Internal herniation through a defect of the broad ligament of the uterus.

Internal herniation through a defect of the uterine broad ligament is rarely encountered. We report a case of a 52-year-old woman in whom a closed bowel loop with approximation of its ends to the uterus was the definitive computed tomographic finding. This type of internal herniation should be considered in the differential diagnosis of female patients presenting with ileus.

Virtual MR microscopy for unruptured aneurysm.

PURPOSE: This study was performed to evaluate the usefulness of virtual magnetic resonance microscopy (VMRM) for the diagnosis of cerebral aneurysms. MATERIALS AND METHODS: We reviewed 11 patients with unruptured aneurysms confirmed by angiography or surgical therapy. We evaluated the ability of VMRM to represent aneurysms and the findings of the form and neck of the aneurysms. RESULTS: VMRM revealed 17 aneurysms, one of which was not detected by MR angiography (MRA). One suspected aneurysm by MRA was denied by VMRM. Although VMRM did not clearly demonstrate either one giant aneurysm or distal middle cerebral artery, two aneurysms in the cavernous sinus were clearly visualized by VMRM. VMRM seems to be almost equivalent to computed tomography angiography when detecting aneurysms without additional radiation exposure. CONCLUSION: VMRM is found valuable not only to plan the microscopic surgical therapy, but to visualize aneurysms.

[Regional cerebral blood flow of the basal ganglia and thalamus measured using Xe-CT].

Cerebral blood flow (CBF) images obtained using Xe-CT have a much higher spatial resolution than SPECT or PET images. The regional CBF (rCBF) of deep brain regions, the basal ganglia and thalamus, was able to be measured using Xe-CT in 6 subjects. Average rCBF was 87.1 +/- 20.7 ml/100 g/min in the caudate nucleus, 83.5 +/- 15.8 ml/100 g/min in the putamen, 50.0 +/- 8.7 ml/100 g/min in the globus pallidus and 88.9 +/- 12.4 ml/100 g/min in the thalamus. The average rCBF value of the globus pallidus was lower than the values of the caudate nucleus, putamen and thalamus. These observations may be explained by reduced cellularity of the globus pallidus in comparison to the other regions. SPECT and PET are not able to clearly demonstrate the globus pallidus on CBF images. However, precise rCBF values can be measured in the globus pallidus using Xe-CT.

Intrapleural therapy with MDP-Lys (L18), a synthetic derivative of muramyl dipeptide, against malignant pleurisy associated with lung cancer.

N2-[(N-acetylmuramoyl)-L-alanyl-D-isoglutaminyl]-N6-stearoyl-L-lysine (MDP-Lys (L18), romurtide) is a synthetic muramyl dipeptide derivative, and has immunomodulating activities including activation of cells of monocyte-macrophage lineage. We examined the effect of intrapleural instillation of MDP-Lys (L18) against malignant pleurisy associated with lung cancer. Six patients with cytologically-positive malignant pleural effusion (four with adenocarcinoma, one with small cell carcinoma and one with large cell carcinoma) were treated with single intrapleural instillation of MDP-Lys (L18) of 200 microg. Clinically, no reaccumulation of pleural effusion for at least 4 weeks was observed in four patients. No major side effects were observed. Total cell number elevated remarkably 4 h after instillation, and main increased population was that of neutrophils. Levels of chemotactic cytokines, such as interleukin (IL)-8, and monocyte chemotactic protein (MCP)-1 and levels of pro-inflammatory cytokines, such as tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta and IL-6, elevated in pleural effusion, and peak IL-1beta and IL-6 levels tended to be higher in clinical responders than non-responders. These results suggest MDP-Lys (L18) instilled by intrapleural route had a potential local immunomodulatory activity. Further study is warranted to further determine the critical factors which correlate with the clinical response.

Histopathologic correlates of temporal diffusion changes in a rat model of cerebral hypoxia/ischemia.

