Agonist and antagonist activity during voluntary upper-limb movement in patients with stroke.

Forty-four patients with hemiplegia following stroke and 10 nondisabled subjects were studied to examine the contributions inadequate motor unit recruitment and co-contraction attributable to impaired antagonist inhibition play in the movement disorder of the hemiplegic arm. Electromyographic data were recorded from agonist and antagonist muscles while subjects attempted six specified tasks. Data from subjects who could complete the tasks were compared with those who could not complete the tasks. Differences between the two groups were found in the electromyographic data obtained from the agonist muscles. Electromyographic values were consistently and significantly lower in patients who were unable to complete the tasks than in patients who were able to complete the tasks. In the antagonist muscles, a significant difference was noted only once; in this case, the EMG values were again lower in the group of patients who were unable to complete the task. Inadequate recruitment of agonists, not increased activity in the antagonists, was a consistent finding in patients who were unable to carry out the movement tasks. This study theoretically supports aiming treatment efforts at improving motoneuron recruitment rather than reducing activity in antagonists while retraining arm function.


Assistive positioning as a control parameter of social-communicative interactions between students with profound multiple disabilities and classroom staff.

This study examined the effects of assistive positioning on social-communicative interactions between 10 students, 6 to 12 years of age, with profound multiple disabilities, and their classroom staff. Interactions were videotaped in the students' classrooms when each student was positioned using a wheelchair, a sidelyer, and a mat on the floor. Data were analyzed by repeated-measures analysis of variance. During unstructured interactions, adults initiated communication at higher rates when students were positioned in their wheelchairs. During structured interactions, when students were given standardized opportunities for interaction, students functioning at lower levels of communication development were more communicative when they were supine on a mat than when in their wheelchairs or a sidelyer. In dynamic systems terms, position served as a control parameter of both adult and student communicative behaviors, which should be considered when recommending use of assistive positioning equipment for students with severe disabilities.


Comparison of three noninvasive methods for measuring scoliosis.

The premise behind most noninvasive techniques for the measurement of scoliotic conditions of the spine is that the lateral distortion of the spine relates directly to transverse rib cage deformity within the transverse plane. The focus of this study was to examine this assumption by comparing different noninvasive methods for the assessment of scoliotic curves. The three techniques examined were (1) use of the Scoliometer (SCOL), (2) use of the back-contour device (BCD), and (3) use of moiré topographic imaging (MTI). Fourteen subjects (10 female, 4 male) with idiopathic adolescent scoliosis were measured. Posterior-anterior radiographs were obtained for the clinical assessment of all subjects and were subsequently used to determine Cobb angles. Significant correlations between axial trunk rotation and Cobb-angle measurements were observed in the thoracic region (MTI, r = .80, df = 10, P less than .005; BCD, r = .70, df = 10, P less than .025; SCOL, r = .59, df = 10, P less than .025) but were not found within the lumbar region (MTI, r = .42; BCD, r = .17; SCOL, r = .20). Factors other than trunk deformity, such as the posture assumed by the subject during measurement, may have influenced axial trunk rotation. Hence, the techniques appear to provide valid estimations of lateral curvature of the spine in the thoracic region of the trunk but not the lumbar region. The results suggest that the measurement techniques cannot be used interchangeably in clinical recording.


Alterations in electrical pain thresholds by use of acupuncture-like transcutaneous electrical nerve stimulation in pain-free subjects.

Acupuncture-like transcutaneous electrical nerve stimulation (ALTENS) was compared with a placebo treatment in altering acute electrical pain thresholds. Ten pain-free subjects underwent, on different days, an acclimatization session, an ALTENS treatment, and a placebo treatment in a cross-over design. Electrical sensation and pain thresholds were measured from the tip of the index finger bilaterally at 15-minute intervals twice before, once during, and three times after a 30-minute treatment session. The ALTENS treatment was given at 4 Hz at an intensity just below pain threshold delivered to acupuncture points in the hand and wrist. The placebo treatment was similarly delivered, except that the intensity of stimulation was just above sensation threshold. Neither the ALTENS treatment nor the placebo treatment produced a significant change in pain threshold. There was no correlation between initial pain threshold and change in pain threshold. Implications for the modulation of pain are discussed.


Influence of high voltage pulsed current on edema formation following impact injury in rats.

High voltage pulsed current (HVPC) has been shown to be effective in curbing posttraumatic edema formation in frogs. The purpose of this study was to establish the utility of HVPC in controlling edema formation in a mammalian model. Both feet of 20 anesthetized rats were traumatized following initial determination of hind-limb volumes. Four 30-minute cathodal HVPC treatments at 120 pulses per second and 90% of visible motor threshold interspersed with 30-minute rest periods were applied to one randomly selected hind limb of each rat via the immersion technique. The other hind limb served as a control. Limb volumes were measured after each treatment and rest period. All data were expressed as changes from pretrauma limb volumes in milliliters per kilogram of body weight; these data were analyzed by repeated-measures analyses of variance and post hoc paired t tests. Volumes of untreated limbs were significantly greater than volumes of treated limbs after the second treatment. Evidence of significant treatment effects in frogs, and now rats, provides a compelling rationale for initiating trials of efficacy of cathodal HVPC in inhibiting acute edema formation in humans.


Photoperoxidation of cholesterol in homogeneous solution, isolated membranes, and cells: comparison of the 5 alpha- and 6 beta-hydroperoxides as indicators of singlet oxygen intermediacy.

Singlet oxygen (1O2) can react with cholesterol (Ch) to give three possible ene-addition hydroperoxides: 3 beta-hydroxy-5 alpha-cholest-6-ene-5-hydroperoxide (5 alpha-OOH), 3 beta-hydroxycholest-4-ene-6 alpha-hydroperoxide (6 alpha-OOH), and 3 beta-hydroxycholest-4-ene-6 beta-hydroperoxide (6 beta-OOH). The rates of dye-sensitized photogeneration and also the fates of 5 alpha-OOH and 6 beta-OOH in membrane bilayers have been studied and compared. Irradiation of unilamellar [14C]Ch/phospholipid vesicles in the presence of aluminum phthalocyanine tetrasulfonate or merocyanine 540 resulted in formation of 5 alpha-OOH and 6 beta-OOH, as determined by high performance liquid chromatography with radiochemical or electrochemical detection. The initial rate of 6 beta-OOH formation was 30-35% that of 5 alpha-OOH in a variety of liposomal systems. However, after a lag, 5 alpha-OOH invariably decayed via allylic rearrangement to 7 alpha-OOH (also known to be a free radical product), whereas 6 beta-OOH accumulated in unabated fashion until Ch depletion became limiting. Photooxidation of Ch in an isolated natural membrane (erythrocyte ghost) or in L1210 leukemia cells gave similar results. When the reaction was carried out in pyridine or methanol, the rate of 6 beta-OOH formation relative to 5 alpha-OOH was reduced by approximately half, with essentially no isomerization of the latter to 7 alpha-OOH.(ABSTRACT TRUNCATED AT 250 WORDS)


9,11-Dicis-12-fluororhodopsin. Chromophore properties from 19F-NMR studies.

From a 19F-NMR study of 9,11-dicis-12-fluororhodopsin and its photobleached product, we concluded that the initially formed chromophore retained its configuration and the photoproduct corresponded to the two-bond isomerized all-trans. Upon standing, it slowly isomerized to the 9-cis isomer. The method represents a direct, non-destructive procedure for determining configuration purity of the pigment formed. Its unique fluorine opsin shift value is consistent with the expected different orientation of the fluoro-substituent in a dicis pigment.


Evidence for an ultraviolet sunscreen role of the extracellular pigment scytonemin in the terrestrial cyanobacterium Chlorogloeopsis sp.

The proposed photoprotective role of the UV-A absorbing, extracellular pigment scytonemin was studied in the terrestrial cyanobacterium Chlorogloeopsis sp. strain O-89-Cgs(1). UV-A (315-400 nm) caused growth delay, cell growth restarting only when scytonemin had accumulated in the extracellular envelopes. Cultures with scytonemin were more resistant to photoinhibition of photosynthesis than cultures without scytonemin, the differential resistance being much greater to UV-A-caused photoinhibition than to photoinhibition caused by visible light. The presence of scytonemin in the extracellular envelopes was correlated with the inability of UV-A radiation to induce strong photopigment fluorescence (685 nm emission), regardless of the specific content os photosynthetic pigments. The physical removal of the scytonemin containing extracellular envelopes brought about the loss of UV-A resistance as measured by photobleaching rates of chlorophyll a under conditions of physiological inactivity (desiccation). These observations provide strong evidence for the proposed protective role of scytonemin, as a passive UV-A sunscreen, in cyanobacteria.


Inhibition of 12-O-tetradecanoylphorbol-13-acetate-induced tumor promotion in murine skin by systemic effects of ultraviolet irradiation.

Systemic effects of UVB irradiation (280-320 nm) have been shown to prevent subsequent chemical tumorigenesis induced by an initiation-promotion protocol. The present investigation was designed to determine whether initiation or promotion is prevented by UV irradiation. Groups of 25 B6D2F1/J mice received 12 weeks of intermittent dorsal UVB radiation treatments administered before, or 3 weeks after, initiation with a single application of 7,12-dimethylbenz[a]anthracene on the ventral skin. All mice were promoted ventrally with 5 micrograms 12-O-tetradecanoylphorbol-13-acetate (TPA) applied three times weekly throughout the experiment. UV irradiation consisted of five 30-min exposures per week to a bank of 6 Westinghouse FS40 sunlamps. UV irradiation applied before or after initiation resulted in a decrease of 18-16 tumors per group of 25 mice, for a reduction of 61 and 50%, respectively, at 24 weeks after the first TPA treatment. Thus, prevention of tumor development was similar whether the UV influence was present or not during initiation. This finding suggests that the UV prevention of promotion could account for UV inhibition of skin tumors induced by an initiation-promotion regimen. Consistent with this concept, pretreatment of mice with dorsal UVB radiation was found to reduce DNA synthesis after exposure to TPA by 46%, although it did not decrease tritiated benzo[a]pyrene binding to DNA, in ventral epidermis. Thus, UVB irradiation systemically reduced TPA-induced tumor promotion in murine skin.


Effect of vitamin E on cytotoxicity, DNA single strand breaks, chromosomal aberrations, and mutation in Chinese hamster V-79 cells exposed to ultraviolet-B light.

