Oxidative stress, advanced glycation end product, and coronary artery calcification in hemodialysis patients.

Coronary artery calcification is an index of the severity of atherosclerotic vascular disease, and may predict future adverse cardiovascular events in uremic patients undergoing hemodialysis (HD). HD patients are exposed to oxidative stress, and show high plasma levels of advanced glycation end products (AGEs). The association between oxidative stress, AGEs, established cardiovascular risk factors, and coronary artery calcification score (CACS) was studied in 225 HD patients (123 male, 102 female patients). CACS was measured by using multi-detector row computed tomography. Age, systolic blood pressure, calcium, calcium x phosphate, malondialdehyde, lipid peroxides, and pentosidine were significantly and positively correlated with CACS. Duration on HD tended to be positively correlated with CACS. From the independent variables included in the forward stepwise multiple linear regression analysis, only age, systolic blood pressure, lipid peroxides, calcium, and pentosidine were independently associated with CACS. The odds ratios for past history of coronary artery disease and the presence of diabetes mellitus for high CACS (> or =100) were 6.25 (95% confidence interval; 1.83-21.4) and 2.03 (95% confidence interval; 1.02-4.05), respectively. The plasma pentosidine was significantly and positively correlated with indoxyl sulfate. In conclusion, in addition to such traditional cardiovascular risk factors as past history, diabetes mellitus, aging, systolic blood pressure and calcium overload, oxidative stress (lipid peroxides), and AGE (pentosidine) are associated with extensive coronary artery calcification in HD patients. Lipid peroxidation and glycoxidation may be involved in the pathogenesis of coronary artery calcification.

Innervation and functional changes in mesenteric perivascular calcitonin gene-related peptide- and neuropeptide Y-containing nerves following topical phenol treatment.

We have previously shown that age-related reduction of innervation and function in mesenteric perivascular calcitonin gene-related peptide-containing vasodilator nerves takes place in spontaneously hypertensive rats. The present study was performed to investigate innervation and functional changes in perivascular calcitonin gene-related peptide- and adrenergic neuropeptide Y-containing nerves after topical treatment with phenol, which damages nerve fibers, around the rat superior mesenteric artery. Under pentobarbital-Na anesthesia, 8-week-old Wistar rats underwent in vivo topical application of phenol (10% phenol in 90% ethanol) or saline (sham rats) to the superior mesenteric artery proximal to the bifurcation of the abdominal aorta. After the treatment, the animals were subjected to immunohistochemistry of the 3rd branch of small arteries proximal to the intestine and to vascular responsiveness testing on day 3 through day 14. The innervation levels of calcitonin gene-related peptide-like immunoreactivity containing fibers and neuropeptide Y-like immunoreactivity containing fibers were markedly reduced on day 3 to day 14 and on day 5 to day 14 after the treatment, compared with those in sham-operated rats, respectively. In perfused mesenteric vascular beds isolated from phenol-treated rats, adrenergic nerve-mediated vasoconstriction and calcitonin gene-related peptide nerve-mediated vasodilation in response to periarterial nerve stimulation (2-12 Hz) were significantly decreased on day 3 and day 7. Neurogenic release of norepinephrine in phenol-treated rats on day 7 was significantly smaller that that in sham-operated rats. Nerve growth factor content in the mesenteric arteries of phenol-treated rats was significantly lower than that in sham-operated rats. Administration of nerve growth factor using osmotic mini-pumps for 7 days after the phenol treatment resulted in greater density of calcitonin gene-related peptide- and neuropeptide Y-like immunoreactivity fibers than in phenol-treated rats and restored decreased vascular responses to periarterial nerve stimulation. These results suggest that topical phenol-treatment of the mesenteric artery effectively induces functional denervation of perivascular nerves, which can be prevented or reversed by nerve growth factor treatment.

Possible link between glycolysis and apoptosis induced by sodium fluoride.

