[Internal jugular vein thrombosis as a paraneoplastic syndrome]. / Jugularvenenthrombose als paraneoplastisches Syndrom.

Thrombosis of the internal jugular vein is a rare form of deep vein thrombosis with potentially life threatening complications. We report on a 46-year-old male presenting with dysphagia and neck swelling. An extensive thrombosis of the internal jugular vein was found on ultrasound of the neck. An interdisciplinary workup revealed an occult gastric carcinoma. This case demonstrates that concomitant malignancies may contribute to a thrombosis of the internal jugular vein, which is then the primary symptom presented by the patient.

Early mammographic and sonographic findings after intraoperative radiotherapy (IORT) as a boost in patients with breast cancer.

The aim of this study was to evaluate mammographic and sonographic changes at the surgical site within the first 2 years after IORT as a boost followed by whole-breast radiotherapy (WBRT), compared with a control group treated with WBRT alone. All patients had breast-conserving surgery for early-stage breast cancer. Group A: n = 27, IORT (20 Gy) followed by WBRT (46 Gy). Group B (control group): n = 27, WBRT alone (56-66 Gy). Mammography: fat necrosis in 14 group A versus four group B patients (P < 0.001); parenchymal scarring classified as unorganized at the last follow-up in 16 vs seven cases, respectively (P = 0.03). Ultrasound: overall number of patients with circumscribed findings 27 vs 18 (P < 0.001); particular hematomas/seromas in 26 vs 13 patients (P < 0.001). Synopsis of mammography and ultrasound: overall postoperative changes were significantly higher classified in group A (P = 0.01), but not judged to have a significantly higher impact on interpretation. Additional diagnostic procedures, due to unclear findings at the surgical site, were performed on four patients of both groups. Within the first 2 years after IORT as a boost, therapy-induced changes at the original tumor site are significantly more pronounced compared with a control group. There is no evidence that the interpretation of findings is complicated after IORT.

[Neoadjuvant chemotherapy of breast carcinomas: what post-therapeutic (preoperative) information is provided by quantitative dynamic MRI?]. / Neoadjuvante Chemotherapie des Mammakarzinoms : Welche posttherapeutischen (präoperativen) Informationen liefert die quantitative dynamische MRT?

PURPOSE: The aim of this study was to evaluate whether quantitative changes in contrast enhancement (CE) after neoadjuvant chemotherapy (NC) are associated with histological signs of tumor regression and whether quantitative dynamic MRI (dMRI) is capable of accurately assessing preoperative tumor size compared to mammography (MG) and ultrasound (US). METHODS: Thirty-one patients with breast cancer underwent MRI before and after NC. Dynamic CE was measured using a turbo-FLASH sequence and quantified by a two-compartment model, where two parameters, k(ep) (distribution constant rate) and A (amplitude), were calculated and color mapped. RESULTS: When tumors had signs of histological regression in the operative specimen (n=17) decrease of the parameters A and k(ep) was significantly more marked compared to tumors without regression (n=12). The correlation between tumor size measured by dMRI and histopathology was 0.81 when areas of unspecific CE were included; when they were not included the correlation was 0.66 and tumor size was systematically underestimated. In 26 patients dMRI was retrospectively compared with MG (r=0.51; dMRI, r=0.80) and in 22 patients with US (r=0.60; dMRI, r=0.75). CONCLUSION: Changes in dynamic CE are associated with histological tumor regression. Quantitative dMRI enables a valid assessment of tumor residue and is superior to MG and US. Remaining unspecific CE within the original tumor site should be considered as potentially malignant.

[Fetal surgery]. / Fetale Chirurgie.

Fetal surgery is a newly evolving multidisciplinary medical field, being performed in specialized centers. It deals with the treatment of selected fetuses with congenital anomalies that cause high morbidity and mortality. The aim of the surgical treatment is to avoid the development of progressive and eventually irreversible damage at birth. Examples of entities treated are obstructive uropathy leading to renal insufficiency, lung hypoplasia in severe congenital diaphragmatic hernia, severe congenital cystic adenomatoid malformation of the lung, and sacrococcygeal teratoma. This review describes principles of fetal surgery, physiopathologic processes of some of the anomalies treated in this way, and diagnostic and therapeutic approaches. Recently published results are presented and discussed.

Midwall myocardial fibrosis in Becker-Kiener muscular dystrophy.

