MRI changes in cryptococcal meningoencephalitis exacerbated by antifungal treatment due to post-infectious inflammatory syndrome: A case report.

Cryptococcal meningitis is one of the most common fungal meningitis in adults and causes disabling morbidity and mortality worldwide. The occurrence of postinfectious inflammatory response syndrome during cryptococcal meningitis treatment presents a diagnostic challenge. This time course seems paradoxical because patients show worsening symptoms and imaging findings. However, laboratory data improve with antifungal treatments. Herein, we present a case of an older woman diagnosed with cryptococcal meningitis who later developed postinfectious inflammatory response syndrome. Despite the initial antifungal treatment and improvements in cerebrospinal fluid analysis results, the patient's neurological condition deteriorated; imaging findings worsened. Magnetic resonance imaging at the time of postinfectious inflammatory response syndrome showed more prominent meningeal enhancement and brain edema, consistent with postinfectious inflammatory response syndrome, combined with negative repeat cerebrospinal fluid cultures for cryptococcal species. This case highlights the importance of considering postinfectious inflammatory response syndrome when patients with cryptococcal meningitis show clinical worsening during treatment. Prompt corticosteroid therapy significantly improves patient outcomes. Radiologists and clinicians should be aware of postinfectious inflammatory response syndrome to provide appropriate therapeutic options and improve prognosis in patients with cryptococcal meningitis.

Evaluation of cartilage invasion by laryngeal and hypopharyngeal squamous cell carcinoma with dual-energy CT.

PURPOSE: To evaluate the clinical usefulness of dual-energy computed tomography (CT) with weighted-average (WA) images and iodine overlay (IO) images in the evaluation of laryngeal cartilage invasion in patients with laryngeal and hypopharyngeal squamous cell carcinoma (SCC). MATERIALS AND METHODS: The institutional review board approved this retrospective study, and written comprehensive consent was obtained from all patients. Seventy-two consecutive patients underwent 128-section dual-source dual-energy CT to stage laryngeal (n=27) or hypopharyngeal (n=45) cancer. Three observers who were blinded to the patients' clinical histories and histopathologic findings evaluated cartilage invasion on WA images alone or in combination with IO images (nonossified cartilages were selectively evaluated on IO images) by using a five-point scale. Thirty of the 72 patients (42%) underwent surgery, and findings from histopathologic examination in those patients were used as the standard of reference for the evaluation of diagnostic performance with receiver operating characteristic (ROC) curve analysis and in terms of sensitivity and specificity. Interobserver reproducibility was calculated with κ statistics. RESULTS: For thyroid cartilage, the area under the ROC curve (AUC) of the WA plus IO images was marginally larger than that for WA images alone (AUC=0.957 vs 0.870, respectively; P=.075). The specificity of WA plus IO images was significantly superior to that of WA images alone (96% vs 70%, respectively; P=.031), with no compromise to the sensitivity (86% for both). For thyroid and cricoid cartilages, the interobserver reproducibility was higher for diagnoses made with WA plus IO images (κ=0.68-0.72 and 0.64-0.79, respectively) than for those made with WA images alone (κ=0.29-0.56 and 0.20-0.64, respectively). CONCLUSION: Combined analysis of WA and IO images obtained with dual-energy CT improves the diagnostic performance and interobserver reproducibility of evaluations of laryngeal cartilage invasion by SCC.

Covalent immobilization of antibody fragments on well-defined polymer brushes via site-directed method.

Well-defined polymer brushes and block copolymer brushes consisting of 2-methacryloyloxyethyl phosphorylcholine (MPC) and glycidyl methacrylate (GMA) were prepared by surface-initiated atom transfer radical polymerization (ATRP). The polymer brushes were used for the immobilization of antibody fragments in a defined orientation. Pyridyl disulfide moieties were introduced to the polymer brushes via a reaction of epoxy groups in GMA units. Fab' fragments were then immobilized onto these surfaces via a thiol-disulfide interchange reaction and the reactivity of antibodies with antigens was investigated. Antigen/antibody binding on the polymer brushes was more preferable than that on epoxysilane films as a control surface. Furthermore, the activity of the antibodies immobilized on the block copolymer brushes having biocompatible PMPC was greater than that on other surfaces that did not have PMPC in their structures.

Surface modification with well-defined biocompatible triblock copolymers Improvement of biointerfacial phenomena on a poly(dimethylsiloxane) surface.