BACKGROUND AND PURPOSE: Although diffusion-weighted MR imaging is a powerful tool for evaluating brain ischemia, histopathologic correlates of temporal diffusion changes in cerebral hypoxia/ischemia have not been extensively examined. Diffusion-weighted MR imaging was used to evaluate the relationship between the time course of apparent diffusion coefficient (ADC) changes and the histopathologic findings in cerebral hypoxia/ischemia. METHODS: Thirty 3-week-old rats were subjected to either a 15-, 30-, or 60-minute hypoxic/ischemic insult (unilateral common carotid artery ligation and exposure to 8% oxygen), during and after which diffusion- and T2-weighted MR imaging was performed. Each animal was killed 48 hours or 6 hours after the insult, and fixed sections of the parietal cortex were examined by light microscopy. Ten other (control) rats were subjected to only unilateral common carotid artery ligation or hypoxia. RESULTS: The experimental rats showed three patterns of ADC change, depending on the duration of the hypoxic/ischemic insult: transient (15-minute), biphasic (15-, 30-, or 60-minute), and persistent (60-minute) ADC reduction patterns. The transient ADC reduction pattern (reduction during the insult and recovery after resuscitation) was associated with selective neuronal death. The biphasic and persistent ADC reduction patterns (transient recovery and no recovery after resuscitation, respectively) were associated with cerebral infarction. CONCLUSION: Different temporal patterns of ADC change are associated with different histopathologic findings. Although the clinical manifestations of these different histopathologic presentations are not yet defined, this study indicates that sequential diffusion studies are a potentially powerful tool in the evaluation of hypoxic/ischemic brain injury.

Production of interleukin-10 by alveolar macrophages from lung cancer patients.

Interleukin (IL)-10 is known to be an autoregulatory factor of functions of monocyte macrophages. The purpose of this study was to determine whether IL-10 production by alveolar macrophages (AMs) is altered in patients with lung cancer. AMs were obtained by bronchoalveolar lavage from 25 patients with lung cancer and 14 control patients. The production of IL-10 by AMs was quantitated by enzyme immunoassay with or without stimulation with lipopolysaccharide (LPS). No significant difference in spontaneous and LPS-stimulated IL-10 production by AMs was observed between lung cancer patients and control patients (mean +/- SEM; 288.0 +/- 56.7 vs. 249.6 +/- 58.4 pg ml-1). IL-10 production of LPS-stimulated AMs was not impaired even in lung cancer patients with systemic metastasis. IL-4 failed to suppress LPS-induced production of IL-10 by AMs both in control patients and in lung cancer patients. In eight patients with lung cancer, IL-10 production by AMs was estimated before and after systemic chemotherapy and IL-10 production by LPS-stimulated AMs tended to increase after systemic chemotherapy from 152.3 +/- 51.9 to 278.0 +/- 112.8 pg ml-1. As IL-10 is a potent inhibitor of tumour angiogenesis, an important process of tumour progression, these results suggest that, even in advanced cancer patients, macrophages can produce potent angiogenesis inhibitor and systemic chemotherapy may augment this inhibitory activity in the lung.

Evaluation of the substantia nigra in patients with Parkinsonian syndrome accomplished using multishot diffusion-weighted MR imaging.

