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  • 2000-2004  (221)
  • 1920-1924
  • 1860-1869
  • MRI  (121)
  • Immunohistochemistry  (100)
  • 101
    ISSN: 1432-0533
    Keywords: Key words Hypothermia ; Immunohistochemistry ; Microtubule-associated protein 2 (MAP2) ; Rat ; Spinal cord injury
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Systemic hypothermia has been shown to exert neuroprotective effects in experimental ischemic CNS models caused by vascular occlusions. The present study addresses the question as to whether systemic hypothermia has similar neuroprotective qualities following severe spinal cord compression trauma using microtubule-associated protein 2 (MAP2) immunohistochemistry combined with the avidin-biotin-peroxidase complex method as marker to identify neuronal and dendritic lesions. Fifteen rats were randomized into three equally sized groups. One group sustained thoracic laminectomy, the others severe spinal cord compression trauma of the T8-9 segment. The control group contained laminectomized animals submitted to a hypothermic procedure in which the esophageal temperature was reduced from 38 °C to 30 °C. The two trauma groups were either submitted to the same hypothermic procedure or kept normothermic during the corresponding time. All animals were sacrificed 24 h following the surgical procedure. The MAP2 immunostaining in the normothermic trauma group indicated marked reductions in MAP2 antigen in the cranial and caudal peri-injury zones (T7 and T10, respectively). This reduction was much less pronounced in the hypothermic trauma group. In fact, the MAP2 antigen was present in almost equally sized areas in both the hypothermic groups independent of previous laminectomy alone or the addition of trauma. Our study thus indicates that hypothermia has a neuroprotective effect on dendrites of rat spinal cords subjected to compression trauma.
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  • 102
    Electronic Resource
    Electronic Resource
    Springer
    Acta neuropathologica 100 (2000), S. 506-512 
    ISSN: 1432-0533
    Keywords: Key words Telencephalin ; Holoprosencephaly ; Cerebral cortex ; Glomerular structure ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Telencephalin (TLN), a telencephalon-specific glycoprotein, is exclusively expressed in neurons of the mammalian telencephalon. In the normally developing human brain, TLN immunoreactivity appeared and increased from 35 gestational weeks (GW) in the temporal cortex, and reached adult level at 5 months of postnatal age, being strong in the molecular layer, and weak in the external and internal granular layers. TLN expression corresponded with the development of neuronal dendrites and synapses. In brains with holoprosencephaly TLN immunoreactivity was already strong from as early as 28 GW. Staining was weak in the molecular layer, but strong in the external sparse and middle cellular layers in most cases. Notably, TLN was abundant in the glomerular structures in the internal pyramidal and multiform layers of fetal brains with alobar holoprosencephaly, which disappeared with increasing age. These results indicate premature and ectopic development of the dendrites and synaptic network in holoprosencephaly.
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  • 103
    ISSN: 1432-0533
    Keywords: Key words Myotonic dystrophy ; Myotonic dystrophy protein kinase ; Immunohistochemistry ; Human brain
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To investigate the pathophysiologic role of myotonic dystrophy protein kinase (DMPK) in the brain in myotonic dystrophy (MD), the developmental characteristics of DMPK immunoreactivity in the central nervous system and its alteration with disease were studied. Eleven patients’ brain with MD (5 congenital form, 6 adult form) were examined by immunohistochemistry using a specific antibody against synthetic DMPK peptides, anti-peptide DM1, and compared with 30 control brains, including 16 age-matched controls. In controls, DM1-immunoreactive neurons appeared in the early fetal frontal cortex and cerebellar granule cell layer, persisting through 29 weeks of gestation and then disappearing. In contrast, immunoreactive neurons continued to persist in the cerebral cortex and cerebellar granule cell layer of MD patients. When we counted DM1-immunoreactive neurons, the increase over controls was greater in the congenital form of MD than in the adult form, and was greater in the cerebrum than in the cerebellum in both forms of MD. DM1 immunostaining was predominantly nuclear, mirroring Western blotting of subcellular fractions. Differences in DM1 expression related to development and to the two forms of MD may be closely related to the pathogenesis of mental retardation in this disease.
