67Ga scan for evaluating response to therapy in malignant lymphoma

⁶⁷Ga scintigrams in a patient with malignant lymphoma before and after chemotherapy are presented. ⁶⁷Ga did not accumulate in the mostly necrotic mass with some viable cells. Negative uptake of ⁶⁷Ga might reflect necrosis of the tumor; however, it is difficult to detect some residual tumor cells. Therefore, negative uptake of ⁶⁷Ga in the mass seen in X-ray CT may not be totally reliable evidence of eradication of viable tumor cells.     

Organization of regenerating serotonergic fibers in the hippocampal formation

To evaluate the capacity of fiber outgrowth of serotonergic and dopaminergic neurons from the dorsal raphe tissue, the following three experiments were performed; (1) fetal mesencephalic raphe tissue was transplanted into the ventricle near the denervated hippocampal formation of adult rats, (2) fetal mesencephalic raphe and neonatal hippocampal tissues were transplanted into the anterior eye chamber of adult rats, and (3) fetal mesencephalic raphe tissue was explanted together with the neonatal hippocampal tissue. The extent of the fiber outgrowth was examined immunohistochemically using serotonin and tyrosine hydroxylase (TH) antisera. Three months after transplantation into the host brain, serotonin-immunoreactive (ir) fibers from raphe graft were densely distributed throughout the graft and in the host hippocampal formation, and TH-ir fibers were restricted to an area near the somata of TH-ir neurons. In particular, hyperinnervation of serotonin-ir fibers was observed in the molecular layer of the dentate gyrus. Two months after intraocular transplantation, mesencephalic raphe tissue contained a large number of serotonin- and TH-ir neurons and fibers. The distribution pattern of outgrowing serotonin-ir fibers in the hippocampal tissue was similar to that observed following intraventricular transplantation. Two weeks after explantation, the raphe tissue contained numerous serotonin-ir neurons and their fibers. These fibers extended into the hippocampal tissue in the same manner as the intraventricular and intraocular transplants. These results indicate that the intrinsic factors of hippocampal tissue influence the organization of serotonergic fibers in the hippocampal formation.     

Identification of genes associated with dedifferentiation of hepatocellular carcinoma with expression profiling analysis.

To identify the genes associated with dedifferentiation of hepatocellular carcinoma (HCC), gene expression profiles of HCCs of well-and moderately differentiated grades were compared by means of oligonucleotide arrays. One tumor showed a nodule-in-nodule appearance (NIN), which is occasionally observed in the course of progression of HCC from well to less differentiated grade, when an inner, moderately differentiated tumor (MD) develops sequentially from the outer, well-differentiated tumor (WD). Seventy-six genes were identified to be up-regulated more than 3-fold and 33 genes were down-regulated in the inner nodule in NIN. By statistical analysis of the profiles from 10 individual additional liver tumors, 5 WDs and 5 MDs, we were able to identify 12 genes, LAMA3, PPIB, ADAR, PSMD4, NDUFS8, D9SVA, CCT3, GBAP, ARD1, RDBP, CSRP2, and TLE1, with significantly elevated expression, and 4 genes, CP, IL7R, CD48, and PLGL, with decreased expression in MD. These selected genes were further validated using another 12 tumors, 5 WDs and 7 MDs, with semi-quantitative RT-PCR. We also applied neighborhood analysis to list the genes with high predictability values as most closely correlated with WD-MD distinction. Seven genes, ADAR, PSMD4, D9SVA, CCT3, GBAP, RDBP, and CSRP2, whose expression was elevated and one gene, IL7R, whose expression was decreased, were included among the top 50 predictor genes. These genes are likely to be associated with dedifferentiation of HCC and their identification may help to elucidate the mechanism of liver cancer progression.     

Visualization of the bone/bone marrow of lower extremities in Ga-67 whole-body images

Patients whose Ga-67 whole-body images showed increased uptake by the bone/bone marrow of the lower extremities were selected and classified into three types according to the extent and the grade of the visualization. These types were then compared with their serum iron levels, iron-binding capacities, and the results of several other serum biochemical tests. Of 374 consecutive whole body 72-hr images reviewed, 59 (15.8%) showed increased uptake of the tracer by the bone/bone marrow of the lower extremities. The three classified types were as follows: type T--visualization of both tibiae and femurs; type S--strong visualization of the femurs; and type W--weak visualization of the femurs. The serum iron concentration was significantly high in type T and low in type S. In conclusion, the pattern of Ga-67 uptake by the bone/bone marrow of the lower extremities fairly closely reflects the status of iron metabolism.     

