Primary iliopsoas abscess successfully treated by ultrasonographically guided percutaneous drainage

We report a case of primary iliopsoas abscess successfully treated by ultrasonographically guided percutaneous drainage. A 56-year-old man presented at our hospital with lumbago, right-sided back pain, fever (temperature 38.5°C) and chills. On physical examination, we found dark red skin, swelling, and tenderness localized at the right side at the back of his waist. Laboratory examination showed leukocytosis (white blood cell count 9700/mm³) with a leftward shift and elevated C-reactive protein (5.2 mg/dl). Ultrasonography (US), computed tomography (CT), and magnetic resonance imaging revealed a hypodense lesion in the right iliopsoas muscle extending to the subcutaneous tissue. About 50 ml of thick yellow pus was obtained by ultrasonographically guided aspiration drainage. A drain catheter was inserted in the abscess cavity. Laboratory findings improved and clinical symptoms abated rapidly after drainage. On the twenty-first day after drainage, US and CT showed that the abscess was no longer present. The patient was discharged after 32 days of hospitalization. As possible primary diseases causing iliopsoas abscess, such as digestive tract disease, tuberculosis, and osteomyelitis, were not found, we diagnosed the disease as primary iliopsoas abscess. Although surgical drainage has been performed in most reported cases of iliopsoas abscess, this case report shows that ultrasonographically guided percutaneous drainage is also effective for treating primary iliopsoas abscess if it is diagnosed early enough. Received for publication on Aug. 20, 1997; accepted on March 4, 1998     

SUPPRESSIVE EFFECTS OF A HERBAL FORMULA, TBL-1, ON TYPE II COLLAGEN-INDUCED ARTHRITIS IN DBA/1J MICE

1. The effects of a formula of traditional Chinese medicine, TBL-1, on collagen-induced arthritis (CIA) were investigated in DBA/1J mice. 2. From 4 weeks after the first immunization with bovine type II collagen (CII), TBL-1 or indomethacin was administered orally for 13 weeks. 3. Clinical scores of CIA were decreased by both TBL-1 and indomethacin intervention compared with the control CII-immunized group. 4. Radiographic scores of phalangeal destruction were markedly improved by TBL-1 intervention (P<0.001), but indomethacin failed. 5. The suppressive effects of TBL-1, but not indomethacin, were manifested in reduced serum anti-CII antibody titres (P<0.001). 6. These findings suggest that TBL-1 may play a role in regulating some immune responses in the present arthritis model.     

Brain tumor accumulation and plasma pharmacokinetic parameters of 2′-deoxy-5-18F-fluorouridine

Using positron emission tomography and radio-high performance liquid chromatography, the accumulation of 2′-deoxy-5-¹⁸F-fluorouridine in the brain tumors and plasma pharmacokinetic parameters were investigated in 20 patients. High accumulation of the tracer in high grade gliomas and meningiomas and very rapid degradation of the tracer in the plasma were found. Very large variations were observed in both tumor accumulation and pharmacokinetic data. The tumor accumulation, however, did not correlate with any of the plasma pharmacokinetic parameters: area under the plasma concentration-time curve, mean residence time, total body clearance and steady-state volume of distribution. The results suggest that the accumulation of the tracer reflects the metabolic activity of the brain tumor tissues and that the effect of the rapid metabolic change in the tracer in the plasma on the tumor accumulation may be minor.     

Suppression of catechol-O-methyltransferase activity through blunting of alpha2-adrenoceptor can explain hypertension in Dahl salt-sensitive rats.