BACKGROUND AND PURPOSE: Although it is important to evaluate the substantia nigra in patients with parkinsonian syndrome, it is difficult to depict its anatomy, even by MR imaging. Using anatomic studies of the direction of nerve fibers around the substantia nigra, we attempted to depict this entity with multishot diffusion-weighted MR imaging to evaluate its topographic changes in patients with Parkinson's disease and secondary parkinsonism. METHODS: We measured the substantia nigra on 72 diffusion-weighted axial MR images obtained in 36 healthy control subjects, on 47 images obtained in 25 patients with Parkinson's disease, and on 10 images obtained in five patients with secondary parkinsonism. We considered the width of the minor axis of the substantia nigra as its "thickness," which appeared as a crescent-shaped region in the midbrain. RESULTS: Diffusion-weighted imaging portrayed the substantia nigra distinctly better than did T2-weighted imaging, because the surrounding white matter appeared as an area of high signal intensity. The mean (+/- SD) thickness values of the substantia nigra were 5.1+/-0.89 mm in control subjects, 4.8+/-0.75 mm in patients with Parkinson's disease, and 3.4+/-0.53 mm in patients with secondary parkinsonism. CONCLUSION: Multishot diffusion-weighted imaging is a better imaging technique than T2-weighted imaging for demonstrating a change in size of the substantia nigra in vivo. The substantia nigra is not reduced in size in patients with Parkinson's disease, but it is reduced in patients with secondary parkinsonism.

Clinical and neuroradiological features of intracranial vertebrobasilar artery dissection.

BACKGROUND AND PURPOSE: We sought to determine the clinical and neuroradiological features of intracranial vertebrobasilar artery dissection. METHODS: The clinical features and MR findings of 31 patients (20 men and 11 women) with intracranial vertebrobasilar artery dissections confirmed by vertebral angiography were analyzed retrospectively. The vertebral angiography revealed the double lumen sign in 11 patients (13 arteries) and the pearl and string sign in 20 patients (28 arteries). RESULTS: The patients ranged in age from 25 to 82 years (mean, 54.8 years). Clinical symptoms due to ischemic cerebellar and/or brain stem lesions were common, but in 3 cases the dissections were discovered incidentally while an unrelated disorder was investigated. Headache, which has been emphasized as the only specific clinical sign of vertebrobasilar artery dissection, was found in 55% of the patients. Intramural hematoma on T1-weighted images has been emphasized as a specific MR finding. The positive rate of intramural hematoma was 32%. Double lumen on 3-dimensional (3-D) spoiled gradient-recalled acquisition (SPGR) images after the injection of contrast medium was identified in 87% of the patients. The 3-D SPGR imaging method is considered useful for the screening of vertebrobasilar artery dissection. CONCLUSIONS: Intracranial vertebrobasilar artery dissection is probably much more frequent than previously considered. Such patients may present no or only minor symptoms. Neuroradiological screening for posterior circulation requires MR examinations, including contrast-enhanced 3-D SPGR. Angiography may be necessary for the definite diagnosis of intracranial vertebrobasilar artery dissection because the sensitivity of the finding of intramural hematoma is not satisfactory.

Abducens nerve enhancement in acute ophthalmoparesis.

Acute ophthalmoparesis (AO) is a monophasic disease characterized by acute onset of paresis of the extraocular muscles without ataxia or areflexia. Here we report a case of AO with gadolinium enhancement in the cisternal portion of the abducens nerves using contrast-enhanced three-dimensional magnetic resonance imaging.

Sarcoidosis associated with acute renal failure and increased levels of interleukin-6 in urine.

A 24-year-old man who had uveitis and showed intrathoracic lymph node swelling on a chest X-ray, was admitted to our hospital for further examination. Transbronchial lung biopsy specimens revealed non-caseating granulomas compatible to sarcoidosis. As the renal function became progressively worse, a specimen was obtained by renal biopsy. It showed a granuloma formation, and was diagnosed as renal sarcoidosis. A high level of interleukin (IL)-6 was detected in his urine. After oral administration of prednisolone, the renal function improved, and the urinary IL-6 level was reduced. These findings suggest that in sarcoidosis associated with renal failure, steroid therapy is effective and that IL-6 plays an important role in the pathogenesis of renal involvement of sarcoidosis.

MRI anatomy of white matter layers around the trigone of the lateral ventricle.

