MRI of Gynaecological Solid Masses: Pictorial Review

Differential diagnosis of gynaecological masses is sometimes difficult, as there are so many histological types. However, magnetic resonance characteristics of some gynaecological tumours have been reported past several years. On the basis of the recent literature, we have made a decision tree for differential diagnosis of solid gynaecological tumours, in which there are some important divergences. Bilateral disease and invasive growth are malignant signs in most cases. Specific findings for different tumour types include: fibrovascular septa in dysgermonimas; preserving ovarian follicles in round cell tumours; pseudolobular patterns in young patients in sclerosing stromal tumours; and extremely hypointense masses on T2WI in Brenner tumours. Distinguishing between sex-cord stromal tumours, Brenner tumours and metastatic tumours may be hard, however, especially in middle age, because they all tend to show well-demarcated, hypointense masses on T2WI. Disproportionately clear zonal anatomy of the uterus, enlarged uterus and thickened endometrium, which are indirect findings of oestrogen-producing tumours, are useful diagnostic findings in children and postmenopausals.Tanaka, Y. O. (2000). Clinical Radiology55, 899–911.     

In-vivo Assessment of Extrahepatic Metabolism of Paeoniflorin in Rats: Relevance to Intestinal Floral Metabolism

The extraction ratios of paeoniflorin in gut wall (E_G), liver (E_H) and lung (E_L) were assessed by comparing AUCs after various routes of its administration to estimate the first-pass effects and the metabolism by intestinal flora. Pulmonary extraction ratio of paeoniflorin was assessed by comparing AUCs calculated from venous and arterial plasma concentrations after its intravenous administration (0.5 mg kg^?1). The mean pulmonary extraction ratio was estimated to be 006. The hepatic extraction ratio (E_H was assessed by comparing AUCs after intraportal and intravenous administrations (0.5 and 5 mg kg^?1). The plasma concentration profiles of paeoniflorin after intraportal administration were very close to those after intravenous administration, suggesting a negligible hepatic extraction ratio of paeoniflorin. The AUC value after intraperitoneal administration (0.5 mg kg^?1) was greater than that after intraportal or intravenous administration. This finding suggests that paeoniflorin is not metabolized in the gut wall. The transference of paeoniflorin from the serosal side to the mucosal side was evaluated by the in-vitro everted sac method. The low intestinal permeability (194% at 60 min) was demonstrated by the comparison with phenobarbital (63.1% at 60 min). We conclude that paeoniflorin is not metabolized by gut wall, liver and lung, its poor absorption from the intestine results in extremely low bioavailability and the unabsorbed fraction of paeoniflorin is degraded by the intestinal flora.     

What is a Dieulafoy Ulcer—Relationship between Dieulafoy Ulcer and Ul-II Ulcer

Abstract: A Dieulafoy ulcer is defined as a gastric ulcer with a massive hemorrhage from a shallow circular depression with an eroded artery in the center. The disease entity has been variously described as Dieulafoy ulcer, exulceratio simplex, gastric aneurysm or submucosal vascular malformation. In this study, the relationship between Dieulafoy ulcers and hemorrhagic Ul-II shallow solitary ulceration was investigated according to the macroscopic and histologic findings of the resected stomach. The hemorrhagic Ul-II solitary ulcers resected were located on the upper or middle gastric body. Most of them were small sized (under 10 mm) ovoid ulcers, and had exposed (eroded) arteries on the ulcer floor. Histologically, the Ul-II ulcers showed ulceration in the acute phase without fibrosis. We concluded that a Dieulafoy ulcer and hemorrhagic solitary Ul-II ulcer are the same. In fact, a Dieulafoy ulcer has no special pathogenesis such as congenital abnormal vessels, aneurysm, etc.     

