Imaging endolymphatic hydrops at 3 tesla using 3D-FLAIR with intratympanic Gd-DTPA administration.

PURPOSE: Visualization of endolymphatic hydrops by 3-dimensional fluid-attenuated inversion recovery-FLAIR using conventional turbo-spin-echo (3D-FLAIR-CONV) after intratympanic injection of Gd-DTPA has been reported in patients with Ménière's disease. Compared to 3D-FLAIR-CONV used in previous studies, the addition of a variable flip-angle technique (3D-FLAIR-VFL) enables very long echo trains and, therefore, shorter scan times. We evaluated whether 3D-FLAIR-VFL could replace 3D-FLAIR-CONV in detecting endolymphatic hydrops after intratympanic Gd-DTPA administration. METHODS: Eleven patients were included in this study. Twenty-four hours after Gd-DTPA injection, we performed 3D-FLAIR-CONV and 3D-FLAIR-VFL imaging at 3T. We compared the contrast-to-noise ratio (CNR) between cochlear fluid and the cerebellum between the 2 FLAIR sequences. We subjectively scored the size of the endolymphatic space in the cochlea and vestibule for each patient and correlated the scores with the clinical diagnoses. RESULTS: The CNR of 3D-FLAIR-CONV was significantly higher than that of 3D-FLAIR-VFL. Scores for the size of endolymphatic space in the vestibule were identical between the 2 sequences; however, those in the cochlea disagreed in 3 cases. 3D-FLAIR-CONV correlated better with the clinical diagnoses. CONCLUSIONS: Currently, we may not be able to replace 3D-FLAIR-CONV with 3D-FLAIR-VFL, at least not with the scanning parameters used in the present study.     

Rat‐bite fever identified by polymerase chain reaction detection of Streptobacillus moniliformis DNA

A 74‐year‐old woman presented with erythema of the extremities, a high fever and arthralgia after being bitten by a rat. The patient was diagnosed as having rat‐bite fever based on the symptoms and clinical course, as well as the polymerase chain reaction detection of Streptobacillus moniliformis DNA in the crust of the bite site. This is the first case to be diagnosed using polymerase chain reaction on a crusted skin lesion specimen. Although clinical symptoms initially remitted with minocycline therapy, they relapsed. Subsequent administration of piperacillin sodium resulted in complete disappearance of the high fever and arthralgia.     

Subcellular distribution and metabolism studies of the potential myocardial imaging agent [99mTc(N)(DBODC)(PNP5)]+

99mTc(N)-DBODC5 is the lead compound of a new series of monocationic 99mTc(N)-based potential myocardial imaging agents that exhibit original biodistribution properties. This study was addressed to elucidate the mechanisms of distribution, retention, and elimination of this promising 99mTc(N)-agent. METHODS: The sex-related in vitro and in vivo stability and the subcellular distribution of 99mTc(N)-DBODC5 were investigated. Studies were performed by considering binding to the serum proteins; stability in rat serum, human serum, and rat liver homogenates; and the chemical integrity of the complex after extraction from rat tissues such as heart, liver, and kidney, as well as from intestinal fluids and urine. The effect of cyclosporin A on the in vivo pharmacokinetic properties of 99mTc(N)-DBODC5 was also evaluated. Subcellular distribution of 99mTc(N)-DBODC5 in ex vivo rat heart was determined by standard differential centrifugation techniques. RESULTS: No significant in vitro serum protein binding and no notable biotransformation of the native compound into different species by the in vitro action of the serum and liver enzymes was evidenced. In vivo experiments showed that sex affects the pharmacokinetic profile of the 99mTc(N)-complexes including metabolism and excretion. Chromatographic profiles of 99mTc(N)-radioactivity extracted from tissues and fluids of female rats were always coincident with the control. Conversely, a small percentage of metabolized species was detected by high-performance liquid chromatography in liver extracts of male rats. Furthermore, administration of cyclosporin A caused a significant reduction of lung, liver, and kidney washout along with a considerable variation in activity distribution in the intestinal tract in both male and female rats, thus indicating a possible implication of Pgp transporters in determining the biologic behavior of 99mTc(N)-DBODC5. However, this phenomenon was more pronounced in females. Subcellular distribution studies showed that 86.3% +/- 7.4% of 99mTc(N)-DBODC5 was localized into mitochondrial fraction as a result of the interaction with the negative membrane potential. CONCLUSION: Evidence showing that the new 99mTc(N)-myocardial tracers behave as multidrug resistance-associated protein P-glycoprotein substrates, combined with their selective mitochondrial accumulation, strongly supports the possibility that diagnostic application of 99mTc(N)-DBODC5 can be extended to tumor imaging and noninvasive multidrug resistance studies.     

Elevation of 11-dehydro-thromboxane B2 levels in unstable angina]

To evaluate in vivo platelet activation, 11-dehydro-thromboxane B2 levels in plasma and urine were measured in 9 patients with unstable angina and 11 with stable angina using radioimmunoassay modified by the extraction method of Kawano et al. The 2 groups were matched for age, sex, coronary risk factors, medications or atherosclerotic lesions in coronary angiography. Although there was no difference in the plasma level between the 2 groups in the usual state, urinary 11-dehydro-thromboxane B2 amount in unstable angina was significantly increased compared to the stable angina group (865.5 +/- 238.7 vs 535.9 +/- 177.4 pg/mg creatinine (mean +/- SD), p < 0.01). There was no correlation between the 11-dehydro-thromboxane B2 level and the degree of coronary atherosclerosis in either group. The plasma level increased during the attacks in 2 patients with unstable angina. The amount of urinary 6-keto-PGF1 alpha did not differ between the 2 groups. These findings suggest that platelet activation in vivo is more pronounced in unstable angina than in stable angina, and that the measurement of urinary 11-dehydro-thromboxane B2 may be useful for evaluating and treating angina.     