We report on a 38- year-old man with Becker-Kiener muscular dystrophy (BMD) and dilated cardiomyopathy without clinical symptoms of congestive heart failure who was referred for risk evaluation of sudden cardiac death. The degree of cardiac involvement in BMD varies greatly from no or hardly any cardiac abnormality to severe arrhythmias, dilatative cardiomyopathy and heart failure to heart transplantation or sudden cardiac death. These cardiac abnormalities have been related to replacement of the cardiomyocytes by connecting tissue or fat. In the clinical setting, cardiovascular magnetic resonance (CMR) has been proved to be a valid non-invasive method for obtaining anatomical and structural information of the heart. Furthermore, gadolinium-enhanced CMR can also characterize areas of myocardial fibrosis. Demonstration of extensive areas of fibrosis in an early stage of the disease might be a surrogate marker for an impaired clinical outcome. Therefore, serial CMR examinations starting upon diagnosis of the disease should be considered, as this may lead to an earlier recognition of cardiac involvement and may affect further management of the patient.

Evaluation of extracranial-intracranial arterial bypass function with magnetic resonance angiography.

Extracranial-intracranial (EC/IC) arterial bypass surgery is a valuable therapeutic modality in the field of cerebrovascular surgery. The assessment of bypass patency and its functional parameters are of utmost importance in the postoperative course. The present study examined the potential role of quantitative MR-based volume flow measurement techniques for the investigation of bypass patency. Forty-one patients with steno-occlusive cerebrovascular disease treated with EC/IC bypass surgery underwent conventional angiographic (CA) and two-dimensional cine-phase MR-based angiographic assessment (MRA) of bypass function. CA bypass function was evaluated as poor (grade I), moderate (grade II), or extensive (grade III) and was compared with quantitative volume flow measurements (BVF) obtained in MRA studies. Bypass filling was classified as grade I in 15% of the cases, grade II and grade III in 36% and 49% of the studies, respectively. Mean BVF differed significantly in the different grades: 31.94 +/- 9.8 ml/min in grade I, 73.6 +/- 16.7 ml/min in grade II, and 97.2 +/- 26.6 ml/min in grade III. BVF values of 48 ml/min or lower (n = 6) were specific for grade I bypass function, while only BVF values higher than 111 ml/min (3/20, 15%) are specific for extensive angiographic bypass function. The assessment of EC/IC bypass patency with quantitative BVF measurements provides exact, investigator-independent information under physiological conditions. MRA is well correlated with the angiographic bypass grading system.

Analysis of triacylglycerol positional isomers in food products as brominated derivatives by high-performance liquid chromatography coupled with a flame ionization detection.

Reversed-phase HPLC resolution and HPLC-flame ionization detection quantitation of model triacylglycerol positional isomer pairs (important in the study of food formulation lipids) after facile conversion to brominated derivatives is reported. The positional isomers in the triacylglycerol pairs were at least 98% resolved from each other during reversed-phase HPLC. Triacylglycerol quantitation obtained by HPLC-flame ionization detector was checked against standard positional isomer pairs known by mass. The flame ionization detection area percent gave absolute error range of 0.3-1.6% per triacylglycerol.

Effect of oleic and linoleic acids on the production of deep-fried odor in heated triolein and trilinolein.

To determine sources of desirable deep-fried flavor in frying oils, degradation products from heated triolein and trilinolein with 5-31% polar compounds representing low to high deterioration were evaluated by purge-trap gas chromatography-mass spectrometry-olfactometry. (E,E)-2,4-Decadienal, 2-heptenal, 2-octenal, 2,4-nonadienal, and 2,4-octadienal produced deep-fried odor at moderate-strong intensities in heated trilinolein. However, unexpected aldehydes-2,4-decadienal, 2,4-undecadienal, 2,4-nonadienal, and 2-octenal (all <15 ppm)-were produced in triolein heated for 6 h. These dienals possibly were produced by hydroperoxidation and/or hydroxylation followed by dehydration of 2-alkenals. The 2-alkenals were produced from thermal decomposition of hydroperoxides, epoxides, and keto and dimeric compounds produced during the heating of triolein. These aldehydes produced low intensities of deep-fried odor in triolein. This information helps to explain sources of the deep-fried flavor that is characteristic of high linoleic frying oils but which is only at low intensity levels in high oleic frying oils.

Autoxidation products of normal and genetically modified canola oil varieties determined using liquid chromatography with mass spectrometric detection.

