Quantitative Assessment of Circumferential Enhancement along the Wall of Cerebral Aneurysms Using MR Imaging.

BACKGROUND AND PURPOSE: The incidence of wall enhancement of cerebral aneurysms on vessel wall MR imaging has been described as higher in ruptured intracranial aneurysms than in unruptured intracranial aneurysms, but the difference in the degree of enhancement between ruptured and unruptured aneurysms is unknown. We compared the degree of enhancement between ruptured and unruptured intracranial aneurysms by using quantitative MR imaging measures. MATERIALS AND METHODS: We performed quantitative analyses of circumferential enhancement along the wall of cerebral aneurysms in 28 ruptured and 76 unruptured consecutive cases by using vessel wall MR imaging. A 3D-T1-weighted fast spin-echo sequence was obtained before and after contrast media injection, and the wall enhancement index was calculated. We then compared characteristics between ruptured and unruptured aneurysms. RESULTS: The wall enhancement index was significantly higher in ruptured than in unruptured aneurysms (1.70 ± 1.06 versus 0.89 ± 0.88, respectively; P = .0001). The receiver operating characteristic curve analysis found that the most reliable cutoff value of the wall enhancement index to differentiate ruptured from unruptured aneurysms was 0.53 (sensitivity, 0.96; specificity, 0.47). The wall enhancement index remained significant in the multivariate logistic regression analysis (P < .0001). CONCLUSIONS: Greater circumferential enhancement along the wall of cerebral aneurysms correlates with the ruptured state. A quantitative evaluation of circumferential enhancement by using vessel wall MR imaging could be useful in differentiating ruptured from unruptured intracranial aneurysms.

Monoclonal antibody analysis of keratin expression in carcinomas of sweat glands.

Characteristics of keratins of five carcinomas of sweat gland origin were immunohistochemically investigated with several antikeratin monoclonal antibodies with differing specificities. Specimens were obtained from two cases of mucinous carcinoma of the skin, two cases of classic type of eccrine adenocarcinoma, and a case of eccrine porocarcinoma. The tumor cells of mucinous carcinoma expressed only simple epithelial keratins. In a case of eccrine adenocarcinoma, simple epithelial keratin 19 was diffusely expressed. The expression of the other simple epithelial keratins was confined to the luminal cells, whereas the remaining tumor cells further expressed stratified epithelial keratins. Eccrine porocarcinoma and a second case of eccrine adenocarcinoma did not express simple epithelial keratins, although stratified epithelial keratins were diffusely expressed. These data suggest that carcinomas of sweat glands express various combinations of simple and stratified epithelial keratins. Development of additional data along these lines may help to further define their classification.

Pigmented dermatofibrosarcoma protuberans (Bednár tumor). An autopsy case with systemic metastasis.

An autopsy case of pigmented dermatofibrosarcoma protuberans (Bednár tumor) with systemic metastasis is reported. No previous example of this tumor showing widespread metastasis has been reported in the literature. The patient, a 45-year-old man, developed a tumor on the right upper arm. The tumor recurred twice and metastasized to other parts of the skin, lungs and brain during the 8-year clinical course. The primary tumor contained melanin-laden tumor cells and showed a storiform growth pattern. Autopsy confirmed multiple metastatic lesions in the skin, lungs, brain, thyroid, pancreas, stomach, small intestine and thigh muscles. The recurrent and metastatic tumors lacked both melanin production and the storiform arrangement, and instead revealed "fibro-sarcomatous" change with a herring-bone or interlacing pattern of growth.

[Evaluation of cardiac function at rest and under acute loading in patients with essential hypertension using pulsed Doppler echocardiography].

We studied 45 untreated patients with mild to moderate essential hypertension (EH) and 27 normotensive controls to assess the relationship between pulsed Doppler echocardiographic parameters and cardiac function, and the effects of acute changes in preload or afterload on these parameters. The following pulsed Doppler parameters were measured: as left ventricular (LV) inflow parameters, rapid filling peak velocity (R), presystolic peak velocity (A), and A/R; as LV outflow parameters, preejection period (PEP), ejection period (ET), ET/PEP, and peak velocity (PV). These parameters were compared with those relating to cardiac function, such as age, interventricular septal thickness (IVST), LV mass index (LVMI), % fractional shortening (%FS), LV end-systolic wall stress (WS), blood pressure, and heart rate. The changes in preload and afterload were induced by sodium nitroprusside (SNP) or phenylephrine infusion, which caused decreases or increases in the mean blood pressure by approximately 15%. 1. LV inflow parameters: Compared to normals, A and the A/R were higher in the group EH (p less than 0.01). IVST in the group EH correlated with R and the A/R, but LVMI did not correlate with these parameters. In normals, A correlated with %FS and WS, but did not in the group EH. R and the A/R correlated with age in normals, but not in the group EH. 2. LV outflow parameters: There were no significant differences between the two groups. PV in the group EH correlated positively with %FS, and negatively with WS. The ET/PEP in normals correlated with %FS and WS, but not in the group EH. 3. Effects of SNP: Reduction in preload caused a decrease in R and an increase in the A/R in both the groups (p less than 0.01). At the same time, reduction in afterload induced increase in PV. 4. Effects of phenylephrine: An increase in afterload did not change A, R or the A/R, though PV decreased significantly in normals and tended to decrease in the group EH. In summary, though the significance of the pulsed Doppler parameters of the LV was not always the same between the two groups, these parameters may be used to evaluate cardiac function in EH, if we pay attention to the influence of preload and afterload.