Fluoride has been used to prevent caries in the dentition, but the possible underlying mechanisms of cytotoxicity induction by this compound are still unclear. Since fluoride is known as an inhibitor of glycolytic enzymes, we investigated the possible connection between NaF-induced apoptosis and glycolysis in human promyelocytic leukemia HL-60 cells. NaF-induced apoptotic cell death is characterized by caspase activation, internucleosomal DNA fragmentation, loss of mitochondrial membrane potential, and production of apoptotic bodies. Higher activation of caspases-3 and -9, as compared with that of caspase-8, suggested the involvement of an extrinsic pathway. Utilization of glucose was nearly halted by NaF, whereas that of glutamine was rather enhanced. NaF enhanced the expression of Bad protein, but not that of Bcl-2 and Bax proteins, and reduced HIF-1alpha mRNA expression. Analysis of these data suggests a possible link between glycolysis and apoptosis.

Sonographic detection of secondary MALT lymphoma of the submandibular gland.

This report describes a case of mucosa-associated lymphoid tissue (MALT) lymphoma of the lacrimal glands that recurred in the submandibular salivary glands. Gray-scale sonography showed small hypoechoic nodules, measuring less than 0.5 cm in diameter, in both submandibular glands. The echogenicity and echotexture of the rest of the submandibular glands and of the parotid glands was normal. Power Doppler sonography revealed increased vascularity within the nodules. A sonographically guided aspiration biopsy of the nodules revealed MALT lymphoma. Secondary MALT lymphoma should be considered in the presence of multiple small hypoechoic nodules in the salivary glands in patients with a history of MALT lymphoma at another location.

Tracheal invasion by thyroid carcinoma: prediction using MR imaging.

OBJECTIVE: The purpose of this study was to evaluate the accuracy of MR imaging in predicting tracheal invasion by thyroid carcinomas and to determine MR imaging criteria for diagnosing tracheal invasion. MATERIALS AND METHODS: MR imaging was performed on the normal trachea of one cadaver and 30 healthy subjects as a standard of reference. Then, MR imaging findings in 67 patients with thyroid carcinoma were reviewed and correlated with surgical and pathologic findings. A logistic regression model was used to determine which MR imaging features were significant for predicting tracheal invasion. RESULTS: Twenty-three (34%) of the 67 patients had tracheal invasion. Logistic regression model analysis revealed that significant MR characteristics for determining tracheal invasion included soft-tissue signal in the tracheal cartilage (p < 0.001), intraluminal mass (p < 0.001), and degree of tumor circumference around the trachea (p = 0.001). The highest accuracy (90%) for determining tracheal invasion was achieved using a combination of findings. A case was considered positive for tracheal invasion if there was soft-tissue signal in the cartilage, an intraluminal mass, or a tumor that abutted a circumference of the trachea of 180 degrees or greater. Using these factors resulted in seven false-positive diagnoses because soft-tissue signal in the cartilage was sometimes seen in healthy trachea. Although intraluminal mass invariably reflected deep tracheal invasion, soft-tissue signal in the cartilage rarely indicated actual cartilage invasion but rather indicated tumor extension between the cartilaginous rings. CONCLUSION: Tracheal invasion by thyroid carcinomas can be accurately diagnosed with MR imaging, and using a combination of criteria is the most accurate method of predicting this phenomenon.

Head and neck lesions: characterization with diffusion-weighted echo-planar MR imaging.

