A new volumetric evaluation of partial splenic embolization for hypersplenism in biliary atresia.

BACKGROUND/PURPOSE: Partial splenic embolization (PSE) has become an important therapeutic modality in the management of hypersplenism in biliary atresia (BA). Fifty percent to 80% of spleen is usually devascularized by embolization. The functional outcome, however, has not been correlated with embolized volume of the spleen. The authors propose a new, reliable method of predicting functional outcome using nonembolized volume of the spleen (NEVS) as an index. METHODS: Between January 1993 and July 2000, 11 children with BA (2 boys and 9 girls, aged 5 to 10 years) underwent 12 PSE procedures. The follow-up period ranged from 6 to 77 months. The NEVS was calculated by enhanced computed tomography (CT) images, and an index was calculated by dividing NEVS with the predicted splenic volume for body weight (standardized NEVS ratio) 2 weeks after PSE. RESULTS: Splenic volumes before PSE ranged from 312 to 1,201 cm(3) (mean, 875.8 cm(3)). NEVS ranged from 140 to 485 cm(3) (mean, 340 cm(3)). Standardized NEVS ratio ranged from 2.21 to 7.22 (mean, 4.25). The platelet counts with standardized NEVS ratio below 5.0 (group I) and above 5.0 (group II) were 15.1 x 10(4)/mm(3) and 7.2 x 10(4)/mm(3) at 6-month follow-up, respectively. CONCLUSIONS: (1) Nonembolized volumetric evaluation is useful in predicting the functional outcome of PSE. (2) Reembolization is indicated for the patients with standardized NEVS above 5.0.

Telomerase inhibiting activity in vitro from natural resources, marine algae extracts.

We attempted to screen for telomerase inhibitingactivity in vitro from a total of 304 marine algae samples which were collected from various Japancoasts by nonradioisotope telomeric repeatamplification protocol (Non-RI TRAP) assay using humanleukemia MOLT-4 cells. Ten of the MeOH extracts andtwo of the PBS extracts from those algal samplesshowed telomerase inhibiting activity. In particular,the MeOH extract from a green alga, Caulerpasertularioides strongly inhibited telomerase activitywhen added to MOLT-4 cell culture at a level of 1.25%(v/v), suggesting that it may be possible to developa novel anti-cancer agent in view of its specificanti-telomeric property.

[MR imaging in patients with bone marrow metastases of neuroblastoma].

Sixty patients with neuroblastoma or ganglioneuroblastoma underwent MRI 87 procedures to detect and follow up bone marrow metastases. The detection of bone marrow metastases by MRI was evaluated with aspiration cytology. Relationships were investigated between bone metastases and bone marrow metastases that were morphologically classified as nodular and diffuse by MRI findings. The usefulness of MRI was also studied in evaluating the effect of chemotherapy. MRI showed bone marrow metastases in all of 17 patients, but aspiration cytology proved metastases in only 7 of 17. Bone metastases were proven by bone scintigraphy or bone X-ray in 5 of 15 patients, and only diffuse bone marrow metastases were accompanied with bone metastases. After or during chemotherapy, 10 patients were examined by MRI more than two times. Bone marrow metastases disappeared in 9, decreased in size in 3, did not change in one and recurred at another site in one. It was observed from MRI findings that in the early stage, bone marrow metastases are nodular, but along with progress of the disease, they become diffuse and invade the bone cortex. If chemotherapy was effective, bone marrow metastases were decreased in size or disappeared completely.

[Currarino triad : a case report].

The authors report a case of Currarino triad comprising anorectal malformations, sacral bony anomaly and presacral mass. A 1-year-old boy was presented with constipation as his chief complaint. No neurological deficit was found on admission. There was no cutaneous evidence of underlying spinal dysraphism. Lumbar X-ray films showed bony defect caudal to the third sacral vertebra. A barium-enema examination revealed an anterior displacement of the rectum. A myelography showed a presacral cavity filled with contrast medium. MRI demonstrated a thick filum terminale, and a round hypointense mass in the pelvis on T1 weighted images and hyperintense on T2 weighted images. Surgically we released the thick filum terminale, and obliterated the anterior sacral meningocele, because total removal would have been hazardous. Postoperatively transient dysuria was observed for a month, and the difficulty in defecation persisted. Recognition of this rare condition will lead to correct diagnosis and proper treatment.

[Two cases of hepatobiliary scintigraphy of liver transplantation in rejection].

We reported two patients with liver transplantation who are performed hepatobiliary scintigraphy in rejection. In one patient hepatobiliary scintigraphy shows dilatation of bile duct but it shows good clearance from liver. In another patient hepatobiliary scintigraphy shows delayed clearance from liver. Both patients recovered from rejection. There are four main complications--vascular and biliary abnormality, infection, rejection--after liver transplantation. Hepatobiliary scintigraphy shows almost same findings except biliary complication, so it is difficult to distinguish between infection and rejection. But hepatobiliary scintigraphy may be useful to evaluate transplanted liver function in rejection.

[Scrotal scintigraphy in the diagnosis and grading of varicocele].

