Hepatic and splenic sarcoidosis: Ultrasound and MR imaging

Abdominal imaging studies may be performed for various indications in patients known to have sarcoidosis. To assess magnetic resonance imaging (MRI) and sonographic ability to detect abnormalities in sarcoidosis patients with abdominal involvement, a prospective study on 18 selected patients was performed. Besides organomegaly, when present, ultrasound demonstrated normal or increased hepatic parenchymal echogenicity, coarsening of the liver parenchyma with or without discrete nodules, focal calcifications, as well as contour irregularity. Splenic discrete nodules were seen on ultrasound in a single patient. Besides organomegaly, MRI abnormalities include abnormal hepatic signal intensity, discrete nodules, contour irregularity, spiculation of small hepatic vascular branches, and a high periportal signal intensity. MRI splenic abnormalities include contour irregularity, nodularity, and abnormal signal intensity.The data presented in this study reveals the spectrum of ultrasound and MRI findings in sarcoidosis patients with abdominal organ involvement, potentially enabling the evaluation of the severity of the disease. MRI appears more sensitive than ultrasound for study of abdominal sarcoidosis.     

Advances in the application of biochemical tests to diseases of the liver and biliary tract: their role in diagnosis, prognosis, and the elucidation of pathogenetic mechanisms

Despite the biochemical complexity of the liver, few laboratory tests provide discriminatory diagnostic information in patients with hepatobiliary disease. Recent efforts have concentrated upon tests which assess the function of the liver, the severity of the disease state, and underlying pathological processes. Bile Acids: The emergence of facile technology and widespread application has brought the realization that these assays are not as sensitive in detecting liver disease as previously believed, although the cholate/chenate ratio may be useful in distinguishing cholestasis from chronic liver disease. The presence of unusual bile acids in serum or urine may be helpful in some cases. Drug Metabolism: A number of tests provide good evidence about liver function, hepatic blood flow and portal shunting, but the aminopyrine breath tests is the most useful, giving prognostic information in acetaminophen overdose and alcoholic liver disease. The antipyrine half-life identifies surgical cases at risk from poor hepatic function. Proteins and Immunochemical Tests: Interest has developed in plasma proteins such as prealbumin and retinol-binding protein to monitor hepatic protein synthetic function. Secretory IgA is more elevated in biliary tract disease, unlike the native protein which is increased principally in cirrhosis. Type III procollagen can be measured in serum, and correlates with the activity of collagen synthesis and the degree of fibrosis in biopsy samples. Reye's Syndrome: Biochemical tests play an essential role in diagnosis of this recently discovered disease. These will be presented and discussed.     

Mass medical repatriation of injured civilians after terrorist attack in Mombassa, Kenya: medical needs, resources used, and lessons learned

INTRODUCTION: On 28 November 2002, three suicide bombers crashed their car into a hotel in Mombassa, Kenya; 12 people were killed, including three Israelis, and 80 were wounded (22 of whom were Israeli). The Israeli Defense Force Airborne Medical Evacuation Flight Teams participated in a repatriation mission to bring the wounded home. OBJECTIVES: The objectives of this study are to outline the distinctive aspects of this mission, as well as to share the experiences and lessons learned. METHODS: Israeli Army debriefing reports were used to study the composition of the crew, medical equipment taken, injury distribution, mode of operation, and mission schedule. RESULTS: A total of six fixed-wing aircraft were used--two Boeing 707s and four Hercules C-130s--with a total of 54 medical team members on board. A total of 260 Israelis were repatriated, 22 of whom were wounded, and three were dead. Of the casualties, 14 were conveyed sitting, and eight supine. The time from the first landing in Kenya to the evacuation of the last supine patient was 5.5 hours. Nurses, as well as social workers, played a central role in the mission. A forward team, including five doctors, was used for the initial organization and for gathering information on the medical status of the casualties. CONCLUSIONS: There was redundancy in the medical crew and medical equipment sent. The need for improved infrastructure on the medical aircraft was stressed. Based on this experience, a new mode for operation for similar missions in the future was formulated.     

Renal accumulation of salicylate and phenacetin: possible mechanisms in the nephropathy of analgesic abuse

Since either aspirin or phenacetin might be causative in the nephropathy of analgesic abuse, studies were designed to examine the renal accumulation and distribution of the major metabolic products of these compounds, salicylate and N-acetyl-p-aminophenol (APAP) respectively, in dogs. Nineteen hydropenic animals were studied, of which seven were given phenacetin, nine received acetyl salicylic acid, two were given both aspirin and phenacetin, and one received APAP directly. Two of three hydrated animals were given phenacetin and one was given aspirin. During peak blood levels of salicylate and (or) APAP, the kidneys were rapidly removed, frozen, sliced from cortex to papillary tip, and analyzed for water, urea, APAP, and salicylate.     