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  • 104
    ISSN: 1432-0533
    Keywords: Key words Cerebral aneurysm ; Immunohistochemistry ; Smooth muscle cell ; Phenotypic modulation ; Myosin heavy chain isoforms
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We used immunohistochemical methods to analyze the phenotypes of smooth muscle cells (SMCs) in human cerebral arteries and aneurysmal walls. Thirty-two aneurysmal walls were studied; 31 aneurysmal walls were resected at operation and 1 aneurysm was obtained at autopsy. Seven control arteries were obtained at autopsy. Semiserial sections were subjected to immunohistochemical staining with antibodies to α-smooth muscle actin (α-SMA), desmin and smooth muscle myosin heavy chain isoforms: SM1, SM2 and SMemb. In control cerebral arteries, SMCs in the media were strongly immunostained for α-SMA, desmin, SM1 and SM2; immunoreactivity for SMemb was faint or weakly positive. SMCs in both non-ruptured and ruptured aneurysmal walls showed no staining for desmin; the expression of α-SMA was well preserved. Compared with control cerebral arteries, in 4 of 11 non-ruptured aneurysmal walls, the staining intensity of SMCs for SMemb was clearly increased. In ruptured aneurysmal walls, the expression of SM2 was lower than in control cerebral arteries and non-ruptured aneurysmal walls. Our study suggests that the phenotype of SMCs in aneurysmal walls is different from the contractile type in the media of normal cerebral arteries, at least partially changing to the synthetic type in some non-ruptured aneurysms. SMCs in ruptured aneurysmal walls may have lost both phenotypes before rupture. Phenotypic modulation of SMCs in the aneurysmal walls appears to be related to a remodeling of the aneurysmal wall and to a rupture mechanism.
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  • 105
    ISSN: 1432-0533
    Keywords: Key words Heme oxygenase-1 ; Heat shock protein-32 ; Traumatic brain injury ; Cerebral infarction ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Extracellular heme derived from hemoglobin following hemorrhage or released from dying cells induces the expression of heme oxygenase-1 (HO-1, HSP-32) which metabolizes heme to the gaseous mediator carbon monoxide (CO), iron (Fe) and biliverdin. Biliverdin and its product bilirubin are powerful antioxidants. Thus, expression of HO-1 is considered to be a protective mechanism against oxidative stress and has been described in microglia, astrocytes and neurons following distinct experimental models of pathological alterations to the brain such as subarachnoidal hemorrhage, ischemia and traumatic brain injury (TBI) and in human neurodegenerative diseases. We have now analyzed the expression of HO-1 in human brains following TBI (n = 28; survival times: few minutes up to 6 months) and focal cerebral infarctions (FCI; n = 17; survival time: 〈 1 day up to months) by ¶immunohistochemistry. Follwing TBI, accumulation of ¶HO-1+ microglia/macrophages at the hemorrhagic lesion was detected as early as 6 h post trauma and was still pronounced after 6 months. In contrast, after FCI HO-1+ microglia/macrophages accumulated within focal hemorrhages only and were absent in non-hemorrhagic regions. Further, HO-1 was weakly expressed in astrocytes in the perifocal penumbra. In contrast to experimental data derived from rat focal ischemia, these results indicate a prolonged HO-1 expression in humans after brain injury.
