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[Diagnosis of thoracic outlet syndrome by angio-MRI]. / Diagnóstico por angiorresonancia magnética del síndrome del estrecho torácico superior.

OBJECTIVE: To evaluate the sequences and maneuvers recommended for the study of the thoracic outlet syndrome (TOS) and the usefulness of magnetic resonance imaging (MRI) in demonstrating its etiology. MATERIAL AND METHODS: We present a study of eight patients with clinical presentation suggestive of TOS. All underwent MRI, gadolinium-enhanced angio-MRI with the arms extended along the body and with postural maneuvers of abduction and elevation of the arms, plain-film chest x-rays, and digital angiography. The anatomic characteristics of the superior aperture of the thorax were analyzed on both sides before and during postural maneuvering. Likewise, the permeability of the vessels and integrity of the brachial plexus was studied. RESULTS: In two cases, angio-MRI demonstrated thrombosis, of the subclavian artery in one case and of the subclavian vein in the other, caused by a cervical rib, which was confirmed at plain-film chest x-ray. In one case, angio-MRI demonstrated stenosis of the subclavian artery on abduction, secondary to hypertrophy of the anterior scalene muscle, and digital angiography showed the same findings. In two cases, angio-MRI showed vascular thrombosis, arterial in one case and venous in the other, without evidence of anatomic anomalies; these findings were confirmed at digital angiography. In two cases, no pathological findings were observed at MRI, angio-MRI, or digital angiography. In one case, MRI showed the presence of a cervical rib without vascular repercussions. CONCLUSION: Gadolinium-enhanced angio-MRI is useful in the evaluation of TOS. It is important to examine patients at rest and during different postural maneuvers. In many cases it is possible to determine the cause of vascular compression.

Diagnóstico por angiorresonancia magnética del síndrome del estrecho torácico superior / Diagnosis of thoracic outlet syndrome by angio-MRI

Objetivo. Valorar las secuencias y las maniobras recomendadas para el estudio del síndrome del estrecho torácico superior (SETS) y la utilidad de la resonancia magnética (RM) a la hora de demostrar su etiología. Material y método. Presentamos un estudio de 8 pacientes con clínica sugerente de SETS. En todos ellos se realizó estudio anatómico de RM, angio-RM con gadolinio, con los brazos extendidos a lo largo del cuerpo y con maniobras posturales de abducción y elevación de los brazos, radiografía de tórax y angiografía digital. Se analizaron las características anatómicas del estrecho torácico superior bilateralmente antes y durante las maniobras posturales. Así mismo, se estudió la permeabilidad de los vasos y la integridad del plexo braquial. Resultados. En dos casos se demostró trombosis de la arteria y vena subclavias respectivamente producida por una costilla cervical, confirmada en la radiografía de tórax. En una paciente se demostró estenosis de la arteria subclavia con maniobra de abducción secundaria a hipertrofia del músculo escaleno anterior; la angiografía digital demostró los mismos hallazgos. En dos casos la angio-RM mostró trombosis vascular, arterial en un caso y venosa en otro, sin evidencia de anomalías anatómicas, este hallazgo se confirmó en el estudio de angiografía digital. En dos pacientes la RM, angio-RM y angiografía digital no mostraron hallazgos patológicos. En un caso la RM puso de manifiesto la presencia de una costilla cervical sin repercusión vascular. Conclusión. La angio-RM con gadolinio es útil para valorar el SETS. Es importante evaluar los pacientes en reposo y con maniobras posturales, pudiendo en muchos casos demostrar la causa responsable de la compresión vascular

