MR imaging of cervical carcinoma: comparison among T2-weighted,dynamic, and postcontrast T1-weighted images with histopathological correlation

Background: To identify the reasons for misdiagnosis of the degree of stromal invasion by uterine cervical cancer with various magnetic resonance sequences. Methods: T2-weighted, dynamic, and postcontrast T1-weighted images were obtained in the sagittal plane in 20 patients with uterine cervical cancer. After evaluating these sequences for the degree of stromal invasion, histologic specimens were directly correlated with these images. Results: The degree of stromal invasion was correctly diagnosed in 15 of the 20 cases on T2-weighted images, in 12 on dynamic images, and in eight on postcontrast T1-weighted images. All misdiagnoses were due to overestimation. Histologically, peritumoral stroma showed inflammation or edema in two patients, whereas no histological abnormality was found in the other patients. A hyperintense rim, i.e., a peritumoral enhanced ring-shaped structure, was observed on the enhanced images of five patients. The hyperintense rim corresponded to the periphery of the tumor in three patients and to the cervical stroma in two patients. Conclusion: T2-weighted images permitted the most accurate evaluation of stromal invasion by uterine tumors. Overdiagnosis may be due to an abnormal intensity of the cervical stroma, which was observed more frequently on dynamic and postcontrast T1-weighted images than on T2-weighted images. Received: 10 November 1995/Accepted after revision: 13 March 1996     

Incidental durotomy during total en bloc spondylectomy

Background Context

The incidence of incidental durotomy (ID) during total en bloc spondylectomy (TES) tends to be higher than that during other spinal surgeries because of the peculiarities of TES, including its highly invasive nature, epidural tumor extension, and use in patients who often have complicated medical backgrounds. However, there have been no detailed reports on ID associated with TES.

A simple enzyme-linked immunoassay of human carbonic anhydrase I for the study of developing erythroid cells

A simple and rapid enzyme-linked immunoassay for human erythrocyte carbonic anhydrase isozyme I was developed. The assay was found to be sensitive enough for the detection of nanogram amounts of the enzyme in incubation mixtures. The first incubation with anti-human carbonic anhydrase I IgG was carried out for 6 hours at room temperature. The second incubation of the enzyme was carried out in the presence of goat plasma C1q coupled with peroxidase for 1 h at room temperature. The enzymatic reaction was performed for 30 min using 2,2'-azino-di(3-ethyl-benzthiazoline sulfonate) as a substrate, and absorbance at 414 nm was recorded. Carbonic anhydrase I was assayed on the range of 1 to 200 ng/ml using this method. The levels of carbonic anhydrase I in K562 cells induced by erythropoietin and in other blood cells were determined. This enzyme-linked immunoassay has application for the study of developing erythroid cells.     

Effects of Breeding Environments on Generation and Activation of Autoreactive B-1 Cells in Anti-red Blood Cell Autoantibody Transgenic Mice

In anti-red blood cell autoantibody transgenic (autoAb Tg) mice almost all B cells are deleted except for B-1 cells in the peritoneal cavity and the gut. About one-half of the auto Ab Tg mice suffer from autoimmune hemolytic anemia (AIHA) in the conventional condition. Oral administration of lipopolysaccharides activates B-1 cells and induces autoimmune symptoms in the Tg mice, suggesting that the autoimmune disease in anti-RBC autoAb Tg mice is triggered by infections. To examine the association of bacterial infections with the generation of B-1 cells and the occurrence of the autoimmune disease, we analyzed anti-RBC autoAb Tg mice bred in germ-free and specific pathogen-free conditions. In germ-free conditions, few peritoneal B-1 cells were detected, while a significant number of peritoneal B-1 cells existed in specific pathogen-free conditions. In both conditions, no mice suffered from AIHA. However, when these Tg mice were transferred to the conventional condition or injected with lipopolysaccharide, peritoneal B-1 cells expanded and some of these mice suffered from AIHA. These results clearly showed that bacterial infections are responsible for both the expansion of B-1 cells and the onset of the autoimmune disease in these Tg mice.     