The effect of pretreatment with vitamin E on cytotoxicity, DNA single strand breaks, and chromosomal aberrations as well as on mutation induced by ultraviolet-B light (UV-B) was investigated in Chinese hamster V-79 cells. Cellular pretreatment with non-toxic levels of 25 microM alpha-tocopherol succinate (vitamin E) for 24 h prior to exposure resulted in a 10-fold increase in cellular levels of alpha-tocopherol. Using a colony-forming assay, this pretreatment decreased the cytotoxicity of UV-B light. However, alkaline elution assays demonstrated that pretreatment with vitamin E did not affect the number of DNA single strand breaks caused by UV-B light. In addition, UV-B exposure produced a dose-dependent induction of chromosomal aberrations and mutations at the HGPRT locus, and neither of these actions of UV-B was influenced by pretreatment with the vitamin. These results suggest that vitamin E protects cells from UV-B-induced cytotoxicity, possibly through its ability to scavenge free radicals. The results also suggest that the extent of genotoxicity induced by UV-B light may not correlate directly with the cytotoxic action of this wavelength region in sunlight.


Photodynamic therapy of chemically- and ultraviolet B radiation-induced murine skin papillomas by chloroaluminum phthalocyanine tetrasulfonate.

Photodynamic therapy (PDT) of cancer combines irradiation of tumors with visible light following selective uptake of the photosensitizer by the tumor cells. PhotofrinR-II (Pf-II) is the only photosensitizer which is in clinical use in PDT, whereas chloroaluminum phthalocyanine tetrasulfonate (AlPcTS) has also shown promise in preclinical studies. In most such studies, the effectiveness of the photosensitizers has been assessed in implanted tumor model systems rather than in model systems where tumors are allowed to grow in their own connective tissue matrix. In this study the pharmacokinetics, tumor ablation capability and cutaneous photosensitization response of AlPcTS have been assessed in mice bearing chemically- and ultraviolet B radiation (UVB)-induced benign skin papillomas. When tumor-bearing animals were injected intraperitoneally with AlPcTS (5 mg/kg body wt), maximum tumor:normal skin ratio of 2.4 was observed at 48 h, at which time the mice were irradiated within the absorption spectrum of the photosensitizer. In tumor ablation studies with SENCAR mice bearing chemically-induced skin tumors, AlPcTS resulted in greater than 80% ablation in tumor volume at 20 days post-irradiation. In cutaneous photosensitization response, AlPcTS produced only transient effects (no effect after 24 h) in SENCAR mice. Pharmacokinetics data, tumor ablation effects and cutaneous photosensitization response of AlPcTS were comparable in SKH-1 hairless mice bearing UVB-induced skin tumors. Our data indicate that AlPcTS produces significant photodynamic effects towards the ablation of murine skin tumors, and that it does not produce prolonged cutaneous photosensitivity.


Lipoprotein-mediated distribution of N-aspartyl chlorin-E6 in the mouse.

The localization of many photosensitizing agents has been attributed to distribution of low density lipoprotein (LDL)-bound drug as a function of the relative numbers of LDL receptors in different tissues. While the chlorin derivative NPe6 is a potent photosensitizing agent in the mouse, it binds mainly to mouse plasma high density lipoproteins (HDL) and albumin, with only 1% bound to LDL. This pattern suggests only a minor role for the LDL-receptor pathway with regard to N-aspartyl chlorin e6 (NPe6) biodistribution. Moreover, patterns of accumulation of radioactive NPe6, LDL and HDL in murine tissues are consistent with the suggestion that distribution of NPe6 to different tissues cannot be explained on the basis of an LDL-mediated mechanism.


Conformational changes of cytosolic loops of bovine rhodopsin during the transition to metarhodopsin-II: an investigation by Fourier transform infrared difference spectroscopy.

In order to assign the structural changes of the protein, observed in the Fourier transform infrared (FT-IR) difference spectra of the rhodopsin-metarhodopsin-II transition, to specific regions of the protein, rhodopsin was treated by proteases. Nonilluminated and bleached rhodopsin was treated with protease K and papain. Rhodopsin digested in the bleached state was subsequently regenerated with 11-cis-retinal. From these modified samples the rhodopsin-metarhodopsin-II FT-IR difference spectra were measured. Comparing the difference spectra with that of unmodified rhodopsin, clear deviations in the amide-I and amide-II spectral range are observed. This indicates that in the unmodified pigment conformational changes of those parts of the cytosolic surface take place which are susceptible to the proteases. From the larger spectral changes obtained with samples digested in the bleached state it is concluded that the extent of modification is larger. The difference spectra of rhodopsin modified with 10 mM dithiothreitol support the existence of the 4th loop which also undergoes conformational changes. The spectral changes are interpreted in terms of a transition of an ordered structure of the loops in rhodopsin to a more random structure in metarhodopsin-II. The results demonstrate that by combining FT-IR spectroscopy with protein modification by specific proteases, conformational changes of the protein can be localized to specific regions.


Iron-sulfur centers as endogenous blue light sensitizers in cells: a study with an artificial non-heme iron protein.

The possible involvement of Fe-S clusters in photodynamic reactions as endogenous sensitizing chromophores in cells has been investigated, by using an artificial non-heme iron protein (ANHIP) derived from bovine serum albumin and ferredoxins isolated from spinach and a red marine algae. Ferredoxins and ANHIP, when exposed to visible light, generate singlet oxygen, as measured by the imidazole plus RNO method. Irradiation with intense blue light of the ANHIP-entrapped liposomes caused severe membrane-damage such as liposomal lysis and lipid peroxidation. In the presence of ANHIP, isocitrate dehydrogenase and fructose-1,6-diphosphatase were photoinactivated by blue light. However, all of these photosensitized reactions were significantly suppressed by a singlet oxygen (1O2) quencher, azide, but enhanced by a medium containing deuterium oxide. Further, the Fe-S proteins with the prosthetic groups destroyed did not initiate the blue light-induced reactions. In addition, the action spectrum for 1O2 generation from ANHIP was very similar to the visible absorption spectrum of Fe-S centers. The results obtained in this investigation appear consistent with the suggestion that Fe-S centers are involved in photosensitization in cells via a singlet oxygen mechanism.


Photochemistry of halogen pyrimidines: iodine release studies.

The feasibility of using direct iodide (I-) measurements to monitor the photochemistry of the halogenated pyrimidines 5-iodocytosine and 5-iodouracil and their corresponding deoxynucleosides was examined. Radiation from either a germicidal lamp (lambda = 254 nm) or a sunlamp (lambda greater than 290 nm) was employed to induce homolytic splitting of the carbon-iodine bond and the release of iodine atoms. These atoms combine to form I2 which reacts with water to ultimately form I- and iodate (IO3-). The formation of I- was followed using either high performance liquid chromatography with electrochemical detection or a specific ion electrode. IO3- was assayed spectroscopically following its conversion to triiodide. The yields of I- relative to starting material destroyed were either close to the theoretical limit of 83% or higher depending upon (a) the compound being irradiated, (b) the irradiation wavelength and (c) the extent of exposure. Yields of iodide greater than 83% are generally accounted for by a concomitant reduction in the yield of iodate such that the sum I(-) + IO3- is approx. 100%. Because iodate is photochemically reduced to iodide by 254 nm but not sunlamp irradiation, exhaustive irradiation at 254 nm converts all of the iodate present to iodide. These studies have application to the use of photochemical methods for quantitating the percent substitution of iodinated pyrimidines in DNA, and should be useful in following the photochemistry of IdUrd and IdCyd substituted DNA.


Room-temperature steady-state fluorescence properties of poly(dG-dC).poly(dG-dC).

We report the steady-state fluorescence properties of the alternating polynucleotide poly(dG-dC).poly(dG-dC) in low-salt solution at room temperature for excitation at the Hg lines 265, 280 and 297 nm. Its fluorescence spectrum peaks at about 325 nm and, within the experimental error, its shape does not change significantly with the excitation wavelength. The fluorescence anisotropy is found to decrease strongly for short-wavelength excitation, a behavior which is very similar to that exhibited by free guanine. In view of the fact that the anisotropy for free cytosine is virtually constant at the aforementioned three excitation wavelengths, the results suggest that in this polynucleotide the emission stems from guanine. The values of the fluorescence quantum yield for the three excitation wavelengths are found to be very low, 0.8 x 10(-5), 0.8 x 10(-5), and 2.8 x 10(-5), respectively; these are compatible with transfer of energy from the lower-energy electronic state of guanine, before vibronic relaxation is established, to cytosine. Upon denaturation, the fluorescence spectrum becomes very broad and the fluorescence quantum yield increases; these observations support the authenticity of the emission from the nondenatured polynucleotide.


Small acidic peptides from wheat germ chromatin. II. Regulatory activity in specific transcription systems reconstituted in vitro.

A variety of evidence suggests that a family of chromatin peptides (CPs), characterized by 1000D molecular weight, a pH dependent association to DNA and a prevailing presence of acidic amino acids in their structure, is involved in the regulation of genes expression. Nevertheless their action mechanism is still unknown. In our in vitro specific RNA transcription systems the CPs affect the initiation and not the elongation. Furthermore they inhibit the RNA transcription by interaction with the DNA rather than with the enzyme. The phagic in vitro specific RNA transcription is less affected by CPs than the eubacteric system, suggesting a kind of selectivity for target DNA sequences involved in the initiation of transcription.


Biodynamics of living cells: the molecule-contraction theory.

Living cells can carry out work, by transforming chemical to mechanical energy. It has been found that such biodynamic activities are carried out by filaments built of proteinaceous subunits. Since work in general involves contractions, the proteins which are involved in the execution of work may thus be called "contractile proteins". There seem to be three such proteins: flagellin, actin and tubulin, forming bacterial flagella, actin filaments and microtubules, respectively. Myosin is also a filament-forming protein, important for the activity of actin filaments, notably in striated muscle cells, but it is not a contractile protein. When a muscle works, that is, contracts, then it is observed that the actin filaments slide in between the myosin filaments, and this observation has been used to develop a theory of contraction, the "sliding filament" theory. But it should be emphasized that this theory is essentially descriptive, not explanatory, and the main point in muscular activity, the presence of two kinds of filament, is not found in most other cases when cells are performing physical work. In order to solve this dilemma and reach a general theory of biodynamics the molecule-contraction theory, as presented here and on some earlier occasions, was created. The essential aspect of the theory is the existence of "contractile" proteins, which also have the property of forming filaments. This theory is based on four premises, out of which three are supposed to be involved in all kinds of biodynamic activity, while the fourth is required only in those instances where polymerization and depolymerization is a constituent part of the performance of mechanical work.