MRI was obtained in eight normal volunteers and seven patients with brain oedema around the trigone. In addition to the conventional sequences, diffusion-weighted and intravoxel-incoherent-motion images using motion-proving anteroposterior and/or lateral direction gradients were obtained to show the white matter pathways better. Coronal proton-density-weighted images showed three thin relatively high-intensity layers in addition to the tapetum and the internal and external sagittal strata. Although they have not been confirmed anatomically, the thin layer between the internal and the external sagittal strata was corroborated by diffusion-weighted and intravoxel-incoherent-motion images, and by characteristics of the spread of oedema into the sagittal stratum. We propose that this layer be named the central sagittal lamina. The other two layers medial and lateral to the sagittal stratum were outside, but in contact with the medial and lateral parts of the sagittal stratum, respectively. We provisionally named them medial and lateral sagittal laminae; they were not evident on any other images. The low-intensity layer on T2-weighting was the internal sagittal stratum. The optic radiation, comprising the external sagittal stratum, appeared as an intermediate to slightly high-intensity layer on T2-weighted images and a low-intensity layer on T1-weighted images as did the corticospinal tract in the posterior internal capsule.

Dilated Virchow-Robin spaces: MRI pathological study.

We performed a histopathological study of two human brains to look at dilated Virchow-Robin (V-R) spaces in the anterior perforated substance and putamen. We measured the diameter of 74 arteries in 54 dilated V-R spaces. In 28 patients without neurological deficits we ascertained the characteristic location of dilated V-R spaces in the anterior perforated substance and basal ganglia on MRI, measuring the distance from 64 foci of cerebrospinal fluid signal intensity to the centre of the mamillary body on 1 mm thick images. In the histopathological study, the mean diameter of the arteries was 39.0 +/- 36.0 microns. Dilatation of the V-R space was observed from the end of the indentation of the pial membrane towards the brain surface along the perforating artery. In the MR images, the mean distance from the dilated V-R space to the mamillary body was 10.0 +/- 4.5 mm. The V-R space was confined to a fixed level in the lower part of the basal ganglia, and not found near the brain surface.

Generation of killer activity by interleukin-12 of mononuclear cells in malignant pleural effusions due to lung cancer.

In the present study, we examined the ability of interleukin (IL)-12 to generate an antitumor effect in the tumor-growing site. Mononuclear cells (MNC) were obtained from 12 malignant pleural effusions due to lung cancer in the tumor-growing site. Non-major-histocompatibility-complex-restricted killer activity, examined by 4-h 51Cr release assay against Daudi lymphoma cells as well as various lung cancer cell lines (H69 and PC-9), and in vitro production of interferon gamma (IFNgamma), measured by enzyme immunoassay, were investigated as mediators of antitumor effects of host cells activated by IL-12. IL-12 induced killer activity of MNC in pleural effusions (pleural MNC) dose-dependently. Moreover, pleural MNC produced a signficant amount of IFNgamma in response to IL- 12. The killer activities of IL-12-activated blood MNC were higher than those of pleural MNC. The supernatants of pleural effusions of these untreated patients suppressed killer induction by IL-12 of blood MNC of healthy volunteers. These observations suggest that MNC present at the site of growing tumors may act as effector cells against lung cancer in the presence of IL-12.

Intrapleural instillation of interferon gamma in patients with malignant pleurisy due to lung cancer.

The effect of intrapleural instillation of recombinant human interferon gamma (IFN gamma) at increasing doses of (1-12) x 10(6) U was examined in six patients with cytologically positive pleural effusion due to lung cancer. Intrapleural instillation was repeated up to three times. Clinically, no reaccumulation of pleural effusion was observed in one patient and disappearance of lung cancer cells from the pleural effusion was seen in two other patients. No severe side-effects were observed. Considerable levels of IFN gamma remained in the pleural effusion as well as in patients' serum up to 7 days after instillation of 2 x 10(6) U and higher doses. The total cell number showed a transient decrease on day 1 of therapy. Levels of pro-inflammatory cytokines, such as tumor necrosis factor alpha, interleukin(IL)-1 beta and IL-6, in the pleural effusion remained almost stable after IFN gamma instillation. On the other hand, intrapleural IL-1 receptor antagonist levels were remarkably elevated by the instillation of IFN gamma. IL-2- and IL-12-inducible killer activity of pleural mononuclear cells tended to increase slightly. Despite the inability of IFN gamma to control pleural effusion in this treatment schedule, IFN gamma instilled by an intrapleural route had a potential local antitumor activity. Moreover, since IFN gamma persists in pleural effusions for a long time after a single instillation, such a therapy in combination with other fibrogenic biological response modifiers can be promising.