To improve interfacial phenomena of poly(dimethylsiloxane) (PDMS) as biomaterials, well-defined triblock copolymers were prepared as coating materials by reversible addition-fragmentation chain transfer (RAFT) controlled polymerization. Hydroxy-terminated poly(vinylmethylsiloxane-co-dimethylsiloxane) (HO-PV(l)D(m)MS-OH) was synthesized by ring-opening polymerization. The copolymerization ratio of vinylmethylsiloxane to dimethylsiloxane was 1/9. The molecular weight of HO-PV(l)D(m)MS-OH ranged from (1.43 to 4.44)x10(4), and their molecular weight distribution (M(w)/M(n)) as determined by size-exclusion chromatography equipped with multiangle laser light scattering (SEC-MALS) was 1.16. 4-Cyanopentanoic acid dithiobenzoate was reacted with HO-PV(l)D(m)MS-OH to obtain macromolecular chain transfer agents (macro-CTA). 2-Methacryloyloxyethyl phosphorylcholine (MPC) was polymerized with macro-CTAs. The gel-permeation chromatography (GPC) chart of synthesized polymers was a single peak and M(w)/M(n) was relatively narrow (1.3-1.6). Then the poly(MPC) (PMPC)-PV(l)D(m)MS-PMPC triblock copolymers were synthesized. The molecular weight of PMPC in a triblock copolymer was easily controllable by changing the polymerization time or the composition of the macro-CTA to a monomer in the feed. The synthesized block copolymers were slightly soluble in water and extremely soluble in ethanol and 2-propanol. Surface modification was performed via hydrosilylation. The block copolymer was coated on the PDMS film whose surface was pretreated with poly(hydromethylsiloxane). The surface wettability and lubrication of the PDMS film were effectively improved by immobilization with the block copolymers. In addition, the number of adherent platelets from human platelet-rich plasma (PRP) was dramatically reduced by surface modification. Particularly, the triblock copolymer having a high composition ratio of MPC units to silicone units was effective in improving the surface properties of PDMS. By selective decomposition of the Si-H bond at the surface of the PDMS substrate by irradiation with UV light, the coating region of the triblock copolymer was easily controlled, resulting in the fabrication of micropatterns. On the surface, albumin adsorption was well manipulated.

Polymer brushes in nanopores surrounded by silicon-supported tris(trimethylsiloxy)silyl monolayers.

A chemically grafted tris(trimethylsiloxy)silyl (tris(TMS)) monolayer on a silicon oxide substrate was used as a template for creating nanoclusters of polymer brushes. Polymer brushes were synthesized by surface-initiated polymerization of 2-methacryloyloxyethyl phosphorylcholine (MPC) and tert-butyl methacrylate (t-BMA) via atom transfer radical polymerization (ATRP) from alpha-bromoester groups tethered to the residual silanol groups on the silicon surface after generating a range of tris(TMS) coverage. CuBr/bpy and CuBr/PMDETA were used as the catalytic system for PMPC and Pt-BMA synthesis, respectively. The percentage of tris(TMS) coverage significantly influenced the thickness and morphology of the polymer brushes. Protrusions representing self-aggregation of PMPC brushes in nanopores as visualized by AFM analysis evidently suggested that PMPC brushes were distributed nanoscopically on the surface. The protrusion size and surface roughness corresponded quite well with the graft density of PMPC brushes. The fact that Pt-BMA brushes grown from nanopores were almost featureless implies that self-aggregation of PMPC brushes is truly a consequence of phase incompatibility between hydrophilic PMPC brushes and hydrophobic tris(TMS). The anti-fouling characteristic of PMPC brushes, inferred from plasma protein adsorption, was subsequently varied by controlling the surface coverage ratio between PMPC brushes and tris(TMS).

Hepatic hemangioma presenting atypical radiologic findings: a case report.

A 69-year-old woman was referred to our hospital due to a liver tumor that was incidentally noted on ultrasound (US). US revealed a pedunculated mass of 5 cm in diameter, with a heterogeneous echo pattern. On arterial phase dynamic contrast-enhanced computed tomography (CT), a tiny enhancing dot in the upper aspect of the mass was seen; whereas, the main portion of the lesion appeared as hypoattenuating. The tumor was of low intensity on T1-weighted magnetic resonance (MR) images, and showed slightly heterogeneous high intensity on T2-weighted MR images. The most characteristic feature of the tumor was its exophytic appearance. On post-gadolinium hepatic arterial dominant-phase MR images, the tumor showed nodular enhancement centrally, with progressive spread of enhancement on later images. Angiography showed dilatation of the right posterior inferior branch of the hepatic artery and C-shaped opacification. Since we could not rule out malignancy for these nonspecific radiologic findings, a partial resection of the liver was carried out, resulting in a pathological diagnosis of hepatic hemangioma. This hemangioma had marked hyalinization and fibrosis, causing a heterogeneous appearance on MR images. The tumor presented an exophytic appearance, which caused some diagnostic confusion.

