percent of dogs were moderately to heavily sedated at extubation. Sixty percent of group 3 dogs remained moderately to heavily sedated 2 hours postextubation. Rectal temperature, pulse rate, respiratory rate, and postoperative change in serum cortisol levels were not significantly different between groups. Postoperative increase in blood glucose was significantly higher in groups 1 and 3 compared with preoperative levels. Twenty-three percent of the dogs required additional analgesia or tranquilization after surgery, as determined by the anesthetist; 1 dog in group 1, 2 in group 2, and 4 in group 3. Each of the three analgesic protocols provided similar pain relief in dogs undergoing total ear canal ablation.

Corrective osteotomy for pes varus in the dachshund.

Five dachshunds were treated for a distal varus deformity of one tibia. Angulations of 20 degrees to 30 degrees resulted from shortening of the medial tibial length with the maximum curvature at the distal metaphysis. Comparison with the contralateral limbs was required to determine the amount of correction necessary for functional and cosmetic results. Open wedge osteotomies stabilized with a modified type II external fixator resulted in correction of the deformities, early return of limb function, and healing of the osteotomies.

Comparison of metrizamide and iohexol for cisternal myelographic examination of dogs.

A double-blind study, using metrizamide, iohexol, or Ringer's solution (control) as cisternal myelographic agents, was performed on 25 dogs. Before myelographic examination was done, each dog was subjected to physical, clinical pathologic, and neurologic examinations, as well as examinations by electroencephalography and computerized tomography. These were repeated 24 hours after completion of the myelographic examination. The group of dogs given metrizamide (group II) had a significantly greater occurrence of seizure activity (6 of 10) than did the control dogs (group I; 0 of 5) or dogs given iohexol (group III; 0 of 10; P less than 0.003). In group II, the CSF microprotein concentration was significantly greater 24 hours after myelography was done than were the values in groups I and III (P less than 0.003). Myelograms of the group II dogs (metrizamide) and group III dogs (iohexol) had similar diagnostic qualities. At 24 hours after myelographic examination was done, computerized tomography scan revealed that each dog given metrizamide and iohexol had myelographic contrast material in the brain and cervical spinal cord parenchyma. Seemingly, iohexol has good diagnostic quality, but is less epileptogenic than metrizamide when used in cervical myelographic examinations of dogs.

Physical and chemical properties of the major envelope glycoprotein gp85 from avian myeloblastosis virus.

The major envelope glycoprotein gp85 of avian myeloblastosis virus, observed by electron microscopy as nearly spherical knobs projecting from the virus surface, was purified to homogeneity by gel filtration in 6 M guanidinium chloride followed by ion-exchange chromatography. The purified glycoprotein has a molecular weight of 80 000 from sedimentation equilibrium analysis. Glycoprotein gp85 contains approx. 45% carbohydrate including 25% N-acetylglucosamine, while the remaining weight consists of a polypeptide chain of approx. 45 000 daltons. Based on the oligosaccharide chain molecular weight data of Lai and Duesberg (Lai, M.M.C. and Duesberg, P.H. (1972) Virology 50, 359-372), the carbohydrate is calculated to be distributed between seven to nine oligosaccharide side chains. No self-association of gp85 was observed up to 2.0 mg/ml in dilute salt solution. The hydrodynamic properties of gp85 in dilute salt solution indicate a highly elongated molecule with an axial ratio of 7. One structural model which reconciles the hydrodynamic properties of gp85 with the nearly spherical architecture observed by electron microscopy requires the organization of the polypeptide chain and approx. 50% of the carbohydrate into a globular form. The remaining covalently linked oligosaccharides would by necessity extend outwardly from the globular structure as randomly oriented chains.

Solubilization and partial isolation of human melanoma tumor-associated antigens.

Human melanoma cell membrane tumor-associated antigens (TAA's) were solubilized in an active form by pronase digestion of either a fresh melanoma or cells from a melanoma cell line maintained in tissue culture. Upon elution from Sephadex G-200 column, TAA's solubilized from the melanoma cell line were found in four distinct peaks that had apparent molecular weights of approximately 48,000 (partition coefficient Kd, 0.426), 25,000 (Kd, 0.567)8 17,000 (Kd, 0.699), and 13,000 (Kd, 0.831) daltons, respectively. Fetal antigen activity was found in all but the 13,000-dalton peak. HLA antigen activity was detected in the 17,000-dalton material. TAA's prepared from the fresh tumor source eluted from Sephadex G-200 column with an apparent molecular weight of 14,000-25,000 (Kd, 0.786-0.572) daltons, as did HLA antigens. A partial resolution of the TAA's from the HLA antigens was achieved with the use of DEAE-cellulose chromatography. Results of antigenic stability assays suggested that the TAA structure is stable to prolonged exposure to low pH. Recovery of TAA activity from the strong denaturing agents 5 m urea, 0.5% (wt/vol) sodium dodecyl sulfate, and 4 m guanidine hydrochloride was partially successful. These properties of the TAA's may be useful for further isolation of the TAA's.

The structural polypeptides of equine infections anemia virus.

The structural polypeptides and glycoproteins of equine infectious anemia virus were identified following electrophoresis in SDS-PAGE. The major non-glycosylated polypeptides had molecular weights of 25,000, 14,000 and 11,000 daltons. Two glycoproteins of 80,000 and 40,000 daltons were also detected. The relationship of these components to the structural elements of mammalian C-type oncoviruses is discussed.

Morphological, chemical, and antigenic organization of mammalian C-type viruses.

New features in the architecture of mammalian type C viruses, in particular knoblike surface projections and hexagonally arranged subunits on the core shell could be demonstrated by electron microscopy, taking advantage of newly developed preparation techniques. As examples, murine leukemia viruses (MuLVs) and newly isolated porcine and bovine C viruses are presented. The major proteins of a MuLV were isolated and partially characterized in chemical terms and with respect to their serological and other biological activities, such as interfering and hemagglutinating (HA) capacity. Most of the characterized proteins could be localized in particular substructures of the virion either by selective removal or isolation of electron microscopically identifiable constituents. The information obtained allowed the design of a more detailed model of mammalian C viruses. Special attention was devoted to the further characterization of interspecies antigens of mammalian C viruses. Different antigenic determinants were revealed. Their distribution allows further subgrouping of mammalian C viruses.

Polypeptides of mammalian oncornaviruses. II. Characterization of a murine leukemia virus polypeptide (p15) bearing interspecies reactivity.

Polypeptide p15 from Friend leukemia virus was isolated by multiple gel filtration steps in guanidine hydrochloride. Because of its marked tendency to aggregate, renaturation of the protein was performed in the presence of 0.2% sodium deoxycholate. Serological analyses revealed cross reactivity with other mammalian C-type oncornaviruses.