Electrical pulses appear in the inferior vena cava and abdominal aorta at contraction of leg muscles.

A vascular-interstitial neuromuscular closed circuit is described anatomically and electrically. The neuromuscular unit has a high resistance due to its axons. The "outer" vascular-interstitial branch has a low resistance due to a large cross section area. When a rat spontaneously contracts leg muscles after pinching a toe, electric potential pulses appear inside the inferior vena cava, between vena cava and peritoneum, between aorta and peritoneum, between vena cava and peritoneum and between aorta and subcutis. Minor pulses between electrodes in the peritoneal fluid are interpreted as induced by the intravascular potential pulses. The use of Ag-AgCl electrodes or platinum electrodes does not appreciably change the results.


Potential differences in the inferior vena cava and between cava and extravascular electrode at leg contraction in man.

When a voluntary adult male contracted his leg muscles, electric potential differences were recorded between platinum electrodes positioned inside the vena cava or between the vena cava and the grounded skin. Two experiments confirm that potential differences at leg contractions in man have a similar appearance as those in the rat at pain-evoked contractions of leg muscles. Platinum electrodes were used in man. The potential differences obtained are thereafter compared with recordings with Ag-AgCl electrodes in salt-bridges in the rat. Slow potential waves with superimposed irregular potential oscillations are recorded in man as previously found in the rat using platinum or Ag-AgCl electrodes. The findings indicate that vascular-interstitial routes participate in a vascular-interstitial-neuromuscular closed circuit, which is activated at contraction of the muscles.


Blood viscosity parameter correlation with types of leukemia.

We investigated the hemorheological, hematological and biochemical parameters in 30 cases of acute lymphocytic leukemia (ALL), 21 cases of acute myelogenous leukemia (AML) and 30 cases of chronic myelogenous leukemia (CML). The parameters studied include whole blood viscosity, plasma viscosity, erythrocyte sedimentation rate (ESR), red cell filterability, hematocrit, platelet count and aggregation, fibrinogen, hemoglobin, leucocyte count, bleeding time and lactate dehydrogenase activity (LDH). In the cases of ALL we observed significant decrease in whole blood viscosity, hemoglobin, hematocrit and platelet count but an increase in plasma viscosity, fibrinogen, bleeding time and LDH activity. In the cases of AML, we observed increase in whole blood viscosity, plasma viscosity, ESR, fibrinogen, leucocyte count, bleeding time and LDH activity but decrease in the hemoglobin, hematocrit and platelet count. In the cases of CML, we observed an increase of whole blood viscosity, plasma viscosity, ESR, fibrinogen elevation but decreases in bleeding time. In all cases, red cell filterability was unaffected.


Localized and transient changes in plasma membrane fluidity during in vitro myoblast fusion: an 1H-NMR study.

High resolution proton NMR was used to study the cell surface molecular events which take place during in vitro myoblast differentiation and fusion. The CH3 and (CH2)n spectral signals were followed throughout in vitro myogenic development. The results show that although both the T1 and T2 relaxation times of the CH3 and (CH2)n groups are sensitive to the fusion process, T1 is the most sensitive. Both T1 of CH3 and (CH2)n increased before fusion indicating a higher degree of molecular motion and then returned to their original values. These results demonstrate how mobile lipid domains observed with proton NMR can be used to study the changes taking place during myoblast differentiation, particularly myoblast membrane fusion.


Small acidic peptides from wheat germ chromatin. I. Isolation and biochemical characterization.

RNA synthesis in cell and cell-free systems is inhibited by a family of acidic, low molecular weight chromatin peptides (CPs). These peptides were extracted from deproteinized DNA of prokaryotic and eukaryotic cells, but the low yield of purified material by this procedure hinders efforts aimed at understanding their action mechanism in gene regulation. In this report we describe two purification methods of CPs from an easily available source, wheat germ. A comparison is made between the method starting from deproteinized DNA and the method from purified chromatin. The biological effects (inhibition of L1210 cell growth and DNA in vitro transcription) of CPs from wheat germ together with their chemical characteristics (molecular weight, amino acid composition and presence of phosphoserine) show strong homology with those of CPs from other sources. These results suggest a possible role of these chromatin peptides in controlling gene expression.


Reduction mammoplasty.

Breast reduction is a good example of the interface between aesthetic and reconstructive plastic surgery as both the breast size and eventual appearance of the breast change. Most patients are happy with their decisions to have the surgery for several reasons, including an appreciation of new clothing choices, improved self-image along with a disappearance of back pain and other physical symptoms associated with large, heavy breasts.


The healing wound: clinical management.

Although research is actively seeking and may even be finding ways to reduce the time required for wounds to heal, the current state of the art is still moderated by correct assessment, appropriate interventions, and most of all, prevention of inhibiting factors that delay the healing process.


Counseling the woman with silicone breast implants.

Public interest in silicone breast implants has heightened in recent months due to increased media hype that has included unscientific reviews and exaggerated accounts of a few women's problems. Lynne McCain, BSN, RN, of Emory Clinic's Section of Plastic and Reconstructive Surgery in Atlanta, provides common questions asked by patients with breast implants followed by appropriate responses that could be given in counseling.


Stress: a self-management approach and nursing care plan for nurses.

Stress is unavoidable but can be controlled to provide the energy for health, growth, and the development of human potential. This article will overview stress and how it can be managed, and will present a care plan for self-management of stress.


[The value of psychotropic drugs in treatment of suicidal behavior].

There is no doubt about the importance of psychopharmacological medication--antidepressants, neuroleptics, tranquilizer--in the treatment of severe mentally ill people. In the last years there are a lot of publications dealing with psychopharmacological treatment of suicidal crises. Recently a few number of reports discuss the promotion of suicidality during or after start of antidepressant therapy. In this paper psychopharmacological medication, especially antidepressant medication is discussed according to suicide prevention or promotion. The author differentiate between acute suicidal crisis and long term treatment of an underlying mental illness and recommend in acute crisis treatment with benzodiazepines and sedating neuroleptics supplying adequate basic treatment. Uptonow to part of psychopharmaca in the treatment of suicidal patients remains uncertain.


[The effectiveness of ambulatory occupational therapy measures for patients with schizophrenia].

This study evaluates the concept of occupational therapy for schizophrenic outpatients. Preliminary results from 18 patients suggest that occupational therapy for outpatients might contribute to an improvement in cognitive-adaptive functions and open up ways for further integration on the job market. The prognosis was favourable when the outset of occupational therapy was not equated with a rise in the level of professional adaptation and a certain approachability and flexibility were to be observed in cognitive, affective and intentional aspects among the chronic schizophrenic patients. With regard to cognitive functions and to professional adaptation, it proved more favourable for occupational therapy to be carried out within the framework of regular service enterprises (external occupational therapy, n = 9) and not within training areas of the psychiatric institution itself (internal occupational therapy, n = 9). Patients taking part in internal occupational therapy felt more heavily burdened by workplace conditions, and greater family-related strain seemed to develop in the therapeutic centre than was the case among patients taking in external occupational therapy.


Mood influences on reasons for living in older adolescents.

Suicide is a major public health problem of the current period, particularly among young people, and is the second leading cause of death among the 15- to 24-year-old age group (Rudd 1989). Moreover, the suicide rate among the nation's youth has increased dramatically in the last two decades, an increase that amounts to having tripled in the years 1956 to 1975 (Holinger 1982).


Relationships with patients in oncology: can a clinician be a friend?

Encounters with patients who are experiencing a life crisis such as cancer can be profoundly meaningful to both patients and those caring for them. Intense emotional involvement with patients can also lead to difficulties including "burnout" (Davitz and Davitz 1975), interstaff conflict (Burnham 1966; Pollack and Battle 1963; Robinson 1984; Weintraub 1964), and violation of professional boundaries (Applebaum 1990; Gartrell et al. 1986; Gutheil 1989a, 1989b). Nicholi (1988) has reviewed the challenges that psychotherapists face in maintaining relationships with patients that are both close and therapeutic. However, there has been little research into the relationships that clinicians in other medical disciplines have with their patients. This report describes both the stresses and rewards of relationships with oncology patients in a comprehensive sample of 192 staff members at a regional cancer center, interviewed about factors affecting their job satisfaction.


Culture, social structure, and quandaries of psychiatric diagnosis: a Vietnamese case study.

In contemporary psychiatry diagnosis is arguably the most important concern of a clinical evaluation insofar as it operates as a scaffolding for therapeutic plans and recommendations. Implicit in the theory and lore of diagnosis is that disorders exist as naturalistic entities possessed of a distinctive form and course. In the event of a complex clinical presentation, a psychiatrist resorts to multiple diagnoses and the use of a rule-out diagnosis, (or several rule-outs). The first practice reflects the dictum of comorbidity. Rule-out diagnoses, on the other hand, support the idea that in some instances extensive anamnesis, observation, and laboratory examination are required in order to establish the true identity of a clinical presentation. The way psychiatrists use the system of diagnosis when examining persons from their own society has been shown to reveal commonalities that conform to a systemic culture pattern (Fabrega et al. 1990a). With these subjects, then, our system of diagnosis works in the sense that it supports widely held assumptions and rationales. In this paper we present a case of a Vietnamese male patient. Its analysis from the standpoint of culture and social structure is used to illustrate some of the problems of reaching diagnoses in persons from other societies and the limitations of our theory about diagnosis.


The mental health treatment team as a work group: team dynamics and the role of the leader.

Although treatment teams have been examined often in the mental health literature, this literature seldom addresses the crucial property of "teamness"--the key set of intangible phenomena that allow a team to function synergistically as more than the sum of its parts, and with a sense of team identity. In this paper, the concept of the work group is used to develop a framework for understanding the factors contributing to effective team functioning and identity, an their implications for the tasks of team leadership and sociotherapy: "the art of maintaining a social system in which the treatment of an individual patient can best occur" (Edelson 1970). Leadership activities that promote team cohesiveness and boundary maintenance are discussed, and suggestions are provided for ways in which the subjective experiences and emotional reactions of the leader and team members can be used to promote improved task performance and clinical care.