Site-specific dense immobilization of antibody fragments on polymer brushes supported by silicone nanofilaments.

For site-specific dense immobilization of antibodies on a solid support, we prepared phosphorylcholine copolymer brushes on silicone nanofilaments. The nanofilaments were prepared on a silicon wafer by treatment with trichloromethylsilane (MeSiCl 3). To generate Si-OH groups on the nanofilaments, O 2 plasma was irradiated on the surface. Initiators for atom transfer radical polymerization (ATRP) were then coupled on the filaments. Phosphorylcholine copolymer brushes were prepared by a "grafting from" process, and pyridyl disulfide groups were introduced into the polymer chains. F(ab') fragments were then specifically immobilized onto these surfaces via a thiol-disulfide interchange reaction. The amount of antibodies immobilized on the nanofilament-supported copolymer brushes was approximately 65 times greater than that on smooth wafer-supported copolymer brushes.

Sensitivity of superselective arteriography for small hepatocellular carcinoma compared with proximal arteriography and computed tomography during superselective arteriography.

PURPOSE: To obtain successful arterial chemoembolization for hepatocellular carcinoma (HCC), we evaluated the sensitivity of proximal arteriography, superselective (subsegmental or more distal branch) arteriography and computed tomography (CT) during superselective arteriography and assessed the method for the injection of contrast medium. METHODS: Thirty-two patients with 38 HCCs (< or = 5 cm) with a mean diameter of 2.2 cm underwent digital subtraction arteriography of proximal and superselective arteriography. In addition, they also had helical CT during superselective arteriography. The contrast medium was injected with a mechanical injector (n = 6 lesions) or by hand (n = 32) for superselective arteriography and CT during superselective arteriography. The amount of contrast medium used for superselective arteriography and CT during superselective arteriography with the mechanical injector was 3.5 times and 9 times that with manual injection, respectively. RESULTS: Overall, 31 lesions (81.6%) were detected by proximal arteriography, 25 (65.8%) by superselective arteriography and 35 (92.1%) by CT during superselective arteriography. CT during superselective arteriography was significantly superior to superselective arteriography (P = 0.005). In both studies, manual injection of contrast medium had a significantly higher sensitivity than mechanical injection (P = 0.013). CONCLUSION: To detect small HCC, CT during superselective arteriography showed significantly higher sensitivity than superselective arteriography. Manual injection of contrast medium was significantly superior to mechanical injection. Therefore, manual injection CT during superselective arteriography is recommended for accurately targeted, transarterial chemoembolization therapy.

Control of nanobiointerfaces generated from well-defined biomimetic polymer brushes for protein and cell manipulations.

To better understand protein/material and cell/material interactions at the submolecular level, well-defined polymer brushes consisting of poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC) on silicon wafers were prepared by atom transfer radical polymerization (ATRP). Silicon wafers were treated with 3-(2-bromoisobutyryl)propyl dimethylchlorosilane (BDCS) to form a monolayer that acts as initiators for ATRP. Silicon-supported BDCS monolayers were soaked in a methanol/water mixture solution containing Cu(I)Br, bipyridine, and a sacrificial initiator. After MPC was added to the solution, ATRP was carried out for 18 h. The molecular weight and thickness of the PMPC brush layer on the silicon surface increased with an increase in the polymerization time. The dense polymer brushes were obtained by the "grafting from" system. By selective decomposition of the BDCS monolayer by UV light-irradiation, the PMPC brush region and the sizes were well controlled, resulting in fabricating micropatterns of the PMPC brushes. When the thickness of the PMPC brush layer was greater than 5.5 +/- 1.0 nm (3 h polymerization), serum protein adsorption and fibroblast adhesion were effectively reduced, i.e., proteins and cells could recognize such thin polymer brushes on the surface. In addition, the density of the adherent cells on the patterned PMPC brush surface could be controlled by changing the size of the pattern.

Hepatic nodules with early enhancement during computed tomography portography: report of six cases.

