Effects of increasing response requirement on choice between cocaine and food in rhesus monkeys.

Rhesus monkeys were trained in a discrete-trials choice procedure and allowed to choose between intravenous injections of cocaine (0.01-1.0 mg/kg/injection) and food presentation (1 or 4 pellets; 1 g/pellet) during daily 7-h experimental sessions. When each reinforcer was available under a fixed-ratio (FR) 30 schedule, the frequency of cocaine choice and the total drug intake increased in a dose-related manner for all monkeys. When the FR for cocaine was differentially increased, the frequency of cocaine choice decreased, shifting the cocaine dose-response function to the right and/or downward. When the FR for cocaine was at least 480, cocaine preference could not be recovered up to doses of 1.0 mg/kg/injection. In a second experiment, when the response requirement for food was differentially increased, the frequency of cocaine choice increased. These results demonstrate that altering the response requirement for cocaine or for alternative reinforcers that are available can substantially affect cocaine self-administration.


Oral self-administration of triazolam, diazepam and ethanol in the baboon: drug reinforcement and benzodiazepine physical dependence.

Reinforcing and physical dependence-producing effects of oral diazepam and triazolam (0.01-1.28 mg/ml) were studied in four non-water-deprived baboons in daily 2-3-h sessions. Drinking initially was food-induced, but subsequently it was maintained for greater than year without the inducing procedures; drug intake greater than 10 mg/kg per session was attained. Triazolam and diazepam reinforcement (compared to vehicle) was concluded for only one baboon for each drug under a single-spout procedure and for two baboons for each drug under a two-spout procedure. However, all baboons showed ethanol reinforcement under a two-spout procedure. When a lever-pressing requirement was imposed for each drink (one-spout procedure), ethanol maintained requirements of 128 or 256 responses/drink, and volume of ethanol consumed was greater than vehicle. Neither benzodiazepine maintained lever pressing better than vehicle at any response requirement and drinking was suppressed by requirements of 1-32. Physical dependence to triazolam and diazepam developed after approximately 1 month of daily ingestion, evidenced by a precipitated withdrawal syndrome after injection of the benzodiazepine antagonist flumazenil. A mild spontaneous withdrawal syndrome occurred after substitution of vehicle for triazolam or diazepam. These data indicate a clear dissociation between the reinforcing and physical dependence-producing effects of triazolam and diazepam.


Amitriptyline, clovoxamine and cognitive function: a placebo-controlled comparison in depressed outpatients.

No longer prescribed only for vegetative signs of depression, tricyclic antidepressants also lessen depressive cognitive distortions. Less clear is whether they ameliorate depressed patients' other cognitive deficits in memory, information processing speed, and psychomotor performance. We tested the alternative hypothesis that amitriptyline, because of its anticholinergic and sedative properties, would exacerbate depressed patients' cognitive disturbances. Depressed outpatients received double-blind placebo (n = 15), amitriptyline (n = 10), or clovoxamine fumarate (n = 10), a serotonin reuptake inhibitor relatively lacking in anticholinergic properties. Depression, memory, and psychomotor performance were assessed at baseline and after 7 and 28 days of drug treatment. Depression was alleviated after all treatments, including placebo. Only amitriptyline impaired performance on tests of memory, producing a significant decrement, relative to placebo, after 4 weeks of treatment. None of the treatments adversely affected performance on psychomotor tasks. These findings add to the evidence that antidepressant drugs with high anticholinergic activity can impair memory, despite alleviation of depression.


Are there changes in sensitivity to 5-HT3 receptor ligands following chronic diazepam treatment?

Administration of 1-(3-chlorophenyl)-biguanide (mCPB), a 5-HT3 receptor agonist (1 and 10 mg/kg IP), was found to be significantly anxiogenic in vehicle treated rats tested in the plus-maze, while having no significant effect in rats withdrawn for 24 h from 21 days diazepam treatment (2 mg/kg/day), suggesting a decreased agonist action at 5-HT3 receptors following withdrawal from chronic diazepam treatment. In the social interaction test, diazepam withdrawn rats showed a significant decrease in social interaction when compared to the chronic vehicle treated group. This anxiogenic response was reversed by low doses of zacopride (0.0001-0.01 mg/kg IP); in the vehicle treated animals 0.1 mg/kg was significantly anxiogenic. The overall pattern of results with zacopride is explained by suggesting that the anxiogenic effects of high doses of zacopride are detectable at low levels of 5-HT function and are due to an agonist action of the S-isomer in the rat at 5-HT3 receptors. The anxiolytic action of low doses is attributed to the R-isomer acting at the R-zacopride binding site and is enhanced in conditions of high 5-HT function, e.g. in the diazepam withdrawn rats. If this hypothesis is correct, then we would predict the R-isomer alone would be more effective in reversing the anxiogenic effects of diazepam withdrawal than the racemate, used here.


Effects of chlorpromazine and lorazepam on explicit memory, repetition priming and cognitive skill learning in healthy volunteers.

To assess the influence of neuroleptics on explicit memory and two forms of implicit memory, repetition priming and cognitive skill learning, the effects of two low doses of chlorpromazine (12.5 and 25 mg orally) were contrasted to those of lorazepam (2.5 mg orally) and of a placebo using a free-recall task, a word-completion task and repeated testing on the Tower of Toronto puzzle, a version of the Tower of Hanoi puzzle. Seventy-two healthy volunteers took part in this double-blind study. Chlorpromazine spared free-recall and word-completion performance, but impaired the acquisition of a cognitive routine in the subjects who completed the first trials of the Tower of Toronto puzzle efficiently. Lorazepam induced an opposite pattern of memory disruption. These preliminary results suggest that chlorpromazine and lorazepam induced a double dissociation between priming and the acquisition of a cognitive routine. They provide evidence that the two forms of implicit memory rely upon distinct neurochemical systems, the latter, but not the former, being dependent upon dopaminergic systems.


MK-801 produces a reduction in anxiety-related antipredator defensiveness in male and female rats and a gender-dependent increase in locomotor behavior.

The present study investigated the effects of the non-competitive NMDA antagonist MK-801 (0.04-0.16 mg/kg), on antipredator defensive reactions of male and female rats in three paradigms comprising the Anxiety/Defense Test Battery (A/DTB). In order to facilitate interpretation of data from the above study, the behavioral effects of the compound were also assessed in the non-threatening environment of the home cage. The data indicate a marked gender difference in the locomotor effects of the compound with females, but not males, showing a dose-dependent increase in general locomotor activity, a decrease in freezing, and a loss of balance at the highest dose, in both non-threatening and threatening contexts. The behavioral profile for males in the A/DTB included decreased orientation to and proxemic avoidance of the cat stimulus or stimulus site, and increased transits and eating in the cat situation. Contacts with the cat odor stimulus were increased, as was normal, curved back, locomotion in this test. In the absence of non-specific locomotor effects for males, this profile for the A/DTB provides convincing evidence for anxiety/fear reduction with MK-801. While locomotor effects tended to mask the putative anxiolytic properties of the compound in females, evidence remains from behavioral changes not attributable to a locomotor influence to indicate anxiety/fear reduction in this sex.


Differential effects of diazepam and lorazepam on repetition priming in healthy volunteers.

The effects of two benzodiazepines, diazepam (15 or 20 mg orally) and lorazepam (1.75 or 2.5 mg orally), and a placebo on explicit memory, lexical priming and perceptual priming were assessed using a free-recall, a word-completion and a picture-completion test. The picture-completion test included two different study conditions intended to manipulate the magnitude of the priming effect. Sixty healthy volunteers took part in this double-blind study. Free-recall performances were altered by both drugs. Lorazepam impaired word-completion and picture-completion performance, whereas diazepam only exhibited a deleterious effect on the more sensitive of the two measures of the picture-completion test. These results indicate that the two benzodiazepines have differential amnestic effects. It is suggested that these differential effects could be accounted for by a different cortical distribution of the two benzodiazepines.


Effect of the 5-HT1A partial agonist buspirone on regional cerebral blood flow in man.

Repeated measurements of regional cerebral blood flow (rCBF) were made in normal volunteers before, and after, the administration of the 5-HT1A partial agonist, buspirone, or placebo. The difference in rCBF, before and after drug, (buspirone versus placebo) was used to identify brain areas affected by buspirone. Buspirone-induced changes in rCBF were studied under two behavioural conditions (5 word-list learning and 15 word-list learning). Compared to placebo, buspirone increased blood flow in the cuneus during both behavioural states. However, decreases in blood flow, centred in the left dorso-lateral prefrontal cortex and posterior cingulate cortex, were only observed under one of the two behavioural conditions. It is concluded that buspirone-induced alterations in regional cerebral blood flow are better understood, not in relation to the known distribution of monoamine neurotransmitter systems (particularly ascending 5-HT projections), but rather in relation to putative neuronal circuits possibly many synapses "downstream" of buspirone's pharmacological site of action.


Slow wave sleep and 5-HT2 receptor sensitivity in generalised anxiety disorder: a pilot study with ritanserin.

Eight patients with generalised anxiety disorder (GAD) and eight matched healthy controls had their polysomnogram measured on two occasions separated by 1 week. On one occasion they received the 5-HT2 receptor antagonist, ritanserin (5 mg orally) and on the other matching placebo. The increase in slow wave sleep produced by ritanserin was the same in GAD patients as in healthy controls. These findings do not support the hypothesis that GAD is associated with a generalised hypersensitivity of brain 5-HT2 receptors; however, the present data cannot exclude the presence of a regionally specific change in this receptor subtype in anxiety disorders.


Focal manifestations of diffuse liver disease at MR imaging.

Detection and exclusion of focal liver lesions is especially difficult in patients with diffuse liver disease. Magnetic resonance (MR) imaging may be particularly valuable in these patients. By judicious comparison of appropriate pulse sequences, normal and hypertrophic liver may be distinguished from atrophic, neoplastic, or otherwise abnormal hepatic parenchyma. Chemical shift (lipid-sensitive) techniques allow definitive identification of fatty liver, including focal fatty infiltration or focal sparing. T2-weighted and T2*-weighted images allow identification of iron overload, depicting malignancies as focal masses without iron. Analysis of signal intensity and internal morphology allows confident distinction between regenerative nodules and hepatocellular carcinoma in most instances, and allows diagnosis of early carcinoma within regenerative nodules. MR imaging provides capabilities for noninvasive characterization of liver tissue beyond those available with other noninvasive modalities.