Water balance,electrolytes and acid-base balance in extremely premature infants

There are few reported studies of water balance and electrolyte abnormalities in extremely low birth-weight (ELBW) infants weighing < 1000 g nursed in high humidity. We retrospectively analyzed water balance, electrolyte and acid-base balance in 100 ELBW infants, of whom 72 were appropriate for gestational age (AGA) and 28 were small for gestational age (SGA). They were cared for in closed incubators at almost full ambient humidity. Fluid intake was restricted to 50–60 mL/kg on the first day of life and was adjusted to maintain normal serum Na concentration. Weight loss in AGA and SGA infants was 21.6 and 16.7%, respectively, and was associated with large urine volume rather than insensible water loss. The incidence of hypernatremia (> 150 mEq/L) and hyponatremia (< 130 mEq/L) was 8.0 and 33.3%, respectively. The incidence of hyperkalemia in AGA infants was 37.0%, and 14.8% in the SGA group. However, hyperkalemia requiring treatment was rare. The incidence of late metabolic acidosis in AGA and SGA infants was 84.6 and 37.5%, respectively (P< 0.01). The difference in water balance and electrolyte abnormalities in AGA and SGA infants needs to be taken into account in managing ELBW infants.     

Erythromycin improves gastrointestinal motility in extremely low birthweight infants

Erythromycin (EM) was administered to five extremely low birthweight infants (ELBWI) with delayed enteral feeding to evaluate the clinical effect on severely impaired gastrointestinal motility. Five patients studied responded well to EM administration without any adverse effects during the course. Four patients were given 15–30 mg/kg per day EM intravenously as a loading and thereafter 3–5 mg/kg per day as a maintenance dose. One patient responded well without loading. The infants could be fed enterally 4, 5, 6, 4 and 2 days after the initiation of EM administration, respectively. Erythromycin administration is a safe and useful way to facilitate gastrointestinal motility in ELBWI who require prolonged ventilator support with an increased risk for nutrient deprivation.     

Anaesthetic management of a 656-g neonate undergoing pulmonary valvotomy

We describe the successful management of a 656-g preterm infantof 29 weeks' postconceptional age undergoing closed transventricularpulmonary valvotomy. The patient had a critical pulmonary stenosisand was treated with an infusion of prostaglandin E,, whichresulted in excessive pulmonary blood flow through the ductusarteriosus. The key points in anaesthetic management were maintainingan optimum balance between the systemic and pulmonary circulationand preparing for the abrupt haemodynamic change caused by valvotomy ^*Present address: Hyogo College of Medicine, Nishinomiya, Hyogo663, Japan     

Complex of subtilisin BPN‘ with Streptomyces subtilisin inhibitor

Structure of the complex of Streptomyces subtilisin inhibitor (SSI) with subtilisin BPN' was studied by examining the thermal denaturation and reducibility of disulfide bonds. The denaturation temperature of the complex was significantly higher than that of the enzyme. Two disulfide bonds localized in the inhibitor side were completely reduced in the complex, whereas only one of them was reduced in the free SSI. Gel filtration of the reduced complex solution showed clearly that the main products of reduction of the complex were two peptide fragments of SSI divided at the active site. The resistive disulfide bond in the complexed inhibitor became accessible as a result of a large conformational change due to splitting of the half-reduced inhibitor.     

Relationship between Teratogenic Effects and Tissue Binding Pattern of Concanavalin A in Rat Embryos

ABSTRACT This study was conducted to examine the effects of concanavalin A (Con A) on rat neurulation. Con A was injected intravenously to pregnant rats at a single dose of 5, 10, or 20 mg/kg between gestational days (GD) 7.5 and 10.0, and the embryos were macroscopically examined on GD 11.5. Con A induced a high mortality rate, the treatment with 10 and 20 mg/kg on GD 9.5 was completely lethal. Con A caused a high incidence of neural tube defects (NTD), the incidence in the 10 mg/kg on GD 8.0 and 8.5 groups and in the 20 mg/kg on GD 8.0, 8.5 and 9.0 groups being significantly higher than that in the control group. Histological evaluation revealed that Con A inhibited neural tube expansion and altered neural crest cell shape. In the Con A-treated embryos, the stratified structure of the neuroepithelium was irregular and its extracellular space was expanded. In rat embryos from intact dams, the distribution of receptors for Con A was demonstrated histochemically on the cell surfaces around neurulation sites between GD 8.5 and 10.5, but not on GD 7.5. These findings indicate that Con A bound around the neurulation sites in rat embryos may disturb the cell-cell communication required to form the neural tube, resulting in NTD.