[A case of rheumatoid lung exacerbated by acetaminophen-induced pneumonitis].

A 57-year-old man was admitted with a high fever, dry cough, severe dyspnea and an interstitial shadow bilaterally on chest roentogenogram. Although his illness was not diagnosed, he was treated with a high dose of methylprednisolone (1 g/day for 3 days) for acute interstitial lung disease. As the 3-day treatment was not effective, high-dose methylprednisolone therapy was repeated. Subsequently, he was treated with prednisolone (60 mg/day), after which his condition improved. After 8 months, the patient caught cold for which he was treated. Subsequently his previous lung disease appeared again. His illness, improved after steroid therapy. The patient had been treated with Shin-Ruru-A tablets during his first admission. A lymphocyte stimulation test for Shin-Ruru-A-Tablet, PL granule, and acetaminophen (which is the common constituent of the former two drugs), was positive. Polyarthralgia, bone lesions joint swelling, and a positive rheumatoid factor test were present on first admission. Therefore, his illness was diagnosed as rheumatoid arthritis (RA). As the interstitial shadow remained after treatment of the lung disease, a thoracoscopic lung biopsy was performed. The specimen revealed an intensive lymphocytic infiltration, perivasculatitis, and thickening of the alveolar septa. These findings corresponded with those of lung disease associated with RA. The results suggest that lung disease associated with collagen vascular diseases may be exacerbated by drug-induced pneumonitis.

Interleukin-12-mediated killer activity in lung cancer patients.

The authors investigated the interleukin (IL)-12-inducible killer activity of blood mononuclear cells (MNC) from 30 untreated primary lung cancer patients and 24 control subjects. Cytotoxicity was assayed as 4-h 51Cr release from Daudi lymphoma cells or lung cancer cells (H-69, N-291 and PC-9). MNC from lung cancer patients exhibited similar killer activity to those from control subjects after in vitro incubation with IL-12 for 4 days. Effective killer induction by IL-12 was observed even in MNC from advanced lung cancer patients and patients with small cell lung cancer. IL-12 and a suboptimal dose of IL-2 had additive effects in inducing killer activity in MNC from both lung cancer patients and control subjects. On the other hand, with an optimal dose of IL-2, IL-12 suppressed killer induction. Addition of IL-12 alone or in combination with IL-2 resulted in interferon (IFN)-gamma production by MNC from lung cancer patients as well as control subjects. These observations suggest that IL-12 could be useful for immunotherapy of lung cancer in humans.

Induction by interleukin-15 of human killer cell activity against lung cancer cell lines and its regulatory mechanisms.

Interleukin (IL)-15 is a novel cytokine with IL-2-like activity. In the present study, we examined IL-15-mediated induction of killer activity of peripheral blood mononuclear cells (MNC) against lung cancer cell lines, and the regulatory mechanisms of this induction by IL-15. Cytotoxic activity was measured by 51Cr release assay. IL-15 at concentrations of more than 10 ng/ml induced significant killer activity of blood MNC against a small cell lung cancer cell line (SBC-3), as well as Daudi cells, and 50 ng/ml was considered its optimal concentration. A time course study revealed that an incubation period of 4-6 days was optimal for induction of killer activity. MNC cultured with IL-15 also exhibited killer activity against other lung cancer cell lines (H-69, N-291 and PC-9 cells). IL-15 and IL-12 had additive effects on induction of killer activity against SBC-3 cells. On the other hand, IL-15 had no synergistic or additive effect on induction of killer activity by IL-2. Fresh human monocytes isolated by centrifugal elutriation augmented the development of killer activity of lymphocytes stimulated by IL-15. As a humoral regulatory factor, IL-4 had a suppressive effect on induction of killer activity by IL-15. IFN-gamma, IL-1beta, TNF-alpha, IL-6 or IL-10 had no effect on induction of killer activity by IL-15 at the optimal concentration. These results suggest that IL-15 has potential for the immunotherapy of lung cancers.