Stereoselective behavioral effects of cocaine and a phenyltropane analog

Intramuscular injections of the stereoisomers of cocaine and of its phenyltropane analog were compared for their effects on schedule-controlled behavior of squirrel monkeys. Monkeys responded by pressing a lever under a multiple schedule with alternating fixed-interval and fixed-ratio components; responding was maintained by presentation of food in some monkeys and by termination of a stimulus associated with electric shock in other monkeys. The levorotatory isomers, (-)-cocaine (0.09-2.7 mg/kg) and WIN 35,065-2 (0.006-0.2 mg/kg), had qualitatively similar effects which depended primarily on the type of component schedule (fixed-interval or fixed-ratio) that maintained responding. In the fixed-interval components, intermediate doses of each drug increased responding, whereas higher doses decreased responding. In the fixed-ratio components, each drug only decreased responding in a dose-related manner. The minimal effective dose of (-)-cocaine was about 10 times that of WIN 35,065-2. Although the dextrorotatory isomers, (+)-cocaine and WIN 35,065-3, also increased responding in the fixed-interval components and decreased responding in the fixed-ratio components in some monkeys, the doses required were 100 to 622 times the minimal effective doses of their enantiomers. The results show a high degree of stereoselectivity in the behavioral effects of both cocaine and its phenyltropane analog.     

Facilitation of ganglionic transmission by sulpiride: evidence for an inhibitory role of dopamine in the canine sympathetic ganglion

Effects of the (R) and (S) enantiomers of sulpiride, a potent dopamine (DA) antagonist, on ganglionic transmission were studied in anesthetized dogs. The pre- and postganglionic nerves of cardiac sympathetic ganglia were stimulated electrically, and heart rate was monitored as a measure of ganglionic transmission and sympathetic nerve activity. The heart rate was free from influence of the central nervous system. (R)- And (S)-sulpiride injected i.a. close to the blood supply of the ganglia did not alter basal heart rate, but facilitated ganglionic transmission as demonstrated by an increase in the tachycardia induced by preganglionic nerve stimulation. The (R) enantiomer was 4 times more active than the (S) enantiomer in this respect. Neither enantiomer affected the tachycardia induced by postganglionic nerve stimulation. Norepinephrine and DA injected i.a. caused inhibition of the tachycardia induced by preganglionic nerve stimulation. The inhibitory effect of both catecholamines was antagonized by the sulpiride enantiomers (R)-sulpiride was about 4-fold more potent than (S)-sulpiride in antagonizing DA, whereas (S)-sulpiride was more active against norepinephrine. The sulpiride enantiomers affected neither the tachycardia induced by i.a. administration of acetylcholine nor the bradycardia induced by vagal nerve stimulation. Thus, cholinesterase inhibition and ganglionic stimulation were excluded. These data are, therefore, consistent with the hypothesis that the facilitatory action of the sulpiride enantiomers is related to the antagonism of catecholamines. Positive correlation between the activity of the (R) enantiomer to facilitate ganglionic transmission and to antagonize DA suggests that DA is a physiologically released catecholamine modulating transmission in the cardiac sympathetic ganglia of the dog.     

Contrast-enhanced two- and three-dimensional sonography for evaluation of intra-abdominal hemorrhage.

OBJECTIVE: To determine whether a contrast agent enhances sonographic detection of bleeding sites in the abdomen and whether contrast-enhanced three-dimensional sonography provides additional information compared with contrast-enhanced two-dimensional sonography. METHODS: Bleeding sites were created within the livers (n = 3), spleens (n = 5), and kidneys (n = 3) of 3 dogs. A sonographic contrast agent with vascular and parenchymal enhancement capabilities was administered intravenously at a dose of 0.02 mL/kg. Before and after each contrast agent injection, the bleeding sites were imaged with two- and three-dimensional sonography in gray scale harmonic imaging and color flow modes. Sonographic findings were compared with gross pathologic findings. RESULTS: Noncontrast-enhanced sonography was not able to show the specific location of the active bleeding in any of the organs evaluated. The contrast agent enhanced the sonographic detection of blood flow in normal vessels and extravasated blood from damaged vessels or organs in all cases. Intrasplenic and intrahepatic hematomas were better identified on delayed imaging sequences because there was marked enhancement of the normal parenchyma, whereas the hematomas remained unenhanced. Reconstructed three-dimensional sonography showed spatial relationships of the bleeding sites and surrounding structures. Gross pathologic findings were consistent with the contrast-enhanced sonographic results. CONCLUSIONS: Contrast-enhanced sonography improves the detection and evaluation of abdominal bleeding sites. Contrast-enhanced three-dimensional sonography appears to provide additional information when compared with two-dimensional sonography.