Nasopharyngeal carcinoma: posttreatment changes of imaging findings

OBJECTIVE: The purpose of this study was to determine the radiologic results of nasopharyngeal carcinoma (NPC) that showed complete responses on follow-up imaging studies after radiation therapy. MATERIALS AND METHODS: This study is a retrospective review of 23 patients (18 male, 5 female, aged 15-71 years; mean age, 48.5 years) affected with NPC, from August 1995 to July 2000, who were examined with magnetic resonance imaging or computed tomography scan before and after either radical radiotherapy or chemoradiotherapy. The median follow-up was 24.7 months and ranged from 12 to 48 months. We analyzed the primary tumors by ascertaining/measuring tumor size, depth, middle ear effusion, skull base invasion, and lymphadenopathy. The treatment responses for primary tumors were classified as either atrophy, scar (asymmetric elevation without enhancement), or normalized. The tumor response and the appearance of bone regeneration in the previous destructive part of the skull base were also recorded. RESULTS: The 23 patients consisted of 12 superficial tumors, for whom treatment results were normalized in 10, atrophy in 1, and scar in 1 and 11 deep tumors for whom treatment results were scar in 6, normalized in 3, and atrophy in 2. Skull base invasion was detected in 6 patients, 5 of whom showed complete healing of skull base destruction after radiotherapy. However, the other patient exhibited an unusual hyperostotic change in the skull base mimicking fibrous dysplasia of the skull base. CONCLUSIONS: The superficial tumors tended to be radiologically normalized even when they were large. However, the deep tumors mainly changed to scar after radiation therapy. On the other hand, skull base invasion could be normalized after radiotherapy.     

Serous retinal detachment in a patient with rhino-orbital mucormycosis

BACKGROUND: Rhino-orbital mucormycosis is a difficult disease to treat. We report one case of rhino-orbital mucormycosis, complicated by serous retinal detachment, that responded to aggressive treatment. CASE: A 38-year-old man with diabetic ketoacidosis was referred to the emergency department of our hospital with fever, proptotic right eye, and complaint of lethargy. OBSERVATIONS: Fundus examination showed serous retinal detachment and focal lesions of retinitis with exudate at the inferior portion coincident with the position of opacification in the orbit on MRI. Fluorescein angiography showed pooling of dye in the detached retina and leakage from focal lesions of retinitis. We thoroughly removed the large necrotic materials in the orbit and sinus through the lower conjunctiva without enucleation or exenteration. Microscopic examination and culture of the necrotic materials that were removed from the orbit proved that the patient had mucormycosis. The serous retinal detachment improved 10 days after orbital debridement combined with intravenous and local (intraorbital) amphotericin B treatment. Visual acuity recovered to 20/50. CONCLUSION: We propose that inflammation of the sclera in close contact with necrotic fungi materials may cause serous retinal detachment.     

Simultaneous determination of loxoprofen and its diastereomeric alcohol metabolites in human plasma and urine by a simple HPLC-UV detection method

A simple, reliable HPLC-UV detection method was developed for the simultaneous determination of loxoprofen and its metabolites (i.e. trans- and cis-alcohol metabolites), in human plasma and urine samples. The method involves the addition of a ketoprofen (internal standard) solution in methanol, zinc sulfate solution and acetonitrile to plasma and urine samples, followed by centrifugation. An aliquot of the supernatant was evaporated to dryness, and the residue reconstituted in a mobile phase (acetonitrile:water=35:65 v/v, pH 3.0). An aliquot of the solution was then directly injected into the HPLC system. Separations were performed on octadecylsilica column (250x4.5 mm, 5 microm) with a guard column (3.2x1.5 cm, 7 microm) at ambient temperature. Loxoprofen and the metabolites in the eluent were monitored at 220 nm (a.u.f.s. 0.005). Coefficients of variations (CV%) and recoveries for loxoprofen and its metabolites were below 10 and over 96%, respectively, in the 200 approximately 15000 ng ml(-1) range for plasma and 500 approximately 50000 ng ml(-1) range for urine. Calibration curves for all the compounds in the plasma and urine were linear over the above-mentioned concentration ranges with a common correlation coefficient of 0.999. The detection limit of the present method was 100 ng for all the compounds. These results indicate that the present method is very simple and readily applicable to routine bioavailability studies of these compounds with an acceptable sensitivity.     

