Impending Rupture of a Blunt Trauma-Induced Left Ventricular Aneurysm: Report of a Case

Most left ventricular true aneurysms that occur secondary to blunt trauma gradually become symptomatic as they enlarge, which validates conservative management as a reasonable initial course of action. We report a case of impending rupture of a left ventricular true aneurysm that showed rapid expansion within a few weeks. A 17-year-old youth was involved in a head-on collision into a car while riding a motorcycle. He underwent repair of a ruptured jejunum and internal fixation of a fractured femur; 28 days after the accident, he was transferred to another hospital for rehabilitation. His chest X-ray just before the transfer was normal. He was re-admitted to our hospital 58 days after the accident complaining of anterior chest pain and dyspnea. Echocardiography showed impending rupture of a left ventricular aneurysm. We performed emergency open repair of a left ventricular true aneurysm with a very thin wall. We report this case to show that even a true aneurysm of the left ventricle should be carefully monitored from the early stage, considering the possibility of rupture.     

Antileishmanial activities associated with plants used in the Malian traditional medicine

Sixty-four extracts issued from twenty-one plants used in the Malian traditional medicine--several of them as antiparasitic drugs--were assayed for their antileishmanial effects against both extracellular and intracellular forms of Leishmania major. Seven extracts from six different plants--Sarcocephalus latifolius, Zanthoxylum zanthoxyloides, Entada africana, Bobgunnia madagascarensis, Pseudocedrela kotschyi and Psorospermum guineense--were found to be significantly active against the intracellular form of the parasite.     

心电图V1、V2导联高R波的心向量意义（附61例分析）

目的：通过心向量（VCG）检验,进一步评估心电图（ECG）中表现为V1、V2导联高R波的意义。方法：对心电图中表现为V1、V2导联高R波的患者进行心向量检查（共61例）,并将结果进行分析、统计。结果：通过心向量对61例V1、V2导联高R波患者进行分析诊断,其结果为左中隔支传导阻滞者18例,占总数29．51％;正后壁心肌梗塞者14例,占总数22．95％;右室肥厚3例,占总数4．92％;双室肥厚2例,占总数3．28％;预激综合征（C型）1例,占1．64％,大致正常者23例,占总数的37．70％。结论：心向量对心电图V1、V2导联高R波的鉴别诊断有意义。     

Magnetic resonance imaging with true fast imaging with steady-state precession and half-Fourier acquisition single-shot turbo spin-echo sequences in cases of suspected placenta accreta

Purpose: To present the magnetic resonance imaging (MRI) findings of placenta accreta in suspected cases of placenta accreta with true fast imaging with steady-state precession (True FISP) and half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences.

Material and Methods: Five patients underwent MRI with HASTE (n=5) and/or True FISP (n=4) sequences for suspected placenta accreta. Retrospective review of MRI was performed to define the location and extent of the implantation abnormality.

Results: The uteroplacental interface was visualized as three layers; inner low signal intensity layer, middle high signal intensity layer of myometrium, and outer low signal intensity layer of uterine serosa. Three cases were diagnosed with placenta accreta on MRI and focal non-visualization of the inner layer was demonstrated.

Conclusion: The finding of focal non-visualization of the inner layer between the placenta and myometrium by MRI with True FISP and HASTE sequences was the diagnostic finding for placenta accreta.     

Differentiation between hepatic cyst and hemangioma: additive value of breath-hold, multisection fluid-attenuated inversion-recovery magnetic resonance imaging using half-Fourier acquisition single-shot turbo-spin-echo sequence

PURPOSE: To evaluate the additive value of breath-hold, multisection fluid-attenuated inversion-recovery (FLAIR) magnetic resonance imaging (MRI) using half-Fourier acquisition single-shot turbo-spin-echo (HASTE) sequence as supplements to moderately and heavily T2-weighted fast-spin-echo (FSE) sequences in differentiating hepatic cyst from hemangioma. MATERIALS AND METHODS: A total of 183 lesions (127 hepatic cysts, 56 hepatic hemangiomas) in 117 patients were evaluated in this study. Three radiologists independently reviewed FLAIR MR images using a HASTE sequence and T2-weighted FSE MR images. Each radiologist used a five-point scale to rate his confidence in determination of hepatic cyst and hemangioma. RESULTS: All three reviewers were significantly better able to differentiate hepatic cyst from hepatic hemangioma with the combination of FLAIR imaging using HASTE and moderately and heavily T2-weighted FSE images (area under the receiver operating characteristic (ROC) curve, 0.99 for each reader) than with moderately and heavily T2-weighted FSE images alone (0.82-0.93; P < 0.05). FLAIR-HASTE imaging in addition to T2-weighted FSE sequences improved the diagnostic performance, including the sensitivity, specificity, accuracy, and confident diagnosis in the differentiation between hepatic hemangiomas and cysts. CONCLUSION: FLAIR-HASTE imaging is useful for distinguishing hepatic hemangioma from hepatic cyst without the use of contrast-enhanced MR images.     