Lateral arcuate ligaments of the diaphragm: anatomic variations at abdominal CT.

The authors have occasionally observed nodular areas abutting the lateral diaphragmatic surface and extending into the posterior pararenal space on computed tomographic (CT) scans. Review of the anatomy literature revealed that this finding represents inferolateral extension of the lateral arcuate ligaments, which reflect over the quadratus lumborum muscles to fuse with the diaphragm. CT scans from 100 consecutive patients were reviewed to determine the frequency, relationship to habitus, and appearance of this finding. Nodularity was found in five patients (bilateral in three, unilateral in two). The average size was 9.4 mm in the transverse plane, 6.3 mm in the anteroposterior plane, and 4.3 cm in the cephalocaudal plane. The extent of retroperitoneal fat was normal in all five patients. In one patient, there were easily visible lobulations; three patients had prominent lobulations, and one patient had few lobulations. It is important to recognize this anatomic variant to avoid confusion with disease.


Prenatally detected myelomeningoceles: sonographic accuracy in estimation of the spinal level.

The sonograms and case records of 53 patients with prenatally detected myelomeningoceles were retrospectively reviewed. Sonographic findings were correlated with pathologic, surgical, and/or radiographic findings in 28 cases. Fourteen mothers chose to continue their pregnancies, and the level of neuromotor deficit was available for 11 children of this group. The sonographic and pathologic levels were in agreement in 18 of 28 cases (64%) and were within one spinal level in 22 of 28 cases (79%). The pathologic level of the lesion was underestimated (sonographic level lower than pathologic) in three fetuses and overestimated (sonographic level higher than pathologic) in another three. In 10 of 11 living children (91%) the neuromotor level was equal to or better than the anatomic level. The authors conclude that ultrasonography can, in most cases, allow accurate prediction of the level of the spina bifida lesion and the severity of neuromotor handicap in children with prenatal diagnoses of myelomeningocele.


Distention of the posterior urethra: association with nonneurogenic neurogenic bladder (Hinman syndrome).

In nonneurogenic neurogenic bladder (NNNB), or Hinman syndrome, a functional bladder outlet obstruction is produced by voluntary contraction of the external sphincter during voiding. To determine whether any radiographic findings are diagnostic of this condition, the authors reviewed the genitourinary images of six boys in whom NNNB was diagnosed in the past 5 years. In contrast to true neurogenic bladder, findings of elongated, trabeculated, high-volume bladders with substantial postvoid residuals, obstructive uropathy, and vesicoureteral reflux were not associated with clinical, radiographic, or urodynamic evidence of an underlying neurologic abnormality. Furthermore, four boys had distention of the posterior urethra that the authors believe is suggestive of this condition. In these patients, the posterior urethra appeared entirely normal during early voiding, but distended after contraction of the external sphincter as voiding progressed. This posterior urethral distention may worsen the symptoms of enuresis, but may also reduce or retard the damage to the proximal urinary tract.


Fractures of the rib head in abused infants.

Fractures of the posterior ribs are well-recognized sequelae of infant abuse. Previous reports have indicated a predilection for fracture near the costotransverse process. This study expands the spectrum to include fractures involving the rib head. The radiologic and histologic features are described, and the mechanism of injury of this lesion is examined. In situ and specimen radiography, followed by histopathologic examination, was performed in 78 ribs removed from seven abused infants who died with posterior rib fractures. Computed tomography of the intact posterior thorax was performed in two of these infants. Fifty posterior rib fractures were identified; 29 involved the rib head. Frontal radiography was insensitive in identifying these fractures, clearly revealing injury only when periosteal reaction was present (four of 29 cases). Axial specimen radiography delineated the fractures in all cases. In the two infants studied, CT depicted five of 19 fractures visible only with axial specimen radiography. The morphologic features of these fractures further support the concept that most fractures in abused infants occur by means of indirect forces and are consistent with anteroposterior manual thoracic compression during assaults.


Thyroid nodules associated with Hashimoto thyroiditis: assessment with US.

Sonographic findings in 109 thyroid nodules in 104 patients with Hashimoto thyroiditis were retrospectively analyzed. Sixty patients underwent ultrasound (US)--guided fine-needle aspiration (FNA) biopsy (65 nodules, 24 palpable, 27 surgically confirmed), 14 of whom also underwent palpation-guided FNA (14 nodules, all palpable, all surgically confirmed). Forty-four patients (44 nodules, 25 palpable) underwent diagnostic US followed up with surgery. US-guided FNA helped differentiate between benign (n = 11) and malignant (n = 16) diseases (sensitivity, 100%). Two papillary carcinomas were falsely diagnosed as Hashimoto thyroiditis with palpation-guided FNA. Eight malignancies were not palpable, and correct diagnosis was obtained with US-guided FNA. Hyperechoic nodules were usually benign, and isoechoic nodules had a low frequency (13%) of malignancy. Most carcinomas were found in hypoechoic masses, and almost all lymphomas were found in markedly hypoechoic masses. Lymphoma was indistinguishable from pseudotumor in Hashimoto thyroiditis or adenomatous hyperplasia at US. US-guided FNA is helpful in making the histologic diagnosis in thyroid nodules associated with Hashimoto thyroiditis. US-guided FNA is clinically beneficial because it can help select patients who need surgery, avoiding unnecessary surgery for patients with nonneoplastic disorders.


Human eye: visualization of perfluorodecalin with F-19 MR imaging.

Perfluorodecalin (PFD) was demonstrated in a human eye with fluorine-19 magnetic resonance (MR) imaging by employing a standard two-dimensional fast low-angle shot (FLASH) sequence. The presence and intraocular distribution of PFD were revealed despite the posterior eye segment being obscured by a narrow pupil, multiple small intraocular gas bubbles, and an intraocular hemorrhage. This examination can be performed with standard sequences on MR imaging systems equipped with a fluorine channel.


Lumbar disk herniation: MR imaging assessment of natural history in patients treated without surgery.

The aim of this study was to evaluate the evolution of lumbar disk herniation in patients treated without surgery. Sixty-nine patients with a lumbar disk herniation proved at magnetic resonance (MR) imaging underwent a follow-up MR imaging study. The disk herniations evaluated during both MR imaging examinations were measured and classified into four categories according to the change in size that occurred. The patients were also divided into three clinical classes on the basis of the clinical outcome. Sixty-three percent of the patients showed a reduction of disk herniation of more than 30% (48% had a reduction of more than 70%), while only 8% demonstrated worsening of the clinical picture. These findings suggest that lumbar disk herniation may be primarily a medical (nonsurgical) disease and that MR imaging could play an important role in management of and research into the disorder.


Neurologic complications of petrosal sinus sampling.

Petrosal sinus sampling has been described as an innocuous, essentially risk-free procedure. The authors report on two patients from two different institutions who sustained brain stem injury as a result of petrosal sinus sampling and two other patients in whom brain stem injury was avoided. Major neurologic complications have occurred in only 0.2% of procedures (one of 508) performed at the National Institutes of Health and in 0.5% of a subset of these procedures (one of 184) that were performed with a specially designed petrosal sinus catheter. The cause of these complications is unclear but is presumed to be localized venous hypertension. Tip-deflector catheter-guide-wire systems, if available, are recommended for petrosal sinus sampling. Inadequate data exist to permit recommendation of any other catheter. Brain stem injury is preventable if the catheter is withdrawn at the earliest sign of even a minor, seemingly insignificant problem. Subtle symptoms and signs that may not appear to be neurologic may herald a clinical catastrophe if not heeded.


Liver metastases from colorectal carcinoma: detection with continuous CT angiography.

A diagnostic approach to assess liver metastases from colorectal carcinoma was prospectively evaluated in 30 patients with and without metastases on the basis of findings at conventional computed tomography (CT). With the technique, termed continuous CT angiography (CCTA), CT data were continuously sampled for 24 seconds at the same section level after initiation of a 3-second injection of 10-20 mL of contrast medium in the common hepatic artery. The procedure was repeated for each contiguous section level of the liver. Findings at preoperative ultrasound (US), conventional CT, and CCTA were compared with those at intraoperative US and surgical exploration as the standard of reference. Forty-four liver metastases were identified in 16 patients, and 14 patients had no metastases. CCTA had a sensitivity of 98% (43 lesions identified) and higher accuracy (81% [54 of 67 diagnoses]) than US and conventional CT. The data indicate that CCTA can supplement information obtained with conventional imaging techniques in patients who must undergo hepatic surgery because of metastases from colorectal carcinoma.


Right-sided segmental infarction of the omentum: clinical, US, and CT findings.

Clinical, ultrasound (US), and computed tomographic (CT) findings at hospital admission and follow-up were retrospectively studied in seven patients with right-sided segmental infarction of the omentum. In all patients, the presumptive clinical diagnosis was appendicitis, although in three patients cholecystitis and pyelitis were also considered. US revealed an ovoid or cakelike, moderately hyperechoic, noncompressible lesion adherent to the peritoneum and located at the level of the umbilicus, anterolateral to the right half of the colon. On CT scans, a corresponding, better defined area of fat interspersed with hyperattenuating streaks was found. No abnormality of bowel or appendix was seen. The clinical symptoms and abnormalities on US scans gradually disappeared in all patients. Because no patient underwent surgery, no histologic proof was obtained. In all patients, however, the clinical, US, and CT findings were similar and consistent. They corresponded to the abnormality called right-sided segmental omental infarction in the surgery and radiology literature and enabled exclusion of appendicitis, thus preventing unnecessary surgery.


Evaluation of radiation-induced liver injury with MR imaging: comparison of hepatocellular and reticuloendothelial contrast agents.

Gadolinium (4s)-4-(4-ethoxybenzyl-3,6,9-tris(carboxylato-methyl)-3,6,9- triazaudecandioic acid (EOB) diethylenetriaminepentaacetic acid (DTPA), a hepatocellular-directed magnetic resonance (MR) contrast agent, and coated superparamagnetic iron oxide particles (SPIO), a Kupffer cell-directed contrast agent, were compared for uptake and enhancement in a rodent model of radiation-induced liver injury. A single x-irradiation exposure (50-70 Gy) was delivered to one side of the liver in 18 rats. MR imaging was performed 3 days after x irradiation with sequential injections of the two contrast agents in the same rats. Additionally, biliary excretion of Gd-EOB-DTPA was quantified after whole-liver irradiation in five rats. Electron microscopy of the irradiated liver demonstrated mitochondrial injury in both hepatocyte and Kupffer cell populations. With Gd-EOB-DTPA, however, liver enhancement and biliary excretion were not affected by irradiation. Uptake of SPIO was decreased in the irradiated portion of the liver, with a precise demarcation between irradiated and nonirradiated zones at MR imaging.