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  • 106
    ISSN: 1432-0533
    Keywords: Key words Cell culture ; Cell line ; Glioma ; Calcium-binding proteins ; Microglia enzymology ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Allograft inflammatory factor-1 (AIF-1) is a Ca2+-binding peptide that constitutes a potential modulator of macrophage activation and function during the immune response of the brain. Peptides termed microglia response factor-1 or ionized calcium-binding adaptor molecule-1 have been reported to be identical with AIF-1. We have investigated the expression of AIF-1 in the rat C6 glioblastoma and 9L gliosarcoma tumor models and additionally assessed AIF-1 expression in a diverse range of human astrocytomas by immunohistochemistry. AIF-1 was expressed by activated microglial cells and a subset of infiltrating macrophages in areas of infiltrative tumor growth and in compact tumor areas in both rat and human gliomas. Double-labeling experiments in rats and humans characterized the nature and the functional status of AIF-1+ cells. AIF-1 expression was detected in cells expressing major histocompatibility complex class II molecules and in a subset of activated macrophages/microglial cells. All MRP-8+ cells coexpressed AIF-1. In humans, there was a strong correlation of AIF-1-expressing activated macrophages/microglial cells with tumor malignancy (P 〈 0.0001). These results suggest that AIF-1 defines a distinct subset of tumor-associated activated macrophages/ microglial cells.
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  • 107
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    Acta neuropathologica 100 (2000), S. 709-711 
    ISSN: 1432-0533
    Keywords: Key words Multiple sclerosis ; Aλ amyloid ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In rare multiple sclerosis cases amyloid is deposited in demyelinated plaques. In one such case amyloid was examined immunohistochemically with a panel of antibodies directed against different amyloid types. The amyloid was classified as the Aλ type produced by a local monoclonal B cell population.
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  • 108
    ISSN: 1432-0533
    Keywords: Key words Cytosine arabinoside ; Heterotopia ; Microcephaly ; Hippocampus ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Pregnant mice were injected intraperitoneally with cytosine arabinoside (Ara-C) on days 13.5 and 14.5 of pregnancy. The brains of their offspring were studied histologically and histochemically. In addition to dysgenic microcephaly, nodular structures consisting of cells with a relatively homogeneous morphology were observed in the depths of the cerebral cortex. The cell clusters were first seen around postnatal day 4, and had a cellular continuity with the disarrayed pyramidal cell layer in the CA1 region of the hippocampus. Golgi-Cox staining showed a number of pyramidal-shaped cells in the clusters. Morphologically, they resembled the pyramidal neurons of the hippocampus. Immunohistochemical examination, using anti-serotonin or anti-tyrosine hydroxylase antibodies, also indicated similarities between the cell clusters and the pyramidal cell layer. It is, therefore, proposed that the cell clusters consisted of heterotopic pyramidal cells of the hippocampus. A few synaptic structures could already be detected in the heterotopic cell clusters on postnatal day 3 by electron microscopy. This early establishment of synaptic contact with related neurons may have caused the heterotopic localization of the pyramidal cells.
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  • 109
    ISSN: 1432-0533
    Keywords: Key words Aging ; Immunohistochemistry ; Inclusion body ; Neostriatum ; Ubiquitin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We examined the presence of ubiquitin-immunoreactive skein-like inclusions (SLI) in the neostriatum and spinal cord in normal individuals and patients with different neurodegenerative diseases. Ubiquitin-immunoreactive SLI in the neostriatum were observed both in the normal individuals and in the patients with a variety of neurodegenerative diseases. In particular, SLI were frequently seen in normal aged subjects and certain neurodegenerative diseases, such as progressive supranuclear palsy and myotonic dystrophy. In contrast, the occurrence rate of SLI in cases with Pick’s disease and multiple system atrophy tended to decrease. On the other hand, SLI in the spinal anterior horn were detected in cases of amyotrophic lateral sclerosis, but not in any cases with other neurodegenerative diseases. SLI in the neostriatum were also identifiable using phosphotungstic acid-hematoxylin and Gomori trichrome staining. Ubiquitin immunoelectron microscopy demonstrated that the SLI in the neostriatum corresponded to bundles of filaments. These features of SLI in the neostriatum were quite similar to those of intracytoplasmic rod-like inclusions (RLI) in the large neurons of caudate nucleus, which were first described by Kojima and Ogawa in 1974. Our findings indicate that SLI in the neostriatum are ubiquitin-related structures whose occurrence increases by aging, and less frequently accompany several neurodegenerative diseases, and are identical to at least some RLI.