Positive withdrawal and the quest for meaning: the reconstruction of experience among schizophrenics.

Psychosocial rehabilitation often remains entrapped within a restrictive definition. It is characterized by a normative orientation, which predetermines the objectives to achieve, and by an approach from outside of the person, which emphasizes the functional aspects of rehabilitation. In this context, marks of withdrawal, lack of involvement, or inactivity are interpreted as signs of passivity or as residual or negative symptoms, which are often associated with a negative prognosis. In parallel, as data regarding the heterogeneity of evolution of schizophrenia begin to accumulate, some authors have defended the idea that studies have to concentrate on the course of the disorder and on the associated processes (Harding et al. 1987; Strauss 1986). They propose going beyond an objective evaluation of signs and behaviors in order to situate them within a larger life-frame. This draws attention to the potential polysemy of symptoms, including the so-called negative symptoms, which can reflect a diversity of influences and therefore possess various psychiatric meanings (Strauss 1989). Yet, the systematic study of "meaning" in psychiatry is still in its infancy and lacks clear conceptual and methodological points of reference (Strauss and Estroff 1989). On another hand, implications for rehabilitation of a meaning-centered approach to psychiatric symptoms have not been fully elaborated. An intensive study conducted in Montreal with patients diagnosed as schizophrenics sought to describe the factors and processes associated with different types of insertion in the community, and particularly to understand the rehabilitative strategies and the specific forms of being-in-the-world associated with an ability to remain in the community. Data collected through open-ended interviews were both quantitatively analyzed and subjected to content and qualitative analysis. The conceptual reference frame was derived from anthropology and from the European school of psychiatric phenomenology. Data indicate that non-rehospitalization is associated with a stance of "positive withdrawal" (Corin 1990); it is characterized by a position at a distance from social roles and social relationships, combined with various strategies for keeping more tenuous links with the social environment. The case study presented here illustrates the complex organization of these various elements in a given life-frame. It also demonstrates the role played by symbols and meanings in developing a new articulation of personal experience.


Making sense of delusions.

True delusions have been conventionally regarded as primary or psychologically irreducible (Jaspers 1913/1959) and thus only explicable in organic terms. While Jaspers acknowledged the existence of secondary delusions, which may be understood in the light of related affect, other experiences, or hallucinations, these were of lesser theoretical importance than true delusions, in which he found a change in "the totality of understandable connections." Anglo-American psychiatry, in espousing Jaspers and rejecting psychoanalysis, has in consequence concentrated on the form and not the sense of delusions.


Late-onset atypical psychosis: a case involving neuroleptic drug toxicity and autoimmune serological abnormalities.

Serious or significant neuroleptic toxicity (Kurlan et al. 1984; Lazarus 1985; Levenson 1985; Pearlman 1986) may complicate the diagnosis and management of patients who develop acute medical problems while under treatment with neuroleptics (Levenson and Simpson 1986). We have found that in some cases it is difficult, if not impossible, to determine whether neuroleptics have contributed to the cause of an acute medical illness, or if the occurrence of acute medical problems precipitated the signs of neuroleptic toxicity by altering the disposition or the pharmacologic effects of the drugs.


The influence of sphincter control and genital sensation on body image and gender identity in women.

The development of one aspect of feeling female is hypothesized to account for certain phenomena in the treatment of young women patients. Fear of loss of genital pleasure experienced as contractions of the anal and genital-urinary sphincters is seen as the central issue in conflicts manifested in genital, oral, and anal modalities. It is suggested that the female's awareness of her genital arises from the generalization of sphincter sensation in the little girl, which is then represented in the body image. The body image is postulated as a link between genital pleasure and the valuing of femininity.


Some vicissitudes of aggression in the interpretive process.

Interpretation is a product of compromise formation that requires optimal use of the analyst's aggression to be an effective analytic intervention. Aggressive aims useful for the interpretive act are problematic for analysts and have led both to clinical difficulties and to various theoretical reactions against considering interpretation essential for analytic progress. In analysis, diverging aims of analyst and patient are highlighted in connection with the analyst's function as interpreter. The interactions between patient and analyst pertaining to interpretation provide insights into the patient's intrapsychic conflicts that may be less apparent in other material.


The wish to be soothed as a resistance.

As the analyst makes the correct interpretations of resistance in the opening phase of an analysis, the patient begins to feel understood, often for the first time. This feeling allays anxiety and depressive affects, and the patient comes to experience the analyst as a soother. These initial exchanges may lay the foundation for a positive transference which acts as a buffer against turbulent transferences. In some patients this positive transference develops rapidly, often with prompt symptom remission. In others--children as well as adults--the analyst must persistently interpret defensive regressions before a stable, positive transference can emerge. In either case, in order to avoid the analysis of conflict, some patients become resistant to the analysis of the wish to be soothed. Many of these patients have had a childhood filled with traumatic parental stimulation or rejection. Two clinical accounts illustrate these contentions.


The psychoanalytic view of phobias. Part III: Agoraphobia and other phobias of adults.

This is the third part of a review and commentary on the psychoanalytic literature on phobias. This section takes up agoraphobia and other phobias of adults, and suggests further avenues for interpenetration of psychoanalytic and psychiatric approaches.


The psychoanalytic view of phobias. Part IV: General theory of phobias and anxiety.

This is the final part of the work on the psychoanalytic view of phobias. Here we consider general views of phobias, developments and issues in the psychoanalytic theory of anxiety, as it relates to phobias, and take up aspects of some broader theoretical issues, including nosology.


Temporal-order judgment and reaction time for short and long stimuli.

The effect of intensity on visual latency was investigated. Visual latency was measured by two methods: simple motor reaction time (RT) and temporal-order judgment (TOJ). It was found, in accordance with previous studies, that the changes in RT were larger than TOJ latency when measured in the same range of intensity. Moreover, the relationship between TOJ latency and intensity was compared in two conditions: under so-called "with-offset", the information about offset order was available for the subject, while under "without-offset" conditions it was not. It was hypothesized on the ground of Jáskowski's 1991 study that the TOJ latency-intensity relation should differ for these two conditions because of the effect of intensity on visual persistence. We were unable to find any such effect.


Optical magnification as event information.

The geometrical optics of approach events is delineated. It is shown that optical magnification provides information about distance and time until collision. An experiment is described in which two objects--white styropor spheres 10 cm in diameter, seen against a white plaster wall--were moved simultaneously at equal, constant speed along straight, converging paths at eye level towards a human observer and towards a common, virtual point of collision which either coincided with the observer's station point or was placed in front of, or behind, that point. Approach events differed with regard to trajectories, distances, velocities, and times-to-collision involved. Events were observed monocularly fixating and binocularly non-fixating, without head movements. The objects always stopped before colliding, and subjects had to respond to the virtual collisions. Most responses were too early, especially for impending collisions at, or behind the observers' station point. Responses for impending collisions in front of the observers tended to be too late, especially for larger total amounts of optical magnification and higher velocities, which together imply shorter times-to-collision. Relative errors were comparatively larger for very short and very long times-to-collision throughout, where events of the first kind were overshot, the latter ones undershot. Results are interpreted with reference to biological theories and the constraints imposed by geometrical optics. Special attention is focused on the issue of unavoidable, necessary confounding of variables in time-to-collision studies.


The tunnel effect, Gibson's perception theory, and reflective seeing.

Subjects can have continuous visual experience of an object's movement across a display though the movement's middle phase takes place behind an opaque screen. The present article considers explanatory issues pertaining to this so-called, tunnel effect, with special reference to Gibson's perception theory and the visual activity that I have been calling reflective seeing. Among the issues discussed are the following. (a) In the tunnel experiments, I suggest, there occur both persisting perception, as Michotte held, and persistence perception, as Gibson held. The subjects pick up stimulus information that allows visually experiencing the object's going out of sight at one edge of the screen and coming back into sight at another edge of the screen; the subjects have visual experience of the continued existence and movement of the object while it is out of sight. Moreover, persistence of perceptual experience is involved: when the object goes out of sight, the subjects' visual experience of its movement goes on. (b) I also argue that the tunnel effect is a phenomenon of both straightforward and reflective seeing. Adopting a phenomenal attitude, as one does when reporting one's perceptual experience, one still sees movement taking place on the other side of the screen, as one does in straightforward seeing. However, whereas straightforward seeing does not give inner awareness of visual experience, the subjects in the tunnel experiments report visually experiencing the object's movement while also visually experiencing the opaque screen in front of it as opaque. I argue that these reports, and those about the object's going out of and coming back into sight, must be based on the kind of visual experience that is part and product of reflective seeing.


Analog versus discrete shifts of attention across the visual field.

Two discrimination experiments were run to investigate analog versus discrete properties of a shift of visual spatial attention. Central cuing was used in Experiment 1, whereas peripheral cuing was used in Experiment 2. Presentation of a probe stimulus between fixation and the target (Distance 1), opposite fixation from the target (Distance 3), or away from an imaginary line running from the target through fixation (Distance 2) permitted a fine-grained analysis of attention at those loci across target-probe delays. D-prime analyses in both experiments suggest that attention is shifted in a discrete manner between locations. Sensitivity to probes was generally greater when the probe was aligned with the target and fixation, with Distance 3 equal to Distance 1, than when it was away (at Distance 2). Analysis of sensitivity to targets across cue-probe delays suggests that attention was directed to the probe upon its appearance.


[Integrated imaging of head and neck tumors in children].

Examinations of 28 children with various tumors of the visceral cranium and neck have shown that both ultrasound and magnetic resonance tomography should be used primarily for diagnosis and follow-up. These tomographic methods are especially suitable for use in children. Ultrasound is better suited to visualization of localized, superficial masses and MRT to examination of deeper lying tumors within the complex structures of the visceral cranium and neck. X-rays in different planes should be regarded as supplementary examinations. The use of CT, preferably as high-resolution CT, provides more precise visualization of fine bone structures. Conventional tomography has been almost completely replaced by CT. Angiography is applied mainly in subsequent, interventional measures; videofluoroscopy should be used to examine lesions of the upper airways and digestive tract.


[Indications for magnetic resonance tomography of abdominal space-occupying lesions in children].