Gastric tumors: radiologic-pathologic correlation and accuracy of T staging with dynamic CT.

Incremental dynamic computed tomography (CT) was prospectively performed in 89 patients with gastric tumors (78 gastric cancers, five malignant lymphomas, and six submucosal tumors) after the intake of 400 mL of water, and findings were compared with those obtained at pathologic examination. Dynamic CT of healthy control subjects (15 patients without gastric lesions) showed the gastric wall as a two- or three-layered structure (multilayered pattern): a markedly enhanced inner layer; an intermediate layer of low attenuation; and (sometimes) an outer layer of slightly high attenuation, which corresponded histologically to the mucosal layer, submucosal layer, and muscular-serosal layer, respectively. In 68 lesions that were removed at surgery, the detectability of early and advanced gastric cancers and the accuracy of classification of gross appearance and serosal invasion as determined with CT were 53%, 92%, 80%, and 80%, respectively. All detected advanced gastric cancers were seen as enhanced areas with the destruction of the multilayered pattern. Differentiation between infiltrating gastric cancer (n = 5) and malignant lymphoma (n = 5) was successful. Five of six submucosal tumors were demonstrated as having an overlying intact mucosal layer.


Immunoscintigraphy performed with In-111-labeled CYT-103 in the management of colorectal cancer: comparison with CT.

Immunoscintigraphy performed after intravenous administration of indium-111-labeled CYT-103, an immunoconjugate of monoclonal antibody B72.3, was evaluated in patients with suspected primary or recurrent colorectal cancer at 25 centers in the United States. Gamma camera imaging, computed tomography (CT), and confirmatory surgical exploration were completed in 169 of 227 patients who received single infusions of In-111 CYT-103. Eight patients (3.5%) had reversible, nonserious adverse reactions, and 39% developed antimurine antibodies. Surgery revealed that 155 of 169 patients had colorectal carcinoma. In these 155 patients, immunoscintigraphy and CT demonstrated similar sensitivity (69% and 68%, respectively) and specificity (77%). However, immunoscintigraphy had greater sensitivity in detection of pelvic tumors (74% vs 57%, P = .035) and extrahepatic abdominal tumors (66% vs 34%, P less than .001); CT enabled detection of a greater proportion of liver metastases (84% vs 41%, P less than .001). These results indicate that In-111 CYT-103 can be administered safely and that immunoscintigraphy performed with this agent frequently enables identification of extrahepatic abdominal sites of disease not visualized with CT.


Gastrointestinal bleeding: improved localization with cine scintigraphy.

Studies of gastrointestinal bleeding, done with technetium-99m-labeled red blood cells were performed in 52 consecutive patients to determine whether cinematic acquisition and display localized sites of bleeding more accurately than did conventional static imaging. Computerized images were obtained for 15 seconds per image in 15-minute sets. Interpretations based on a cinematic display were compared with those based on standard 1-minute images obtained every 5 minutes. Pathologic confirmation of a site of bleeding was obtained in 21 patients. The cinematic display demonstrated bleeding not seen on static images and yielded either more accurate localization or increased sensitivity in eight of 21 patients (38%). Linear regression showed that the cinematic correlation (r = .98) to the actual site of bleeding was better than either of two readers' interpretations of the static display (r = .93, P less than .02; and r = .88, P less than .0004). The mean error for cinematic localization of bleeding (0.4 anatomic segments +/- 0.6 [standard deviation]) was less than that for the static interpretations (1.1 anatomic segments +/- 1.4) (P less than .01). It is concluded that computerized cinematic acquisition and display of scintigrams improves localization and detection of gastrointestinal bleeding.


Colorectal villous adenoma: transrectal US in screening for invasive malignancy.

Exclusion of focal infiltrating malignancy in colorectal villous adenoma is a prerequisite when nonsurgical treatment is considered. In a study of 81 patients with endoscopically identified colorectal villous adenoma screened for malignancy with transrectal ultrasonography (US), 15 patients were excluded because of incomplete follow-up. Twelve carcinomas were present, confirmed with either histopathologic examination after surgical resection (n = 9) or biopsies during laser treatment (n = 3). Nine of them were detected with transrectal US on the basis of disruption of the anatomic wall layers (sensitivity, 75%). In 46 of the 54 adenomas transrectal US helped confirm the benign nature of the lesion (specificity, 85%). Seven of the eight false-positive cases happened to be previously treated with surgery or coagulation. Treatment-associated inflammatory changes in the wall layers seemed responsible for this misinterpretation. Because of the high predictive value for a negative result (benign adenoma, 94%), transrectal US is recommended for the evaluation of villous adenomas to detect malignancy, especially when nonsurgical treatment is considered. Transrectal US should be performed before diagnostic polypectomy.


Staging of cervical cancer: reliability of transrectal US.

One hundred twenty-four patients with invasive carcinoma of the cervix were examined with transrectal ultrasound (TRUS) before treatment. Since surgery preceded any other kind of therapy, sonographic findings could be compared with the surgical pathologic stage. The accuracy of staging with TRUS was 83%, compared with an accuracy of 78% for clinical staging performed according to the criteria of the International Federation of Gynecology and Obstetrics (FIGO). For extent of parametrial involvement, the sensitivity of TRUS evaluation was 78%, with a specificity of 89% and a diagnostic accuracy of 87%. The same reliability parameters for clinical evaluation were 52%, 92%, and 84%, respectively. From these data and from analysis of the cases--in which a discrepancy between clinical and TRUS staging was observed--it can be concluded that TRUS could be usefully applied to routine pretreatment evaluation of patients with cervical carcinoma.


Myometrial invasion by endometrial carcinoma: assessment with plain and gadolinium-enhanced MR imaging.

A prospective study was designed to determine the sensitivity and specificity of nonenhanced T2-weighted and contrast material-enhanced T1-weighted magnetic resonance (MR) imaging in assessing the depth of myometrial invasion in patients with proved endometrial cancer. In 56 consecutive patients with clinically determined early-stage disease, findings of the two MR imaging techniques were compared with results of histologic examination of surgical specimens. Myometrial invasion was classified as absent (stage IA), superficial (stage IB), or deep (stage IC). In the assessment of each tumor stage, the sensitivity and specificity of contrast-enhanced T1-weighted MR imaging were higher than those of non-enhanced T2-weighted MR imaging. In determining the degree of myometrial tumor invasion, the overall sensitivity of enhanced T1-weighted MR imaging was 87.5%, whereas that of nonenhanced T2-weighted MR imaging was 71.4% (P less than .05). The use of contrast material may improve the ability to assess, with MR imaging, the depth of myometrial invasion by endometrial cancer.


Limitations of liver surface US in the diagnosis of cirrhosis.

Ultrasound (US) of the liver surface with a high-frequency, small-parts, short-focused probe has been proposed as a method of diagnosing cirrhosis. US of the liver was performed in 50 consecutive patients undergoing diagnostic liver biopsy to assess the clinical usefulness of this noninvasive procedure in diagnosing hepatic cirrhosis. Eight patients had histologically proved cirrhosis, and 42 had no histologic evidence of cirrhosis. Seven of the eight patients with cirrhosis had a normal liver surface at US, and five of the 42 patients without cirrhosis had an abnormal liver surface. US of the liver surface with this probe was not reliable in this heterogeneous patient population.


The pelvis: T2-weighted fast spin-echo MR imaging.

Fast spin-echo (SE) T2-weighted magnetic resonance (MR) imaging provides images with highly T2-weighted contrast in substantially reduced imaging times. In a prospective evaluation, fast SE T2-weighted imaging of the pelvis was compared with conventional SE T2-weighted imaging in 30 consecutive patients in whom pelvic pathologic conditions were suspected. Three reviewers independently analyzed the images for (a) overall image quality, (b) pelvic organ definition, (c) conspicuity of pelvic fluid, and (d) conspicuity of pelvic pathologic conditions. Fast SE images were rated superior to conventional SE T2-weighted images in 60% (54 of 90) of the case reviews for overall image quality, in 69% (62 of 90) for pelvic organ definition, in 63% (57 of 90) for conspicuity of pelvic fluid, and in 68% (43 of 63) for conspicuity of pelvic pathologic conditions. The fast SE examinations were typically three to four times faster than conventional SE T2-weighted examinations. No pathologic findings seen on conventional SE T2-weighted images were undetected on fast SE images. Fast SE images may replace conventional SE T2-weighted images in MR imaging of the pelvis.


Medial malleolar stress fractures in seven patients: review of the clinical and imaging features.

Stress fractures of the medial malleolus were discovered in seven patients, five male and two female subjects aged 16-34 years. All except one were involved in running and jumping athletic activities. Gradual onset of pain over the medial malleolus occurred with repetitive activity. Focal intense increased uptake in the medial malleolus was present on bone scans. Conventional radiography and computed tomography demonstrated the presence of subtle fissures at the junction of the medial malleolus and the tibial plafond, and well-circumscribed lytic lesions were also seen in three patients. Two patients developed a complete fracture of the medial malleolus. Stress fractures of the medial malleolus should be suspected in patients involved in athletic and/or unusual activities who have experienced persistent and unexplained pain over the medial malleolus. Bone scans and radiographs should be obtained for diagnostic purposes in these patients.


Double injuries of the forearm: a common occurrence.

To evaluate the frequency of different types of forearm fractures and, in particular, determine the frequency of double injury to the forearm, the authors prospectively examined 119 consecutive forearm fractures and found double injuries to the forearm in all but five cases. In 79 of the 119 patients (66%), ligamentous injury was seen in addition to the obvious fracture. Nine patients with apparent isolated fractures on initial radiographs underwent examination by means of radionuclide bone scanning, which revealed a second injury in eight of them. Four patients with apparent single fractures did not undergo bone scanning because of their critical conditions. In four patients, a single fracture was initially diagnosed, but after reduction and casting, dislocation of the radioulnar joint was seen. These findings indicate that injury to the forearm almost invariably occurs at two or more sites and involves either both bones or bone and ligament. Because the distal radioulnar joint was affected in 71 patients (60%), scrutiny of the wrist is imperative whenever injuries to the bones of the forearm are discovered.


Rheumatic and nonrheumatic disease in the temporomandibular joint: gadolinium-enhanced MR imaging.

