Comparison of pre- and postcontrast 3D time-of-flight MR angiography for the evaluation of distal intracranial branch occlusions in acute ischemic stroke

BACKGROUND AND PURPOSE: Three-dimensional time-of-flight (TOF) MR angiography is used routinely in stroke workup to detect arterial occlusions, but a major drawback is its inadequate depiction of vessels with slow or in-plane flow. We hypothesized that the use of contrast-enhanced MR angiography improves delineation of vessels with diminished or absent flow on precontrast MR angiograms. METHODS: Pre- and postcontrast 3D TOF MR angiograms were acquired in 55 consecutive patients with acute stroke. Patency of 480 intracranial vessels was assessed on both the pre- and postcontrast angiograms. Diffusion-weighted (DW) and perfusion-weighted (PW) imaging data were also obtained and results correlated with those of pre- and postcontrast MR angiography. RESULTS: For 50 abnormal vessel segments seen on precontrast MR angiograms, postcontrast MR angiograms resulted in change in the vascular signal intensity in 70% (35 vessel segments); 94% of these changes showed a greater extent of vessel patency. Venous and soft-tissue contrast enhancement had no effect on assessment in 95% of all 480 vessels examined. Interobserver reliability was moderate, with postcontrast interpretation (kappa = 0.48) showing a slight improvement over precontrast interpretation (kappa = 0.41). Good agreement was found between the TOF results and the pooled DW and PW imaging results. CONCLUSIONS: Compared with precontrast 3D TOF MR angiograms, postcontrast 3D TOF angiograms improve assessment of intracranial vessel patency in acutely ischemic vascular territories. In some patients, an improved understanding of acute ischemic stroke was obtained by viewing the pre- and postcontrast images. Postcontrast MR angiography should be included in the MR evaluation of acute stroke.     

The relationship between power and the time to achieve .VO(2max)

PURPOSE: The severe exercise intensity domain may be defined as that range of work rates over which .VO(2max) can be elicited during constant-load exercise. The purpose of this study was to help characterize the .VO(2) response within this domain. METHODS: Eleven participants performed cycle ergometer exercise tests to fatigue at several discrete work rates between 95% and 135% of the maximum power (P(max)) achieved during an incremental exercise test. RESULTS: As previously demonstrated, the relationship between power and time to fatigue was hyperbolic. The asymptote of power (critical power, P(critical)) was 198 +/- 44 W. The rapidity of the .VO(2) response increased systematically at higher work rates such that the relationship between power and time to .VO(2max) was also well fit by a hyperbola. The power asymptote of this relationship (196 +/- 42 W) was not different from P(critical)(P > 0.05). The two hyperbolic relationships converged at 342 +/- 70 W (136% P(max)). CONCLUSION: These data suggest that, for this population of male and female university students, the upper boundary of the severe exercise intensity domain is approximately 136% P(max). This upper boundary is the highest work rate for which exercise duration is prolonged sufficiently (in this study, 136 +/- 17 s) to allow .VO(2) to rise to its maximal value. The lower boundary for severe exercise is just above P(critical), which is the highest work rate that is sustainable for a prolonged duration and that will not elicit .VO(2max).     

Predictive factors associated with long-term survival in patients with neuroendocrine tumors of the pancreas

Background Neuroendocrine tumors of the pancreas are rare tumors. We identified predictive factors that are associated with long-term survival (≥5 years). Methods Fifty patients with a diagnosis of neuroendocrine tumors of the pancreas were retrospectively evaluated. The following factors were evaluated for disease-specific mortality: age, sex, primary tumor location, functional status, type of primary tumor treatment, presence or absence of liver metastases, timing of liver metastases occurrence, and type of liver metastases treatment. Aggressive treatment of the liver metastases included surgery, chemoembolization, or intrahepatic arterial infusion chemotherapy. Results Twenty-three patients (47%) had tumor located in the head of the pancreas, and 29 patients (58%) had nonfunctioning tumor. Thirty-nine patients (78%) had liver metastases. The median follow-up for the entire group was 35 months (range, 76–206 months). The median survival for the entire group was 40 months, and the overall 1-, 2-, and 5-year survival rates were 84%, 69%, and 36%, respectively. Factors that had a significant favorable effect on survival included curative resection of the primary tumor, metachronous liver metastases, absence of liver metastases, and aggressive treatment of the liver metastases. Conclusions Definitive surgical resection of the primary tumor, absence of liver metastases, metachronous liver metastases, and aggressive treatment of the liver metastases were predictors of long-term survival in patients with neuroendocrine tumors of the pancreas. Presented as a poster presentation at the Society of Surgical Oncology 55th Annual Cancer Symposium, Denver, Colorado, March 14–17, 2002.     