Objective. To evaluate the sequences and maneuvers recommended for the study of the thoracic outlet syndrome (TOS) and the usefulness of magnetic resonance imaging (MRI) in demonstrating its etiology. Material and methods. We present a study of eight patients with clinical presentation suggestive of TOS. All underwent MRI, gadolinium-enhanced angio-MRI with the arms extended along the body and with postural maneuvers of abduction and elevation of the arms, plain-film chest x-rays, and digital angiography. The anatomic characteristics of the superior aperture of the thorax were analyzed on both sides before and during postural maneuvering. Likewise, the permeability of the vessels and integrity of the brachial plexus was studied. Results. In two cases, angio-MRI demonstrated thrombosis, of the subclavian artery in one case and of the subclavian vein in the other, caused by a cervical rib, which was confirmed at plain-film chest x-ray. In one case, angio-MRI demonstrated stenosis of the subclavian artery on abduction, secondary to hypertrophy of the anterior scalene muscle, and digital angiography showed the same findings. In two cases, angio-MRI showed vascular thrombosis, arterial in one case and venous in the other, without evidence of anatomic anomalies; these findings were confirmed at digital angiography. In two cases, no pathological findings were observed at MRI, angio-MRI, or digital angiography. In one case, MRI showed the presence of a cervical rib without vascular repercussions. Conclusion. Gadolinium-enhanced angio-MRI is useful in the evaluation of TOS. It is important to examine patients at rest and during different postural maneuvers. In many cases it is possible to determine the cause of vascular compression

Detection of hepatitis B virus DNA and determination of surface antigen expression in peripheral blood mononuclear cells from patients with AIDS.

The polymerase chain reaction (PCR) was used to analyze the presence of hepatitis B virus (HBV) DNA in serum and peripheral blood mononuclear cells (PBMCs) from 20 patients with AIDS with and without conventional HBV serological markers. DNA sequences of HBV were detected in PBMCs from 13 patients, nine of whom were positive for anti-HBc only and four of whom were also positive for anti-HBs. When PBMCs from patients were activated in culture with phytohemagglutinin, the presence of HBsAg could be detected in the culture supernatants from four of 13 patients with HBV DNA in their PBMCs; for two of the four, HBV DNA could also be detected in the culture supernatant after DNA amplification. It was observed that HBV DNA sequences found in PBMCs can be reactivated by mitogen stimulation in some HIV-1 infected patients.

Detection of human immunodeficiency virus type 1 by PCR before seroconversion in high-risk individuals who remain seronegative for prolonged periods.

HIV-1 seronegative patients at high risk for HIV infection were followed up. In 1990 PCR was positive for HIV DNA sequences in samples of 17 seronegative patients who continued to report for surveillance of HIV infection. There was clear evidence of seroconversion in four of these 17 seronegative patients, while in one patient an indeterminate result for HIV was repeatedly obtained in different samples. The other 12 patients continue to be seronegative without any evidence of HIV infection except the presence of provirus in peripheral blood mononuclear cells. It is important to apply the PCR technique together with tests to detect other virological and immunological markers, in order to identify seronegative carriers and thus avoid HIV transmission by them.

Detection of hepatitis B virus DNA in chronic carriers by the polymerase chain reaction.

The polymerase chain reaction (PCR) was used to detect hepatitis B virus DNA (HBV-DNA) in serum samples of 104 chronic HBV carriers. Of 22 patients positive for both HBV surface (HBsAg) and HBVe (HBeAg) antigens, seven were positive for HBV-DNA on dot blot hybridisation, and all 22 positive in the PCR. Of 41 HBsAg positive patients who had antibodies against HBeAg (anti-HBe), only three were positive for DNA-HBV on dot blot hybridisation, however DNA was detected in 30 of them with the PCR. Similarly, of 41 individuals with antibodies against HBsAg (anti-HBs), 23 yielded positive results in the PCR technique, although dot blot hybridisation detected HBV-DNA in only one patient. These results indicate that while serological and conventional DNA hybridisation assays are not sensitive enough to determine the infectivity of HBV chronic carriers, PCR is an accurate method for establishing the status and progression of disease in these patients.

Evidence of an in vitro association between human immunodeficiency virus antigen P24 and Epstein-Barr virus DNA.