Catecholamines have been reported to be involved in the development of salt-sensitive hypertension. We investigated the relation between catechol-O-methyltransferase (COMT) and salt-sensitivity. In the first experiment, Dahl salt-sensitive (DS) rats were given a normal-salt (NS), high-salt (HS), or HS+hydralazine (80 mg/l water) diet for 4 or 13 weeks, and Dahl salt-resistant (DR) rats were given a NS or HS diet. COMT activities in both the kidneys and liver and urinary norepinephrine (NE) and dopamine (DA) excretion were measured. In the second experiment, HepG2 cells were used to investigate the role of NE in regulating COMT activity. In the third experiment, we investigated the reactivity of pre- and postsynaptic alpha(2)-adrenoceptor (AR) in DS rats. HS loading significantly suppressed the activities of membrane-bound COMT (MB-COMT) and, consistent with this finding, increased the urinary NE level in DS rats, but not in DR rats. Hydralazine did not restore the MB-COMT activities, which suggested that HS loading rather than elevated blood pressure suppressed the MB-COMT activities. The in vitro experiment using HepG2 cells revealed that NE increased the MB-COMT activity via the alpha(2)-AR. However, both the pre- and postsynaptic alpha(2)-AR reactivity was decreased by HS loading in DS rats. In conclusion, HS intake suppresses the MB-COMT activities in DS rats, presumably by blunting alpha(2)-AR signaling. The suppression of MB-COMT activities, consequent decrease in degradation of NE, and increase in NE release by blunting of alpha(2)-AR function may be involved in the development of salt-sensitive hypertension in DS rats, in whom DA-dependent natriuresis may be suppressed.     

Three cases of right-sided active endocarditis with multiple pulmonary infarction

We have experienced three patients with right-sided active endocarditis combined with multiple pulmonary infarction. Ventricular septal defect (VSD), aortic regurgitation (AR), tricuspid regurgitation (TR) and congestive heart failure were present in case 1. TR was present in case 2. VSD, TR and patent ductus arteriosus were present in case 3.α-Streptococcus caused endocarditis in case 1 and 3;Candida albicans caused endocarditis in case 2. Antibotic therapy had no effect in case 2 and 3. Case 1 and 3 developed pulmonary hemorrhage, which resolved before the operation in case 1, but not in case 3. Our three patients underwent surgery and recovered successfully. They were discharged on the 43th, 58th and 32th postoperative day and are presently free of clinical symptoms. These experiences suggest surgery should be undertaken in the following situations: 1. antibiotic therapy has no effect on the infection, 2. hemodynamics are worsening, and 3. pulmonary infarction and pulmonary hemorrhage ccur repeatedly.     

Medical therapy in patients with left main coronary artery stenosis]

To elucidate the long-term prognosis of medically-treated patients with left main coronary artery (LMCA) lesions, 119 consecutive patients with LMCA lesions undergoing coronary angiography were analyzed retrospectively. Among these, 3 patients died soon after angiography and were excluded from this study. Among the remaining 116 patients, 22 were treated medically (Group M) for the following reasons: profound left ventricular (LV) dysfunction (3 patients), effective pharmacological treatment (10), and patients' refusal of surgical therapy (9). Among 94 patients who underwent coronary artery bypass graft (CABG), 83 patients survived (Group S). During the follow-up period, cardiac events occurred in 5 patients in Group M; cardiac deaths in 3, non-fatal myocardial infarction (MI) in one and late application of CABG in one. Two-year cardiac event-free rate after diagnosis was 77%, which remained unchanged thereafter. The cumulative survival rate was 83%. The incidence of cardiac events in Group M was higher than that in Group S (p < 0.01). However, cardiac event rates were similar between these 2 groups for patients with good collateral circulations to the left coronary arteries, no preceding MI and LV end-diastolic pressure less than 15 mmHg. We concluded that the Japanese patients with severe LMCA lesions who respond favorably to pharmacological intervention have unexpectedly good prognoses, however, obstructed collateral circulation to the left coronary system, the presence of preceding MI and high LV end-diastolic pressure were all high-risk factors for medically-treated patients.     

Quantitative and qualitative assessment of reactive hematopoietic bone marrow in aplastic anemia using MR spectroscopy with variable echo times

OBJECTIVE: To assess quantitative and qualitative differences in water components between normal bone marrow and reactive hematopoietic marrow in aplastic anemia using magnetic resonance (MR) spectroscopy with variable echo times (TEs). DESIGN: Water content, T2 value of the water component, and signal change in water related to TE were assessed in normal bone marrow and reactive hematopoietic bone marrow by a stimulated echo acquisition mode with TEs of 30, 45, 60, and 90 ms. PATIENTS: Six patients with aplastic anemia (13-84 years) and seven normal volunteers (25-38 years) were examined. RESULTS AND CONCLUSION: Reactive hematopoietic marrow showed significantly higher water content than normal bone marrow. The T2 value of water components tended to be longer in reactive hematopoietic marrow. Water signal ratio related to TE was significantly higher in reactive hematopoietic marrow. These results suggest a quantitative and qualitative difference in water components between normal and reactive hematopoietic bone marrow.