Involvement of the endocannabinoid system in the ability of long-term tricyclic antidepressant treatment to suppress stress-induced activation of the hypothalamic-pituitary-adrenal axis.

The efficacy of antidepressants has been linked in part to their ability to reduce activity of the hypothalamic-pituitary-adrenal (HPA) axis; however, the mechanism by which antidepressants regulate the HPA axis is largely unknown. Given that recent research has demonstrated that endocannabinoids can regulate the HPA axis and exhibit antidepressant potential, we examined the hypothesis that the endocannabinoid system is regulated by long-term antidepressant treatment. Three-week administration of the tricyclic antidepressant desipramine (10 mg/kg/day) resulted in a significant increase in the density of the cannabinoid CB(1) receptor in the hippocampus and hypothalamus, without significantly altering endocannabinoid content in any brain structure examined. Furthermore, chronic desipramine treatment resulted in a reduction in both secretion of corticosterone and the induction of the immediate early gene c-fos in the medial dorsal parvocellular region of the paraventricular nucleus of the hypothalamus (PVN) following a 5 min exposure to swim stress. Acute treatment with the CB(1) receptor antagonist, AM251 (1 mg/kg), before exposure to swim stress, completely occluded the ability of desipramine to reduce both corticosterone secretion and induction of c-fos expression in the PVN. Collectively, these data demonstrate that CB(1) receptor density in the hippocampus and hypothalamus is increased by chronic tricyclic antidepressant treatment, and suggest that this upregulation could contribute to the ability of tricyclic antidepressants to suppress stress-induced activation of the HPA axis.     

USCAP Specialty Conference: Case 1-Type I Pleuropulmonary Blastoma

Pleuropulmonary blastoma (PPB) was defined in 1988 by Manivel et al. in a series describing 11 intrathoracic pulmonary neoplasms in young children [1]. The PPB is a unique peripheral pulmonary or pleural-based tumor of childhood that is characterized in its earliest form as a bland-appearing multiloculated cyst with small foci of tumor cells and in later forms as mixed and predominantly primitive, overtly malignant neoplasms [2,3]. Prior to the introduction of the PPB as a distinct entity, this tumor had been reported in the literature as pulmonary blastoma, sarcoma arising in mesenchymal cystic hamartoma, embryonal sarcoma, malignant mesenchymoma, primary pulmonary rhabdomyosarcoma and rhabdomyosarcoma arising in congenital adenomatoid malformation or bronchogenic cyst. Over the past 15 years, PPB has come to be recognized in centers around the world. With the establishment of the Pleuropulmonary Blastoma Registry by Jack Priest, MD, and colleagues, there has been improved understanding of this rare pediatric neoplasm. The registry Web site serves as an important resource for physicians and families ().     

Effects of aerobic fitness on fat oxidation and body fatness

OBJECTIVE: This study investigated the contributions of physical fitness and body composition to 24-h fat oxidation in adults under sedentary conditions in a whole-room calorimeter. METHODS: The following measurements were studied in 109 adults (49 male/45 female) at least 36 h after a bout of exercise: 1) aerobic fitness level assessed by VO2max, 2) body composition determined by underwater weighing, 3) resting metabolic rate (RMR) after an overnight fast, and 4) 24-h energy expenditure (EE) and substrate oxidation determined in a whole-room calorimeter. While in the calorimeter, subjects were provided with a diet (15% protein, 30% fat, and 55% carbohydrate) estimated to produce energy balance on a sedentary day and of similar nutritional composition to their daily dietary intake. RESULTS: We found strong negative correlations between VO2max and % body fat in both male and female subjects, but no relationship between VO2max and 24-h EE under the sedentary conditions of this study. In male subjects, VO2max (mL O2 x kg(-1) fat-free mass x min(-1)) was negatively related to fat oxidation (r = -0.397, P < 0.005), and fat oxidation was more closely related to fat mass (r = 0.434, P < 0.0002) than to fat-free mass (r = 0.165, NS). In contrast, none of these relationships were significant in females. CONCLUSION: The results show that in male subjects under sedentary conditions, 24-h fat oxidation is positively related to body fat mass and negatively related to VO2max (the marker used here for level of physical fitness). This supports our hypothesis that regularly active males maintain lower body fat stores as the low contribution to daily fat oxidation from a lower body fat mass is counterbalanced by the high contribution to fat oxidation from daily physical activity. The lack of a relationship between VO2max and 24-h EE under the sedentary conditions of this study suggests that the major effects of physical activity on total daily EE and fat oxidation may occur during and relatively quickly after an exercise bout. Further, these data also suggest that cessation of regular exercise will likely be associated with a high risk of positive fat balance and weight gain.