Normal, high stearic acid and high lauric acid canola oil varieties were heated in the presence of air to allow autoxidation to occur. After the reaction, the oils were analyzed using a non-aqueous reversed-phase high-performance liquid chromatographic separation followed by detection using atmospheric pressure chemical ionization mass spectrometry. Oxidized products were separated and identified. The major autoxidation products which remained intact were epoxides and hydroperoxides. Two classes of epoxy triacylglycerols (TAGs) were formed. One class with the epoxy group replacing a site of unsaturation and one class adjacent to a site of unsaturation, as was previously reported for model TAGs. Intact oxidation products resulted mostly from oxidation of oleic acid, while oxidation products of linoleic and linolenic acid chains decomposed to yield chain-shortened species. Both neutral and polar chain-shortened products were observed. Polar chain-shortened decomposition products eluted at very short retention times and required a different chromatographic gradient to separate the molecules. This class of molecules was tentatively identified as core aldehydes. The high stearic acid canola oil yielded more intact oxidation products containing stearic acid, as expected. The high lauric acid oil produced intact oxidation products which contained lauric acid.

Triacylglycerol analysis of potential margarine base stocks by high-performance liquid chromatography with atmospheric pressure chemical ionization mass spectrometry and flame ionization detection.

Several margarine base stock candidates have previously been prepared for the purpose of finding better, more oxidatively stable food components: high-saturate vegetable oils, randomized vegetable oils, vegetable oil-hard stock blends, and interesterified vegetable oil-hard stock blends. Here are reported the triacylglycerol compositions of these products, determined using reverse-phase high-performance liquid chromatography (HPLC) coupled with a flame ionization detector or a quadrupole mass spectrometer with an atmospheric pressure chemical ionization source. Triacylglycerol percent composition results for samples of known composition (randomized and interesterified samples) exhibited less average error by HPLC coupled with a quadrupole mass spectrometer with an atmospheric pressure chemical ionization source, after application of response factors, than the results by HPLC coupled with a flame ionization detector. The fatty acid compositions calculated from the mass spectrometric data exhibited less average error than the fatty acid compositions resulting from the flame ionization detector data. The average error of the fatty acid compositions by the mass spectrometer was lowest for interesterified blend samples, next lowest for randomized samples, then followed by high-saturated fatty acid oils, normal oils, and blends. Analysis of the vegetable oil-hard stock blends by mass spectrometer required special treatment for calculation of response factors.

[Diagnosis of pancreas tumors: MRI or multidetector spiral CT?]. / Diagnostik von Pankreastumoren: MRT oder Mehrzeilenspiral-CT?

Recent technical advances in the field of abdominal MRI and multi-detector spiral-CT (MSCT) have resulted in improved diagnostic capabilities of pancreatic tumors. Preliminary data demonstrate slight advantages of MRI in the detection of liver metastases and papillary tumors as well as in the differential diagnosis of pancreatic masses while MSCT might be advantageous in the assessment of vascular infiltration, particular in uncooperative patients.

Pulse-inversion contrast harmonic imaging: ultrasonographic assessment of cerebral perfusion.

Pulse-inversion contrast harmonic imaging is a new ultrasonographic technique that can assess brain perfusion. In an adult with moyamoya disease and multiple recurrent strokes, this method detected subtle hemispheric differences in temporal-lobe perfusion, presumably due to neovascularisation, which were not shown by xenon-computed tomography or magnetic resonance perfusion imaging.

Pancreas picture of the month. Pancreatic manifestation of cystic fibrosis.

The Magnetic Resonance Cholangio Pancreatography (MRCP) provides within a few seconds complete information on cystic degeneration of the pancreas in patients with cystic fibrosis. The authors present a case report of cystic fibrosis with a pathognomonic magnetic resonance cholangio pancreaticography image of the pancreas.

Pinch-plasma radiation source for extreme-ultraviolet lithography with a kilohertz repetition frequency.

An extreme-ultraviolet radiation source based on a xenon pinch plasma is discussed with respect to the demands on a radiation source for extreme-ultraviolet lithography. Operation of the discharge in a self-igniting-plasma mode and omitting a switch permits a very effective and low-inductive coupling of the electrically stored energy to the electrode system. The xenon plasma exhibits broadband emission characteristics that offer radiation near 11 and 13 nm. Both wavelengths are useful in combination with beryllium- and silicon-based multilayer mirrors. The plasma emits approximately 74 mW/sr at 11.5 nm and 40 mW/sr at 13.5 nm in a bandwidth of 2% when operated at a repetition frequency of 120 Hz. The source size is less than 500 microm in diameter (FWHM) when viewed from the axial direction. The pulse-to-pulse stability is better than 3.6%. First results with a repetition rate of as much as 6 kHz promise the possibility of scaling to the required emission power for extreme-ultraviolet lithography.