Scrotal scintigraphy with 99mTc-red blood cells has been reported as a useful method for detecting varicocele. In this study we analysed the scintigraphy of 251 infertile males with clinically diagnosed or suspected varicocele, in an attempt to establish a grading system of varicocele. Scintigraphically varicocele was diagnosed in 207 patients on the basis of pooling in hemiscrotum in static images and/or early flow through the spermatic cord vessels in dynamic images; physical examination overlooked 17 of them. Of the 207 patients, all had pooling (153 left-sided, 1 right-sided, and 53 bilateral pooling) and 52 had early flow. The early flow was a less sensitive sign for varicocele than the pooling and invariably accompanied by the intense pooling. The early flow may be related to increased shunt flow through varicocele. According to the scintigraphic findings, varicocele was classified as follows: Grade I (small varicocele with faint early flow or mild localized pooling, n = 103), Grade II (medium varicocele with obvious early flow or curvilinear mottled pooling, n = 67) and Grade III (large varicocele with marked early flow or pooling, n = 37). Clinical assessment (93 small, 68 medium, and 54 large varicocele) supported the scintigraphic classification. Scrotal scintigraphy, therefore, facilitates precise evaluation of varicocele based on its morphology and hemodynamics.

[Usefulness of a 201Tl dynamic study of thyroid tumors].

A thallium 201 dynamic study was performed on 39 patients with thyroid tumor by use of a digital gamma-camera, which was connected to the computer data system. They consisted of 12 patients with a benign lesion and 27 patients with a malignant lesion. Regions of interest (ROIs) were assigned for tumor, normal thyroid, and background. Time activity curves (TACs) were generated from these ROIs. The following six parameters were created from the TACs and compared between benign and malignant tumors: 1) Tmax, 2) T3/4max, 3) distribution index (DI) = peak count determined for a tumor divided by that for the normal thyroid, 4) mean transit time (MTT), 5) relative MTT (r-MTT) = MTT for a tumor divided by that for the normal thyroid, and 6) perfusion curve (PC) = TAC that is drawn on the basis of the quotients obtained by dividing A by B (A = counts in the individual frames determined for a tumor; B = those for the normal thyroid). Among the first five parameters, DI, T3/4max, and r-MTT were significantly different between the two sorts of lesions. To be more precise, DI was significantly lower (p less than 0.01) and T3/4max and r-MTT were higher (p less than 0.05) in the malignant group. PC was classified into three types: decreased type, parallel type, and increased type. In the benign group the PCs were decreased or parallel type in all cases except two. In the malignant group the PCs were parallel or increased type in all cases. In conclusion, the present observations suggest that thallium 201 accumulates in a malignant lesion at nearly the same rate as in the normal thyroid in an early phase, or otherwise its washout from the lesion is prolonged, and further that early-phase accumulation in a benign lesion is high and washout from the lesion is rapid compared with the normal thyroid. Functional images (peak count, MTT), which were obtained through computer analysis, facilitated visual diagnostic evaluation of thyroid tumor.

[Clinical evaluation of 123I-orthoiodohippurate (123I-OIH) for diagnosis of renal function: dose finding study].

The safety, clinical usefulness and the optimal dose of 123I-orthoiodohippurate (123I-OIH) were evaluated in patients with mild renal disorders. 123I-OIH was administered intravenously to 45 patients, and 39 of those patients were analyzed for the clinical usefulness. The numbers of cases analyzed were 10 for 9.25 MBq (0.25 mCi), 18.5 MBq (0.5 mCi) and 74 MBq (2.0 mCi) and 9 for 37 MBq (1.0 mCi). Neither adverse reaction nor abnormal laboratory findings due to 123I-OIH administration were observed in the 45 patients. The clinical usefulness of the drug was evaluated in terms of individual renal function, regional renal functions, renal blood flow, parenchymal function and urinary function, and ability to differentiate between the renal and urinary functions, and the overall clinical usefulness. In the evaluation by the investigators, there were no significant differences in each of these parameters among any of the doses administered. In the evaluation by the Committee, however, the usefulness with 74 MBq superior to those with 9.25 MBq and 18.5 MBq, while there was no significant differences between those with 37.5 MBq and 74 MBq. The qualities of the blood flow phase images, functional phase images, functional images, and the statistical noises of the individual and the regional kidney renograms were also evaluated by the Committee. The image qualities and the statistical noises with 37 MBq were superior to those with 9.25 MBq and 18.5 MBq except for the functional image quality, and there were no significant differences between those with 37 MBq and 74 MBq other than the regional renograms and the functional images, which were superior with 74 MBq.(ABSTRACT TRUNCATED AT 250 WORDS)

MRI of mediastinal cavernous hemangioma.

A cavernous hemangioma of the anterior mediastinum was studied by CT and MRI. CT did not give the diagnosis of the vascular tumor but MRI demonstrated the morphology of the vascular tumor. MRI is very useful for detecting a vascular tumor in the mediastinum.

[A case of tracheal agenesis].

A case of neonate boy with tracheal agenesis and other anomalies, which is very rare, is reported. This case belongs to VATER association. No radiolucent area of trachea could be seen and esophagography demonstrated tracheoesophageal fistula and defects of trachea.