Quantification of proteinuria in children using the urinary protein-osmolality ratio

A prospective study was conducted to determine the correlation of early morning urinary protein/osmolality ratio (mg/l/mosmol/kg) with 24-h urinary protein excretion (mg/m²/day). Study patients consisted of 53 children (aged 1 month to 15 years). Early morning urine samples and 24-h urine samples were collected and analyzed. In group 1 (children without proteinuria), early morning urinary protein/creatinine ratio (Uprot/Ucr, mg/mg) was 0.061±0.011 and the protein/osmolality ratio (Uprot/Uosm, mg/l/mosmol/kg) was 0.073±0.014. Twenty-four hour urinary protein excretion in group 1 had no significant correlation with Uprot/Ucr or Uprot/Uosm. In group II (children with proteinuria), Uprot/Ucr was 5.78±1.10 and Uprot/Uosm was 4.42±1.34. Twenty- four hour urinary protein excretion in group 2 was 1483.6±303.7 mg/m²/day and its correlation with both Uprot/Uosm and Uprot/Ucr was highly significant (r= 0.87, P<0.001 and r=0.88, P<0.001, respectively). The accepted nephrotic level of proteinuria of 40 mg/m²/h coincides with a Uprot/Uosm ratio of 1.9. In conclusion, early morning urinary Uprot/Uosm is a simple and potentially useful test for 24-h urinary protein excretion, and possibly could be used safely for the assessment of the degree of proteinuria in children. Received: 13 April 1999 / Revised: 23 February 2000 / Accepted: 15 August 2000     

Long-term results with St. Jude Medical and CarboMedics prosthetic heart valves

BACKGROUND AND AIM OF THE STUDY: The clinical evaluation and comparison of St. Jude Medical (SJM) and CarboMedics (CM) prosthetic heart valves implanted between 1988 and 1997 is presented. METHODS: In total, 648 SJM valves were implanted in 641 patients, and 601 CM valves in 591 patients. There were 684 mitral valve replacements, 256 aortic valve replacements, 252 mitral and aortic (double) valve replacements, 16 triple valve replacements, and 41 other tricuspid-related valve replacements. Total follow up was 98%. The overall incidence of valve-related events was compared before and after establishment of a 'valve clinic' in 1993. RESULTS: The overall hospital mortality was 3.4%; late mortality was 8.2%. The five- and ten-year survival for all patients was 92.1% and 86.2%, respectively. There were 31 episodes of thromboembolism in 27 patients (including valve thrombosis in three), 21 episodes of bleeding events in 20 patients, and 18 re-replacements of implanted valves. No structural valve deterioration was observed. Freedom from thromboembolism was 97.8% at five years and 96.3% at ten years; freedom from bleeding episodes was 98.1% and 97.6%, respectively. In terms of hospital and late mortality, and incidence of thromboembolism, hemorrhagic episodes and structural valve failure, no statistically significant differences were found between the SJM and CarboMedics patient groups. Freedom from thromboembolism was 96.7% at five years before initiation of an intensive follow up program, and 99.0% thereafter (p = 0.031). In contrast, freedom from bleeding episodes fell from 99.3% to 96.1% during the same time period (p = 0.0004). CONCLUSION: Both the SJM and CM prosthetic heart valves performed well in our study, and no discernible differences in clinical performance of the two valves were detected. The intensive follow up program resulted in a reduced incidence of thromboembolism, but an increased number of bleeding complications. An optimum anticoagulation regimen to manage these two conflicting problems has yet to be elucidated.     