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  • 110
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    Acta neuropathologica 100 (2000), S. 106-110 
    ISSN: 1432-0533
    Keywords: Key words Posterior pituitary ; Ganglion cell ; Immunohistochemistry ; Ectopia ; Transdifferentiation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Histologic examination revealed large ganglion cells within the posterior pituitary of an 80-year-old woman who died of myocardial infarction. Apparently fully mature, the cells were an incidental finding scattered within hyperplastic foci of pars intermedia (PI)-derived cells (basophil invasion) on histologic examination of the pituitary obtained at autopsy. Immunocytochemistry showed staining reactivity for neuron-specific enolase, synaptophysin, alpha subunit of the glycoprotein hormones and beta-endorphin. The presence of these ganglion cells with features similar to those of magnocellular hypothalamic neurons could be considered the result of abnormal migration during the early phase of embryonic life, or differentiation/maturation of neuroblasts, presumed to occur in the embryonic neurohypophysis. Alternatively, transdifferentiation from proliferating PI cells may explain the emergence of neurons; a hypothesis supported by the proximity and shared alpha subunit, and beta-endorphin immunoreactivities of the two cell types.
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  • 111
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    European radiology 10 (2000), S. 1691-1696 
    ISSN: 1432-1084
    Keywords: Key words: Herniography ; MRI ; Hernia ; Groin pain
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The aims of the present study were to assess if MRI gives the same diagnostic information as herniography concerning the presence of hernias and reveals other causes of groin pain. The prospective study enrolled 20 patients referred for herniography, 6 women and 14 men, mean age 48 years. After herniography the patients underwent MRI using T1-weighted, fat-suppressed inversion recovery (STIR), and magnetic resonance cholangiopancreaticography (MRCP) pulse sequences. No contrast medium was administered at MRI. Herniography revealed 11 hernias and MRI depicted 8 of these. Magnetic resonance imaging depicted well the anatomy in the groins. In 3 patients where hernias were not revealed, MRI revealed inflammatory changes in the symphysis region as a possible cause of groin pain. The primary diagnostic tool for diagnosing hernias is herniography. If the herniogram is normal, MRI may reveal other causes of groin pain and may also better visualize related structures in the groin.
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  • 112
    ISSN: 1432-1084
    Keywords: Key words: Ovarian cancer ; Lesion characterization ; Recurrence ; PET ; CT ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The aim of this study was to compare prospectively the accuracy of whole-body positron emission tomography (PET), CT and MRI in diagnosing primary and recurrent ovarian cancer. Nineteen patients (age range 23–76 years) were recruited with suspicious ovarian lesions at presentation (n = 8) or follow-up for recurrence (n = 11). All patients were scheduled for laparotomy and histological confirmation. Whole-body PET with FDG, contrast-enhanced spiral CT of the abdomen, including the pelvis, and MRI of the entire abdomen were performed. Each imaging study was evaluated separately. Imaging findings were correlated with histopathological diagnosis. The sensitivity, specificity and accuracy for lesion characterization in patients with suspicious ovarian lesions (n = 7) were, respectively: 100, 67 and 86 % for PET; 100, 67 and 86 % for CT; and 100, 100 and 100 % for MRI. For the diagnosis of recurrent disease (n = 10), PET had a sensitivity of 100 %, specificity of 50 % and accuracy of 90 %. The PET technique was the only technique which correctly identified a single transverse colon metastasis. Results for CT were 40, 50 and 43 %, and for MRI 86, 100 and 89 %, respectively. No statistically significant difference was seen. Neither FDG PET nor CT nor MRI can replace surgery in the detection of microscopic peritoneal disease. No statistically significant difference was observed for the investigated imaging modalities with regard to lesion characterization or detection of recurrent disease; thus, the methods are permissible alternatives. The PET technique, however, has the drawback of less accurate spatial assignment of small lesions compared with CT and MRI.