Magnetic resonance (MR) imaging of 36 temporomandibular joints (TMJs) in 27 patients and six healthy volunteers was performed before and after injection of gadopentetate dimeglumine. Twelve asymptomatic joints were used as controls, 12 TMJs had symptomatic internal derangement, and 12 TMJs had rheumatic inflammatory disease. A small or moderate joint effusion was seen in one asymptomatic joint, four joints with internal derangement, and one joint with rheumatic involvement; in all of these, contrast enhancement of the effusion was observed. A large effusion in one rheumatic joint was enhanced only after delayed imaging. In healthy controls and patients with internal derangement, no or only minimal enhancement of intraarticular tissues was seen. Eleven of the 12 rheumatic TMJs showed moderate or intense soft-tissue enhancement along the disk and articular surfaces (ie, in areas normally devoid of synovial membrane). The one rheumatic joint without enhancement had bony ankylosis and no remaining soft tissue within the joint space. Gadolinium-enhanced MR imaging of the TMJ may effectively depict the proliferating synovium of rheumatic inflammatory joint disease.


Severity of aortic regurgitation: interstudy reproducibility of measurements with velocity-encoded cine MR imaging.

The interstudy reproducibility of velocity-encoded cine (VEC) magnetic resonance (MR) imaging for quantification of regurgitant volume (RV) and regurgitant fraction (RF) was studied in 10 patients with chronic aortic regurgitation. Each patient underwent two VEC MR imaging studies. RV and RF were measured on the aortic flow curve by quantifying antegrade and retrograde flow per cardiac cycle. VEC MR imaging measurements for RV and RF correlated closely with volumetric measurements for both studies (r greater than .97). Interstudy reproducibility for VEC MR imaging measurement of RV and RF was high (r greater than .97), and the interstudy variability for VEC MR imaging measurements was low. These results demonstrate a high accuracy of VEC MR imaging for measurement of RV and RF in patients with chronic aortic regurgitation. The level of interstudy reproducibility of VEC MR imaging for quantitative assessment of RV and RF indicates the potential of this technique for follow-up and monitoring of response to therapy.


Three-dimensional motion and deformation of the heart wall: estimation with spatial modulation of magnetization--a model-based approach.

A method for in vivo estimation of the three-dimensional (3D) motion and deformation of the heart from tagged magnetic resonance images of the myocardium is presented. The method is based on a 3D deformable model fitted to the motion of tagged points in two views (short and long axes), which results in a comprehensive kinematic model of the dynamic geometry of the left ventricle. The method was applied to data obtained in four healthy volunteers, and data were pooled according to position within the model. Analytic modeling demonstrated that the calculated strain field was relatively invariant to the type of smoothing constraint applied; the greatest error was in the circumferential-radial shear strain. Displacement, torsion, and strain extracted from the model agreed with previous results of two-dimensional MR imaging analyses and 3D studies involving the implantation of radiopaque beads in canine myocardium. The model-driven approach provides an accurate and flexible technique for noninvasive estimation of 3D in vivo deformation of the human heart.


Aortic aneurysms: growth rates measured with CT.

Because of a lack of information about the rates of growth of aortic aneurysms, such rates in thoracic and abdominal aortic aneurysms were determined. One hundred seventy-one patients with atherosclerotic aortic aneurysm managed nonoperatively were followed up for more than 6 months with sequential computed tomography (CT). There were 211 aneurysms (thoracic aortic, 82; abdominal aortic, 129). The growth rates of thoracic and abdominal aortic aneurysms were 0.42 and 0.28 cm/y, respectively. Aneurysms at the aortic arch (n = 34) grew at a faster average rate (0.56 cm/y) than aneurysms arising at other levels, even when the rate was corrected for the initial diameter. It is recommended that thoracic aortic aneurysms, especially aortic arch aneurysms, be followed frequently with CT examination of size.


Automatic film processing: analysis of 9 years of observations.

A survey method known as the sensitometric technique for the evaluation of processing (STEP) has been used to monitor processing speed of over 2,000 automatic film processors in hospitals, private offices, and mammography facilities since 1981. Analysis of data obtained through this program revealed underprocessing at 33% (76 of 231) of observed hospitals in 1987, 7% (13 of 179) of mammography facilities in 1988, and 42% (101 of 241) of private practices in 1989. Underprocessing at mammography facilities decreased from 18% (25 of 139) in 1985, which was contrary to the trend in hospitals. The consequence of underprocessing is higher radiation exposure and a degradation in film contrast. Evaluation of automatic film processors is a necessary part of any comprehensive evaluation of a diagnostic radiography facility. The STEP procedure was designed only as a field survey test; to ensure optimal conditions for obtainment of diagnostic quality radiographs, facilities should perform quality assurance evaluations of their processing equipment and verify that processing recommendations of manufacturers are being followed.


Patent paraumbilical vein: anatomic and hemodynamic variants and their clinical importance.

Fifty-five of 353 patients with suspected portal hypertension studied with Doppler sonography had a patent paraumbilical vein. Of these 55 patients, 39 had the classic intrahepatic venous circulation found in Cruveilhier-Baumgarten syndrome: hepatopetal flow in all segmental portal veins and hepatofugal flow leaving the liver in a paraumbilical vein in the falciform ligament to join veins of the anterior abdominal wall. Sixteen patients had variants of the classic pattern: Flow in one or more segmental portal veins of the left lobe or the entire liver was hepatofugal. In addition, new venous channels connecting the left portal vein with the extrahepatic paraumbilical vein were found. Assessment of liver function with the Pugh score showed severe impairment in the majority of patients with a patent paraumbilical vein. Patients with the classic intrahepatic circulation had smaller esophageal varices than those with hemodynamic or anatomic variants. The presence of a patent paraumbilical vein did not prevent formation of esophageal varices in the patients studied.


Access-site thrombosis after placement of inferior vena cava filters with 12-14-F delivery sheaths.

Inferior vena cava filters were placed in 60 patients. Ultrasound (US) of the venous access site was performed before and 3-5 days after filter placement to determine the prevalence of occlusive and nonocclusive access-site thrombosis (AST). Prevalence of symptoms attributable to AST was also evaluated at 1-month clinical follow-up in 58 of the 60 patients. All filters were placed with delivery sheaths with outer diameters of 12-14 F. US depicted development of occlusive AST in six of the 60 patients (10%). Nonocclusive AST developed in 15 (25%). Symptoms related to AST occurred in two of 58 patients (3%). There was a substantially increased prevalence of occlusive thrombus in patients in whom partially occluding thrombus or extrinsic compression in the inferior vena cava or ipsilateral iliofemoral veins was demonstrated on vena cavograms obtained before filter placement. The prevalence of both symptoms attributable to AST and US-detected occlusive thrombus in this series with smaller delivery systems is lower than that reported after percutaneous placement of stainless steel Greenfield filters via 29.5-F (outer diameter) sheaths.


Fine-needle aspiration biopsy of abdominal lesions: diagnostic yield for different needle tip configurations.

Four fine-needle aspiration biopsy needles with different tip configurations were used in 133 patients with abdominal lesions. The 20-gauge needles were used in random sequence by several physicians. The specimen from each of the 522 needle passes was evaluated by two cytopathologists for adequacy to render a diagnosis and for the presence of cell block material. The Franseen needle produced a 16% and 9% better yield for diagnostic material than did the cut biopsy and spinal needles (P less than .05), respectively. The Westcott needle was better than the cut biopsy needle by 13%, and the spinal needle produced an 11% better yield than did the cut biopsy needle. Differences did not exist in liver biopsies but were present in pancreatic biopsies. The spinal needle was the least successful in yielding cell block material. Use of the cut biopsy needle resulted in the largest proportion of inadequate specimens, except its yield in cell blocks in the liver was 25% higher than that of the Westcott needle. The authors conclude that not all unusual designs for 20-gauge needle tips render results superior to those of the simple spinal needle.


In vivo evaluation of iophendylate-cyanoacrylate mixtures.

Cyanoacrylate glue is a rapidly polymerizing agent used for vascular embolization. Polymerization occurs when the glue comes into contact with ions in the blood or on the vascular endothelium. Mixing iophendylate with cyanoacrylate causes slowing of polymerization, allowing flow-directed embolization into the nidus of an arteriovenous malformation (AVM) or the central neovascularity of a tumor or hemangioma. The authors attempted to define the relationship between the iophendylate-glue ratio and polymerization time with an in vivo swine model. In this model, glue setup occurred much more rapidly than predicted on the basis of in vitro studies. This appeared to be due to glue polymerizing on the endothelium at vessel bifurcations and at areas of acute angulation or marked vessel narrowing. On the basis of these data, the authors substantially increased the iophendylate-glue ratio in their most recent AVM embolization procedures and achieved nidus occlusion in each case. With use of the authors' guidelines, it is possible to achieve optimal distal flow-directed embolization with cyanoacrylate.


Peripheral pulmonary nodules: preoperative percutaneous needle localization with CT guidance.

Despite recent advances in endoscopic surgical techniques, small nonpalpable peripheral pulmonary nodules may not be amenable to thoracoscopic resection. To facilitate resection in such cases, a technique of percutaneous needle localization involving use of a conventional mammographic needle localization system and computed tomographic guidance was developed. The technique has been used successfully in localization of 19 peripheral pulmonary nodules in 20 patients referred for thoracoscopic surgery.


Preoperative needle localization of subtle breast calcifications: magnification technique.

The authors adapted a windowed needle localization compression plate to allow performance of mammography with magnification technique, facilitating preoperative needle localization of subtle breast calcifications. The technique has been successfully used in 20 needle localization procedures.


Localization of breast lesions identified on one mammographic view: the skin-pinch technique.

Mammographic abnormalities may occasionally be seen on only one view. With a simple method, preoperative needle localization of such clinically occult lesions can be performed. The technique involves use of the relative mobility of the skin and subcutaneous tissue of the breast compared with that of the more fixed parenchymal cone. Geometric ratios and changes in tube angulation are unnecessary with this approach.


Dual-purpose tube for enteroclysis and nasogastric-nasoenteric decompression.

A catheter designed for the dual purpose of nasogastric-nasoenteric decompression and enteroclysis is described. The catheter facilitates direct decompression of the obstructed small bowel and, if necessary, subsequent performance of enteroclysis. The use of this tube obviates dual intubation and its accompanying discomfort.


Evaluation of section sensitivity profiles and image noise in spiral CT.