[Correlation of regional cerebral blood flow between Xe-CT and 133Xe-SPECT: validity of Xe-CT in evaluating rCBF].

Stable xenon-enhanced computed tomography (Xe-CT), a relatively inexpensive addition of an inhalation system to the CT, has been a common method for the measurement of rCBF in recent years. Although the 133Xe clearance method has been accepted as a standard method since the 1970s, a comparative study of rCBF between Xe-CT and 133Xe-SPECT has not been reported. We studied the validity of Xe-CT for evaluating rCBF in comparison with 133Xe-SPECT. From May 1993 to December 1994, rCBF studies in 31 cases were performed using both methods within one month of each other. We evaluated rCBF of the unilateral cerebral hemisphere at a slice of OM + 80 mm level. Finally, Eleven cases were excluded from the analysis because of the existence of ventricle in the image and/or discrepancy in the clinical state between the two examinations. In the remaining 20 cases, there was a significant correlation of rCBF between Xe-CT (Y) and 133Xe-SPECT(X)(Y = 0.95X-1.7, r = 0.86, p < 0.001, n = 40). The results supported the usefulness of Xe-CT for the quantitative assessment of rCBF. As compared with SPECT, Xe-CT offers the advantages of much higher spatial resolution, allowing more precise reference of flow and anatomy, and providing quantitative information on rCBF in deeper regions of the brain.

Fluid collection in the pericardial sinuses and recesses. Thin-section helical computed tomography observations and hypothesis.

RATIONALE AND OBJECTIVES: This study describes the thin-section helical computed tomography (CT) appearance of near-water-density structures situated posterior to the pulmonary trunk and right main pulmonary artery, and to consider the implications of these CT images. METHODS: Three-millimeter-thick helical CT scans of the mediastina of 133 patients were reviewed to determine the incidence and range of appearance of near-water-density structures situated posterior to the pulmonary trunk and right main pulmonary artery. Thin-section helical CT appearance was compared with that of fluid collection in the pericardial sinuses and recesses of patients with pericardial effusion, and with descriptions of the pericardial sinuses and recesses in the literature. RESULTS: Near-water-density structures showing varied appearance ranging from bands to mass-like densities were observed on thin-section helical CT images of 49 patients (37%) who had no obvious effusion in the pericardial cavity proper. The locations of the structures corresponded to the sites of recesses in the transverse and oblique sinuses, and their appearance was similar to that of fluid in the pericardial sinuses and recesses. CONCLUSION: Near-water-density structures situated posterior to the pulmonary trunk and right main pulmonary artery in patients without obvious pericardial effusion were concluded to be physiologic fluid collections in the recesses of the transverse and oblique sinuses.

Palliative steroid therapy and serum interleukin-6 levels in a patient with lung cancer.

We report a patient with metastatic adenocarcinoma of the lung who had a detectable serum interleukin-6 (IL-6) level. Despite systemic chemotherapy, the tumor progressed, with elevation of serum IL-6 level. Palliative steroid therapy with 20 mg/day of prednisolone resulted in the decline of serum IL-6 level and, simultaneously, improved anorexia and oral intake. Although there was no weight gain or improvement in hypoalbuminemia, these results suggest that steroids may suppress the abnormal production of IL-6 in cancer patients and that this action affects symptoms. Further study is warranted to clarify the role of IL-6 in tumor-related symptoms and the effect of steroid therapy in relation to IL-6 production in cancer patients.