The Therapeutic Effect of OK‐432 (Picibanil) Sclerotherapy for Benign Neck Cysts

Background and Objectives: In general, benign neck cysts are treated by surgical excision. This can present technical difficulties and frequent recurrences, because of insufficient surgery. Sclerosing agents such as OK‐432 have been tested for the nonsurgical treatment of these cysts. We have assessed the efficacy of OK‐432 sclerotherapy for benign neck cysts. Materials and Methods: The study group consisted of 75 patients (42 men, 33 women) diagnosed with and treated for benign neck cysts between March 2001 and December 2007 by intralesional injection of OK‐432. The liquid content of each cyst was aspirated as much as possible, and the same volume of OK‐432 solution was injected. Patients were assessed by ultrasonography or computerized tomography, and therapeutic outcomes and adverse effects were evaluated by patient age, sex, cyst type, and number of injections. Results: Of the 75 treated patients, 31 (41.3%) showed total shrinkage, seven (9.3%) showed near‐total shrinkage (>90% of cyst volume), five (6.6%) showed marked shrinkage (>70% of cyst volume), and 17 (22.7%) showed partial shrinkage (<70% of cyst volume). No response was seen in 15 patients (20%). Despite repeated sclerotherapy, eight patients (10.7%) showed recurrences. Minor adverse effects of therapy included fever, localized pain, and odynophagia but these complications spontaneously disappeared within several days. Conclusions: OK‐432 sclerotherapy is a safe and effective primary alternative to surgery in patients with benign neck cysts.     

Screening for occult coronary artery disease with radiographic detection of coronary calcification

Coronary atherosclerosis is ubiquitous among adults, yet many afflicted persons will suffer no coronary events. Atherosclerotic plaque formation in the coronary arteries is a dynamic process, and the onset of a coronary event is often unheralded, sudden, and lethal. In addition, it is known that the amount of calcification in the coronary arteries correlates with the amount of atherosclerosis in different persons and, to a lesser degree, in segments of the coronary tree in the same person. Radiographic imaging methods, including fluoroscopy, electron-beam computed tomography, and helical computed tomography, can detect coronary calcium and seem to be able to diagnose coronary atherosclerosis. However, data on the relationship between quantity of coronary calcium and event likelihood are limited. Thus, the diagnostic value and, particularly, the prognostic value of calcium detection are controversial and may be applicable only to certain subgroups of patients.     

In vitro inducible nitric oxide synthesis inhibitors from Alismatis Rhizoma.

Bioassay-guided fractionation of an aqueous extract of Alismatis Rhizoma has furnished two inducible nitric oxide synthase (iNOS) inhibitory compounds, alismol (1) and alisol B monoacetate (2), together with an inactive triterpene, alisol C monoacetate (3). Compounds 1 and 2 inhibited nitric oxide (NO) synthesis in a dose-dependent manner in murine macrophage-like RAW 264.7 cells stimulated with interferon-gamma (IFN-gamma) plus lipopolysaccharide (LPS). The inhibitory effects of 1 and 2 on NO synthesis were partly due to suppression of iNOS mRNA expression as determined by Northern blotting.     

Detection of transforming growth factor-alpha in the serum of gastric carcinoma patients.

Transforming growth factor-alpha (TGF-alpha) is a ligand for epidermal growth factor receptor (EGFR) and it is overexpressed in various malignancies including lung, esophageal, colorectal, ovarian and gastric carcinomas. In patients with gastric carcinoma, its overexpression may be associated with advanced stage or poor prognosis. We have recently demonstrated that the mean serum level for EGFR in gastric carcinoma patients was significantly elevated compared with that of healthy controls. Using the enzyme-linked immunosorbent assay, the levels of TGF-alpha were determined in serum from 40 patients with gastric carcinoma (5 patients with stage I, 2 stage II, 4 stage III, and 29 stage IV patients) and 33 healthy controls. The mean serum level for TGF-alpha in the gastric carcinoma patients was significantly elevated as compared with that of healthy controls (104 +/- 235 vs. 22 +/- 16 pg/ml; p = 0.03). Eleven patients with gastric carcinoma (27.5%) showed elevated serum TGF-alpha levels above the cutoff value of 54 pg/ml (defined as 2 standard deviations above the mean of the control group). No significant association was noted between the positivity of TGF-alpha and clinicopathologic characteristics including gender, age and stage. However, poorly differentiated adenocarcinoma showed a higher positivity of serum TGF-alpha (43.8%) compared with other histologic types, which was marginally significant (p = 0.06). These results suggest that serum TGF-alpha could be useful as a tumor marker of gastric carcinoma for predicting prognosis and follow-up after surgery in patients whose initial serum TGF-alpha levels are elevated.