Urticarial Vasculitis with Papular Lesions in a Patient with Type C Hepatitis and Cryoglobulinemia

We describe a case of urticarial vasculitis accompanied by erythematous wheals, palpable pupura, and subsequent necrotic ulcerated papular lesions in a patient with type C chronic hepatitis and type II cryoglobulinemia (IgM-kappa and polyclonal IgG). A 56-year-old man developed recurrent urticarial lesions on his lower extremities and trunk. The histology revealed leukocytoclastic vasculitis with perivascular immunoglobulin deposits. Subsequently, multiple reddish papular lesions with necrotic ulcerations appeared on the extensor aspect of his extremities and buttocks. Histology of these lesions showed cryoglobulinemic vasculitis with prominent fibrinoid necrosis of the vascular walls and cryoprecipitate within the vasculature as well as increased hyalinized collagen bundles. These papular lesions have not previously been described as cutaneous necrotizing venulitis to the best of our knowledge. It is suggested that the immune response to hepatitis C virus infection and cryoglobulins may be responsible for severe necrotizing venulitis, resulting in unusual cutaneous lesions.     

Tracer delay correction of cerebral blood flow with dynamic susceptibility contrast-enhanced MRI.

Cerebral blood flow (CBF) and vascular mean transit time (MTT) can be determined by dynamic susceptibility contrast-enhanced magnetic resonance imaging and deconvolution with an arterial input function. However, deconvolution by a singular value decomposition (SVD) method is sensitive to the tracer delay that often occurs in patients with cerebrovascular disease. We investigated the effect of tracer delay on CBF determined by SVD deconvolution. Simulation study showed that underestimation of CBF due to tracer delay was larger for shorter MTTs. We developed a delay correction method that determines tracer delay by means of least-squares fitting pixel-by-pixel. The corrected CBF was determined by SVD deconvolution after time-shifting of the measured concentration curve. The simulations showed that the corrected CBF was insensitive to tracer delay irrespective of the vascular model, although CBF fluctuation increased slightly. We applied the delay correction to the CBF and MTT images acquired for nine patients with hyperacute stroke and unilateral occlusion of the middle cerebral artery. We found in some patients that the delay correction modulated the contrast of CBF and MTT images. For hyperacute stroke patients, tracer delay correction is essential to obtain reliable perfusion image when SVD deconvolution is used.     

Effectiveness of Ilizarov external fixation in elderly patients with pilon fractures

BackgroundPilon fractures are associated with soft tissue complications such as skin necrosis, and deep infections have been reported very often. This study retrospectively compared the treatment effects of Ilizarov external fixation and of internal fixation methods in elderly patients with pilon fractures.MethodsA total of 37 patients >60 years old with pilon fractures (AO classification type 43) were investigated. Patients were treated either with internal fixation (n = 15) or Ilizarov external fixation (n = 22). The patients' mean age was 74.2 (range, 60–78) years in the internal fixation group and 76.1 (range, 60–82) years in the Ilizarov external fixation group. Many patients in the internal fixation group received toe-touch to 1/3 partial weight-bearing at 2–4 weeks postoperatively and full weight-bearing by 6–8 weeks postoperatively. Many patients in the Ilizarov external fixation group received partial weight-bearing (as tolerated) 1 day postoperatively, 1/2 partial weight-bearing at 2 weeks postoperatively, and full weight-bearing at 4 weeks postoperatively.ResultsThe mean duration of hospitalization was 79.1 ± 30.1 days for the internal fixation group and 29.1 ± 18.8 days for the Ilizarov external fixation group (p < 0.05). Bone mineral density (T-score) was 2.6 ± 0.7 for the internal fixation group and 3.6 ± 1.2 for the Ilizarov external fixation group (p < 0.05). The incidence of skin disorders that required additional surgical treatment was 33.3% (5/15 patients) in the internal fixation group and 0% (0/22 patients) in the Ilizarov external fixation group (p < 0.05).ConclusionsIn elderly patients with periarticular fractures of the ankle, those who underwent Ilizarov external fixation had a shorter duration of hospitalization and fewer complications than those who underwent internal fixation.