A model for antiHelicobacter pylori chemotherapy using an experimental murine infection withHelicobacter felis

Colonization ofHelicobacter felis was observed to continue for at least 24 weeks in a BALB/c mouse stomach after oral inoculation of the bacteria. Bacteria were observed on the surface of the gastric mucosa and in the gastric pits as is typically seen withHelicobacter pylori infection in the human stomach.H. felis-colonized mice were treated for 5 consecutive days with various chemotherapeutic regimens used againstH. pylori for humans. The status ofH. felis infection was then assessed by the urease test 2 weeks after the final treatment. The clearance rates were 100% for a triple combination of amoxicillin (15 mg/kg), metronidazole (10 mg/kg) and bismuth subnitrate (5 mg/kg), 71% for amoxicillin alone (15 mg/kg), 80% for metronidazole alone (15 mg/kg), and 0% for bismuth subnitrate (60 mg/kg) or omeprazole (60 mg/kg) alone. Bacterial recurrence occurred more often in mice treated with amoxicillin alone than with the triple regimen during the 24-week posttreatment period. These results were very similar to the efficacy of each regimen obtained in clinical trials. Thus, this mouse model usingH. felis may be useful for evaluating drugs or regimens for the treatment of humanH. pylori infections.     

Atherosclerosis is accelerated in patients with long-term well-controlled systemic lupus erythematosus (SLE)

BACKGROUND: It is uncertain whether atherosclerosis is accelerated in premenopausal and postmenopausal patients with long-term well-controlled systemic lupus erythematosus (SLE). METHODS: We measured the intima-media thickness (IMT) of the carotid arteries and the cardio-ankle vascular index (CAVI) in 39 women with SLE and in age- and sex-matched controls. RESULTS: In the premenopausal state, carotid plaque was detected only in SLE patients (36%). In the postmenopausal state, the maximum IMT was about 2-fold greater in SLE patients than in control subjects (1.3+/-0.7 vs. 0.7+/-0.2 mm, p<0.001). CAVI was higher in both the premenopausal and postmenopausal SLE patients. The serum amyloid A protein (SAA) was higher in SLE patients in the premenopausal state (p=0.025), while remnant like particle-cholesterol (RLP-C), the homeostasis model assessment of insulin resistance (HOMA-IR), and SAA were significantly increased in postmenopausal SLE patients (p=0.001, p<0.001 and p<0.05, respectively). Multiple regression analysis revealed that the maximum IMT was associated with cumulative PSL dosage (p=0.027) and SAA (p=0.074) in the premenopausal SLE patients, and with HOMA-IR (p<0.001) in the postmenopausal SLE patients. CONCLUSION: Atherosclerosis is accelerated in long-term well-controlled SLE. More attention should be given to subclinical inflammation and insulin resistance in the management of SLE patients.     

Issues in cancer pain management

In this article, three aspects of recent issues in cancer pain management such as pain assessment, drowsiness with morphine, and problem in home care setting. First, the assessment of 'impact of pain' is to assess whether the treatment is sufficient for the patient. On the other hand, assessment of 'pain intensity' is the effectiveness of the treatment. Therefore, to reduce the gap in pain evaluations between cancer patients and medical stuffs by assessing the 'impact of pain' in addition to 'intensity of pain'. Second, increasing dosage of morphine often reduces pain, at the same time patients become drowsy. This is often observed soon after starting morphine administration, especially, patients who have renal dysfunction. An active morphine metabolite morphine-6-Glucuronide is excreted into urine, so that, renal dysfunction causes drowsiness. Third, at home care setting, patients tend to be into poor pain control condition. It is necessary that paying attention on patient's knowledge of medications and having support program for pain management for home care setting.     

Cytapheresis for the treatment of myeloperoxidase antineutrophil cytoplasmic antibody-associated vasculitis: report of five cases.

To minimize the adverse effects of high-dose administration of steroids and cyclophosphamide in patients with myeloperoxidase (MPO) antineutrophil cytoplasmic antibody (ANCA), granulocytapheresis (GCAP) or leukocytapheresis (LCAP) was performed to reduce inflammation. Four patients with rapidly progressive glomerulonephritis (RPGN) and one patient with pulmonary hemorrhage due to MPO-ANCA-associated vasculitis were treated by cytapheresis. The prednisolone (PSL) dose was 0.28 +/- 0.15 mg/kg/day (mean +/- SD) (range 0.18-0.50 g/kg/day). In the 4 RPGN patients, the peak serum creatinine level was 3.7 +/- 1.9 mg/dl (range 1.7 to 5.6 mg/dl). GCAP was performed in 3 RPGN patients and in 1 pulmonary hemorrhage patient. LCAP was performed in 1 RPGN patient. In the 4 RPGN patients, renal function improved after combined therapy with cytapheresis and corticosteroids. In the pulmonary hemorrhage patient, evidence of pulmonary hemorrhage on chest computed tomography scanning diminished after combined therapy with cytapheresis and corticosteroids. Cytapheresis, when combined with a low-dose or intermediate-dose PSL regimen, is effective in the treatment of ANCA-associated vasculitis.