Spiral computed tomography (CT) offers continuous volume scanning of complete organs or body sections within a single breath hold. Almost all image quality characteristics of spiral CT are identical to those of conventional section-by-section CT; however, there is a change in pixel noise values and degradation in the shape of the section sensitivity profiles (SSPs). Computer simulations, phantom measurements, and clinical studies were used in evaluating the SSP and noise characteristics of two new section-interpolation algorithms. The results were compared with standard CT and spiral CT data processed with the commonly employed linear section-interpolation algorithm. Degradation of SSP quality was insignificant for a table feed distance per 360 degrees revolution equal to the section thickness when the new algorithms were applied; noise values, however, increased. SSP width increased for table feed distances greater than the section width, the effect being less pronounced with the new algorithms. The value of these algorithms is primarily seen in the improved quality of multiplanar reformations and cine and three-dimensional displays.


Minimum scan speeds for suppression of motion artifacts in CT.

Cardiac and ventilatory motions cause artifacts at chest computed tomography (CT). To determine how short the scan times on third-generation units must be to avoid such artifacts, motion was measured with fast and ultrafast CT scans. Minimum detectable motion was then determined. The longest scan time that avoided a barely perceptible artifact was calculated by dividing the minimum detectable motion by the peak physiologic velocity. The posterior left ventricular wall moved at a maximum velocity of 52.5 mm/sec, necessitating a scan time of 19.1 msec or less to avoid artifact. Lung vessels near the heart moved at 40.5 mm/sec for a scan time of 24.7 msec or less. During quiet breathing, pulmonary vessels moved at 10.7 mm/sec for a scan time of 93.5 msec or less. The authors conclude that the shortest scan time on third-generation units (0.6 second) cannot prevent all artifacts arising from motion in the chest. Even ultrafast scan times (50 msec) are not short enough to eliminate artifacts on these units. Thus, reduction of motion artifacts will require techniques other than fast scanning.


Radiography of the lumbosacral spine: characteristics of examinations performed in hospitals and other facilities.

A survey of 523 facilities performing radiographic lumbosacral spine examinations was conducted as a part of the Nationwide Evaluation of X-Ray Trends program in 1987 and 1989. Average patient radiation exposure was measured by using a standard phantom developed by the Center for Devices and Radiological Health of the Food and Drug Administration, U.S. Public Health Service. Data pertaining to radiographic equipment, film processing, and radiographic techniques were obtained. The overall average entrance skin air kerma was 3.65 mGy (420 mR). Ninety-eight percent (496 of 506) of observed facilities used a grid, 89% (466 of 523) had tube potentials between 70 and 89 kVp, and 67% (280 of 418) used screen-film systems with a speed of 400. The most important finding is that underprocessing of film remains a major concern. Thirty-three percent (78 of 234) of the hospitals, 25% of the radiologists in private practice (four of 16), 33% of the nonradiologist private practitioners (27 of 82), and 48% (69 of 143) of the chiropractors underprocessed their film.


Recruiting radiologists: the 1991 hiring survey.

Recent studies present widely varying views on the radiologist staffing situation, ranging from a projected surplus of over 6,000 radiologists to an estimated shortage of 5,000. To help clarify the situation, the American College of Radiology undertook a stratified random sample survey of radiology groups' recruitment efforts and hiring results in 1991. This survey of 192 groups achieved a 78% response rate. It found that half of all groups recruited, seeking to fill a nationwide total of 1,900 positions. Larger groups were more likely to recruit than smaller ones. Groups filled 1,348 (71%) of these positions, while 552 positions remained unfilled, which was 2.8% of groups' total staff. Remaining vacancies ranged from 5% of total staff in the Northeast and 3% in the Midwest to 2% in the South and 1% in the West. The percentage of positions filled was higher (76%) in nonmetropolitan areas than elsewhere. The authors conclude that the supply of radiologists is very close to balancing the number of positions available; the disparity is about 1/10 of some numbers mentioned previously and is probably shrinking. Also, recruiting is not less successful in nonmetropolitan areas and small cities than elsewhere.


Deployment and utilization of MR imaging in Michigan: observations of a statewide data base.

Patterns of deployment and utilization of magnetic resonance (MR) imaging were studied with a Michigan Department of Public Health data base containing data regarding more than 218,000 patient visits. Michigan currently has 16 hospital-based fixed MR systems (magnets), 14 (13 operational) freestanding fixed magnets, and 11 (10 operational) mobile magnets operating at 45 host sites. The imaging volume for 1991 was approximately 127,000 procedures, with associated charges of $126,500,000. Central nervous system imaging accounted for 82.6% of procedure volume, with extremities accounting for another 12.9%. The average total charge per procedure ranged from $844 to $1,076, and the average professional charge per procedure ranged from $178 to $226. The annual throughput ranged from 1,356 to 7,480 procedures per magnet. Wide variation in many measures was observed both within and among hospital-based, freestanding, and mobile facility types. The use of computed tomography (CT) before MR imaging for the same diagnostic problem continues to be substantial (average, 44% for MR imaging of the head). Patterns of inpatient imaging and prior use of CT indicate that the technical benefit of mobile MR imaging should be investigated further.


Periocular lymphoproliferative diseases: natural history, prognostic factors, and treatment.

A study was undertaken to assess the natural history of periocular lymphoproliferative diseases, identify key prognostic factors, and clarify the role of orbital irradiation. Thirty-four patients with periocular lymphoproliferative disease were treated with orbital irradiation between 1975 and 1990. Eight patients had atypical lymphoid infiltrate, and 26 had malignant lymphoma. Forty-three eyes were irradiated with en-face electrons or 6-MV photons. Five-year disease-free survival for all stages was 65%; it was not significantly affected by bilaterality or site. Stage, distinction between atypical lymphoid infiltrate and malignant lymphoma, and working formulation grade were important prognostic indicators. A complete response during irradiation was achieved in 24 of 43 (56%) eyes at a median dose of 2,400 cGy, and a partial response was achieved in 19 (44%), with resolution at a median of 2.8 months. Patients with periocular reactive lymphoid hyperplasia or atypical lymphoid infiltrate may have or are at significant risk of developing lymphoma and dissemination. Local treatment remains important; orbital irradiation achieves prompt local control with acceptable morbidity.


Optic neuropathy after irradiation of meningioma.

Radiation-induced optic neuropathy (RON) is a rare and catastrophic complication of currently employed radiation therapy regimens for meningiomas that have been partially resected and sampled for biopsy. Between 1972 and 1989, 49 patients received postoperative irradiation for partially resected or biopsy sampled meningiomas, with the optic nerve within the treatment field. One patient experienced RON. The latency period for this case was 23 months. A review of the literature disclosed few cases of RON after treatment for meningioma; however, 42 cases of RON have been reported after radiation therapy for other lesions. The authors constructed two approaches to predict optic nerve radiation tolerance. The first is modeled on a previous proposal for a neural tissue nominal standard dose term and enabled accurate prediction of safe treatment regimens and risk of RON. This approach compared favorably with previously employed nominal standard dose terms. The second approach, based on the linear-quadratic model, proved unsuccessful due to its failure to achieve statistical significance.


Mammographic appearance following implant removal.

Potential complications of augmentation mammaplasty with silicone gel breast implants have been the subject of much recent debate in the medical and lay communities. Some women have undergone implant removal, and others may follow. The mammographic appearance following submammary implant removal in four women and the histologic appearance in one case are described. Bilateral symmetric soft-tissue masses posterior to the glandular tissue with accompanying calcifications should suggest the diagnosis. The radiologist should be familiar with the mammographic appearance following implant removal. Such knowledge may prevent unnecessary concern and unwarranted biopsy.


Efficacy of spot compression-magnification and tangential views in mammographic evaluation of palpable breast masses.

To define the role of special mammographic views in evaluating palpable breast masses, 70 consecutive women with palpable breast masses underwent standard two-view examination of each breast and spot compression-magnification and tangential view examination of the palpable mass. Thirty palpable masses were found in 30 patients (43%). Standard views depicted 26 masses (87%). Tangential views also depicted 26 masses. Some of the masses seen on tangential views were not seen on standard views and vice versa. Spot compression-magnification views depicted 29 masses (97%). Special views thus depicted an additional 9% of palpable masses not seen on standard views (four of 44 cases). All lesions not seen on tangential views were central; the one lesion not seen on spot compression-magnification views was peripheral. Special views allowed correct prediction of benign or malignant status in 77% of cases (23 of 30), while standard views allowed correct prediction in 69% of cases (18 of 26).


Chronic hypersensitivity pneumonitis: high-resolution CT and radiographic features in 16 patients.

To evaluate the manifestations of chronic hypersensitivity pneumonitis at radiography and high-resolution computed tomography (HRCT), findings in 16 patients with this disease were reviewed. To ensure objectivity, 50 patients with other chronic infiltrative lung diseases (fibrosing alveolitis [n = 29], sarcoidosis [n = 16], and miscellaneous conditions [n = 5]) were included. All patients had chronic disease with evidence of fibrosis at HRCT, as indicated by irregular linear areas and architectural distortion. Radiographs and HRCT scans were reviewed separately, in random order, and without knowledge of diagnosis. On radiographs and HRCT scans, the fibrosis in cases of hypersensitivity pneumonitis was situated predominantly in the middle lung zones or showed no zonal predominance. Lung apices and bases were relatively spared in all cases. The distribution of fibrosis in the transverse plane was random in seven cases, subpleural in six, and peri-bronchovascular in three. The distribution of fibrosis can allow distinction of chronic hypersensitivity pneumonitis from other causes of fibrosis in many cases.


Differentiation of alveolitis and pulmonary fibrosis with a macromolecular MR imaging contrast agent.

The ability of macromolecular contrast agent (polylysine-[gadopentetate dimeglumine]) to allow differentiation of pulmonary fibrosis and alveolitis at magnetic resonance imaging was investigated. Lung damage was induced by means of left bronchial instillation of 200 micrograms of cadmium chloride. Rats were imaged 3 hours (early alveolitic stage, n = 5), 24 hours (late alveolitic stage, n = 5), and 8 days (fibrotic stage, n = 5) later. Rats imaged 3 hours after cadmium chloride instillation demonstrated a gradually increasing contrast enhancement over 45 minutes (from 314% +/- 110 to 476% +/- 69 over baseline [P less than .01]), indicating a leak of paramagnetic macromolecules from the intravascular into the extravascular spaces. Conversely, lung enhancement remained virtually constant after injection of contrast material in contralateral control lungs and in damaged lungs imaged 24 hours and 8 days after cadmium chloride instillation. Furthermore, the enhancement in the fibrotic lung was lower (170% +/- 50) than that in the alveolitic and control lungs (320% +/- 65 and 298% +/- 61, respectively), indicating a decrease in plasma volume in the fibrotic lung. A macromolecular contrast agent can facilitate the differentiation between the exudative and fibrotic phases of interstitial lung disease.