Non-volatile products of triolein produced at frying temperatures characterized using liquid chromatography with online mass spectrometric detection.

Oxidation products from triolein under model heated frying conditions have been analyzed using liquid chromatography with an evaporative light scattering detector and atmospheric pressure chemical ionization (APCI) mass spectrometric detection. Triolein was heated at 190 degrees C with 2% water added each hour, to simulate the moisture of a frozen product, until polar components reached approximately 30%. The samples were separated using reversed-phase high-performance liquid chromatography with APCI-MS detection. Triolein oxidation products included hydroperoxides, epoxides and a ketone. Other products were formed by shortening of an acyl chain on the intact triolein. Normal and oxygen-containing products formed by the dimerization of triolein were also observed. Other products included chain addition products formed by addition of acyl chain subunits to intact triolein to form higher molecular weight products.

Highly repetitive, extreme-ultraviolet radiation source based on a gas-discharge plasma.

An extreme-ultraviolet (EUV) radiation source near the 13-nm wavelength generated in a small (1.1 J) pinch plasma is presented. The ignition of the plasma occurs in a pseudosparklike electrode geometry, which allows for omitting a switch between the storage capacity and the electrode system and for low inductive coupling of the electrically stored energy to the plasma. Thus energies of only a few joules are sufficient to create current pulses in the range of several kiloamperes, which lead to a compression and a heating of the plasmas to electron densities of more than 10(17) cm(-3) and temperatures of several tens of electron volts, which is necessary for emission in the EUV range. As an example, the emission spectrum of an oxygen plasma in the 11-18-nm range is presented. Transitions of beryllium- and lithium-like oxygen ions can be identified. Current waveform and time-resolved measurements of the EUV emission are discussed. In initial experiments a repetitive operation at nearly 0.2 kHz could be demonstrated. Additionally, the broadband emission of a xenon plasma generated in a 2.2-J discharge is presented.

Particulate Air Pollution in Mexico City: A Collaborative Research Project.

PM10, PM25, precursor gas, and upper-air meteorological measurements were taken in Mexico City, Mexico, from February 23 to March 22, 1997, to understand concentrations and chemical compositions of the city's particulate matter (PM). Average 24-hr PM10 concentrations over the period of study at the core sites in the city were 75 H g/m3. The 24-hr standard of 150 µ g/m3 was exceeded for seven samples taken during the study period; the maximum 24-hr concentration measured was 542 µ g/m3. Nearly half of the PM10 was composed of fugitive dust from roadways, construction, and bare land. About 50% of the PM10 consisted of PM2.5, with higher percentages during the morning hours. Organic and black carbon constituted up to half of the PM2.5. PM concentrations were highest during the early morning and after sunset, when the mixed layers were shallow. Meteorological measurements taken during the field campaign show that on most days air was transported out of the Mexico City basin during the afternoon with little day-to-day carryover.

Spontaneous healing of cervical pseudoaneurysm in vertebral artery dissection under anticoagulant therapy.

We report a 41-year-old woman with embolic stroke of the mid-pons attributed to embolism from vertebral artery dissection. Angiography revealed an occluded artery on one side and an incidental pseudoaneurysm of the midcervical portion of the vertebral artery on the other. After 3 months of warfare in therapy control angiography showed complete occlusion of the pseudoaneurysm. We discuss therapeutic choices and review the literature.

Cranial nerve syndrome in thrombosis of the transverse/sigmoid sinuses.

Cerebral venous thrombosis (CVT) is a cerebrovascular disease associated with a wide variety of clinical signs and symptoms, which may often delay appropriate diagnosis. Single or multiple cranial nerve palsies (III-VIII) without evidence of other signs and symptoms have not, so far, been considered a relevant syndrome of CVT. This event turned out to be a characteristic finding in five patients with thrombosis of the ipsilateral transverse/sigmoid sinus, who were recruited prospectively over a 14-month period. The diagnosis was supported by non-invasive MRI with the application of a newly developed subtraction technique. In view of the considerable mimics of the syndrome, and the long-standing need for conventional angiography to confirm the disease, it is likely to have been underestimated in the past; since appropriate treatment seems possible the diagnosis and utility of early MR venography should be considered in patients with single or multiple cranial nerve lesions of uncertain aetiology.