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  • 113
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    European radiology 10 (2000), S. 780-782 
    ISSN: 1432-1084
    Keywords: Key words: Uterus ; Endometrial stromal sarcoma ; Uterine myometrium ; Uterine leiomyoma ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Two cases of uterine endometrial stromal sarcoma whose main mass was located in uterine myometrium are reported. They mimicked uterine leiomyoma with cystic degeneration or uterine leiomyosarcoma. Endometrial stromal sarcoma should be suggested in the differential diagnosis of mass lesion in uterine myometrium.
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  • 114
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    European radiology 10 (2000), S. 832-840 
    ISSN: 1432-1084
    Keywords: Key words: Osteochondroma ; Complications ; Chondrosarcoma ; Bone tumors ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Osteochondromas can be complicated by mechanical irritation, compression or injury of adjacent structures, fracture, malignant transformation, and postoperative recurrence. Magnetic resonance imaging represents the most valuable imaging modality in symptomatic cases, because it can demonstrate typical features of associated soft tissue pathology, which can be differentiated from malignant transformation. Reactive bursae formation presents as an overlying fluid collection with peripheral contrast enhancement. Dislocation, deformation, and signal alterations of adjacent soft tissue structures can be observed in different impingement syndromes caused by osteochondromas. Magnetic resonance imaging provides excellent demonstration of arterial and venous compromise and represents the method of choice in cases with compression of spinal cord, nerve roots, or peripheral nerves, depicting changes in size, position, and signal intensity of the affected neural structures. Malignant transformation as the most worrisome complication occurs in approximately 1 % of solitary and 5–25 % of multiple osteochondromas. Magnetic resonance imaging is the most accurate method in measuring cartilage cap thickness, which represents an important criterion for differentiation of osteochondromas and exostotic (low-grade) chondrosarcomas. Cartilage cap thickness exceeding 2 cm in adults and 3 cm in children should raise the suspicion for malignant transformation. Finally, MR imaging can detect postoperative recurrence by depiction of a recurrent mass presenting typical morphological features of a cartilage-forming lesion.
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  • 115
    ISSN: 1432-1084
    Keywords: Key words:18FDG-PET ; Osteomyelitis ; Antigranulocyte antibody scintigraphy ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The purpose of this report is to discuss FDG-PET as a potentially new imaging tool in the diagnosis of infections of osteosynthetic material. We present a patient with a poly-trauma who developed a chronic osteomyelitis and ostitis after repeated osteosynthesis in a fibular transplant to the left femur. Work up included MRI, antigranulocyte antibody scintigraphy and positron emission tomography (PET) with F-18 fluorodeoxyglucose (FDG). Infection of the fibular transplant was demonstrated clearly by PET but not by the other methods. Positron emission tomography may become an important indication in the diagnosis and follow-up of bone infection.
