Placental deposition of C-reactive protein is a common feature of human pregnancy.

This study examined the occurrence of placental C-reactive protein (CRP) in normal pregnancy with term delivery, spontaneous preterm delivery (sPTD), preeclampsia, and miscarriage. CRP immunoreactivity was detected in the syncytiotrophoblast. The immunopositive rate was significantly higher in sPTD than preeclampsia. The CRP immunopositive rate was also higher in acute chorioamnionitis than those without and showed a good correlation with the maternal serum CRP concentration. CRP mRNA expression was not detected in human and mouse placentas or choriocarcinoma cells. CRP may play a role in the pathological and physiological states of pregnancy.

Clinical impact of positron emission tomography or positron emission tomography/computed tomography in the posttherapy surveillance of endometrial carcinoma: evaluation of 88 patients.

The objective of this study was to evaluate the validity and clinical impact of positron emission tomography (PET) or positron emission tomography/computed tomography (PET/CT) using 18-fluoro-2-deoxy-D-glucose in the posttherapy surveillance of patients with endometrial carcinoma. Eighty-eight patients previously treated for histopathologically diagnosed endometrial adenocarcinoma underwent 99 PET or PET/CT scans at follow-up visits at Asan Medical Center, Seoul, Korea, between 2001 and 2007. The standard of reference for tumor recurrence consisted of histopathologic confirmation or follow-up information at least 6 months after PET or PET/CT. Of the 88 patients, 24 underwent PET (n = 11) and/or PET/CT (n = 14) scans due to suspected disease recurrence. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of PET and/or PET/CT in detecting recurrence in these patients were 100%, 83.3%, 96%, 95%, and 100%, respectively. Especially, PET/CT revealed true-positive findings in three patients with elevated tumor markers but negative CT findings. The remaining 64 patients underwent PET (n = 8) and/or PET/CT (n = 66) as part of routine posttherapy surveillance; these patients were asymptomatic, with no evidence of disease. The sensitivity, specificity, accuracy, PPV, and NPV of PET and/or PET/CT in detecting recurrence in these patients were all 100%. Clinical decisions on treatment were changed in 14 (21.9%) patients by introducing PET or PET/CT into their conventional posttherapy surveillance program. PET and/or PET/CT were highly effective in discriminating true recurrence in patients with suspected recurrence, highly sensitive in detecting recurrence in asymptomatic patients, and had impacts on clinical decisions in a considerable portion of patients.

Proton magnetic resonance chemical shift imaging (1H CSI)-directed stereotactic biopsy.

INTRODUCTION: To add metabolic information during stereotactic biopsy target selection, the authors adopted proton chemical shift imaging (1H CSI)-directed stereotactic biopsy. Currently, proton single voxel spectroscopy (SVS) technique has been reported in stereotactic biopsy. We performed 1H CSI in combination with a stereotactic headframe and selected targets according to local metabolic information, and evaluated the pathological results. PATIENTS AND METHOD: The 1H CSI-directed stereotactic biopsy was performed in four patients. 1H CSI and conventional Gd-enhancement stereotactic MRI were performed simultaneously after the fitting of a stereotactic frame. After reconstructing the metabolic maps of N-acetylaspartate (NAA)/phosphocreatine (Cr), phosphocholine (Cho)/Cr, and Lactate/Cr ratios, focal areas of increased Cho/Cr ratio and Lac/Cr ratios were selected as target sites in the stereotactic MR images. RESULTS: 1H CSI is possible with the stereotactic headframe in place. No difficulty was experienced performing 1H CSI or making a diagnosis. Pathological samples taken from areas of increased Cho/Cr ratios and decreased NAA/Cr ratios provided information upon increased cellularity, mitoses and cellular atypism, and facilitated diagnosis. Pathological samples taken from areas of increased Lac/Cr ratio showed predominant feature of necrosis. CONCLUSION: 1H CSI was feasible with the stereotactic headframe in place. The final pathological results obtained were concordant with the local metabolic information from 1H CSI. We believe that 1H CSI-directed stereotatic biopsy has the potential to significantly improve the accuracy of stereotactic biopsy targeting.

Muscular sarcoidosis: Ga-67 scintigraphy and magnetic resonance imaging.

Ga-67 scintigraphy is helpful in the assessment of active extrapulmonary sarcoidosis. Muscular involvement of sarcoidosis is often asymptomatic or nonspecific, and laboratory examinations do not provide convincing evidence of muscular involvement. The authors report a case of muscular sarcoidosis detected by Ga-67 scintigraphy. In a patient who had fever and arthralgia of both knee joints, Ga-67 scintigraphy showed mediastinal and hilar involvement of sarcoidosis with unexpected extensive muscular uptake. Magnetic resonance imaging revealed in detail intramuscular infiltration of sarcoid granuloma. Ga-67 scintigraphy is useful in detecting inflammatory muscular involvement of sarcoidosis and other multiorgan involvement.

Metabolic changes in pericontusional oedematous areas in mild head injury evaluated by 1H MRS.

In order to define metabolic brain changes associated with mild traumatic brain injury, proton magnetic resonance spectroscopy (MRS) was performed in patients with regional brain contusion and 13-15 of initial GCS score. The authors measured N-acetylaspartate(NAA)/creatine(Cr) ratio and lactate signal on in vivo proton MRS, which indicated cell loss and ischaemic dAmage respectively, in pericontusional oedematous areas (region of interest; ROI) adjacent to traumatic brain contusion on brain MRI to determine possible metabolic changes. The metabolic ratio of NAA/Cr and lactate/Cr peaks was measured both in the ROI and a corresponding region of the contralateral hemisphere (ROC) in seven patients and twenty-five normal control. In initial NAA/Cr ratios, the values of ROIs were significantly lower than those of the control (p = 0.009), but there was no difference either between ROI and ROC (p = 0.410) or between ROC of patients and the control (p = 0.199). In lactate/Cr ratios, the ROI in all seven patients and the ROC in two showed increased lactate signals. The lacate/Cr ratios of the ROIs were significantly elevated as compared to those of the ROCs (p = 0.02) and the control (p = 0.015). In 2-month follow up, lactate signals were absent or significantly reduced (p = 0.015). In no patients, clinical or radiological deterioration has been observed. Our results demonstrate that there is significant neuronal dysfunction in pericontusional oedematous areas as indicated by NAA/Cr ratios in the patients with mild head injury at both early and late stages. And there are significant ischaemic changes as indicated by increase of lactate level in ROI at early stage. These findings suggest that pericontusional oedematous areas can be vulnerable to secondary brain insults even in the patients with mild head injury.

Studies on the synthesis and structure-activity relationships of 2-(2-functionalized pyrrolidin-4-ylthio)-1 beta-methylcarbapenems.

A series of new carbapenem derivatives, which have a pyrrolidin-4-ylthio group substituted with a hydroxyalkyl or carbamoyl group at the 2' position as the C-2 side chain, have been prepared. The antibacterial activity and the stability to renal dehydropeptidase-I of these compounds were investigated, and the structure-activity relationships were studied. Among these new carbapenems, (1R,5S,6S)-2-[(2S,4S)-2-¿(2-hydroxy)ethylmercaptomethyl¿pyrroli din-4 -ylthio]-6-[(1R)-I-hydroxyethyl]-1-methyl-1-carbapen-2-em-3- carboxylic acid (1a) showed the most potent and well balanced activity and was selected as a candidate for further evaluation.