Pyogenic brain abscess: findings from in vivo 1.5-T and 11.7-T in vitro proton MR spectroscopy

BACKGROUND AND PURPOSE: Metabolites in pyogenic brain abscesses, as detected with in vivo proton MR spectroscopy, are different from those found in brain and can help differentiate pyogenic brain abscesses from necrotic neoplasms. We compared the findings of in vivo with those of in vitro MR spectroscopy and categorized the MR spectral patterns with respect to the causative organisms and abscess size. METHODS: Fifteen patients with pyogenic brain abscesses underwent in vivo 1.5-T (1)H MR spectroscopy and had findings of ring enhancement. The causative organisms were determined from cultures of aspirated pus. Single-voxel (1)H MR spectroscopy was performed with the point-resolved method (1600/270, 135 TR/TE). In six representative patients, in vitro 11.7-T (1)H MR spectra were obtained from the aspirated pus. RESULTS: Three in vivo MR spectral patterns were noted: A) presence of lactate at 1.3 ppm, cytosolic amino acids (leucine, isoleucine, and valine) at 0.9 ppm, alanine at 1.50 ppm, and acetate at 1.92 ppm, with the presence or absence of succinate at 2.4 ppm and lipids (0.8-1.3 ppm), representing mostly obligate anaerobes or a mixture of obligate and facultative anaerobes; B) presence of lactate at 1.3 ppm and cytosolic amino acids at 0.9 ppm, with the presence or absence of lipids but not acetate or alanine (0.8-1.3 ppm), representing mostly obligate aerobes or facultative anaerobes; and C) presence of lactate at 1.3 ppm alone, showing small abscess. Additional resonance peaks of lysine at 1.73 and 3.0 ppm, glutamate/glutamine at 2.09-2.36 ppm, taurine at 3.24 and 3.42 ppm, glycine at 3.55 ppm, and amino acids at 3.75 ppm could be observed in the in vitro MR spectra. CONCLUSION: Results from the in vivo observations were satisfactorily verified by the in vitro experiments. The in vitro measurements may offer complementary information that cannot be extracted from in vivo MR spectra. Determination of the three (1)H MR spectral patterns may be helpful in devising the best possible treatment plans for patients with pyogenic abscesses.     

The insulin sensitivity, glucose effectiveness and acute insulin response to glucose load of non-obese adolescent type 2 diabetes

To determine the clinical characteristics in adolescent type 2 diabetes (young diabetes, YDM) in Taiwan, we enrolled 11 males who were diagnosed with YDM before 19 years of age into our study. Another 11 patients with adult type 2 diabetes (mature age diabetes, MADM) who were diagnosed after the age of 40 were enrolled as compare group. Subjects from both groups were being treated with oral hypoglycemic agents only at the time of enrollment, and none of the subjects had a history of diabetic ketoacidosis. Plasma lipid levels were measured from the fasting plasma sample. A homeostasis model assessment was used to estimate insulin sensitivity (HOMA-S) and beta-cell function (HOMA-B). Frequent-sampled intravenous glucose tolerance test was also performed to measure the insulin sensitivity (S(I)), glucose effectiveness (E(G)), and acute insulin response after glucose load (AIR). After adjusting for age and BMI, fasting plasma glucose, total cholesterol, HDL-cholesterol, triglycerides, and HOMA-B levels were similar between two groups. The fasting plasma insulin and HOMA-S were significantly higher in YDM. However, the S(I), E(G) and AIR in both groups were also not significantly different. In conclusion, the early onset of diabetes in YDM may be due to the early deterioration of the S(I), E(G) and AIR with similar severity compared with MADM. The role of E(G) might be more important than previously thought in these patients. Finally, the YDM might be a subtype of type 2 diabetes.     