PURPOSE: To evaluate whether apparent diffusion coefficients (ADCs) calculated from diffusion-weighted echo-planar magnetic resonance (MR) images can be used to characterize head and neck lesions. MATERIALS AND METHODS: Diffusion-weighted echo-planar MR imaging was performed with a 1.5-T MR unit in 97 head and neck lesions in 97 patients. Images were obtained with a diffusion-weighted factor, factor b, of 0, 500, and 1,000 sec/mm(2), and an ADC map was constructed. The ADCs of lesions, cerebrospinal fluid, and spinal cord were calculated. RESULTS: Acceptable images for ADC measurement were obtained in 81 (84%) patients. The mean ADC of malignant lymphomas, (0.66 +/- 0.17[SD]) x 10(-3) mm(2)/sec (n = 13), was significantly smaller (P <.001) than that of carcinomas. The mean ADC of carcinomas, (1.13 +/- 0.43) x 10(-3) mm(2)/sec (n = 36), was significantly smaller (P =.002) than that of benign solid tumors. The mean ADC of benign solid tumors, (1.56 +/- 0.51) x 10(-3) mm(2)/sec (n = 22), was significantly smaller (P =.035) than that of benign cystic lesions, (2.05 +/- 0.62) x 10(-3) mm(2)/sec (n = 10). No significant differences were seen in the mean ADC of cerebrospinal fluid and of spinal cord among four groups of lesions. When an ADC smaller than 1.22 x 10(-3) mm(2)/sec was used for predicting malignancy, the highest accuracy of 86%, with 84% sensitivity and 91% specificity, was obtained. CONCLUSION: Measurement of ADCs may be used to characterize head and neck lesions.

Effect of endotoxin-induced reactive oxygen species on sperm motility.

OBJECTIVE: To define the mechanism of infection-induced damage of sperm. DESIGN: The effect of lipopolysaccharide (LPS)-induced reactive oxygen species (ROS) on sperm motility and its modification by scavengers were investigated. SETTING: Research laboratory of a university hospital. PATIENT(S): Normozoospermic semen samples were obtained from 37 healthy volunteers. INTERVENTION(S): The sperms were incubated in the presence of LPS with or without scavengers. MAIN OUTCOME MEASURE(S): Sperm motility was evaluated by a sperm quality analyzer (SQAIIB). ROS formation in semen samples was measured by a Berthold luminometer (LB953). RESULT(S): Motility of spermatozoa was decreased in the LPS-treated samples compared with that in the control groups. ROS was significantly higher in the LPS-treated groups than in the control groups. The addition of ROS scavengers restored the motility index and suppressed ROS production in the LPS-treated semen samples. CONCLUSION(S): These data suggest that endotoxin-induced excessive production of ROS is responsible for the decrease in sperm motility and that antioxidant therapy may be a therapeutic option for infertile men with bacterial genital tract infection.

MR imaging of the lingual thyroid. Comparison to other submucosal lesions.

PURPOSE: To study MR findings for clues to the diagnosis of lingual thyroid. MATERIAL AND METHODS: MR findings and clinical and scintigraphic data of 5 cases of lingual thyroid were reviewed and the MR findings were compared to those of 16 cases of other submucosal lesions in the base of the tongue. RESULTS: Four of the 5 patients with lingual thyroid were women and all had hypothyroidism. MR imaging depicted lingual thyroid in the midline in the base of the tongue (n=5) and additional ectopic thyroid glands in the floor of the mouth (n=2) or between the right and left sternohyoid muscles (n=1). Ectopic thyroid glands appeared isointense or hyperintense relative to muscle tissue on T1-weighted images and showed slight or fair contrast enhancement. All glands had low to intermediate T2 signal, which was also seen in 1 case of non-Hodgkin's lymphoma and 1 case of adenoid cystic carcinoma. All ectopic thyroid glands had well-defined margins, whereas malignant tumors tended to have ill-defined margins and to invade the surrounding structures. All but the 5 cases of lingual thyroid had an MR-demonstrable thyroid gland in the normal cervical position. CONCLUSION: A well-defined mass of low-intermediate T2 signal in the midline base of the tongue, neither with invasive tendency nor with a cervical thyroid gland in the normal site on MR imaging, may strongly indicate lingual thyroid.

Cytotoxic activity of saponins from Camassia leichtlinii against human oral tumor cell lines.

