Pulmonary lymphangitic spread of carcinoma: appearance on CT scans

Chest computed tomography (CT), including high-resolution CT with thin (1.5-mm) sections was used to evaluate proved (pathologically or clinically) lymphangitic spread (LS) of tumor in 12 patients. These appearances were compared with thin-section scans obtained in 11 healthy subjects. Thin-section CT demonstrated findings consistent with thickening of the normal lung interstitium. In all patients, thin sections showed an increase in the number of peripheral lines (1-2 cm in length) that were diffuse in generalized disease and localized in focal disease. Normal peripheral arcades were not increased in number, but the limbs forming the arcades were thickened in all patients. A diffuse increase in linear and curvilinear structures (reticular pattern) was seen toward the center of the lung. Polygonal structures 1-2 cm in diameter were seen in seven patients with LS but not in healthy subjects. Fissures were thickened in nine patients. Selected 1.5-mm-thick CT sections are recommended through abnormal areas (seen at CT or on chest radiographs) or if these are normal at three levels (midapex, hilus, and 3 cm above the diaphragm) when scanning patients with tumors known to cause LS.     

Potentiated 5-hydroxytryptophan induced response suppression in rats following chronic reserpine

Since reserpine precipitates depression in some hypertensive patients, we tested this drug on our animal model of depression. The present experiment was designed to measure the effects of chronic reserpine treatment on 5-hydroxytryptophan (5-HTP) induced behavioral depression in rats trained on a food reinforcement operant schedule. Based on the Aprison et al. model of depression involving the serotonergic system, we predicted the development of receptor supersensitivity of postsynaptic serotonin (5-HT) receptors due to the decreased release of this neurotransmitter as a consequence of chronic reserpine treatment. Rats were trained on a VI 1 reinforcement schedule and then divided into 3 chronic treatment groups. One received daily injections of a placebo, another 0.025 mg/kg reserpine and the third 0.05 mg/kg reserpine. We found that 5-HTP induced behavioral depression was potentiated in rats chronically treated with reserpine, thus suggesting the development of supersensitive 5-HT receptors. These results support the hypothesis that in some types of human depression a decreased release of 5-HT occurs of sufficient duration to permit the subsequent development of supersensitive 5-HT receptors.     

Development of Targeted Message Concepts for Recent Asian Immigrants About Secondhand Smoke

Residents of Boston's Chinatown and the Vietnamese community in Boston's Dorchester section are recent immigrants from China and Vietnam, countries whose smoking prevalence rates for men are among the highest in the world and whose rates for women are very low. We conducted exploratory focus groups in these communities to examine issues related to secondhand smoke and to generate message concepts for health education materials that would convince recent Asian immigrants to respond to the public health threat that secondhand smoke poses. The message concepts, which were tailored specifically for Chinese and Vietnamese immigrants, used themes that were consistent with the cultural values of each group as expressed in the focus groups, yet also reflected the fact that, in many ways, these immigrants are seeking to adapt to American norms. We suggest that it is possible to construct culturally appropriate health education materials for recent immigrant populations rather than rely on simple translations of English-language materials. An intervention study using these message concepts is needed.     

Residential Traffic Exposure,Pulse Pressure,and C-reactive Protein: Consistency and Contrast among Exposure Characterization Methods

Background

Traffic exposure may increase cardiovascular disease (CVD) risk via systemic inflammation and elevated blood pressure, two important clinical markers for managing disease progression.

Objectives

We assessed degree and consistency of association between traffic exposure indicators as predictors of C-reactive protein (CRP) and pulse pressure (PP) in an adult U.S. Puerto Rican population (n = 1,017).

Methods

Cross-sectional information on health and demographics and blood data was collected. Using multiple linear regression, we tested for associations between CRP, PP, and six traffic exposure indicators including residential proximity to roads with > 20,000 vehicles/day and traffic density [vehicle miles traveled per square mile (VMT/mi²)]. Diabetes and obesity [body mass index (BMI) ≥ 30 kg/m²] were tested as effect modifiers.

Results

CRP was positively associated with traffic density in the total population [36% CRP difference with 95% confidence interval (CI) 2.5–81%] for residence within the highest versus lowest VMT/mi² level. With BMI ≥ 30, CRP showed significant positive associations with five of six traffic indices including residence ≤ 200 m versus > 200 m of a roadway [22.7% CRP difference (95% CI, 3.15–46.1)] and traffic density in the third highest versus lowest VMT/mi² level [28.1% difference (95% CI, 1.0–62.6)]. PP was positively associated with residence within ≤ 100 m of a roadway for the total population [2.2 mmHg (95% CI, 0.13–4.3 mmHg)] and persons with BMI ≥ 30 [3.8 mmHg (95% CI, 0.88–6.8)]. Effect estimates approximately doubled for residence within ≤ 200 m of two or more roadways, particularly in persons with diabetes [8.1 mmHg (95% CI, 2.2–14.1)].

Conclusions

Traffic exposure at roadway volumes as low as 20,000–40,000 vehicles/day may increase CVD risk through adverse effects on blood pressure and inflammation. Individuals with elevated inflammation profiles, that is, BMI ≥ 30, may be more susceptible to the effects of traffic exposure.     

Radium in the environment: exposure pathways and health effects

Radium is a naturally occurring radioactive element in the environment that can exist as several isotopes. Little information is available on the acute (short-term) non-cancer effects in humans. Radium exposure has resulted in acute leukopenia, anemia, necrosis of the jaw, and other effects. Cancer is the major effect of concern. Radium, via oral exposure, is known to cause bone, head, and nasal passage tumors in humans. The US Environmental Protection Agency has not classified radium for carcinogenicity.     