MURCS association and hypothalamic anovulation.

A new case of MURCS association (mullerian duct aplasia, renal aplasia and cervicothoracic somite dysplasia) in an 18 year old patient is reported. In addition to other minor phenotypical features, hypothalamic chronic anovulation was documented. Basal concentrations of PRL, TSH, GH, F and E were within reference values for adult women. Challenges with TRH and ACTH evoked normal responses in terms of TSH and F respectively. Basal levels of LH and FSH and a LHRH stimulation test demonstrated dissociation of both gonadotrophins. Persistent progesterone values within follicular phase levels led us to the diagnosis of hypothalamic chronic anovulation which was confirmed by the induction of ovulation by clomiphene citrate. This finding shows the importance of a detailed endocrinological evaluation in patients with the MURCS association in order to prevent secondary disorders due to endocrinological impairment.


[The Philadelphia chromosome 30 years later].

We review the changing concepts regarding the nature of the Ph chromosome during the last thirty years. The role of molecular biology techniques in its identification are discussed as well as its present status in the diagnosis, prognosis and management of chronic myelogenous leukemia and acute lymphoblastic leukemia.


[Clinico-pathological diagnostic agreement among 429 autopsies from the Instituto Nacional de la Nutrición Salvador Zubirán].

Comparison of clinical and autopsy findings of the cases studied between 1984 and 1988, were made at the Department of Pathology of the Instituto Nacional de la Nutricion Salvador Zubiran in Mexico City. The goal was to determine the accuracy of clinical diagnoses. The total number of cases was 429. A decreasing number of autopsies as a function of time was observed. Thus, in 1985, 34.65% of the deaths was autopsied, whereas in 1988, the number dropped to 21.16%, overall mean of 27.31%. In 229 autopsies (53.8%), 353 findings of clinical significance were found; of these, 86 were in the main diagnoses and 267 in the causes of death. There were 171 overdiagnoses with therapeutic implications, 38 in the main diagnoses and 133 in the causes of death. Overdiagnoses and underdiagnoses were most common in infectious diseases, followed by respiratory and digestive diseases, while endocrinologic and rheumatologic diseases had the highest diagnostic concordance. It was also found that the diagnostic accuracy did not improve with time of hospitalization. A brief analyses of the probable causes of the decrease in the number of autopsies is made. It is concluded that, in spite of the great advances in clinical and technological knowledge, the high frequency of disagreements between clinical and anatomical diagnoses, indicate that autopsy continues playing a key role in the quality control of medical practice. This justifies by itself the performance of necropsies.


Nutritional status of a nationwide sample of rural Mexican populations.

Information on nutritional status of the rural Mexican population is mostly obtained from cross-sectional studies. This investigation evaluates semi-longitudinally the nutritional level of a sample of the rural population of Mexico. A total of 15,552 individuals in 2,587 households from 208 rural communities were evaluated. Body weight and height of rural boys and girls were found to be significantly lower than in their urban counterparts. Severe forms of weight for age or height for age inadequacy were more frequent in females than in males, in smaller communities than in larger ones, and in economically depressed zones than in those with a good economy. Our data showed a lower frequency of mild and moderate forms of possible malnutrition than previous studies (20 vs 50%) using as a criterion weight for age. These differences are explained on the basis of sampling bias.


[Plasma clearance of ethanol and its excretion in the milk of rural women who consume pulque].

Women from rural areas of the central plateau of Mexico drink during pregnancy and lactation a mild alcoholic beverage called pulque as a galactogogue. Ethanol present in milk could have a harmful effect on growth and development of breast-fed children. The purpose of this study was to quantify the ethanol consumed as pulque by eleven lactating rural women as well as its clearance rate in blood and milk. Mothers were separated in two groups depending upon the ethanol ingested in a single dose of pulque 0.21 +/- 0.08 g/kg of body weight (group A) and 0.44 +/- 0.11 g/kg (group B). Maximal concentration of ethanol was reached in milk at 60 minutes and almost equaled that in plasma. Both groups showed a similar clearance pattern regardless of the volume of pulque ingested. Clearance rates between groups were different: ethanol concentration in milk at 60 min were 8.4 +/- 3.0 mg/dL for group A and 26.2 +/- 7.0 mg/dL for group B. Two hours later ethanol levels were 3.6 +/- 3.4 mg/dL and 23.3 +/- 9.4 mg/dL respectively. Clearance rates were slower in mothers showing the highest concentration of ethanol in milk. The present data demonstrate that there is no differential elimination of ethanol in maternal blood and milk following ingestion of a moderate amount of pulque during lactation. The amount of ethanol received by infants through milk is relatively low and therefore it is unlikely to have harmful effects on them. Pulque consumption adds about 350 kcal/day to the customary dietary intake of these lactating women.


[Oral pathology in 161 asymptomatic and symptomatic HIV-positive patients].

The aim of this study was to establish the prevalence of oral manifestations in HIV-infected patients and to correlate their frequency with the clinical stage. One hundred and sixty one HIV-positive individuals were examined, of whom 64 (40%) were in stages CDC-II and III and 97 (60%) in stage CDC-IV. The patients were examined at the AIDS out-patient clinic of the Instituto Nacional de la Nutrición Salvador Zubirán. The oral exams were performed by three examiners who were intra and inter calibrated, so that standard clinical criteria were followed. One hundred and twenty five patients (78%) showed one or more oral lesions. The proportion of patients with oral lesions increased significantly (p less than 0.05) according to the severity of the infection. Hairy leukoplakia (40%) and erythematous candidiasis (31%) were the most frequent lesions. When the prevalence of the different oral lesions was compared between the patients at early stages with the patients at the late stage no significant differences were found; only the pseudomembranous candidiasis and the exfoliative cheilitis were found with significantly higher values at stage CDC-IV than at earlier stages (p less than 0.001 and p less than 0.05 respectively). No association was found between oral candidiasis and tobacco use or xerostomia. Our study demonstrates that the prevalence and clinical features of the oral manifestations found showed similarities with those reported in other countries, but ulcero-necrotizing gingivitis was not found in our patients.


A controlled trial of pravastatin vs probucol in the treatment of primary hypercholesterolemia.

We compared the safety, tolerability and efficacy of the HMGCoA reductase inhibitor pravastatin and probucol in the treatment of patients with primary hypercholesterolemia using an active, drug controlled, double blind, randomized, double placebo design. Patients were included if LDL-C levels after a minimum of six weeks on an AHA phase I diet were greater than 150 mg/dL and triglycerides were less than 350 mg/dL. Included patients were randomly assigned to either pravastatin 40 mg pm or probucol 500 mg bi. They also received matching placebos for each drug. The active drug period lasted 16 weeks, during which the patients were seen at 4, 8, 12 and 16 weeks after baseline. There were no significant differences in baseline values between both treatment groups. Significantly lower values of total cholesterol and LDL-C were observed with pravastatin as compared to probucol. While a non significant increase of HDL-C was observed with pravastatin, a remarkable and statistically significant decrease was observed with probucol. A large dispersion of triglycerides levels was observed with both drugs and no statistically significant changes were demonstrated. Both pravastatin and probucol were well tolerated: only minimal clinical and laboratory changes, not considered to have been drug-related, were observed. No changes, considered drug-related, were observed in the cristalline lens. This study shows an overall superiority of pravastatin over probucol with significant larger decreases of total cholesterol and LDL-C and a better effect on HDL-C.


[Antibodies against human T-cell lymphotropic viruses in subjects at high risk for HIV in Monterrey].

HIV and HTLV-1 are retrovirus that can produce human disease. It is known that HTLV-1 is associated to the adult T cell leukemia and to the spastic tropical paraparesis. AIDS is now a pandemic infection and HTLV-1 has a high endemicity in the Caribbean region and Japan, whereas the south of the United States has a low endemicity. In Mexico there is little information on HTLV-1 incidence. In the present work we looked for anti HTLV-1 antibodies in one hundred persons that belong to the high risks AIDS population in the city of Monterrey, Mexico. We found that 93 sera were positive for anti HIV antibodies in a ELISA test and seven were negative. All 93 sera were also positive in the Western Blot assay. In the confirmatory test two out of the seven negative sera were classified as indeterminate and five as negative. We also included in this study 50 sera from healthy control volunteers that did not belong to the high risk AIDS population and resulted negative in the HIV and HTLV-1 test. Anti HTLV-1 antibodies were determined by using an agglutination test with gelatin particles covered with HTLV-1 and confirmed by a Western Blot assay. We found that only three sera resulted positive in this agglutination test, but were negative by the Western Blot technique.


Pathology of renal transplantation.

Renal transplantation is the most appropriate form of treatment for end-stage renal disease in all age groups. We present the experience of two hospitals in the pathology of kidney allograft. Renal biopsy is the most adequate method for the follow-up of these patients, because it permits the differential diagnosis of acute and chronic rejection, transplant glomerulopathy, recurrent and "de novo" glomerulonephritis and immunosuppression nephrotoxicity, mainly by cyclosporine A. We present the pathology features of all these entities, and study the representativity of the biopsy for diagnosis of rejection. The actuarial survival of the graft is 82% and 71% at 1 and 5 years, respectively.


[Comparison of 2 chemotherapy protocols in adult acute myeloblastic leukemia. Results of the Instituto Nacional de la Nutrición Salvador Zubirán cooperative group].