Preliminary results of transarterial rhenium-188 HDD lipiodol in the treatment of inoperable primary hepatocellular carcinoma

A multicentre study was sponsored by the International Atomic Energy Agency (Vienna) to assess the safety and efficacy of trans-arterial rhenium-188 HDD conjugated lipiodol (radioconjugate) in the treatment of patients with inoperable hepatocellular carcinoma (HCC). The radioconjugate was prepared by using an HDD (4-hexadecyl 1-2,9,9-tetramethyl-4,7-diaza-1,10-decanethiol) kit developed in Korea, and lipiodol. Over a period of 18 months, 70 patients received at least one treatment of radioconjugate. Some patients were re-treated if there was no evidence of disease progression. The level of radioconjugate administered was based on radiation-absorbed dose to critical normal organs, calculated following a scout dose of radioconjugate. The organs at greatest risk for radiation toxicity are the normal liver, the lung and the bone marrow. An Excel spreadsheet was used to determine maximum tolerated activity (MTA), defined as the amount of radioactivity calculated to deliver no more than 12 Gy to lungs, or 30 Gy to liver, or 1.5 Gy to bone marrow. These doses have been found to be safe in multiple trials using external beam therapy, but this has not been confirmed for systemically administered radiopharmaceuticals. Patients were followed for at least 12 weeks after therapy, until recovery from all toxicity. The clinical parameters evaluated included toxicity, response as determined by contrast-enhanced computed tomography, palliation of symptoms, overall survival, performance status (Karnofsky) and hepatic function (Childs classification). Liver function tests, serum -fetoprotein (AFP) levels and complete blood counts were done at each follow-up visit. In the majority of patients, the scout dose studies indicated the radiation absorbed dose to normal liver to be the limiting factor to the treatment dose, while in a few patients dose to lung was the limiting factor. Radiation dose to bone marrow was negligible and was thus not a factor for the MTA calculations. Side-effects were minimal and usually presented as loss of appetite, right hypochondrial discomfort and low-grade fever, even at high levels of administered radioactivity. The symptoms resolved with simple supportive therapy within 3 days of onset. Liver function tests at 24 and 72 h showed no significant changes and complete blood counts at 1 week, 4 weeks and 12 weeks showed no changes (no bone marrow suppression). Sixteen patients were treated in the dose escalation phase of the study, when the activities administered started at 1.8 GBq (50 mCi) and rose to 7.7 GBq (206 mCi). In the efficacy phase of the study a further 54 patients were treated. Both groups of patients are included in this paper. The treatment activity of ¹⁸⁸Re-lipiodol administered transarterially ranged from 1.8 to 9.8 GBq (50–265 mCi), with a mean activity of 4.6 GBq (124 mCi). Survival at 3 months was 90%, and at 6 months, 60%; 19% survived for 1 year. Mean survival after treatment in the total treated group of 70 patients was 9.5 months, with a range of 1–18 months. The results of this multicentre study show that ¹⁸⁸Re-lipiodol is a safe and cost-effective method to treat primary HCC via the transarterial route. In terms of efficacy, it is potentially a new therapeutic approach for further evaluation by treatment of larger numbers of patients.     

Use of splenic artery embolization as an adjunct to nonsurgical management of blunt splenic injury

BACKGROUND: Splenic artery embolization (SAE) has been used as an adjunct to the nonsurgical treatment of blunt splenic injuries since 1981. It is imperative to define the role of SAE in the management of splenic trauma and to establish a guideline for its use. METHODS: In this study, 39 consecutive patients with blunt splenic ruptures were evaluated. All the patients were treated according to the authors' protocol, which included SAE as an adjunct. Angiographic study was performed for patients with any of the following presentations: recurrent hypotension despite fluid resuscitation, significant hemoperitoneum or extravasation of contrast media on computed tomography, grade 4 or 5 splenic injury, or progressive need for blood transfusion. Laparotomy was reserved for patients with unstable hemodynamics or failure of SAE. RESULTS: Four patients were excluded from the study, and 6 of the 35 remaining patients (male-to-female ratio, 22:13) received SAE. One of the six SAE patients underwent operation because of persistent hemorrhage after SAE. Nonoperative treatment was successful for 31 patients. Splenic artery embolization increased the success rate for nonsurgical management from 74% (26 of 35 patients) to 89% (31 of 35 patients). CONCLUSIONS: Judicious use of SAE for patients with blunt splenic injury avoids unnecessary surgery and expands the number of patients who can retain their spleen.     