Five steroidal saponins from Camassia leichtlinii showed higher cytotoxicity against human oral squamous cell carcinoma cells HSC-2, as compared to normal human gingival fibroblasts HGF. The tumor specificity of saponins varied considerably from sample to sample, but was generally higher than that of tannins, flavonoids and prenylated compounds such as geranylgeraniol and vitamin K2 (MK-2). Agarose gel electrophoresis showed that the saponins failed to induce internucleosomal DNA fragmentation, but produced large DNA fragments in HSC-2 cells, whereas two saponin samples (compounds 1 and 5) induced internucleosomal DNA fragmentation in human promyelocytic leukemic HL-60 cells. In contrast to epigallocatechin gallate or gallic acid, the cytotoxic activity of saponins was not significantly affected by metals (Co2+, Cu2+, Fe3+) or by antioxidants (sodium ascorbate, N-acetyl-L-cysteine, catalase). Furthermore, the saponins did not produce radicals (detected by ESR spectroscopy) nor oxidation potential (measured by NO monitor). These data suggest that an oxidation-mediated mechanism is not involved in the cytotoxicity induced by the steroidal saponins.

MR imaging of primary malignant lymphoma in the larynx.

We present MR findings in a patient with primary laryngeal lymphoma. The MR images showed a homogeneous mass in the right supraglottic larynx extending to the true vocal cord through the paraglottic space, of which signal intensity was intermediate both on T1- and T2-weighted images. The tumor was moderately enhanced and preserved mucosal layers were demonstrated as hyperintense bands on gadolinium-enhanced fat-suppressed T1-weighted images. Primary laryngeal lymphoma should be included in the differential diagnosis for a homogeneous solid mass in the supraglottic submucosal area.

Detection of occult metastatic lymph nodes in the neck with gray-scale and power Doppler US.

PURPOSE: To determine the most accurate criterion for predicting malignancy of small cervical lymph nodes with gray-scale ultrasound (GSUS) and power Doppler ultrasound (PDUS). MATERIAL AND METHODS: Findings of 69 pathologically verified cervical nodes (38 benign, 31 malignant) in 57 patients without wide echogenic hilum on GSUS that measured less than 10 mm in minimal axial diameter were prospectively studied. Minimal and maximal axial diameters, ratios of minimal to maximal axial diameters, and presence or absence of calcification or necrosis of the nodes were assessed. On PDUS, vascularity in the node was classified into 4 pattern groups. A logistic model was used to evaluate the significant factors for predicting malignancy. RESULTS: The logistic model revealed that the minimal axial diameter and vascularity patterns were the only significant factors for malignancy. Using the minimal axial diameter, a node larger than 8 mm showed the highest accuracy (73%) with 45% sensitivity and 93% specificity. Of the vascularity patterns, spotted or peripheral pattern had the highest accuracy (80%) with 61% sensitivity and 93% specificity. A combined criterion of the minimal axial diameter larger than 8 mm and spotted or peripheral pattern increased the accuracy to 82% and sensitivity to 77% but specificity decreased to 86%. CONCLUSION: A combined criterion of minimal axial diameter and vascular patterns was most accurate for diagnosing occult metastatic lymph nodes in the neck.

Spontaneous extensive necrosis in non-Hodgkin lymphoma: prevalence and clinical significance.

PURPOSE: We studied the prevalence of spontaneous extensive necrosis in the nodes of patients with non-Hodgkin lymphomas and assessed the clinical significance of this finding. METHOD: CT and MRI performed before initiation of radiation or chemotherapy were reviewed in 60 consecutive patients with non-Hodgkin lymphomas to evaluate the presence or absence of spontaneous extensive necrosis in the lymphomatous nodes. The results were correlated with histopathologic grading, stages of lymphomas, maximal axial diameters of the lesions, International Prognostic Index (IPI), age, and serum lactate dehydrogenase (LDH) levels. We then performed Kaplan-Meier analysis of disease-free survival using each factor. RESULTS: Extensive necrotic nodes that appeared as rim-enhanced masses on enhanced CT or MR images were found in 15 patients (25%), of whom 10 patients had pathologic verification. The patients with necrosis had significantly higher stages (Stage II or higher), greater IPI (IPI of > or = 2), and higher serum LDH levels than those without necrosis (p = 0.001, p = 0.005, and p = 0.005, respectively). With the Kaplan-Meier method, a statistically significant difference was noted for serum LDH levels (p = 0.015) and IPI (p = 0.021) but not for extensive necrosis (p = 0.600). CONCLUSION: Spontaneous extensive necrosis in lymphomatous nodes is not a rare event. This finding may have a prognostic significance for patients with non-Hodgkin lymphomas.