Combined treatment with surgery and intraperitoneal hyperthermic perfusion (IPHP) for far-advanced gastrointestinal cancer with peritoneal seeding

In 19 patients with advanced gastric carcinoma intraperitoneal hyperthermia combined with mitomycin C was administered. After this therapy in repeated cytological examinations of the peritoneal effusion malignant cells could be determined. From 19 patients 5 died innert the first 10 months. The other patients lived 12 months without recurrence.     

Liddle's syndrome, an uncommon form of hyporeninemic hypoaldosteronism: functional and histopathological studies

Liddle's syndrome was diagnosed in a 72-year-old man who presented clinically with hypertension and muscle weakness. This disorder has been characterized by hyporeninemic hypoaldosteronism, hypertension, hypokalemia and enhanced erythrocyte sodium influx. Administration of spironolactone failed to correct the hypertension and electrolyte abnormality, which subsequently improved with triamterene therapy and a low salt diet. However, suppression of the renin-angiotensin-aldosterone system remained unchanged after this treatment. In addition, an atrophic juxtaglomerular apparatus and hypertensive lesions in the arterioles were confirmed by kidney biopsy after triamterene therapy. Therefore, a process of intrinsic hyperactive distal sodium reabsorption, probably affected by aldosterone-independent sodium transport into erythrocytes, appears to be important in the pathogenesis of this syndrome. Triamterene therapy, which usually is performed in patients with this disease, might not be the ultimate therapy in the future even if electrolyte abnormalities were to be improved temporarily.     

Structure-activity relationship studies of (+/-)-terbutaline and (+/-)-fenoterol on beta3-adrenoceptors in the guinea pig gastric fundus.

(+/-)-Terbutaline and (+/-)-fenoterol are both arylethanolamine analogs that have tertbutyl and aryliso-propyl substituents respectively at the a position on the nitrogen of the ethanolamine side chain. In the present study, we have investigated the structure-activity relationships of (+/-)-terbutaline and (+/-)-fenoterol as beta3-adrenoceptor agonists in the guinea pig gastric fundus. (+/-)-Terbutaline and (+/-)-fenoterol induced concentration-dependent relaxation of the precontracted gastric fundus with pD2 values of 4.45+/-0.10 and 5.90+/-0.09, and intrinsic activities of 1.00+/-0.03 and 0.99+/-0.01 respectively. The combination of the selective beta1-adrenoceptor antagonist (+/-)-atenolol (100 microM), and the selective beta2-adrenoceptor antagonist (+/-)-butoxamine (100 microM), produced a 2 and 6 fold rightward shift of the concentration-response curves for (+/-)-terbutaline and (+/-)-fenoterol respectively, without depressing the maximal responses. The order of potency of these agonists was (pD2 value): (+/-)-fenoterol (5.09+/-0.10) > (+/-)-terbutaline (4.13+/-0.08). In the presence of (+/-)-atenolol and (+/-)-butoxamine, however, the non-selective beta1, beta2- and beta3-adrenoceptor antagonist (+/-)-bupranolol caused a concentration-dependent rightward shift of the concentration-response curves for (+/-)-terbutaline and (+/-)-fenoterol. Schild plot analyses of the effects of (+/-)-bupranolol against these agonists gave pA2 values of 6.21+/-0.07 ((+/-)-terbutaline) and 6.37+/-0.06 ((+/-)-fenoterol) respectively, and the slopes of the Schild plot were not significantly different from unity (p>0.05). These results suggest that the relaxant responses to (+/-)-terbutaline and (+/-)-fenoterol are mainly mediated through beta3-adrenoceptors in the guinea pig gastric fundus. The beta3-adrenoceptor agonist potencies of arylethanolamine analogs depend on the size of the end of the alkylamine side chain.     

Study of cerebral blood flow in patients with cerebral infarction by 133Xe inhalation method--comparison between affected and unaffected hemispheres, and sequential changes

Cerebral blood flow in both hemispheres was studied by the 133Xe inhalation method in 49 patients with cerebral infarction in the unilateral hemisphere. They were classified into three groups by computed tomographic findings as follows; relatively large low density lesion including the cerebral cortex and subcortex (cortical: C group), relatively large low density lesion including the subcortical white matter and basal ganglia (large subcortical: L group), and small low density lesion including the subcortical white matter (small subcortical: S group), respectively. Mean cerebral blood flow (mCBF) in the affected hemispheres was markedly low in C group, moderately low in L group, and slightly low in S group, in all of the examinations. Several cases in C and L groups revealed remarkable changes of mCBF less than one month after the onset. MCBF in both hemispheres was lower in C group than in L and S groups less than one week after the onset. Seven to twelve weeks after the onset, mCBF in the affected hemisphere was lower in C and L groups than in S group, and than in the unaffected hemisphere of C and L groups. There was no difference between mCBF in the affected hemisphere and that in the unaffected hemisphere in most of S group. Sequential changes of mCBF in both hemispheres were divided into seven types in 27 cases, who were examined first less than one week and repeatedly then. However, the sequential changes were classified roughly into two patterns.(ABSTRACT TRUNCATED AT 250 WORDS)