Intraspinal transplantation of CD34+ human umbilical cord blood cells after spinal cord hemisection injury improves functional recovery in adult rats

The present study was designed to compare the functional outcome of the intraspinal transplantation of CD34+ human umbilical cord blood (CB) cells with that of human bone marrow stromal (BMS) cells in adult rats with spinal cord injury. Sixty adult Wistar rats were subjected to left spinal cord hemisection, and then divided into three groups randomly. The control group received an injection of PBS without cells, while the two other groups of rats received a transplantation of 5 x 10(5) CD34+ CB or BMS cells, respectively. Functional outcome was measured using the modified Tarlov score at days 1, 7, 14, 21, and 28 after transplantation. A statistically significant improvement in functional outcome and survival rate in the experimental groups of rats was observed compared with the control group. Rats that received CD34+ CB cells achieved a better improvement in functional score than those that received BMS cells at days 7 and 14 after transplantation. Histological evaluation revealed that bromodeoxyuridine (BrdU)-labeled CD34+ CB and BMS cells survived and migrated into the injured area. Some of these cells expressed glial fibriliary acidic protein (GFAP) or neuronal nuclear antigen (NeuN). Our data demonstrate for the first time that intraspinal transplantation of human CD34+ CB cells provides benefit in function recovery after spinal cord hemisection in rats and suggest that CD34+ CB cells may be an excellent choice of cells as routine starting material of allogenic and autologous transplantations for the treatment of spinal cord injury.     

In vitro exposure to carbon dioxide induces oxidative stress in human peritoneal mesothelial cells

BACKGROUND: The objective of this study was to verify whether in vitro exposure of human peritoneal mesothelial cells to carbon dioxide (CO(2)) influences the levels of 8-isoprostaglandin F(2alpha) (8-iso-PGF(2alpha)), a marker of oxidative stress. METHODS: Mesothelial cells were exposed to either: (i). 100% CO(2) for 4 h; (ii). 100% helium (an alternative gas with which to create hypoxic conditions) for 4 h; (iii). 100% CO(2) for 24 h; or (iv). standard conditions (control). After gas exposure, mesothelial cells were returned to standard conditions and harvested immediately (T(0)), and at 1-(T(1)) and 3 (T(3)) h afterwards. Cell viability and culture medium pH were monitored throughout the experiments. 8-iso-PGF(2alpha) was assayed by enzyme-linked immunosorbent assay (ELISA). RESULTS: Exposure to CO(2) decreased the culture medium pH whereas helium increased the pH. 8-iso-PGF(2alpha) levels in all treated groups were significantly higher than in the control group: in the 4 h CO(2) group at T(1); in the 24 h CO(2) group at T(0) and T(1); and in the 4 h helium group at T(0), T(1) and T(3). 8-iso-PGF(2alpha) levels following 4 h CO(2) exposure were significantly lower than after 24 h CO(2) exposure at T(1), and lower than following 4 h helium exposure at all time points. CONCLUSIONS: Exposure to both CO(2) and helium induces oxidative stress in mesothelial cells. Hypoxia-reoxygenation may play a role in this process.     

Expression of adhesion molecules and Ki-67 in female adnexal tumor of probable Wolffian origin (FATWO): report of two cases and review of the literature

Female adnexal tumor of probable Wolffian origin (FATWO) is a rare entity which is believed to originate from mesonephric (Wolffian) remnants on the basis of its location where the remnants are abundant. Its behavior is usually indolent, although some cases can recur or metastasize. The authors present the clinicopathological features of two cases of FATWO arising in the broad ligament, and focus on the expression of adhesion molecules and proliferative marker. Mesonephric duct remnants are also examined in an attempt to elucidate the histogenesis of FATWOs. The two FATWOs were well-circumscribed solid masses arising in the leaves of the broad ligament and histological examination revealed a mixture of cysts and tubules imparting a sieve-like pattern and mucin-negative eosinophilic secretion within these tubules. Immunohistochemically, the tumors showed the expression of cytokeratin 7 and 20, high-molecular-weight cytokeratin, and calretinin, which closely resembled that of the mesonephric duct remnants. Regarding CK 20, CD 10, EMA, S-100 protein, and vimentin their expression was in part not identical with previous studies. E-cadherin, alpha and beta-catenin were strongly expressed along the cell membrane of the tumor cells. The Ki-67 labeling index of FATWO was 0% and 3.2% in each case. The preservation of the E-cadherin-catenin complex and low Ki-67 labeling index could explain the indolent behavior and low malignant potential of this tumor.