The frequency of magnetic resonance imaging for investigation of abdominal tumors in childhood is increasing. Malignancies of the liver can be visualized. For benign lesions the accuracy is high particularly in the case of hemangiomas. Magnetic resonance investigations are advisable in the presence of abdominal tumors, in order to differentiate lymph nodes and vascular involvement. Magnetic resonance imaging is mandatory in the case of retroperitoneal and presacral masses to depict any intraspinal tumor spread. RARE myelography can replace computed tomography myelography.


[Characteristics of thyroid sonography in infants and children].

In a prospective study the thyroid glands of 598 healthy boys and girls (newborn to 17 years old) were examined by ultrasound. The volume of the normal gland was 1.1 cm3 in neonates, 2 cm3 in 4 year-old-children, and 8.7 cm3 in schoolchildren. The gland of a normal newborn, a girl with congenital hypothyroidism, a girl with inflammation of a median cervical cyst, a girl with insulin-dependent diabetes mellitus and autoimmune thyroiditis, and a girl with an adenoma all showed typical differences in ultrasonic structure from the normal adult gland. Sonography of the thyroid gland discloses valuable information, especially in childhood.


[Aluminum poisoning caused by the phosphate binder in a non-dialysed child with chronic renal insufficiency].

In patients with chronic renal failure, aluminium, which is included in the dialysate or released from phosphate binders, cannot be eliminated adequately. It forms a deposit in the tissues and leads to intoxication. After a 6-month therapy with aluminium-containing phosphate binders in a non-dialysed baby with chronic renal insufficiency, an osteomalacia arose with distinct subepiphyseal and metaphyseal changes attributable to disorders of mineralization. The consequence of this was a "bone-within-bone" appearance and pathological fractures. After a change of therapy, the bone alterations receded within a few months. Simultaneously, the distinctly elevated serum level of aluminium fell. Therefore, aluminium should be avoided in non-dialysed children with chronic renal insufficiency.


[Diagnosis of complications of ventriculo-peritoneal and ventriculo-atrial shunts].

The value of imaging (cranial CT, cranial and abdominal sonography, plain film surveys) was examined retrospectively in 28 shunted children in whom 82 instances of suspected dysfunction arose. There were 23 obstructions, 12 dislocations, 1 disconnection, 6 infections, 3 overdrainages and 5 slit ventricle syndromes. Impaired absorption with ascites, a peritoneal liquor cyst and a seroma occurred in the peritoneal part of the shunt. Progressive dilatation of the ventricle system shown by CCT (89%) or ultrasound was the most sensitive sign of high-pressure hydrocephalus. Periventricular hypodensity and flattening of the gyri (15%) were found less often. An examination strategy in suspected shunt dysfunction is suggested on the basis of these findings.


[Digital luminescence radiography of premature and term infants. Possibilities and limitations].

Postmortem images of seven premature and term newborns, acquired with various conventional screen-film combinations and by a digital technique with appropriate radiation exposures, were compared. Images without and with simulated pathology were used in this study. With electronic manipulation of the computed radiographs we obtained well-balanced images with good contrast, and in many cases the artifacts were better visualized than with the conventional screen film. However, in our study no significant dose reduction for this young age group was possible with the digital technique compared with conventional screen film.


[Magnetic resonance tomographic diagnosis of internal lesions of the shoulder following luxation. A comparison with arthroscopic findings].

Fifteen patients with a recurrent dislocation of the glenohumeral joint were preoperatively investigated by MRI. We created a special protocol with axial T1-, T2-, proton-density- and sagittal T1-weighted images. MRI findings such as defects of the glenoid labrum and Hill-Sachs compression fractures proved to be correct during surgery. In the chosen protocol the diagnostic imaging of rotator cuff lesions was not specific. In 10 cases lesions were seen but in only 5 patients did these findings prove to be correct during surgery. However, MRI imaging of glenohumeral joints is a reliable non-invasive diagnostic method.


Analysis of cancers missed at screening mammography.

Analysis of 320 cancers found in a screened population between August 1985 and May 1990 revealed 77 cancers that were "missed" at screening mammography. The missed lesions consisted of cancers incorrectly diagnosed after mammography (false-negative results) but visible in retrospect (n = 19); cancers correctly diagnosed after mammography but visible in retrospect on an earlier mammogram (n = 47); and cancers that went undetected by the first of two readers (n = 11). Missed lesions were categorized according to type of miss, reason for the miss, breast density, lesion features, and lesion location. The missed lesion were compared with 121 cancers that were correctly diagnosed at screening mammography. The missed cancers occurred in women with denser breasts (P = .046), were less likely to demonstrate malignant microcalcifications, and were more likely to demonstrate a developing opacity as an indication of cancer (P = .005). An understanding of the characteristics of missed lesions may be a valuable aid in increasing the sensitivity of screening mammography.


Reading and decision aids for improved accuracy and standardization of mammographic diagnosis.

Image-reading and decision aids were designed to improve the accuracy of mammogram interpretation. The reading aid was a list of diagnostic radiographic features and scales for quantification of each feature. The decision aid, a computer program, converted the reader's scaled values, weighted for predictive power, into an advisory estimate of the probability of malignancy. The features were identified and their importance was assigned in four steps: (a) interviews of five expert readers to establish an initial set of features, (b) perceptual tests to refine the feature set, (c) a consensus meeting to refine this set and establish nomenclature and scales, and (d) the expert's scaling of each feature in a set of 150 mammograms. Those scaled judgments were analyzed to provide the final list of features and their relative importance and to program the computer decision aid. To test the enhancement effect, six other radiologists interpreted a different set of mammograms without, and later with, the two aids. Receiver operating characteristic analysis showed a gain of approximately 0.05 in sensitivity or specificity when the other value remained at 0.85. In a subset of the more difficult cases, the enhancement effect was approximately 0.15 in either sensitivity or specificity.


A comparison of mammography screen-film combinations.

A comparison study was performed to evaluate the image quality and radiation dose of six mammographic screen-film combinations: a Min-R screen with OM-1, SO-155, and SO-177 films (Eastman Kodak); a Min-R medium screen (Eastman Kodak) with OM-1 film; an HR Mammo medium screen (Fuji Medical Systems USA) with OM-1 film; and a Min-R fast screen with T-Mat M II film (Eastman Kodak). SO-177 films were processed with an extended cycle. Exposures of an acrylic test object with embedded masses, fibers, and specks and of a preserved breast specimen were made, for two paired image comparison tests in which the visibility of diagnostic features, contrast, and noise were judged. In most areas of image quality evaluated, a Min-R screen with OM-1, SO-155, and SO-177 films was superior. These three screen-film combinations had similar imaging characteristics, even though OM-1 film requires a higher radiation exposure. Images produced with a Min-R fast screen and T-Mat M II film were significantly lower in quality.


MR relaxometry imaging. Work in progress.

Acquisition of relaxation rate dispersion curves from magnetic resonance images was demonstrated on a clinical, whole-body imaging system. Study of the behavior of relaxation rates over a range of field strengths probes the structural environment of imaged hydrogen protons and reveals information about the composition of tissue. The authors determined relaxation rates in extremities and heads of healthy volunteers. The sensitivity of the measurement is sufficient to obtain a distinctive relaxation rate dispersion behavior for different tissues.


Animal rights and research: common sense must prevail.

The advances that radiologic science has experienced in recent history have been earned through many means, one of them being animal research. Since the 1980s, animal research has come increasingly into the public eye, through the efforts of animal welfare and animal rights activist groups. These groups, by their varied means, have exacted changes in how animals are used experimentally and how the public perceives such use. In some cases, their lobbying efforts have resulted in laws that raise the cost of research and provide little improvement in animal welfare. Because of the financial and political power of these groups and the increasing public awareness of such issues, it is extremely important that the medical and scientific communities become more involved in educating the public on the importance of animal research and clarifying the difference between animal welfare and animal rights. Equally important, the medical community must continue to adhere to high standards in research that involves animals.


Simple adnexal cysts: the natural history in postmenopausal women.

Transabdominal and transvaginal ultrasound (US) examinations were performed in 184 asymptomatic postmenopausal volunteers to determine prospectively (a) the frequency and natural history of simple adnexal cysts in healthy postmenopausal women and (b) the relationship between cyst activity and both hormone replacement and length of time since menopause. Eighty-three simple adnexal cysts were found in 52 women. Thirty-two of 184 women (17%) had 37 cysts identified at initial examination; 46 new cysts appeared in 31 women (11 of whom previously had cysts). Forty-nine women with 72 cysts were reevaluated with subsequent US scanning over a period of 3-23 months. Thirty-eight of the 72 cysts (53%) disappeared completely, 20 (28%) remained constant in size, eight (11%) enlarged by 3 mm or more, two (3%) decreased in size by 3 mm or more, and four (6%) both increased and decreased in size on repeated examinations. No statistical relationship was found between presence of cysts or cyst activity with respect to the type of hormone replacement or length of time since menopause.


Ovarian cysts in postmenopausal women: preliminary results with transvaginal alcohol sclerosis. Work in progress.

Seven patients with a recurrent ovarian cyst after transvaginal needle aspiration underwent alcohol sclerosis of the cyst. The cysts had the appearance of simple cysts at ultrasound (US). Sclerosis, an outpatient procedure, was performed with a transvaginal approach under continuous endovaginal US guidance. After aspiration of the cyst contents, approximately two-thirds of the aspirated fluid was replaced with 100% alcohol that was left in place for 20 minutes and then aspirated. No complication was observed. Four cysts had not recurred at follow-up examinations performed 2, 5, 7, and 12 months, respectively, after sclerosis. One patient underwent surgery because mucinous material was found on analysis of the specimen, which was proved to be a benign cystadenoma. The two other cysts recurred, and one patient underwent surgery. Alcohol sclerosis of ovarian cysts may have a role in the treatment of postmenopausal women with ovarian cysts with a low risk of malignancy.


Distinction between hyperaldosteronism due to bilateral hyperplasia and unilateral aldosteronoma: reliability of CT.