Picotamide inhibition of excess in vitro thromboxane B2 release by colorectal mucosa in inflammatory bowel disease.

BACKGROUND: Inflammatory bowel disease is associated with increased mucosal release of eicosanoids. Among these, thromboxane A2 has been proposed as a possible inflammatory mediator; its suppression may be a useful therapeutic option. METHODS: Using a tissue incubation technique, we compared release of immunoreactive thromboxane B2 by colonic biopsies from patients with ulcerative colitis, Crohn's disease and controls, and assessed the inhibitory effect of picotamide, a thromboxane synthesis inhibitor-receptor antagonist, which has been widely used in Italy for management of ischaemic heart and cerebrovascular disease. RESULTS: Increased amounts of thromboxane B2 were released from biopsies from patients with active ulcerative colitis (median 238 pg/20 min/mg wet weight (interquartile range 147- 325), n = 12) and active Crohn's disease (252 (174-450), 6) compared with those from patients with quiescent ulcerative colitis (95 (61- 140), 12) or Crohn's disease (105 (57-201), 13), or controls (136 (64- 206), 8). Incubation with picotamide at concentrations between 100 microM and 1 mM reduced thromboxane B2 release (IC50 890 microM). CONCLUSION: Since increased thromboxane A2 production may have pathogenetic importance, thromboxane synthesis inhibitor-receptor antagonists such as picotamide merit therapeutic trial in the management of inflammatory bowel disease.     

The double puncture: an effective percutaneous technique for removing complex, multiple renal calculi

Percutaneous nephrostolithotomy, which can require a double puncture, is presently the method of choice in our institution for the removal of renal stones. Patients that underwent this procedure were evaluated to identify the possible reasons for the double puncture. Of 200 patients evaluated, 14 needed a second tract. The three variables that determined whether a second puncture was needed, in order of importance, were number and size of the stones, with second tracts needed in patients with multiple stones and staghorn calculi; anatomical variations of the renal collecting system itself, with bifid systems the most significant anatomic variation; and the dexterity of the radiologist in performing the puncture and the ability of the urologist to extract the stone. Second tracts were needed more frequently in patients who presented with stones in both the lower and middle poles of the collecting systems.     

Experience with the Amplatz retrievable vena caval filter. Work in progress

The Amplatz retrievable vena caval filter was designed in an attempt to decrease complications associated with the placement of Mobin-Uddin or Kimray-Greenfield filters. The design allows percutaneous retrieval, thus expanding application of the filter to situations requiring temporary prophylaxis against pulmonary embolism. Filters have been placed in 16 patients, nine (56%) for prophylactic purposes. All filters were easily inserted percutaneously. Complications occurred in three patients; these included complete thrombosis of the inferior vena cava below the filter, misplacement of one filter into the pericaval retroperitoneal tissue, and development of thrombus cranial to the filter. With the current introduction system, the possibility of filter misplacement has been essentially eliminated. No patient experienced symptoms suggestive of pulmonary embolism after filter insertion. One filter retrieval has been performed, with no complications.     

EUS-guided radiofrequency ablation in the pancreas: results in a porcine model.

BACKGROUND: Our aim in this study was to investigate the feasibility and safety of performing radiofrequency (RF) ablation in the pancreas with endoscopic ultrasound (EUS). METHODS: RF was applied to normal pancreatic tissue in 13 anesthetized Yorkshire pigs with specially modified 19-gauge needle electrodes (1.0 to 1.5 cm tip). The pancreas was localized with EUS and punctured through a transgastric approach. RF current (285 +/- 120 mA) was delivered for 6 minutes. Diagnostic imaging (EUS and CT) and serum amylase and lipase levels were obtained at baseline, immediately after ablation, and 1 to 14 days after the procedure. Pigs were killed immediately (n = 5), 1 to 2 days after ablation (n = 2), and 2 weeks after the procedure (n = 6). Pathologic examination was performed. RESULTS: Sixteen ablations were performed. During ablation, round hyperechoic foci (diameter to 1.0 cm) gradually surrounded the tip of the electrode. Immediately after the procedure CT demonstrated 1 cm hypodense foci that did not enhance with iodinated contrast. In pigs killed immediately and 1 to 2 days after ablation, pathologic examination showed discrete, well-demarcated spherical foci of coagulation necrosis measuring 8 to 12 mm in diameter surrounded by a 1 to 2 mm rim of hemorrhage. Radiologic-pathologic correlation was within 2 mm. In 4 of 6 (67%) pigs killed on day 14, retraction of the coagulated focus was observed. A 1 to 3 mm fibrotic capsule surrounded the coagulated tissue in the remaining 2 pigs. One pig had mild hyperlipasemia, a focal zone of pancreatitis (<1 cm), and later a pancreatic fluid collection. Biochemical parameters were normal in the remaining pigs. Other complications included three gastric and one intestinal burn caused by improper electrode placement. CONCLUSIONS: EUS-guided RF ablation can be used safely to produce discrete zones of coagulation necrosis in the porcine pancreas. Potential clinical uses of this technology include management of small neuroendocrine tumors and possibly palliation of unresectable pancreatic adenocarcinoma.     

Aberrant carotid artery: recognition on high resolution computed tomography

In the investigation of a pulsatile retrotympanic mass it is important to recognize the high resolution computed tomography findings of an aberrant internal carotid artery. These include an absent exocranial opening of the carotid canal and a tubular density coursing along the medial wall of the middle ear in continuity with the horizontal carotid canal through a dehiscence of the lateral carotid plate. Our report highlights an unusual variation where two anomalous arteries, an aberrant internal carotid and an inferior tympanic to petrous carotid anastomoses, course through the middle ear.