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  • 116
    ISSN: 1432-119X
    Keywords: Endothelin-A receptor ; Endothelin-B receptor ; Rat ; Pulmonary fibrosis ; Immunohistochemistry ; Quantitative PCR
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Medicine
    Notes: AbstractPulmonary fibrosis is characterized by excessive extracellular matrix deposition with concomitant loss of gas exchange units, and endothelin-1 (ET-1) has been implicated in its pathogenesis. Increased levels of ET-1 from tissues and bronchoalveolar lavage have been reported in patients with pulmonary fibrosis and in animal models after intratracheal bleomycin. We characterized the cellular distribution of alveolar ET receptors by immunohistochemistry in bleomycin-induced pulmonary fibrosis in the rat and determined the regulation by bleomycin of ET receptor mRNA expression in isolated alveolar macrophages and rat lung fibroblasts. We found significant increases in the numbers of fibroblasts and macrophages at day 7 compared to day 28 and control animals. ETB receptor immunoreactivity was observed on fibroblasts and invading monocytes. Isolated fibroblasts expressed both ETA and ETB receptor mRNA, and ETA receptor mRNA was upregulated by bleomycin. Isolated resident alveolar macrophages expressed neither ETA nor ETB receptor mRNA which were also not induced by bleomycin. We conclude that, while ETB receptor stimulation of fibroblasts and monocytes recruited during bleomycin-induced lung injury exerts antagonistic effects on fibroblast collagen synthesis, the observed increase in the number of fibroblasts in vivo and upregulation of fibroblast ETA receptor mRNA by bleomycin in vitro point to a predominance of the profibrotic effects of ET receptor engagement.
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  • 117
    ISSN: 1432-119X
    Keywords: Endometrium ; Normal ; Immunohistochemistry ; Immunofluorescence ; Inhibin/activin subunits ; Inhibin-alpha ; Inhibin-beta A ; Inhibin-beta B
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Medicine
    Notes: AbstractInhibins are dimeric glycoproteins composed of an alpha (α) subunit and one of two possible beta (β-) subunits (βA or βB). The aims of this study were to assess the frequency and tissue distribution patterns of the inhibin subunits in normal human endometrium. Samples from human endometrium from proliferative phase (PP; n=32), early secretory phase (ES; n=10) and late secretory phase (LS; n=12) were obtained. Immunohistochemistry, immunofluorescence and a statistical analysis were performed. All three inhibin subunits were expressed by normal endometrium by immunohistochemistry and immunofluorescence. Inhibin-α was primarily detected in glandular epithelial cells, while inhibin-β subunits were additionally localised in stromal tissue. Inhibin-α staining reaction increased significantly between PP and ES (P〈0.05), PP and LS (P〈0.01), and ES and LS (P〈0.02). Inhibin-βA and -βB were significant higher in LS than PP (P〈0.05) and LS than ES (P〈0.05). All three inhibin subunits were expressed by human endometrium varying across the menstrual cycle. This suggests substantial functions in human implantation of inhibin-α subunit, while stromal expression of the β subunits could be important in the paracrine signalling for adequate endometrial maturation. The distinct expression in human endometrial tissue suggests a synthesis of inhibins into the lumen and a predominant secretion of activins into the stroma.
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  • 118
    ISSN: 1432-1084
    Keywords: Key words: Lumbar spine ; Ganglion cyst ; Posterior longitudinal ligament ; Radiculopathy ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. A 35-year-old man with a long history of left L5 radicular pain was found to have an intraspinal cystic lesion causing radicular compression. Magnetic resonance imaging demonstrated a round lesion situated in the anterior epidural space, with uniform high signal intensity on T2-weighted sequences characteristic of a cystic lesion. During surgery a liquid-containing cyst originating from the posterior longitudinal ligament was punctured and resected. The histologic aspect was that of a ganglion cyst without synovial layers. The radiologic differential diagnoses are discussed.
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  • 119
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    European radiology 10 (2000), S. 786-801 
    ISSN: 1432-1084
    Keywords: Key words: CT ; MRI ; Colon ; Colonography ; Virtual colonoscopy ; Colorectal polyp ; Screening
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. With the introduction of multidetector technology in CT and the moveable table with integrated coil modules in MRI, the concept of multiorgan screening has become realistic. CT colonography and MR colonography are new radiologic techniques that promise to be highly sensitive colorectal screening examinations. This article reviews the current status and research directions in CT colonography and MR colonography, and compares these methods.