To investigate the association between human immunodeficiency virus (HIV) and Epstein-Barr virus (EBV), simultaneous determinations of HIV antigen (HIV Ag) p24 and EBV DNA were performed in lymphocyte culture supernatants from 63 individuals at risk of HIV infection. In vitro data, together with HIV immune status results, were subjected to a statistical analysis. HIV infection was identified in 49 patients (78%); of these, in vitro EBV DNA was found in 44 individuals (90%), while in only 3 of the 14 non-infected ones (21%). Statistical analysis demonstrated a close relationship between evidence of HIV infection and in vitro detection of EBV DNA (87.3% concordant with 95% confidence interval: 76.5%-94.5%). Furthermore, a strong dependence was revealed between the presence of EBV DNA and HIV Ag in culture (p less than 0.00001). These results indicate the existence of in vitro viral interactions, with likely in vivo implications in the pathogenesis and evolution of HIV infection.

[Detection of hepatitis B virus DNA in peripheral blood mononuclear cells from patients with various hepatopathies using in situ hybridization]. / Detección del DNA del virus de la hepatitis B en células mononucleares de sangre periférica de pacientes con distintas hepatopatías mediante hibridación "in situ".

We have investigated, by "in situ" hibridisation, the presence of hepatitis B virus (HBV) DNA in peripheral blood mononuclear cells (PBMC) from 45 patients with acute and chronic hepatic disorders directly related with HBV or with some seric HBV marker. Results has been related with serological markers and the different types of hepatopaties. The HBV-DNA was detected in PBMC more frequently in patients with hepatic alterations more prolongated (chronic active hepatitis, chronic persistent hepatitis and cirrhosis) than in acute hepatitis patients. It was not detected in any asymptomatic patient with HBV serological markers. As regards HBV serological markers, HBV-DNA was detected in PBMC in 8/11 HBsAg positive patients and in 11/34 HBsAg negative patients: 3 antiHBc positive, 5 antiHBc and antiHBs positive and 3 without conventional seric markers. The detection of HBV-DNA in antiHBc and/or antiHBs positive subjects means the virus may persist after recovery of infection and suggests PMBC could serve as additional reservoirs for reinfection of hepatocytes leading to a reactivation of the liver disease. Our results suggest that HBV infection of PBMC is a frequent event during HBV infection and can have important consequences fundamentally with respect to pathogenic mechanisms of HBV induced liver disease and to the transmission of the virus.

[Detection and antigenic distribution of hepatitis B virus in liver tissue and its relation to other serological markers of viral replication]. / Detección y distribución antigénica del virus de la hepatitis B en tejido hepático y su relación con otros marcadores serológicos de replicación viral.

The aim of this work has been the production of specific monoclonal antibodies against HBV-antigens and their utilisation in order to study their distribution on liver tissue. The monoclonal antibodies anti-HBc and anti-HBs were obtained by the modified hybridoma technique. This study was performed on 50 patients affected by several chronic hepatopathies. For the detection of the antigens, avidin-biotin-peroxidase complex immunostaining was used. Both cytoplasmic and membranous HBsAg were detected in 15 out of 16 HBsAg+ patients; 8 of 12 HBsAg-/anti-HBc+ patients and 1 HBsAg-/antiHBc- patient. Cytoplasmic and nuclear HBcAg was observed in 12 of 16 HBsAg+ patients and 4 of 20 HBsAg- patients. Although the presence of serum HBsAg is an index of liver infection, in some HBsAg-/antiHB+ patients (20%) with undetectable levels of HBsAg, hepatic injury may be disclosed by the detection of other markers of active viral replication.

[Detection of human immunodeficiency virus in seronegative adults]. / Detección del virus de la inmunodeficiencia humana en adultos seronegativos.

The diagnosis of human immunodeficiency virus infection is sometimes difficult or nonspecific, both in early and late stages, as the patients may be seronegative at the time of testing. Although serologic testing usually suffices to identify infected individuals and to follow up the course of the infection, in some cases direct detection of the virus is required. The culture of the mononuclear cells of the patient permits, after stimulation with mitogens and interleukin-2, the expression of viral antigens even in asymptomatic patients with latent or apparently nonproductive infection. In this way we have recovered the virus in four patients without serological evidence of infection. The possibility that human immunodeficiency virus infection can be undetectable with the usual diagnostic techniques, at least in a small proportion of patients, supports the need to use other methods such as direct viral culture to permit the identification of a greater number of infected individuals and the adoption of the appropriate prophylactic or therapeutic measures.