Hyperaldosteronism due to a unilateral adenoma must be distinguished from hyperaldosteronism due to bilateral hyperplasia to enable the proper choice between surgical treatment (for adenoma) or medical treatment (for hyperplasia). To compare the efficacy of computed tomography (CT) and adrenal venous sampling, both examinations were performed in 24 patients with primary aldosteronism. All patients with a diagnosis of adenoma based on findings at venous sampling underwent adrenalectomy. The CT-based diagnosis was unilateral aldosteronoma in 17 patients and hyperplasia in seven patients. On the basis of venous sampling, unilateral adenoma was diagnosed in 22 patients; this diagnosis was confirmed by means of unilateral adrenalectomy in 21 patients. The most common error was diagnosis of hyperplasia based on the presence of bilateral nodules on CT scans: In six of seven patients with such a diagnosis, venous sampling and subsequent surgery revealed a unilateral adenoma. In hyperaldosteronism with multiple bilateral nodules, CT cannot reliably permit distinction between hyperplasia and adenoma.


Venocclusive disease of the liver: prospective study of US evaluation.

Twenty-one bone marrow transplantation (BMT) patients were studied prospectively to determine the prevalence of sonographic hepatobiliary abnormalities and to determine if these abnormalities were associated with hepatic venocclusive disease (VOD). Baseline US was performed in all patients prior to chemoradiation therapy, with follow-up ultrasound (US) examinations at the time of BMT and 14 days and 28 days after BMT. Sonograms were reviewed for the presence of ascites, gallbladder wall thickening, hepatosplenomegaly, hepatofugal flow, hepatic vein compression, increased periportal echogenicity, and increased hepatic echotexture. The baseline scans showed 13 of 21 patients (62%) with abnormalities prior to BMT. Within 2 weeks after BMT, serial US showed interval development of hepatomegaly in five patients (three with VOD and two without), gallbladder wall thickening in one (with VOD), hepatic vein compression in two (both with VOD), hepatofugal flow in one (without VOD), and ascites in one (with VOD). US scans obtained 4 weeks after BMT in 15 of the 21 patients showed even fewer new abnormalities. No sonographic finding was strongly associated with VOD.


Hepatic metastases from colorectal cancer: influence of hepatic volumetric analysis on surgical decision making.

A prospective study was performed to determine the impact of preoperative assessment of estimated postoperative liver volume on surgical decision making for liver metastases from colorectal cancer. Assessment of estimated postoperative liver volume was performed before surgery in 25 patients. Mean estimated postoperative liver volume +/- standard deviation (SD) was 697 cm3 +/- 317 (range, 320-1,532 cm3). Mean relative estimated postoperative liver volume +/- SD was 51% +/- 16 (range, 20%-90%). In two patients, relative estimated postoperative liver volumes of less than 35% prevented resection. These two patients underwent preoperative portal vein embolization, which resulted in marked hypertrophy of the unembolized healthy part of the liver and subsequent safe resection. Before surgery, all patients had a relative estimated postoperative liver volume of greater than 35%, and no cases of postoperative liver failure occurred. The results demonstrated that assessment of estimated postoperative liver volume provides vital preoperative data for reducing the risk of postoperative liver failure.


Focal nodular hyperplasia of the liver: MR imaging and pathologic correlation in 37 patients.

Thirty-seven patients with 48 lesions of focal nodular hyperplasia (FNH) underwent preoperative magnetic resonance (MR) examination and surgical resection. Sixteen lesions were imaged at 0.5 T with T1- and T2-weighted spin-echo sequences; 32 lesions were imaged at 2 T with T1-and T2-weighted spin-echo and gradient-recalled-echo sequences. Contrast material-enhanced MR imaging was performed in 20 lesions. MR imaging failed to depict six tumors that were less than 3 cm in diameter. Typical appearance was present in 18 of the 42 (43%) lesions seen at MR. Atypical lesion features included no scar (n = 15), hypointense scar on T2-weighted images (n = 7), pseudocapsule (n = 6), strong hyperintense lesion on T2-weighted images (n = 3), diffuse hyperintensity on T1-weighted images (n = 3), and heterogeneous lesion (n = 1). Comparison between findings at MR imaging and at histopathologic examination was performed in 38 lesions: There was good correlation between presence and size of the scar on both examinations. In 13 of 20 (65%) of the hyperintense scars on T2-weighted images, edema was prominent, whereas in five of the seven (71%) hypointense scars on T2-weighted images, edema was absent or low.


Unilocular hydatid liver cysts: treatment with US-guided, double percutaneous aspiration and alcohol injection.

Sixteen hydatid liver cysts in 14 patients were treated with a percutaneous double puncture-aspiration-injection (D-PAI) technique with alcohol used as the scolecidal agent. With ultrasound guidance, fine-needle drainage of cysts was performed, and 95% sterile alcohol was injected and left in situ to partly refill the cystic cavities. The same procedure, without reaspiration of the injected alcohol, was performed 3 days later. Viability of scoleces was assessed at each aspiration. Benzoimidazolic drugs were administered 1 week before and 3 weeks after the procedure, to reduce the risk of seeding scoleces. Follow-up ranged from 8 to 28 months (mean, 14 months). Six cysts disappeared within 40-75 days of completion of D-PAI. In the other patients, smaller liquid areas or hypo- or hyperechoic solid masses were observed. Anaphylactoid reactions did not occur. In one patient, a biliary fistula developed after the first aspiration; the second ethanol injection was postponed until 6 months later but was effective. Viable scoleces were found at the second aspiration in only two patients whose hepatic liver cysts completely healed. Serologic titers substantially decreased in seven cases and became negative in two.


Hepatosplenic schistosomiasis: comparison of sonographic findings in Brazilian and Sudanese patients--correlation of sonographic findings with clinical symptoms.

Twenty-seven Brazilian and 32 Sudanese patients with hepatosplenic schistosomiasis from areas where the disease is endemic were examined with ultrasound (US). Hyperechoic periportal areas indicating periportal fibrosis (PPF) were present in all patients irrespective of their origin. Nonspecific findings were splenomegaly (all patients), gallbladder wall thickening (81% and 92%, respectively, in Brazilian and Sudanese patients), portal vein (74% and 87%, respectively) and splenic vein (59% and 70%, respectively) enlargement, and portosystemic vascular shunts (62% and 61%, respectively). The hepatic alterations were congruent and the frequency of their occurrence was similar in both patient groups. With a standardized grading system, it was shown that grade of PPF was significantly correlated with a history of bleeding from endoscopically proved esophageal varices and with distention of the portal vein as measured with US. It was concluded that sonographic grading may be used in patients with hepatosplenic Schistosoma mansoni infection who originate from completely different endemic areas.


Measurement of tissue carcinoembryonic antigen levels from fine-needle biopsy specimens: technique and clinical usefulness.

Levels of tissue carcinoembryonic antigen (CEA) in 54 abdominal fine-needle biopsy specimens from 50 patients were measured to ascertain the use of tissue CEA levels in diagnosis of malignancy. Biopsy was performed in the following sites: liver (n = 34), retroperitoneum (n = 8), adrenal gland (n = 3), pancreas (n = 2), omentum (n = 2), pelvis (n = 2), spleen (n = 2), and stomach (n = 1). Histologic findings proved malignancy in 39 patients and benign disease in 11 patients. In these 11 patients, the mean levels of tissue CEA were lower than the normal level of serum CEA (3 ng/mL). Tissue CEA levels were higher than serum CEA levels in nine patients with colonic carcinoma and in 12 of 16 patients with noncolonic CEA-secreting malignancies. Four patients with noncolonic CEA-secreting malignancies had tissue CEA levels within the normal range (less than 3 ng/mL). Tissue CEA levels were also normal in 13 patients with various non-CEA-secreting tumors. Tissue CEA levels may prove useful in biopsy of necrotic or cystic lesions and assessment of response to ablative therapy for colon metastases.


Transnasal US of the esophagus: preliminary morphologic and function studies.

High-frequency catheter-based ultrasound (US) transducers can be inserted into the esophagus transnasally to evaluate esophageal wall structures. Studies were performed in two sheep esophagus specimens in vitro, in 17 healthy human subjects, and in 16 patients with esophageal abnormalities (eight with achalasia, four with scleroderma, three with esophageal carcinoma, and one with esophagitis). In the sheep specimens, endoluminal US delineated seven layers of the esophageal wall; these results correlated closely with histologic findings. Real-time US of the normal esophageal wall was performed during resting and swallowing. Muscles at the lower esophageal sphincter (LES) were shown to be thicker than muscles in the body of the esophagus. Thickening of the muscular layers at the LES in achalasia, dilated blood vessels within the submucosa in esophagitis, and fibrotic changes within the muscular layers in scleroderma were demonstrated. Extramural structures adjacent to the esophagus were also seen. These preliminary results suggest that transnasal esophageal US may become an important diagnostic tool in evaluation of the esophagus.


Esophageal strictures: treatment with a new design of modified Gianturco stent. Work in progress.

To overcome the drawbacks of the modified Gianturco stent tube with barbs, a new barbless stent tube was constructed. Twenty-two barbless stent tubes 4.5-14.0 cm long were placed with a new introducing tube in 21 patients: 10 stent tubes in 10 patients with recurrent dysphagia after radiation therapy or chemotherapy, 10 in 10 patients with esophageal cancer in whom surgical management was contraindicated, and two in one patient with postoperative benign stricture. No technical failure or procedural complications occurred. After the procedure, all but two patients could ingest most or all foods. In two patients with an esophagorespiratory fistula and one patient with esophageal rupture, the barbless stent tube successfully occluded the fistula and rupture site. The stent tube migrated in one patient. Fifteen patients are surviving, with the stent tubes patent for 3-35 weeks (mean patency, 13 weeks); the six other patients died 7-24 weeks (mean, 16 weeks) after stent placement. It is concluded that barbless stent tubes show promise in the management of dysphagia caused by esophageal strictures.


Optimizing gallbladder stone lithotripsy: an international survey.

Rates of stone clearance with extracorporeal shock wave cholecystolithotripsy (biliary lithotripsy [BL]) initially reported by European groups were encouraging. An American multicenter BL study (the Dornier National Biliary Lithotripsy Study [DNBLS]) did not reproduce these results. The BL treatment strategies and 6-month stone clearance rates of six leading European and Japanese centers were compared with those of DNBLS. All foreign centers used adjuvant oral chemolitholysis and greater shock wave energies from the same lithotriptor as that in DNBLS. Six months after BL, the stone clearance rates at all six centers were higher than those of DNBLS. There were no significant differences in complication rates between centers. These findings suggest that the poor results of DNBLS were chiefly due to the use of low kilovoltage and few BL sessions. Increased energy levels and a fragment size end point of less than 5 mm optimize BL. Despite the popularity of laparoscopic cholecystectomy, BL can be recognized as a successful treatment alternative for patients with a low burden of radiolucent stones.