Parotid masses: prediction of malignancy using magnetization transfer and MR imaging findings.

OBJECTIVE: We determined the most accurate criteria for predicting malignancy of masses in the parotid gland using magnetization transfer ratios. SUBJECTS AND METHODS: Lesion-to-muscle magnetization transfer ratios obtained with a spoiled gradient-recalled acquisition in a steady state sequence with a 1-kHz off-resonance pulse were measured in 72 parotid masses (52 benign lesions, 20 malignant tumors). Various MR imaging findings and lesion-to-muscle magnetization transfer ratios were simultaneously assessed using a logistic model to determine the useful factors for predicting malignancy. We also studied the clinical usage of magnetization transfer ratios. RESULTS: Of the MR imaging findings, poorly defined margins showed the highest accuracy, 81%, with 60% sensitivity and 88% specificity. Of the lesion-to-muscle magnetization transfer ratios, a ratio of greater than 0.71 was most accurate (85%), with 90% sensitivity and 83% specificity. All four recurrent tumors and 10 (91%) of 11 secondary tumors were correctly diagnosed using the magnetization transfer ratio analysis. The logistic model revealed that the margin characteristics (p = 0.084) and lesion-to-muscle magnetization transfer ratios (p < 0.001) were statistically significant predictors for malignancy. A combined criteria of poorly defined margins and a lesion-to-muscle magnetization transfer ratio of greater than 0.71 raised the accuracy to 86% and specificity to 96%, but the sensitivity decreased to 60%. CONCLUSION: A combination of MR imaging findings and lesion-to-muscle magnetization transfer ratios was the most accurate predictor of malignancy.

Protective effect of Ninjin-yoei-to on damage to isolated hepatocytes following transient exposure to tert-butyl hydroperoxide.

To establish a simple screening system for estimating efficacy of an agent for an oxidative-related lesion, we investigated the damage in isolated rat hepatocytes exposed to 75 microM tert-butyl hydroperoxide (t-BuOOH) and then subsequently incubated the cells in fresh medium. By electron spin resonance spectroscopy analysis using 5,5-dimethyl-1-pyrroline-N-oxide (DMPO), DMPO adducts of tert-butoxyl radicals and carbon center radicals were detected during the t-BuOOH exposure, and DMPO-OH formation was detected after t-BuOOH removal. In t-BuOOH-exposed cells, the level of phosphatidylcholine hydroperoxide (PCOOH), a peroxidative product of biomembranes in the hepatocytes, and the leakage of enzymes into the culture medium were significantly increased. An increase in acid phosphatase (AP) activity representing lysosome destabilization preceded the aspartate oxoglutarate aminotransferase (AST), alanine oxoglutarate aminotransferase (ALT) and lactate dehydrogenase (LDH) leakage. Ninjin-yoei-to added to the culture medium following the t-BuOOH exposure significantly inhibited the PCOOH formation and the leakage of AP, AST, ALT and LDH, concentration-dependently. Ninjin-yoei-to at 1 mg/ml in culture medium completely diminished these increases in enzyme activities down to the background levels found in control experiments and this reduction was greater than the most effective alpha-tocopherol concentration of 20 micromol/ml. Considering all of these results, it is likely Ninjin-yoei-to may exert its protective effect by antioxidative action and membrane stabilization.

[Presence of alpha 5 beta 1 integrin and fibronectin in the anterior subcapsular cataract].

