EUS changes predictive for recurrence of esophageal varices in patients treated by combined endoscopic ligation and sclerotherapy.

BACKGROUND: Recurrence of varices is still common after endoscopic treatment of esophageal varices. In this study, predictive signs of variceal recurrence were investigated by ultrasonic (US) miniature probe in patients treated by combined endoscopic ligation and sclerotherapy. METHODS: Detectability of vessels by US miniature probe was evaluated first in rats. In 41 patients treated by combined therapy, the esophagus and the cardia region were examined by US miniature probe. In 25 patients examined by percutaneous transhepatic portography, the relationship between US miniature probe and percutaneous transhepatic portography findings was evaluated. RESULTS: The smallest vessel detected by US miniature probe was 0.3 mm in diameter in the study using intra-abdominal vessels of rat. After variceal eradication, US miniature probe showed intramural vessels in the cardia that were classified as follows: grade I, a few vessels (19 patients, 46%); grade II, uniformly scattered vessels (11, 27%); grade III, abundant vessels resembling a honeycomb (11, 27%). As the sonographic grade increased, the rate of variceal recurrence increased. As the venographic grade of staining in the distal esophagus increased, the esophageal wall became thicker and the sonographic grade at the cardia increased. CONCLUSIONS: Endosonographic evaluation of the distal esophagus and cardia is predictive of variceal recurrence.

Enhanced color flow images in small hepatocellular carcinoma.

BACKGROUND: Features of enhanced color flow images in small hepatocellular carcinoma (HCC) are not fully elucidated. The purpose of this study was to clarify the characteristic vascular images in small HCC observed by enhanced color Doppler. METHODS: Enhanced color Doppler using the contrast agent Levovist was performed on 13 patients with HCC smaller than 30 mm. Enhanced color flow appearance was compared with angiographic findings. Time-intensity changes after injection of the contrast agent were analyzed in HCC nodules. RESULTS: Significant improvement in the detection of color flow signals was obtained in small HCC using Levovist, from 33% in precontrast to 92% in postcontrast (p < 0.005). Three patterns of enhanced color flow images, which were related to the angiographic findings, were observed. The time-intensity curve was classified into two types by "time to peak" and "time on plateau" and was associated with the patterns of enhanced images. CONCLUSION: Enhanced color flow imaging promises to be a useful method for evaluating tumor vascularity noninvasively and to contribute to the elucidation of the hemodynamics in small HCC.

White ball appearance in endoscopic ligation of bleeding esophageal varices.

BACKGROUND: Endoscopic variceal ligation is useful in the control of bleeding from esophageal varices. However, confirmation of ligation precisely at the site of bleeding is usually difficult when treating massive variceal bleeding. Characteristic endoscopic findings that appeared when ligation was performed at the site of bleeding are reported in this article. METHODS: Emergency endoscopic variceal ligation was performed in 14 patients with active bleeding from esophageal varices. Endoscopic findings after variceal ligation at the site of bleeding were compared with those at sites without bleeding. RESULTS: Active bleeding ceased just after endoscopic ligation at the site of bleeding in all patients. After ligation of the bleeding site of the varix, an unusual white-colored ball-like appearance (white ball appearance) was observed in all patients. This finding was markedly different from the purple-colored ball-like appearance that is usually observed after ligation of a varix at a site without bleeding. CONCLUSIONS: White ball appearance was a characteristic finding that appeared after ligation of a varix at the site of bleeding. This finding may be useful in the confirmation of successful ligation of a varix at its bleeding site.

IgG antibody level to mycobacterial glycoprotein in pulmonary tuberculosis by ELISA.

Sera from patients with active pulmonary tuberculosis and sera from appropriate control individuals were assayed for IgG, IgA and IgM antibodies against glycoprotein from tubercle bacilli by an enzyme-linked immunosorbent assay. The mean antibody levels in IgG and IgA were significantly higher in the tuberculosis patients than in the controls. By measuring IgG antibody, this assay may provide a diagnostic tool to distinguish patients with active pulmonary tuberculosis from patients with other pulmonary disease.

Effect of long-chain acyl-CoA on the omega-oxidation of monocarboxylic acid.

In vitro addition of stearoyl-CoA in 10,000 x g supernatant of rat livers, first enhanced the rate of omega-oxidation of free [1-14C] stearate, until a concentration of the acyl-CoA reached to the same level of that of the substrate. Further addition of stearoly-CoA decreased gradually the oxidation rate.

Relation between insulin and glucose flux rates in the dog.

A constant infusion isotope dilution procedure for measurement of plasma insulin flux rates was performed in acutely eviscerated dogs receiving an infusion of nonlabeled insulin; the calculated rate of insulin flux corresponded closely to that of the administered rate, thus validating the isotope dilution procedure. Flux rates of insulin and glucose were measured simultaneously at different steady levels in intact dogs. There was a linear relationship between plasma insulin concentration and insulin flux rate. In each animal there was also a linear relationship between glucose flux rate and insulin concentration, and between rates of glucose flux and insulin flux, but there was considerable inter-animal variation in the slope of the regression lines.