Intussusception in children: reliability of US in diagnosis--a prospective study.

To assess the diagnostic value of ultrasound (US) in clinically suspected acute intestinal intussusception in children, the authors prospectively compared US and enema studies in 83 episodes. None of the cases negative at US proved to be intussusception at enema study (negative predictive value = 100%). The sensitivity of US was 100%, and the specificity was 88%. Most of the sonograms were initially obtained and examined by residents. Several unsuspected abnormalities were also found with US. The authors conclude that a few months of training in US appears to be sufficient for high-accuracy investigation of clinically suspected intussusception, enabling selection of those patients in need of an enema.


Appendicitis in children: color Doppler sonography.

The authors used color Doppler ultrasonography (US) to evaluate 33 children with suspected appendicitis and found locally increased blood flow in all of 10 patients with appendicitis or periappendiceal abscess; the studies were normal in 16 patients without appendicitis. The gray-scale sonographic results were concordant in all 26 of these patients. In two other patients with presumptive mesenteric adenitis and in one patient with a hemorrhagic ovarian cyst at gray-scale US, color Doppler imaging showed no increased perfusion and aided in confirming the absence of a significant inflammatory process. In four other children, color Doppler US clarified gray-scale sonographic findings that might have been confused with complicated appendicitis and aided in the diagnosis of other causes of acute abdominal pain. These findings indicate that color Doppler US is a useful adjunct to gray-scale US in evaluating children with suspected acute appendicitis.


US measurement of the subarachnoid space in infants: normal values.

The subarachnoid space was examined with real-time ultrasonography (US) in 89 healthy infants. US of the brain in all infants revealed no abnormalities. Three variables were measured in the coronal plane at the level of the foramen of Monro: the sinocortical width (SCW) ranged from 0.4 to 3.3 mm, the craniocortical width (CCW) from 0.3 to 6.3 mm, and the interhemispheric width (IHW) from 0.5 to 8.2 mm. All variables can be used routinely, as the SCW could be demonstrated in all infants, and the CCW and IHW were demonstrated in 96% (85 of 89). Correlation of sonographic measurements with the independent variables age, head circumference, body weight, and body length was poor. To differentiate normal from pathologically dilated subarachnoid spaces, the following upper limits are proposed on the basis of the 95th percentile: 3 mm for SCW, 4 mm for CCW, and 6 mm for IHW.


Enhanced detection of vesicoureteral reflux in infants and children with use of cyclic voiding cystourethrography.

Cyclic voiding cystourethrography (VCUG) was prospectively evaluated to determine its ability to demonstrate vesicoureteral reflux (VUR) in children whose VCUG results were initially negative. The authors also assessed the effect of change in the patient's position on the detection of VUR. Seventy-seven children younger than 3 years of age, with negative results from a VCUG study performed while they were supine, underwent a second cycle of bladder filling after they were placed prone (group 1). Sixty-five children who were also younger than 3 years of age and had negative results from an initial VCUG examination performed in the usual supine position underwent a second cycle of bladder filling, which was also performed with the patient supine (group 2). VUR occurred in three children (4%) in group 1 and in eight (12%) in group 2. Most children (68.8%) in the two groups combined had grade II reflux. Cyclic VCUG increased detection of VUR, which led to a change in clinical treatment. Prone positioning did not enhance detection of VUR to the same degree as did multiple studies performed with the patient supine.


Paranasal echogenic mass: sonographic sign of bilateral complete cleft lip and palate before 20 menstrual weeks.

A paranasal echogenic mass identified at ultrasound performed during the second trimester was the initial and primary clue to the presence of bilateral complete cleft lip and palate in four fetuses. Referral had been for dating purposes in three cases and because of high maternal serum alpha-fetoprotein level in one. Genetic amniocentesis revealed deletion of the 15th chromosome in one case. The clefts were small and difficult to visualize; the finding of the echogenic mass (representing a premaxillary protrusion) therefore added confidence to the diagnosis.


Spectrum of salivary gland disease in HIV-infected patients: characterization with Ga-67 citrate imaging.

The authors retrospectively reviewed 45 gallium-67 citrate scans of 28 patients infected with the human immunodeficiency virus (HIV). Abnormal salivary gland radiotracer activity was seen in 13 patients with diffuse infiltrative lymphocytosis syndrome (DILS), five patients with undifferentiated salivary gland disease (USD), and 10 patients with acquired immunodeficiency syndrome (AIDS). More DILS patients (54%) had intense gallium uptake than did the AIDS and USD patients combined (13%) (P less than .05). DILS patients had markedly elevated CD8 cell counts and moderately reduced CD4 cell counts, while AIDS patients had normal CD8 cell counts and markedly reduced CD4 cell counts. These differences were statistically significant (P less than .05). The authors recommend that DILS be considered in the differential diagnosis when abnormal, particularly intense, bilateral salivary gland gallium uptake occurs in HIV-infected patients. This disease is more likely to occur when circulating CD8 lymphocytosis is present, while AIDS is the more likely diagnosis when the patient has a normal CD8 cell count and a markedly depressed CD4 cell count.


Postoperative diskitis: distinguishing early MR imaging findings from normal postoperative disk space changes.

To distinguish early magnetic resonance (MR) imaging findings in postoperative diskitis from normal postoperative changes, a prospective study was performed in 15 asymptomatic patients (17 disk levels) who underwent uncomplicated lumbar diskectomy and seven patients with proved postoperative diskitis. On postoperative MR images, four of the asymptomatic patients had a finding that could also be seen in patients with diskitis. Gadolinium enhancement was useful in making the distinction and occurred as follows: (a) vertebral bone marrow: all seven diskitis patients and one asymptomatic patient; (b) disk space: five diskitis patients and three asymptomatic patients; and (c) posterior anulus fibrosus: all seven diskitis patients and 13 asymptomatic patients (14 of 17 levels). This entire triad of findings, which is strongly suggestive of postoperative diskitis, was not seen in any of the asymptomatic patients. Changes in the disk space and adjacent bone marrow on pre- and post-contrast MR images after routine diskectomy are uncommon and should not be assumed to be normal postoperative changes without careful consideration and analysis for early diskitis.


Moyamoya disease: diagnosis with three-dimensional time-of-flight MR angiography.

Twelve patients with moyamoya disease were studied with three-dimensional time-of-flight magnetic resonance (MR) angiography, and the findings were compared with results obtained with conventional arteriography. Of a total of 24 supraclinoid internal carotid arteries studied, 21 arteries (88%) were accurately evaluated with MR angiography and in three arteries the extent of occlusive disease was overestimated. Of a total of 72 large branch basal cerebral vessels, including the bilateral anterior, middle, and posterior cerebral arteries, 61 arteries (85%) were accurately evaluated with MR angiography and in 11 arteries the extent of occlusive disease was overestimated. While conventional arteriography showed basal cerebral moyamoya vessels in all 24 hemispheres, MR angiography showed moyamoya vessels in 20 of these. Of a total of 28 large leptomeningeal and transdural collateral vessels, 18 were identified with MR angiography. In the one surgical collateral vessel evaluated, MR angiography successfully showed its patency. MR angiography may have value in following disease progression and, perhaps, in evaluation of surgical bypass patency.


Diffuse panbronchiolitis: correlation of high-resolution CT and pathologic findings.

Diffuse panbronchiolitis (DPB) is characterized by chronic airflow limitation and airway inflammation with bronchiolar lesions. Chest radiographs of patients with DPB usually show small nodular shadows throughout both lungs. The authors investigated the nature and pathogenesis of the radiologic features of DPB by correlating high-resolution computed tomographic (HRCT) findings with histopathologic features. The HRCT images of nine patients with DPB were compared with the observations made with inflated lung specimens. The HRCT findings of DPB included centrilobularly distributed, small rounded areas of attenuation; branched linear areas of attenuation, contiguous with the small rounded areas; dilated airways with thick walls, also common outside secondary pulmonary lobules; and decreased lung attenuation in peripheral areas due to air trapping caused by bronchiolar narrowing in the subpleural zones. The authors believe that HRCT best demonstrates this characteristic location of small rounded areas of attenuation associated with dilated airways.


Pneumothorax after lung biopsy: prevention with transpleural placement of compressed collagen foam plugs.

The effectiveness of pleural sealing with a compressed collagen foam plug in preventing the development of pneumothorax was evaluated in a prospective, comparative study of 50 patients undergoing transthoracic needle biopsies. The 4-cm-long plug was deposited through the thin-walled guidance needle at the end of the procedure in a position where it would cross both the visceral and the parietal pleura. The prevalence of postbiopsy pneumothorax was 28% (seven of 25 patients) in the control group and 8% (two of 25 patients) in the plug group. In each study group, two patients with pneumothoraces required chest tubes. Although further experience is necessary, the authors conclude that transpleural collagen foam plug placement may be an effective supplement for transthoracic needle biopsies.


Pulmonary toxoplasmosis in AIDS.

The chest radiographs obtained in nine patients with acquired immunodeficiency syndrome (AIDS) and pulmonary toxoplasmosis were reviewed. In three patients, a bilateral, diffuse, fine to medium reticulonodular pattern indistinguishable from that seen in Pneumocystis carinii pneumonia (PCP) was observed. In six patients, however, a bilateral, predominantly coarse, nodular pattern was observed. This type of abnormality is unusual with PCP, and its presence may help in distinguishing between pulmonary infections caused by Toxoplasma gondii and P carinii. Other opportunistic pneumonias occurring in patients with AIDS, including tuberculosis, histoplasmosis, and coccidioidomycosis, might show similar coarse, nodular opacities on chest radiographs and thus may not be differentiated from pulmonary toxoplasmosis. No hilar or mediastinal adenopathy was observed. Two patients had pleural fluid. Radiologists familiar with the chest radiographic appearance of T gondii pneumonia could be first to suggest this unusual complication of AIDS.


Interstitial thermal radiation therapy: five-year experience with head and neck tumors.

