Perfluorobutane contrast-enhanced ultrasonography: a new standard for ultrasonography-guided thermal ablation of sonographically occult liver tumours?

INTRODUCTIONImage-guided thermal ablation, preferably with ultrasonography (US), is increasingly used for treatment of small liver tumours. Perfluorobutane-contrast-enhanced US (pCEUS) is a promising tool that may allow for targeting of tumours that are otherwise imperceptible on greyscale US. Although pCEUS has been reported to be effective, the literature has been limited outside of Japan and South Korea. We aimed to provide data that supports the use of pCEUS in the thermal ablation of sonographically occult liver tumours.METHODSWe conducted a retrospective single-centre study of 35 consecutive patients who underwent pCEUS-guided ablation of 48 liver tumours with a median size of 1.2 cm. Periprocedural, one-month post-treatment and relevant follow-up imaging studies were reviewed. Electronic records were also obtained, with long-term follow-up data of 12–28 months being available for 32 patients.RESULTS36 (75%) tumours that were imperceptible on greyscale US became visible with pCEUS. Overall, complete tumour ablation at one month was 89%. 1 (3%) patient developed a major complication following treatment, while 6 (17%) had minor post-treatment complaints. The local tumour progression rate was 17%, with a median time of 14 months.CONCLUSIONpCEUS has a role in US-guided thermal ablation of liver tumours, offering a high technical success rate that is comparable to reported data. Additional benefits may include improved procedural time and freedom from ionising radiation.     

Temporal arteritis in Sj?gren's syndrome

We report the first case of co-existing temporal arteritis and Sj?gren's syndrome in the English language literature. Characteristic clinical and laboratory findings of both disorders were present. The combination of these two illnesses could be on the basis of chance alone or there may be a common etiology. Temporal arteritis could therefore be an addition to the spectrum of vasculitis diseases seen in Sj?gren's syndrome.     

Histiocytosis X of the hypothalamus

An 18-year-old woman presented with visual disturbance and endocrine dysfunction (diabetes insipidus, delayed puberty, hypothyroidism, hypoadrenalism, and hyperprolactinemia). Computed tomography and enhanced cisternography showed a single hypothalamic mass, which proved at biopsy to be histiocytosis X. Further studies showed the disease to be restricted to the hypothalamus. The patient was treated with hormonal replacement therapy, but her visual acuity continued to worsen. Visual acuity improved after low-dose irradiation of the pituitary fossa and hypothalamus, which also led to disappearance of the mass. This case shows that localized hypothalamic histiocytosis X can be diagnosed and treated successfully before other systems become involved.     

The value of magnetic resonance imaging in the detection of type II hemorrhagic lacunes

Lacunar infarcts (lacunes) are small necrotic/cystic lesions of the brain associated with hypertension. Many are clinically silent, but some are associated with localizing symptoms and signs. Lacunes recently were classified into three types, namely, those resulting from small infarcts (type I), those arising as small hemorrhages (type II), and those due to dilatation of perivascular spaces (type III). The type II lacunes are thought to be much less common than those of type I. Type II lacunes have not previously been reported during life. We report a case of subacute type II lacune in the pontine tegmentum that was detected by magnetic resonance imaging and later verified by histopathologic examination. The patient was hypertensive and had numerous other type I lacunes. This case shows that the magnetic resonance imaging features of hemorrhagic lacunes are identical to those of small hemorrhages or small hemorrhagic infarcts and that magnetic resonance imaging is a useful tool in the detection of lacunes and their correlation with clinical neurologic symptoms and signs.     

Minimal cross-linking and epitope requirements for CD40-dependent suppression of apoptosis contrast with those for promotion of the cell cycle and homotypic adhesions in human B cells

Eight different CD40 mAb shared with soluble trimeric CD40 ligand (sCD40LT) the capacity to rescue germinal center (GC) B cells from spontaneous apoptosis and to suppress antigen receptor-driven apoptosis in group I Burkitt's lymphoma cells. Three mAb (G28-5, M2 and M3) mimicked sCD40LT in its ability to promote strong homotypic adhesion in resting B cells, whereas others (EA5, BL-OGY/C4 and 5C3) failed to stimulate strong clustering. Binding studies revealed that only those mAb that promoted strong B cell clustering bound at, or near to, the CD40L binding site. While all eight mAb and sCD40LT were capable of synergizing with IL-4 or phorbol ester for promoting DNA synthesis in resting B cells, co-stimulus-independent activation of the cells into cycle through CD40 related directly to the extent of receptor cross-linking. Thus, mAb which bound outside the CD40L binding site synergized with sCD40LT for promoting DNA synthesis; maximal levels of stimulation were achieved by presenting any of the mAb on CD32 transfectants in the absence of sCD40LT or by cross-linking bound sCD40LT with a second antibody. Monomeric sCD40L, which was able to promote rescue of GC B cells from apoptosis, was unable to drive resting B cells into cycle. These studies demonstrate that CD40-dependent rescue of human B cells from apoptosis requires minimal cross-linking and is essentially epitope independent, whereas the requirements for promoting cell cycle progression and homotypic adhesion are more stringent. Possible mechanisms underlying these differences and their physiological significance are discussed.