Syringocystadenoma papilliferum developed from giant comedo: a case report.

A case of syringocystadenoma papilliferum in a 44-year-old Japanese male provided interesting clinical and histological findings. The lesion was diagnosed clinically as an infectious when on the flexor aspect of the right thigh. Optical microscopical examination of serial sections showed that the tumor parenchyma was deeply seated along the boundary zone between the cutis and subcutis around the lower half of a giant comedo, and extended into the surrounding tissues from the non-keratinized epithelial portion of the giant comedo where the non-keratinized epithelium merged with the upper, keratinized epithelium. The tumor thus appeared to have developed from the non-keratinized transitional epithelium corresponding to the intrafollicular part of the apocrine sweat gland apparatus. Although 103 cases of syringocystadenoma papilliferum have been reported from Japan since 1924, the present findings are both clinically and histologically unique.

Follicular mucinosis developing into cutaneous lymphoma. Report of two cases and review of literature and 64 cases in Japan.

Two cases of follicular mucinosis which developed into lymphoma are reported. The infiltrative atypical lymphocytes proved to be T cells, which were identified by monoclonal antibodies. The association of follicular mucinosis and lymphoma in Japan is estimated to be 9.4%.

Pseudoxanthoma elasticum--a fresh approach to morphogenesis using tannic acid fixation.

A lesion of pseudoxanthoma elasticum at a very early stage was studied by light microscopy and electron microscopy using both tannic acid fixation and the conventional method of fixation. The observations strongly indicated that the primary morphological event arose from alteration in the composition of normal native collagen fiber by way of so-called "elastotically degenerated collagen". Deposition of calcium salts did not appear to initiate degenerative changes in the involved fibers, but merely accompanied the abnormally increased elastic fiber as a secondary phenomenon.

[Study of the distribution of chrome in 17 Cr stainless steel by autoradiography using 51Cr (author's transl)].

The segregation of alloying elements in steels even as small as undetectable in X-ray microanalysers seems to affect physical properties for instance, the ridging phenomenon in a 17 Cr stainless steel sheet due to fine wrinkles of the surface by drawing, the mechanism of which is not yet clear. Study was made of a method for detecting small segregations by autoradiography using 51Cr for the 17 Cr stainless steel. In results. (1) in the steel containing a 0.025% carbon or no carbon content, a small variation in photographic density relating to the concentration of chromium was found. (2) In the case of the steel with a 0.05% carbon content, similar one to commercial steel, a clear photographic density variation was observed which was considered to be a cause of the ridging. (3) The autoradiography is suitable to investigation of the small segregation undetected by an X-ray microanalyser.

Two cases of chromomycosis.

More than 190 cases of chromomycosis have been reported in Japan since the first one in 1933. We encountered two cases of this fungal disease in the last four years. The diagnosis of chromomycosis is still difficult, especially in the early stage and brain metastasis is frequently seen in this country. We report here these two cases with a discussion on clinical manifestations of previous reports in Japan for early diagnosis.

Eight cases of sporotrichosis.

About 1,100 cases of sporotrichosis were reported in Japan between 1955 and 1973. From February 1975, when our hospital opened, to November 1979, we encountered eight cases of this disease. The patients, two males and six females, were aged from 6 months to 90 years old. Among the clinical types, three cases were of the lymphangitic type and five cases were of the localized type. Seven cases treated with oral potassium iodine and one case treated with topical thermotherapy were cured or improved by such treatments. We report here these eight cases with a discussion on clinical manifestations in previous reports of cases in Japan.

Solitary adult xanthogranuloma: a case report with new observation on lipid droplet formation.

A case of solitary xanthogranuloma was studied by optical and electron microscopy. The tumor parenchyma cells were composed mainly of multilocular lipid droplets together with rough-surfaced endoplasmic reticulum, a few mitochondria, glycogen particles, and fine filaments sparsely scattered throughout the cytoplasm. The parenchyma cells bore a close structural resemblance to Ito's "fat-storing cells" which are situated in Disse's space, contain lipid droplets and are thought to be the only cells participating in intralobular fibrillogenesis in the liver. Another notable finding was that the lipid droplets of the tumor parenchyma cells originated directly from rough-surfaced endoplasmic reticulum. Thus, the tumor morphology was incompatible with the currently favored concept of a benign, reactive non-neoplastic process of prominently histiocyte cells, being characterized instead by prominently fibroblastic cells.