Sixty-two patients with 24 primary advanced, six persistent, 28 locally recurrent, and four metastatic tumors of the head and neck were treated with combined interstitial low-dose iridium-192 radiation therapy, interstitial 915-MHz microwave hyperthermia (IHT), and external-beam radiation therapy. Diagnoses were squamous cell carcinoma in 56, adenocarcinoma in three, and soft-tissue sarcoma in three lesions. IHT was applied immediately before Ir-192 was placed and after its removal for 45-60 minutes at 41 degrees C-44 degrees C. At 3 months, complete remission had occurred in 39 lesions; partial remission, in 18; and no change or progressive disease, in five. At 12-month follow-up, local control was achieved in 29 of 50 patients; seven other patients had slow ongoing tumor regression with an unclear residual mass at computed tomography or magnetic resonance imaging. Lesion type, tumor volume, total radiation dose, and thermal parameters with "good quality of heating" at high minimum tumor temperature were identified as statistically significant (P less than .05) prognostic factors influencing initial and long-term tumor response. There was no prognostic factor for acute or late thermal damage.


Improved radiology film library operations.

An interdisciplinary task force at the authors' institution developed a design for a new film library that placed heavy emphasis on service to its customers. The task force established locations and staffing for "satellite" inpatient film libraries organized by clinical specialties. Inpatient films were not permitted to be taken from the radiology department but were available for 24-hour viewing. Film locations were recorded in the radiology information system. Reorganization led to important improvements in film library operations and in the clinical staff's opinion of film library service. Objective measures of performance, such as the fraction of requested films available for conferences, showed significant improvement (P less than .001). Closer working relationships developed between film librarians, radiologists, and their clinical colleagues. Film library personnel were recruited more easily and stayed on the job longer. Several hundred thousand film-tracking transactions per year were recorded. The authors conclude that decentralization of certain film library activities improved many critical aspects of performance.


Peripheral MR angiography with variable velocity encoding. Work in progress.

An electrocardiographically triggered two-dimensional phase-contrast (PC) magnetic resonance angiographic pulse sequence was developed in which velocity encoding (VENC) was varied throughout an acquisition in response to changes in blood velocity during the cardiac cycle. This was done to better capture signal in the peripheral vasculature, where pulsatile flow degrades images. After reconstruction, a matched filter addition technique was applied to the cardiac phase images to obtain a single high-quality static image. Images were obtained of six healthy volunteers--with and without varying VENC--and contrast-to-noise ratio (C/N) calculations were performed for the added images. Varying VENC significantly improved vascular signal from small and large vessels (P less than .02), but it was most helpful for small vessels, for which the C/N increased by as much as 260% (average increase, 149%). These preliminary findings suggest that variable VENC can enhance the signal from the small and large peripheral blood vessels in cardiac-gated PC acquisitions.


Cephalic migration of the bird's nest inferior vena caval filter: report of two cases.

The Bird's Nest inferior vena caval filter (Cook, Bloomington, Ind) has been approved for clinical use since 1989. The authors report two cases of cephalic migration of the filter. Both cases of migration occurred in association with a massive thromboembolism after placement of the filter. It appears that a massive thromboembolism can cause this filter to migrate cephalad. The authors suggest that there is potential for nonsurgical management of the migrated filter.


Human coronary and peripheral arteries: on-line three-dimensional reconstruction from two-dimensional intravascular US scans. Work in progress.

To explore the feasibility of computer-based, on-line three-dimensional reconstruction, timed manual withdrawal (pullback) recordings were obtained with two-dimensional intravascular ultrasound (US) in 42 patients who underwent percutaneous revascularization. Three-dimensional processing was performed with commercial software that stacked serially obtained intravascular US scans and created a new set of data points in four steps: interpolation, segmentation, boundary encoding, and surface rendering. In all 42 patients, satisfactory on-line three-dimensional reconstruction was accomplished. In the first three patients, 70-90 seconds was required for three-dimensional processing, and display was limited to the sagittal format. In the next six patients, a sagittal display was rendered in 45-60 seconds, and on-line reconstruction in the cylindrical format was achieved within 30 additional seconds. In the last 33 patients, an unlimited number of sagittal views could be produced in 30-40 seconds, the extra time required for cylindrical display was shortened to 15-20 seconds, and a luminal cast display was added to the on-line menu.


Femoropopliteal stent placement: long-term results.

Twenty-one patients who underwent percutaneous transluminal angioplasty (PTA) followed by attempted insertion of a self-expandable vascular endoprosthesis for femoropopliteal lesions were prospectively followed up for an average of 17.6 months with angiographic, Doppler ultrasound, and clinical examinations. Stents were placed bilaterally in one patient. Of the 22 lesions, 18 were total occlusions and four, stenoses. Stent placement was successful in 21 of 22 lesions. Nine occlusions occurred: four in the first 30 days and five 1-5 months after PTA. Three patients developed intrastent intimal hyperplasia that necessitated an additional percutaneous procedure. At 12 months, the patency rate without other interventions (the primary patency rate) was 49%. In patients who underwent secondary intervention (fibrinolysis, atherectomy, or PTA), the secondary patency rate was 67%, which fell to 56% after 18 months. At the end of the study, the overall rate of reocclusion was 43%. It is concluded that use of the self-expandable vascular endoprosthesis in the femoropopliteal region likely does not decrease the reocclusion rate after PTA alone. Its use is indicated for treatment of acute closures after femoropopliteal PTA.


US-guided percutaneous liver biopsy with plugging of the needle track: a prospective study in 72 high-risk patients.

The efficiency, accuracy, and safety of ultrasound-guided liver biopsy with plugging of the needle track were prospectively assessed in 72 patients at high risk for hemorrhage. Seventy-eight biopsy procedures were performed in 72 consecutive patients prospectively classified into four different groups on the basis of coagulation parameters. Sixty-two patients (86%) had severe or moderately severe coagulation disorders. Fifty-four biopsy procedures were performed in 50 patients with diffuse liver disease, and 24 were performed in 24 patients with focal liver lesions. The biopsy track was embolized with gelatin particles and thrombin. Biopsy specimens adequate for histologic diagnosis were obtained in 69 of the 72 patients (96%). In focal lesions, accuracy and sensitivity in the diagnosis of malignancy were 75% and 89%, respectively. Two serious bleeding complications (2.8%) were encountered in two of the patients with major coagulation disorders. Liver biopsy with plugging of the needle track is a practical technique and is a feasible alternative to the transjugular approach. Respective indications for both methods depend on the severity of coagulation disorders and the presence of focal lesions.


Evaluation and comparison of automated biopsy devices. Work in progress.

The performance of four automated biopsy devices (Bard Biopty, Bard Monopty, Microvasive ASAP 18, Medical Device Technologies Ultra-Cut) was compared when they were used to obtain 96 liver and 96 kidney samples from eight dogs under ultrasound guidance. There was no significant difference in the lengths of the samples obtained with the four devices. The Monopty device yielded a significantly greater mean weight of both kidney (30.8%) and liver (31.6%) samples compared with the other devices. There were no significant differences between the four devices relative to cellular and histologic preservation, crush artifact, and number of renal glomeruli or liver lobules and portal triads. Renal subcapsular hematomas were identified in most instances, and there was no difference between the devices in the amount of renal trauma resulting from their use. There was only one instance of severe injury to the liver. The choice of instrument should remain one of personal preference, since all four devices were satisfactory and none produced significantly greater renal or hepatic injury.


MR imaging of patellar tendinitis.

To identify magnetic resonance (MR) imaging characteristics of normal patellar tendons and those affected by tendinitis, the authors evaluated MR images obtained in 10 healthy volunteers, in 50 patients who underwent MR imaging for evaluation of knee structures other than the patellar tendon, in 11 patients with patellar tendinitis, and in two athletes with patellar tendon injuries. Normal tendons had uniformly low signal intensity on T1-, T2-, and proton-density-weighted images and displayed distinct margins, and the anteroposterior (AP) diameter slightly increased proximally to distally. It was concluded that the AP diameter of a normal tendon, in its proximal portion, should not exceed 7 mm. In patellar tendinitis, the tendon showed increased signal intensity on T1-, T2-, and proton-density-weighted images and increased AP diameter proximally. The margins of affected tendons were indistinct, especially posterior to the thickened segment. In all groups studied, women had thicker proximal tendons than did men.


The deep lateral femoral notch: an indirect sign of a torn anterior cruciate ligament.

Magnetic resonance (MR) imaging has shown that tears of the anterior cruciate ligament (ACL) are frequently accompanied by meniscal and osseous injuries. Abnormalities of the cartilage overlying the lateral femoral condylopatellar sulcus (notch) also have been noted during arthrotomy of ACL-deficient knees. In this study, the appearance of this sulcus on MR images and the depth of the sulcus on conventional radiographs are compared in patients with normal and torn ACLs to determine whether a deep sulcus is a useful indirect sign of a torn ACL. In 62 patients with clinically and/or arthroscopically confirmed normal ACLs, the mean depth of the lateral femoral sulcus was 0.45 mm (range, 0.0-1.2 mm) compared with 0.89 mm (range, 0.0-5.0 mm) in 41 patients with clinically and/or arthroscopically confirmed ACL tears (significant at the 5% level). No patient with a normal ACL had a sulcus greater than 1.2 mm in depth. A sulcus deeper than 1.5 mm is equivalent to 3 standard deviations above the mean and was a reliable indirect sign of a torn ACL.


Ewing sarcoma: MR imaging of chemotherapy-induced changes with histologic correlation.

In a study group of 18 consecutive patients with Ewing sarcoma proved by means of biopsy, the signal intensity characteristics of tumor on magnetic resonance (MR) images were assessed before and after chemotherapy. Sixteen patients underwent MR imaging at 1.5 T before chemotherapy; all 18 patients underwent MR imaging at 1.5 T within 10 days after chemotherapy. Standard spin-echo sequences were used with T1 and T2 weighting in all patients. The primary tumor was visualized in all 16 patients who underwent MR imaging before chemotherapy. Histologic correlation, obtained in 14 patients, showed that areas of high T2-weighted signal intensity on MR images obtained after chemotherapy may represent tumor necrosis, cystic hemorrhagic areas, and fibroblastic repair tissue. In 10 patients (71%), microscopic clusters of viable tumor cells were depicted in areas of both low and high signal intensity after treatment. It is concluded that MR imaging is unreliable for exclusion of active disease, although a pattern of change in signal intensity is qualitative evidence of chemotherapeutic effect.