Up to now, the best treatment for patients with acute myelogenous leukemia (AML) is the induction of bone marrow hypoplasia by ablative combined chemotherapy; the prototype of these schedules is the so-called 7 + 3 (seven days of continuous infusion of cytarabine and three days of one-hour infusion of any anthracycline); these schedules require the support of both platelet transfusions and antibiotics. Other non-ablative schedules have also been tried in the treatment of such patients. Here we analyze the results of the treatment of 76 adult patients with AML; 43 were treated with the classical 7 + 3 schedule, whereas 33 were treated with a combination of chemotherapy used in non-ablative doses (TADOP: thioguanine, arabinosyl-citosine, doxorrubicin, vincristine and prednisone). The results were as follows, respectively, for 7 + 3 and TADOP: complete remission (CR) was achieved in 60 and 48% of patients (p NS); the number of cycles to achieve CR had a median of 1 and 5 months (p less than 0.001); the median duration of the CR was 21 and 10 months (p less than 0.05); fatal myelotoxicity was 30 and 42% (p NS), one-year disease free survival (DFS) was 45 and 46% (p NS) and three-year survival was 22% and 15% (p NS). Additionally, patients treated with 7 + 3 were divided into two groups according to the type of platelet transfusion support; those supported with apheresis equipment and those with centrifugation-derived platelets.(ABSTRACT TRUNCATED AT 250 WORDS)


Combination daytime chlorpropamide-metformin/bedtime insulin in the treatment of secondary failures in non insulin dependent diabetes.

To determine the effectiveness of the combination therapy with daytime chlorpropamide-metformin and bedtime NPH insulin in the treatment of secondary failures in NIDDM and to study its effects on insulin secretion. Non randomized open study with a duration of two months. The patients were followed six months after ending the study. Department of Diabetes and Lipid Metabolism. Instituto Nacional de la Nutrición "Salvador Zubirán", Mexico City. CHARACTERISTICS OF THE PATIENTS: Nine patients (seven women and two men) were included. All had NIDDM and secondary failure to antidiabetic oral drugs. Their fasting plasma glucose was 14.5 +/- 2 mM/L and their HbA1c 13.37 +/- 2.9%. At the entry and at the end of the study a 5h-OGTT was done with assays of plasma glucose and C-peptide. Chlorpropamide (375 mg/day) plus metformin (1200 mg/day) and bedtime insulin (0.1 U/kg/day). After two months on combination therapy, fasting plasma glucose and HbA1c levels were remarkably improved (decreases of 7.3 +/- 0.6 and 9.1 +/- 1.02 respectively, p less than 0.002). The insulin dose was small (6.77 +/- 2.09 U/day). Side effects were minimal and infrequent. During the 5h-OGTT, the mean glucose area under the curve also decreased. The insulin secretion did not change but the C-peptide/glucose ratio increased. At the end of the study, the insulin dose was tapered off and stopped when possible. The four patients with the best glycemic control during the study were able to suspend the bedtime insulin and maintain a good control six months after the insulin suspension. The combination therapy is useful in the treatment of secondary failures in NIDDM: Its advantages are the very low mean daily insulin dose needed, the low incidence of side effects and, if a HbA1c less than 8.7% is achieved, the restoration of oral antidiabetic drugs efficacy. The very low insulin dose used in this study could be explained by complementary effects of metformin and bedtime insulin on hepatic glucose output and a putative decrease in peripheral resistance attributable both to sulfonylurea and metformin.


The role of histopathology in hepatic transplantation.

In hepatic transplantation, the recipient and the graft must manage a difficult symbiosis. The causes that can unbalance the mutual adaptation are various, but the clinical-biochemical hepatic graft syndromes they produce are not specific. Morphological study of the graft shows a distinct pattern for each type of dysfunction etiopathogeny. Such study may find: (1) immune attack: acute rejection or chronic rejection; (2) technical complications in the biliary tract or in the blood perfusion of the graft; (3) nonspecific cholestasis secondary to graft cold ischemia or preceding development of chronic rejection; (4) recurrence of the previous illness: graft infected by hepatitis virus; (5) opportunistic viral infections (cytomegalovirus, Epstein-Barr virus, herpesvirus, adenovirus); (6) reactions to drugs and toxics; and (7) combinations of several etiologies. Morphological knowledge enables the pathologist to collaborate in hepatic transplantation programs: elaborating protocols, selecting patients, diagnosing hepatic graft dysfunction, and assessing program quality.


[Efficacy and tolerance to acarbose in non-insulin-dependent diabetics].

Oral acarbose, a competitive inhibitor of alpha-glucosidase, has been shown to be effective in decreasing the postprandial rise in blood glucose and insulin. A double blind, cross-over, placebo controlled, randomized study in poorly controlled, non-insulin dependent diabetic patients under treatment with sulfonylureas was carried out. The patients continued receiving sulfonylureas throughout the study period and were randomly allocated into two sequences. In sequence A they received 100 mg tablets tid during 12 weeks; placebo tid during 2 weeks (wash-out period) and finally they were crossed over to placebo tid during 12 weeks. In sequence B, they received placebo tid 12 weeks, placebo tid during 2 weeks and finally acarbose 100 mg tid during 12 weeks. Sixteen patients were included in each sequence; three were excluded from sequence A, one because of side effects, one because of severe neuropathy and one because of change of address. One was excluded from sequence B because of failure to take the sulfonylurea. A slight but statistically significant decrease in weight was observed with acarbose as compared with placebo in both sequences. Significant reductions in postprandial glucose were observed in both sequences with acarbose. Significant reductions in fasting blood glucose were also observed in some visits. Although lower mean values of triglycerides and HbA1c were observed with acarbose, they were not statistically significant. Acarbose had side effects almost in all patients, but decreased on continued therapy. Only one patient had to be excluded for this cause. Acarbose is a useful therapeutic resource in poorly controlled non-insulin dependent diabetic patients in combination with sulfonylureas.


[Observer agreement in the measurement of leg length].

The lower limb length measurement is an important element for the diagnosis of mechanical or structural lumbar pain. Also it has been used for referral pain associated with hip or knee osteoarthritis or the groin and suprapubic areas. The aims of the present study were: 1) to measure the intra and inter observers variation; 2) to measure the intra-method variation using two different techniques for lower limb length measurement, one called the "apparent measure" (9) and comparing both with the radiological measurement technique. Two medical doctors, training on the techniques for lower limb measurement, performed the measurements. The exclusion criteria were flexion deformity of the hip or an overweight greater than 20% over the mean weight expected according to age and sex. A correlation coefficient and its 95% confidence interval (CI) were estimated, one tail test (Ho: r = 0.75). Seventeen patients fulfilled the inclusion criteria, 15 females and two males. The mean age was 35.8 years +/- 13.0 (SD). The correlation coefficient for the inter-observers variation using the "apparent measure" was 0.99 (CI = 0.985) and for the difference between legs it was 0.88 (CI = 0.10). The inter-observers variation for lower limb length measurement using the technique of "real measure" showed a correlation coefficient of 0.77 (CI = 0.95) and for the difference in length between legs it was 0.99 (CI = 0.85). The intra-observer correlation coefficient was 0.95 (CI = 0.85). The correlation coefficient for the inter-observer using the X-ray pictures was 0.98 (CI = 0.92).(ABSTRACT TRUNCATED AT 250 WORDS)


Pathology of lung transplantation.

The pathology of lung transplantation has many features in common with other solid organ grafts. Acute pulmonary rejection is characterized by perivascular, peribronchiolar, and interstitial mononuclear infiltrates. Chronic rejection causes obliterative bronchiolitis and vascular sclerosis. The transplanted lung is uniquely susceptible to infections, both usual and opportunistic, and these can be difficult to differentiate from rejection. Infection in the foreign graft can produce unusual histological appearances. Posttransplant lymphoproliferative disease can affect the lung allograft primarily. Transbronchial lung biopsy and bronchoalveolar lavage are considered essential to the postoperative management of lung transplants and to the understanding of the pathological processes limiting graft survival.


[Interaction of the cytoskeleton of E. histolytica with human erythrocytes].

The mechanism by which trophozoites of E histolytica destroy mammalian cells has been correlated with the polymerization of the actin contained in the amoeba's cytoskeleton. This is preceded by the attachment of the amoeba lectins with carbohydrates in the cell surface. Here we describe the events of the interaction of E histolytica cytoskeleton with human red blood cells using fluorescence microscopy of glutaraldehyde-fixed trophozoites membrane removed with triton X-100 and stained with rhodamine-phalloidin. The challenge with RBC revealed a maximum polymerization two minutes after the challenge. The most active phagocytosis was observed four minutes after challenge. The use of fluorescent phalloidin showed to be a fast method which specifically binds to the F form of actin; this method is easier than methods which use monoclonal antibodies to identify actin.


Pathology of bone marrow transplantation.

For evaluating the therapeutic approaches in the follow-up and complications of patients treated with bone marrow transplantation (BMT), the histopathology is important on many occasions. The authors describe the different morphological changes that have an important role for treatment of these patients, classified according to their target organs of localization: skin, digestive tract, liver, and bone marrow. Graft-versus-host disease (GVHD) mainly affects the skin, gastrointestinal tract, and liver, and is sometimes difficult to differentiate from radiochemotherapy or infectious diseases. In the liver, the most frequent complications are GVHD, veno-occlusive disease, and infections. In the bone marrow, it is most important to evaluate the elimination of hemopathy and the reconstitution of normal hematopoiesis.


[4 cases of annular pancreas at the Instituto Nacional de la Nutrición Salvador Zubirán].

Annular pancreas (AP) is a rare congenital anomaly due to malrotation of the pancreatic ventral yolk. Although it has been described in young and middle age adults it predominates in children. Its clinical picture is that of duodenal obstruction or acute pancreatitis episodes. In this paper we report four cases of AP that were seen at the Instituto Nacional de la Nutricion Salvador Zubiran in Mexico City. Three were females and three were less than twenty years old. In one case the diagnosis was established at birth and the operation done in another hospital. In another patient a diagnosis of pyloric hypertrophy was made and a pyloroplasty was performed. This young man was admitted in our hospital because of abdominal pain and hyperamylasemia. An eighty four year old woman was seen due to abdominal pain, nausea and vomit. In all cases the diagnosis of AP was carried out with radiological studies and confirmed by laparotomy. Surgical procedures consisted of duodenal-duodenal anastomosis in two, sphincteroplasty in one, and gastrojejunoanastomosis in the other. Two patients are asymptomatic, one died in the postoperative period, and one was lost for follow up. These four cases represent all the experience of our institute and correspond to one case in 36,735 admissions.


Fine-needle aspiration biopsy in transplantation pathology.

Invasive methods are the only reliable method for diagnosis of rejection and other intragraft complications. Needle biopsy (NB) histology is considered as the "gold standard," but because of potential complications, cannot be used for frequent monitoring of organ allografts. Fine-needle aspiration biopsy (FNAB) is an invasive, but less traumatic, diagnostic method for continuous monitoring of intragraft events. The FNAB method makes it possible to evaluate the onset, intensity, and duration of inflammatory episodes of acute rejection. Parenchymal changes in the FNAB specimens give additional information of the intragraft events. As FNAB can be repeated daily, it enables not only diagnosis of the presence or absence of acute rejection, but can also monitor the effect of immunosuppressive therapy and the response to antirejection treatment. However, the diagnosis of chronic rejection and other later complications is established only by biopsy histology.