Dose optimization of mannitol solution for small bowel distension in MRI

PURPOSE: To optimize the dose of a hydro solution containing 2.5% mannitol and 0.2% locust bean gum (LBG) for small bowel MRI in terms of bowel distension and patient acceptance. MATERIALS AND METHODS: A total of 10 healthy volunteers ingested a hydro solution containing 2.5% mannitol and 0.2% LBG. Four different volumes (1500, 1200, 1000, and 800 ml) were assessed on four different examination days. Small bowel distension was quantified on coronal two-dimensional TrueFISP images by measuring the diameter of eight bowel loops throughout the jejunum and the ileum. In addition, volunteer acceptance was evaluated for every single examination by using a questionnaire. RESULTS: Optimal distension was obtained with either, 1000, 1200, or 1500 ml, with no statistically significant differences in distension between these groups. Administration of 800 ml led to significantly less distension of the small bowel. Significantly less side effects were noted using either 800 or 1000 ml compared to using larger volumes. CONCLUSION: We recommend a dose of 1000 ml mannitol/LBG solution as an oral contrast agent for optimal bowel distension and minimal side effects.     

Identification of cells of the human mononuclear phagocyte system with rat monoclonal antibodies

Five rat monoclonal antibodies (McAbs) to human macrophages are described: YTH 8.18, YTH 25.7, YTH 51.1, YTH 85.12.1, and YHB 65.5. These McAbs are divided into three groups, since YTH 8.18, YTH 51.1, and YHB 65.5 are thought to identify the same antigen. These McAbs react with some bone marrow blast cells, granulocytes, and different percentages of peripheral blood monocytes. When studied on different body tissues, they were found to identify all members of the mononuclear phagocyte system (MPS), except Langerhans cells of skin and epithelium and in the case of one group (YTH 8.18/YTH 51.1/YHB 65.5) osteoclasts. In nine reactive lymph nodes the anti macrophage McAbs identified germinal centre macrophages, sinus macrophages, and interdigitating cells, but not dendritic reticulum cells. They also identified epithelioid macrophages and Langhans-type multi-nucleated giant cells in lymph nodes involved in granulomatous lesions (sarcoidosis and toxoplasmosis). In 24 cases of non-Hodgkin's lymphoma, the antimacrophage McAbs identified reactive macrophages in cases of B- or T-lymphocyte origin, whereas in three selected cases of true histiocytic lymphoma all the McAbs were found to be reactive with the vast majority of neoplastic macrophages as they were with the cells of a neoplastic macrophage line (U937). The possible use of these McAbs in the identification of benign and malignant macrophages in different systems is discussed.     

HLA-DR-associated genetic control of the type of leprosy in a population from Surinam

The relationship between HLA phenotype and leprosy classification was studied in 73 unrelated patients and 92 healthy controls from a mixed Negroid-Caucasoid population originating from Surinam, South America. Heterogeneity in the distribution of HLA-DR (but not A, B, and C) was detected between tuberculoid (TT^* + BT^*) leprosy and lepromatous (BL^* + LL^*) leprosy patients (p = 0.024). This heterogeneity appeared to be caused almost exclusively by DR3. Most significantly, the frequency of DR3 was increased among polar tuberculoid (TT) leprosy patients as compared to the rest of the patients (p = 0.0003). Compared with healthy controls the frequency of DR3 was increased among TT patients p = 0.0006), unchanged in BT patients, and decreased among lepromatous (BL + LL) patients (p = 0.027). These data indicate that in this population an DR3-associated factor controls the type of the disease that develops after infection with Mycobacterium leprae.     

Bizarre leiomyoma of the prostate

Summary Obstruction of the urethra, caused by a prostatic tumour necessitated prostatectomy in a 49-yr-old man. Histology revealed a moderately cellular and vascular tumour with marked cellular atypia. After a follow-up for three years, the results of both the clinical investigations and prostatic needle biopsy were negative. Thus the original opinion of malignant prostatic mesenchymal tumour was revised, resulting in the diagnosis of bizarre leiomyoma. Subsequently the smooth muscle cell origin and the benign nature of the tumour were demonstrated by electron microscopy and Feulgen-cytophotometry, respectively. This is the first prostatic bizarre leiomyoma in which malignancy was excluded by demonstrating euploid polyploidy. This case also calls the attention to the need of more sophisticated methods in everyday diagnostic pathology.