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  • 120
    ISSN: 1432-1084
    Keywords: Key words: Eye injuries ; CT ; MRI ; Eye foreign body
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Detection and characterization of intraorbital foreign bodies (IFB) is fundamental in acute trauma setting, preventing inflammatory sequelae or complications related to IFB movements when a MRI study is planned. Papers concerning plain film and CT sensibility in IFB detection show controversial results. For this reason we investigated plain film, CT and MRI sensibility in the evaluation of IFB. For an in vitro model, specimens of dry and fresh wood, glass, iron, plastic and graphite were immersed in animal lard and in a 0.9 % sodium chloride plus 3.5 g/dl human serum albumin solution. Specimens of different size and nature where also implanted into enucleated pig eyes. Air bubbles were introduced also. Plain film, CT and MRI investigation were performed. Plain films underestimated intraocular IFB as plastic, fresh or dry wooden IFB were not demonstrated. The CT study was always able to depict and differentiate IFB according to the attenuation values. Severe artefacts prevented demonstration of iron, glass and graphite IFB on MRI, whereas plastic or wooden IFB were always detected. Despite radiographs have been suggested as a prerequisite for MR imaging, because our results showed plain film to underestimate radiolucent IFB, we suggest CT as the modality of choice when IFB has to be ruled out.
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  • 121
    ISSN: 1432-1084
    Keywords: Key words: Brain ; MRI ; Neoplasms ; Diffusion image ; Echo-planar MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. We assess diffusion-weighted MR images in the differential diagnosis of intracranial brain tumors and tumor-like conditions. Heavily diffusion-weighted (b = 1100 or 1200 s/mm2) axial images were obtained with single-shot echo-planar technique in 93 patients with pathologically confirmed various intracranial tumors and tumor-like conditions with diffusion gradient perpendicular to the images. We compared signal intensity of the lesions with those of gray and white matter, and cerebrospinal fluid (CSF). In 29 cases (31.1 %) the lesions were isointense to gray and/or white matter. However, 5 cases (5.4 %) showed extremely increased signal intensity: two epidermoid cysts; two chordomas; and one brain abscess. The entire portion of a tumor was markedly hyperintense in 10 cases (10.8 %): four malignant lymphomas; four medulloblastomas; one germinoma; and one pineoblastoma. A CSF-like hypointense signal was seen in many cystic tumors, and cystic or necrotic portions of tumors. A neurosarcoid granulation was the only solid lesion showing characteristically a hypointense signal like CSF. The combination of markedly hyperintense and hypointense signals was seen generally in hemorrhagic tumors. Diffusion-weighted echo-planar MR imaging is useful in the differential diagnosis of brain tumors and tumor-like conditions, and suggests specific histological diagnosis in some cases.
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  • 122
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    Neuroradiology 42 (2000), S. 290-295 
    ISSN: 1432-1920
    Keywords: Key words Blake's pouch cyst ; Dandy-Walker complex ; Dandy-Walker malformation ; Posterior fossa malformation ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Abnormal cerebrospinal fluid (CSF) collections within the posterior fossa are defined by the Dandy-Walker complex (DWC) and by arachnoid cysts (AC). The DWC includes the Dandy-Walker malformation (DWM), the Dandy-Walker variant (DWV) and the mega-cisterna magna (MCM). In addition, Tortori-Donati et al. added persistent Blake's pouch cyst (BPC) as an independent entity within the DWC. BPC represents a posterior ballooning of the superior medullary velum into the cisterna magna. All of these malformations are overlapping developmental anomalies characterized by varying degrees of malformation of the medullary vela, the cerebellar vermis and hemispheres, the fourth ventricle choroid plexus, the posterior fossa subarachnoid cisterns and the enveloping meningeal structures. We present two cases of persistent BPC detected in two adult women without history of gestational or subsequent growth problems. They underwent neuroradiological investigation because of headache and because of recurrent episodes of loss of consciousness, respectively. The MRI findings included tetraventricular hydrocephalus, wide communication of the fourth ventricle and the cystic posterior fossa (i. e. BPC), inferior posterior fossa mass effect with or without hypoplasia of both the cerebellar vermis and the medial aspects of the cerebellar hemispheres, and absence of communication between fourth ventricle and the basal subarachnoid space in the midline posteriorly. Persistent BPC is defined by a failure of embryonic assimilation of the area membranacea anterior within the tela choroidea associated with imperforation of the foramen of Magendie. Typically this condition becomes symptomatic early in life. In the current cases the normal function of the laterally positioned foramina of Luschka probably helped to maintain some CSF flow between intraventricular and subarachnoid spaces, with the establishment of a precarious equilibrium characterized by a compensatory enlargement of the cerebral ventricular system (i. e. hydrocephalus).