Pathology of heart transplant through endomyocardial biopsy.

Cardiac transplantation is most effective method for treatment of patients with end-stage heart disease. We present the experience of our institution with 1,564 biopsies and 11 autopsies of 105 orthotopic heart transplants. This report describes the morphological features and the grading systems of acute rejection. Also, we present the morphological characteristics of other complications of heart transplants such as chronic rejection, "Quilty" effect, interstitial fibrosis, heart hypertrophy, previous biopsy sites, calcification, cytomegalovirus infections, toxoplasmosis, and the appearance of malignancies, mainly, lymphomas. Actuarial survival of patients is 91% and 88% at 1 and 5 years' posttransplant, respectively.


Cancer rehabilitation: a consumer perspective.

Twenty years ago, quantity took precedence over quality of life as a matter of necessity. The idea of incorporating rehabilitation programs into the oncology arena was essentially a foreign concept. Quality-of-life issues are receiving more attention because of the survivorship movement; however, the ramifications for surviving the cancer experience in our current culture extend far beyond the medical diagnosis and treatment.


Cancer rehabilitation: an overview.

Cancer rehabilitation is a practical attempt to maximize independence and dignity and to reduce the extent to which cancer interferes with an individual's physical, psychosocial, and economic functioning. The rehabilitation process should begin at the time of diagnosis or definitive medical intervention and should continue until the individual is able to maintain the desirable level of independence.


Life cycle issues affecting cancer rehabilitation.

Developmental stage of the person with cancer has a profound effect on the rehabilitation plan. Although the issues faced by the very young and the elderly are quite different, the struggle to maintain optimal function is universal. As we continue to see improved survival rates and cures, the need for comprehensive rehabilitative care for all persons experiencing cancer becomes a challenge. Our success in meeting this challenge will be realized in measurable outcomes that will direct future rehabilitative care.


Functional rehabilitation in cancer care.

The most frequent difficulties that cancer patients face are physical problems, thus, evaluating the functional level of the patient is the cornerstone of rehabilitation. The Functional Independence Measure (FIM) measures self-care, sphincter control, mobility, locomotion, communication, and social cognition.


The status of psychosocial research in the rehabilitation of the cancer patient.

This article has tried to describe the current status of psychosocial research in the rehabilitation of the cancer patient. It attempted to weave together the author's perspective of how decisions early in the history of sponsored research programs, particularly by the National Cancer Institute, combined with a limited knowledge base led to limited growth of the Rehabilitation Program. Thus, the current status of psychosocial cancer rehabilitation can be reasonably attributed to the decision at the National Cancer Institute to encourage the development of cancer rehabilitation services, rather than to aggressively expand the knowledge base. Although, in retrospect, it is possible to criticize these decisions, in fact, they were legitimate choices among a wide range of options. It was also not possible in this article to discuss many topics in psychosocial cancer rehabilitation, particularly differences in psychosocial adjustment as a function of type of cancer. What the study attempted to do was to confront the impression that cancer rehabilitation, in general, and psychosocial cancer rehabilitation, in particular, are ancillary activities that can receive a secondary level of resource allocation and support. The point was made that determining if psychosocial rehabilitation is possible raises as many basic research questions as does understanding how chemotherapy works or how a malignancy develops. All three areas ask legitimate basic research questions on how the body works and how behavior changes. Today, 10 years after the start of the original Rehabilitation Program, psychosocial cancer rehabilitation is an established field of study and an integral part of most major oncology services. Now, as stated, what is needed is an expansion of its knowledge base. Some of the issues that are deserving of support include studies on cosmesis, to what extent voluntary processes can compensate loss in speech and swallowing functions, functional evaluation following alternative surgical procedures, what is the quality of life following long-term survival of cancer, what are the group dynamics following return of a cancer patient to a work site, and so on. Each of these research questions can be guided by the same model developed for cancer control research by Greenwald and Cullen. Other more general approaches include recognizing and promoting the preventative dimension of cancer rehabilitation and developing the art and practice of psychometric assessment of psychosocial aspects of cancer rehabilitation, just to name two such areas. The American Cancer Society also recently sponsored a meeting to review and set new directions for psychosocial rehabilitation research.(ABSTRACT TRUNCATED AT 400 WORDS)


Vocational rehabilitation of cancer patients.

Indeed, cancer patients do face job discrimination. Empirical studies have shown evidences of personnel selection bias and many other work-related problems. Laws and legislation are good tools but are not the answers to most of the problems. A competent multidisciplinary rehabilitation team, a well-educated general public and employers, together with empowered cancer patients can do more towards eliminating destructive road blocks to the employment of the employable. This takes time and initially may be costly for all concerned. However, evidence has shown that the cost of closed cancer rehabilitation cases is the lowest per case for all occupational disabilities including tuberculosis, diabetes, mental disorders, heart disease, and orthopedic problems. In short, we dare not forget the simple truth put forth by Harold Dodds that "No, work is not an ethical duty imposed on us from without by a misguided and outmoded Puritan morality; it is a manifestation of man's deepest desire that the days of his life shall have significance." Cancer patients living with cancer desire significance to their days to the same degree that those of us who are healthy and well desire and need it.


Rehabilitation resources within the team and community.

The resources of a cancer rehabilitation team can provide the support, skills, and information needed whether the individual's life expectancy is short or long. The setting of such services must include both the inpatient and outpatient settings and serve as a comprehensive approach to enhance the survival for the patient with cancer.


Future directions in cancer rehabilitation.

Many of the current and future directions in cancer rehabilitation have been briefly discussed; and some of the important areas for development are outlined in Table 1. Implementation of rehabilitation measures may be facilitated by organized and creative multidisciplinary rehabilitation programs. Advances are also dependent on health care policy, particularly in reimbursement for rehabilitation services and in the funding of rehabilitation research. Much progress can be expected in the years ahead.


Chromium exposure assessment of outdoor workers in Hudson County, NJ.

A large quantity of chromate chemical production waste, containing hexavalent chromium, has been used as fill at over 150 sites in Hudson County, New Jersey. One site is in a state park, and several other sites are adjacent to the park. Blood and urinary chromium levels were compared between 17 employees at the Hudson County park and 35 employees from two other state parks. A limited number of soil and personal air samples were also taken. Urinary and RBC chromium levels between the two groups were similar, even after adjusting for potentially confounding variables. The air sampling results demonstrated slightly higher chromium levels at Hudson County, but these were still very low level in nature (mean = 0.18 micrograms/m3). These results call into question the utility of chromium biomonitoring under environmental exposure conditions.


The impact of the banning of tributyltin-based antifouling paints on the Sydney rock oyster, Saccostrea commercialis.

Two years after the banning in New South Wales (Australia) of tributyltin (TBT)-based antifouling paints for vessels under 25 metres in length, the impact on the Sydney rock oyster, Saccostrea commercialis, has been assessed. Reduced growth and shell deformities present before banning were found to be absent and healthy oysters contained TBT at concentrations close to the detection limit of 0.2 micrograms Sn kg-1. High tissue concentrations of both copper and zinc, prior to banning were also significantly reduced. This behaviour was predicted by field experiments which showed that TBT had a synergistic effect on the uptake of copper. The distribution of both TBT and copper in the various organs of the oyster were examined in an attempt to explain this synergism.


Pesticide exposure and cholinesterase levels among farm workers in the Republic of South Africa.

A preliminary survey was undertaken to establish the extent of pesticide exposure in a farming community. The area under investigation included a coffee plantation in the northern region of South Africa. Cholinesterase levels in red blood cells and plasma were used as markers to monitor the extent of organophosphate and carbamate exposure. Sixty-nine farm workers with specific pesticide exposure were selected for the study, and the frequency of the different symptoms which may be related to pesticide exposure was determined by interview and questionnaire. Of the workers, 77% had their red blood cell cholinesterase levels below the normal reference range, while 27% of the workers had depressed plasma cholinesterase levels.


Arsenic lipids in the digestive gland of the western rock lobster Panulirus cygnus: an investigation by HPLC ICP-MS.

The digestive gland of the western rock lobster, Panulirus cygnus, was shown to contain phosphatidylarsenocholine and a phosphatidyldimethylarsinylriboside by HPLC ICP-MS examination of lipid materials rendered water-soluble by hydrolysis. Water-soluble arsenic material in the digestive gland was chiefly arsenobetaine but the deacylated analogue of the phosphatidyldimethylarsinylriboside and an unidentified compound were also present.


Carnivorous plants: phylogeny and structural evolution.

The carnivorous habit in flowering plants represents a grade of structural organization. Different morphological features associated with the attraction, trapping, and digestion of prey characterize a diversity of specialized forms, including the familiar pitcher and flypaper traps. Phylogenetic analysis of nucleotide sequence data from the plastic rbcL gene indicates that both carnivory and stereotyped trap forms have arisen independently in different lineages of angiosperms. Furthermore, these results demonstrate that flypaper traps share close common ancestry with all other trap forms. Recognition of these patterns of diversification may provide ideal, naturally occurring systems for studies of developmental processes underlying macromorphological evolution in angiosperms.


Oxidized redox state of glutathione in the endoplasmic reticulum.

The redox state of the endoplasmic reticulum (ER) was measured with the peptide N-Acetyl-Asn-Tyr-Thr-Cys-NH2. The peptide diffused across cellular membranes; some became glycosylated and thus trapped within the secretory pathway, and its cysteine residue underwent reversible thiol-disulfide exchanges with the surrounding redox buffer. Glycosylated peptides from cells were disulfide-linked to glutathione, indicating that glutathione is the major redox buffer in the secretory pathway. The redox state of the secretory pathway was more oxidative than that of the cytosol; the ratio of reduced glutathione to the disulfide form (GSH/GSSG) within the secretory pathway ranged from 1:1 to 3:1, whereas the overall cellular GSH/GSSG ratio ranged from 30:1 to 100:1. Cytosolic glutathione was also transported into the lumen of microsomes in a cell-free system. Although how the ER maintains an oxidative environment is not known, these results suggest that the demonstrated preferential transport of GSSG compared to GSH into the ER lumen may contribute to this redox compartmentation.