PURPOSE: We investigated whether alpha 5 beta 1 integrin and fibronectin were present in myofibroblast-like lens epithelial cells in anterior subcapsular cataract (ASC). METHODS: Nine anterior capsule specimens were obtained from the patients during cataract surgery and frozen for cryostat sections. Six specimens were anterior capsule obtained from cataract with ASC. As a control, three specimens were obtained from cataract without ASC. Alpha-smooth muscle actin (alpha-SMA), alpha 5 beta 1 integrin, and fibronectin were detected by immunohistochemical observation. RESULTS: In all 6 specimens from patients with ASC, the lens epithelial cells around fibrosis tissue included myofibroblast-like lens epithelial cells which were positive for alpha-SMA. alpha 5 beta 1 integrin was detected in these lens epithelial cells. Fibronectin was also detected around these myofibroblast-like lens epithelial cells. Three control specimens showed no immunoreactivity against alpha-SMA, alpha 5 beta 1 integrin, or fibronectin. CONCLUSIONS: Alpha 5 beta 1 integrin and fibronectin may play an important role in myodifferentiation of lens epithelial cells.

MR imaging of primary leiomyosarcoma of the thyroid gland.

Primary leiomyosarcoma of the thyroid gland is extremely rare and radiological information on this tumor is scant. We presented radiological findings on primary thyroid leiomyosarcoma in a 66-year-old woman in which anaplastic carcinoma was suspected based on clinical and cytological features and discussed the radiological clues to distinguish between the two diseases. Ultrasonography showed an ill-defined hypoechoic mass without halo in the left lobe and the isthmus of the thyroid gland. Computed tomography depicted a low-density mass with calcification and necrosis, which invaded the thyroid cartilage. No lymphadenopathy was seen. The tumor was demonstrated as an isointense mass on T1-weighted MR images and a mass of intermediate signal on T2-weighted images. The tumor showed a fair enhancement on gadolinium-enhanced T1-weighted images. Although the radiological picture was nonspecific, primary thyroid leiomyosarcoma appeared less invasive and far less frequent in developing nodal metastasis than anaplastic carcinoma in light of the literature.

Singlet oxygen generation from phosphatidylcholine hydroperoxide in the presence of copper.

This study pursued whether singlet oxygen ((1)O2) is generated from phosphatidylcholine hydroperoxide (PCOOH), the oxidized modification product of a major constituent of biomembranes and serum lipoproteins. The (1)O2 formation was detected, by utilizing the oxidation of 2,2,6,6-tetramethyl-4-piperidone (TMPD) by (1)O2 to yield 2,2,6,6-tetramethyl-4-piperidone-1-oxyl (TEMPONE), which generates electron spin resonance (ESR) signals. The TEMPONE signal was detected in human plasma with addition of PCOOH by ESR determination after introducing copper(II). The TEMPONE formation was proportional to the amounts of PCOOH added according to moles of active oxygen. The TEMPONE signal intensity was weakened significantly in the presence of beta-carotene and histidine in a concentration-dependent manner, but was not at all decreased by mannitol, Mn-superoxide dismutase and catalase. In addition, HPLC-chemiluminescence analysis demonstrated that incubation with the PCOOH/Cu(II) combination oxidized cholesterol, a relatively oxidation-resistant component, to the cholesterol hydroperoxide. These results reveal that (1)O2 is generated from PCOOH in contact with copper(II). In conclusion, this in-vitro study provides directly the (1)O2 formation in living organisms following the advancement of peroxidation of constitutive lipids.

Glutathionyl hemoglobin in uremic patients undergoing hemodialysis and continuous ambulatory peritoneal dialysis.

