Skeletal metastases from hepatoma: frequency, distribution, and radiographic features

Over the past 6 years, the authors evaluated 300 patients with hepatoma as part of phase 1 and 2 treatment protocol trials. Analysis of the available clinical data and radiographic studies revealed 22 patients (7.3%) with skeletal metastases demonstrated by radiography, computed tomography (CT), and/or nuclear scintigraphy. The plain film appearance of skeletal metastases from hepatoma was osteolytic in all cases. CT scanning best demonstrated the expansile, destructive nature of these metastases, which were often associated with large, bulky soft-tissue masses. Skeletal metastases from hepatomas demonstrated increased radiotracer uptake on standard bone scans and were gallium avid, similar to the hepatoma itself. In addition, they could be targeted therapeutically with I-131 antiferritin immunoglobulin. The most frequent sites of skeletal metastases were the ribs, spine, femur, pelvis, and humerus. An initial symptom in ten patients was skeletal pain corresponding to the osseous metastases. In five patients, pathologic fractures of the proximal femur or humerus developed and required total hip replacement or open-reduction internal fixation. Patients with long-standing cirrhosis or known hepatocellular carcinoma who also have skeletal symptoms should be evaluated for possible osseous metastases.     

Inferior vena caval filters: noninvasive evaluation

Transvenous inferior vena caval filters were placed in 32 patients (21 bird's nest [BN] and 11 Kimray-Greenfield [K-G] filters). Positive contrast cavography was performed before and immediately after filter placement as well as during long-term follow-up studies. In 23 patients, computed tomographic (CT) scanning was also performed; in 10 patients, real-time ultrasound (US) study was used as an adjunct. CT scans of the BN filter showed one case of hemorrhage and one case of air embolism, both of which were not recognized at cavography. CT scanning of the K-G filter demonstrated two cases of deep penetration of the prongs and one large retroperitoneal hematoma. Real-time US scanning played a major role in checking the final position of the filter and in determining its stability during repositioning of the upper prongs of one BN filter. Noninvasive examinations, including CT and US scanning, are valuable adjuncts in immediate and long-term follow-up study of patients with inferior vena caval filters.     

Ovary volume in young and premenopausal adults: US determination. Work in progress

Normal adult ovary volume determined by ultrasonography (US) is often stated to be less than 6 cm3. This is based on data from teenagers and young adults aged 12-20 years. Recently, the mean normal volume determined by US was reported to be considerably higher. We measured the volumes of 28 ovaries from 15 healthy young adults and found them to range as high as 13.84 cm3, with an average of 6.48 cm3.     

Pharmacological characterization of binding sites identified in rat brain following in vivo administration of [3H]-spiperone.

[3H]-spiperone is commonly used to label dopamine receptors in vitro in brain tissue. However, spiperone also interacts with brain 5-hydroxytryptamine and noradrenaline receptors. In vivo, [3H]-spiperone has been used for identifying dopamine receptors in both animals and man but the nature of the sites identified is unknown. The in vivo administration of [3H]-spiperone to rats leads to a selective accumulation of radioactivity in the olfactory lobes, tuberculum olfactorium, nucleus accumbens, striatum, substantia nigra, hippocampus, frontal cortex and hypothalamus, when compared to the cerebellum. In vivo drug displacement studies suggest that the binding of [3H]-spiperone in these areas may be to dopamine, 5-HT or noradrenaline receptors. [3H]-spiperone in vivo mainly labels dopamine receptors in striatum, tuberculum olfactorium, hypothalamus, substantia nigra and olfactory lobes. However, in the frontal cortex and nucleus accumbens specific binding involves not only dopamine receptors but also 5-HT and/or noradrenaline receptors. Interpretation of in vivo studies in man using radioactive spiperone and its derivatives must take into account the fact that this ligand only labels dopamine receptors in some brain areas.