AIM: To study the clinicopathologic characteristics of hepatic nodular lesions with high attenuation (increased portal blood flow) compared with surrounding hepatic parenchyma on computed tomography (CT) during arterial portography (CTAP). METHODS: For six lesions found in six patients demonstrated as a high-attenuated mass by CTAP, CT during hepatic arteriography (CTHA; n = 3 patients), digital subtraction hepatic arteriography (n = 6) and conventional helical CT (n = 6) were evaluated retrospectively and compared with histopathologic findings (n = 4). Pathologic diagnosis was atypical adenomatous hyperplasia, nodule-in-nodule hepatocellular carcinoma (HCC) in one resected lesion each and overt HCC in two biopsied lesions. Two patients did not undergo any therapy and were followed up. RESULTS: The average size of lesions was 2.2 cm (range 1.2-3.5 cm). The CTAP revealed high attenuation in all six lesions; entirely within the lesion (n = 4 lesions) or peripherally with a central low attenuation (n = 2). In contrast, CTHA showed low attenuated lesions; entirely within the mass (n = 2) or peripherally with a central high-attenuated spot (n = 1). Hepatic arteriogram revealed only two hypervascular lesions; entirely and partially in one each. In the arterial phase of helical CT, all but one lesion were iso- or hypo-attenuated. In two patients who were followed up to 39 and 55 months without therapy, neither tumor growth nor hemodynamic change of the lesion was recognized on CT. CONCLUSIONS: Even though the incidence of hepatic nodular lesions demonstrated as high attenuating on CTAP is low, all but one lesion in the current series showed iso- or hypo-attenuation on CTHA and/or helical CT, suggesting the hemodynamics are reciprocal between CTAP and CTHA. One exceptional lesion that showed high attenuation on both CTAP and conventional CT was pathologically advanced HCC. Based on the follow-up study of two untreated patients, this kind of lesion with high attenuation on CTAP seems to grow slowly.

Prognostic factors in patients with hepatocellular carcinoma treated by transcatheter arterial embolization.

BACKGROUND: Transcatheter arterial embolization induces marked antitumor response in patients with hepatocellular carcinoma, but the survival benefit of transcatheter arterial embolization remains to be determined. This study investigated prognostic factors in patients with advanced hepatocellular carcinoma treated by transcatheter arterial embolization. METHODS: A total of 128 consecutive patients with non-resectable hepatocellular carcinoma, who had undergone transcatheter arterial embolization between May 1990 and August 1998, were analyzed to investigate prognostic factors. RESULTS: Median survival time and survival proportions at 1, 3 and 5 years were 3.3 years, 92.0, 54.6 and 23.4%, respectively. By multivariate analysis using the accelerated failure time model, age <60 years, hepatitis C virus antibody positivity, serum albumin >3.5 g/dl, absence of portal vein invasion and serum alpha-fetoprotein level <400 ng/ml were significantly associated with favorable survival. For clinical application, we also propose a prognostic equation with combination of specific prognostic factors, by which survival curves of each patient could be predicted directly. CONCLUSION: The findings of the current study may be helpful in predicting the life expectancy of hepatocellular carcinoma patients treated by transcatheter arterial embolization and in designing future clinical trials of transcatheter arterial embolization for hepatocellular carcinoma.

Transcatheter arterial embolization with zinostatin stimalamer for hepatocellular carcinoma.

Zinostatin stimalamer (SMANCS) is a lipophilic intra-arterial chemotherapeutic agent for hepatocellular carcinoma (HCC). In our previous study, transcatheter arterial infusion chemotherapy using SMANCS for HCC showed a response rate of 20%. In an effort to obtain a superior anti-tumor effect against HCC, we conducted a phase II study of transcatheter arterial embolization (TAE) using SMANCS and gelatin sponge in 50 chemotherapy-naive patients with HCC. Four milligrams SMANCS plus 4 ml lipiodol emulsion was injected into the hepatic artery, followed by an injection of gelatin sponge. The responses were evaluated by computed tomography (CT) 1 month after treatment and thereafter every 3-4 months. One patient (2%) showed complete response and 15 patients (30%) had partial response resulting in an overall response rate of 32% (16/50; 95% confidence interval 19-45%). In 33 patients (66%), the disease remained stable, and 1 patient (2%) showed progressive disease. In 35 patients (70%), the rate of necrotic area to whole tumor was more than 50% according to the evaluation method using lipiodol accumulation in CT. The 1-, 3- and 5-year survival rates were 90, 55 and 19%, respectively. Grade 3 hematological toxicity was observed as thrombocytopenia in 2 patients (4%). Grade 3 and 4 non-hematological toxicity (liver dysfunction) occurred in 17 (34%) and 7 patients (14%), respectively. TAE using SMANCS, which was well tolerated, may be an effective treatment for advanced HCC.