BACKGROUND: To assess the redox state in hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients, we focused on the formation of glutathionyl hemoglobin (Hb) because the ratio of oxidized glutathione disulfide (GSSG) to reduced glutathione (GSH) is increased in uremia, and GSSG is a source of glutathionyl Hb. METHODS: Glutathionyl Hb levels were measured in 30 HD patients, 10 CAPD patients, and 20 healthy subjects by using liquid chromatography/electrospray ionization-mass spectrometry (LC/ESI-MS). RESULTS: Hbbeta showed a peak at 15,868 D in a deconvoluted ESI mass spectrum. Glutathionyl Hbbeta was detected at 16,173 D (15,868 + 305). The peak at 16,173 D was identified as glutathionyl Hbbeta based on the following findings: (1) the peak disappeared by reducing the sample with dithiothreitol, and (2) the peak could be detected at a high level by incubating Hb in vitro with GSH in water at 37 degrees C for seven days. Glutathionyl Hb levels expressed as the peak height ratios of glutathionyl Hbbeta to intact Hbbeta were significantly elevated in HD patients (8.0 +/- 3.6%, mean +/- SD, N = 30, P < 0.0001) and CAPD patients (5.9 +/- 2.7%, N = 10, P < 0.05) as compared with normal subjects (3.0 +/- 1.6%, N = 20). However, there were no significant differences in the glutathionyl Hb levels before (8.7 +/- 3.2%, N = 12) and after HD (8.7 +/- 2.8%, N = 12). CONCLUSION: Glutathionyl Hb levels were increased in HD and CAPD patients, probably because of enhanced oxidative stress. The measurement of glutathionyl Hb may be useful to assess oxidative stress in uremic patients.

Dialysis-related amyloidosis of the heart in long-term hemodialysis patients.

BACKGROUND: Dialysis-related amyloidosis (DRA) predominantly occurs in the osteoarticular structures, but it also systemically appears in the extra-articular tissues as well. However, the pathological characteristics of DRA in the hearts of hemodialysis (HD) patients have rarely been reported. METHODS: We studied the pathological characteristics of DRA in the hearts of 18 HD patients, including its relationship to calcification. Furthermore, we studied the immunohistochemical localization of advanced glycation end products (AGEs) using monoclonal anti-imidazolone and anti-Nepsilon-(carboxymethyl)lysine (CML) antibodies. RESULTS: beta2-microglobulin (beta2m) amyloid deposits were detected in the hearts of seven patients who had undergone HD for more than 10 years. beta2m amyloid deposits in the left atrium were localized in the endocardium, the myocardium, and the walls of small blood vessels, whereas in the left ventricle, they were localized only in the walls of small blood vessels. The extent and prevalence of DRA in the heart were severe in the patients on HD for more than 15 years. Most calcification areas near mitral valve were dotted with beta2m amyloid deposits, while diffuse fine calcification was localized within the beta2m amyloid tissues in some cases. Imidazolone and CML were localized not only in massive beta2m amyloid deposits, but also in cardiac myocytes. CONCLUSION: DRAs were localized extensively in the hearts of long-term HD patients. A strong affinity was observed between beta2m amyloid deposits and calcification.

Prognostic significance of magnetic resonance findings in advanced papillary thyroid cancer.

We assessed the prognostic importance of magnetic resonance (MR) findings in locally advanced papillary thyroid cancer. MR findings, clinical data, and pathologic (and surgical) data for 66 patients, including 51 women and 15 men with a mean age of 57 years, who had primary surgery for papillary thyroid cancers were correlated with prognosis. Mean follow-up was 27.5 months (range, 5-117 months). Recurrence was seen in 18 patients (27%). In univariate analyses, age of 60 years or more (p = 0.0066), male gender (p = 0.0373), six MR findings (tumor size of > or = 4 cm ([p = 0.0002], ill-defined margins ([p < 0.0001], tumor extension of the trachea [p = 0.0337], carotoid artery [p = 0.0028]), esophagus [p < 0.0001], and lymph nodes [p = 0.0005]), and three pathologic findings (tumor extension of soft tissues [p = 0.0288], carotid artery [p = 0.0013], and esophagus [p < 0.0001]) had a significant adverse effect on disease-free survival. In multivariate analyses, tumor size (p = 0.0169) and nodal metastasis (p = 0.0393) determined on MR imaging and pathologic esophageal invasion (p = 0.0016) were the only significant independent variables. Esophageal invasion was accurately diagnosed with MR imaging (94% accuracy). MR findings may contain prognostic importance of locally advanced papillary thyroid cancer.