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  • 123
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    Der Pathologe 21 (2000), S. 433-440 
    ISSN: 1432-1963
    Keywords: Schlüsselwörterα1-Antitrypsin-Mangel PiZ ; Lebermorphologie ; Immunhistochemie ; “Single-strand conformational polymorphism” ; DNA-Sequenzierung ; Keywords Alpha-1-antitrypsin deficiency PiZ ; Liver morphology ; Immunohistochemistry ; Single-strand conformational polymorphism ; DNA sequencing
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Whether heterozygotes with alpha-1-antitrypsin (AAT) deficiency type PiZ bear an increased risk for chronic liver disease is controversial. On the basis of liver tissue from 1,030 autopsies (autopsy series), 1,847 biopsies (biopsy series) and 317 primary liver carcinomas (tumor series), we analysed the effect of heterozygous state PiZ for the development of liver diseases. The PiZ status was screened immunohistochemically and verified in selected cases by SSCP analysis and by sequencing DNA extracted from paraffin embedded tissue. The PiZ frequency in the biopsy series (3.4%) and tumor series (5.99%) was significantly higher than in the autopsy series (1.8%). Hepatic PiZ deposits in heterozygotes sometimes were as extensive as in homozygotes. The amount of PiZ deposits correlated positively with the inflammatory activity and stage of fibrosis, as well as with the age of patients. Patients with concurrent liver disease such as hepatitis and alcoholic liver disease showed significantly higher scores of inflammatory activity, stage of fibrosis and amount of PiZ deposits than those without additional liver disease. Cholangiocarcinomas and combined hepato-cholangiocarcinomas were seen significantly more frequently in patients with PiZ-associated liver carcinoma than in genetic healthy individuals (p=0.004). Three out of 19 PiZ-associated liver carcinomas had developed in cirrhotic liver tissue. Heterozygotes of type PiZ have an enhanced risk for chronic liver disease including primary liver carcinoma. PiZ-associated liver diseases will become clinically manifest in middle or old aged adults. Rarely this genetic defect causes liver cirrhosis even without concurrent liver disease. PiZ-associated liver carcinomas are frequently characterized by cholangiocellular differentiation and may develop often in non-cirrhotic liver tissue. Immunohistochemistry is a specific method to detect hepatic PiZ deposits.
    Notes: Zusammenfassung Bisher ist umstritten, ob heterozygote Patienten mit α1-Antitrypsin (AAT)-Mangel Typ PiZ ein erhöhtes Risiko für Lebererkrankungen aufweisen. An Leberproben von 1030 Autopsien (Autopsie-Serie), 1847 Biopsien (Biopsie-Serie) und 317 primären Leberkarzinomen (Tumor-Serie) sollte der Einfluss des heterozygoten PiZ-Status auf die Leber untersucht werden. Die PiZ-Bestimmung erfolgte immunhistochemisch, teilweise ergänzt durch SSCP-Analyse und DNA-Sequenzierung von DNA-Extrakten aus paraffineingebettetem Material. Die PiZ-Häufigkeit der Biopsie-Serie (3,4%) und der Tumor-Serie (5,99%) war signifikant höher als die der Autopsie-Serie (1,8%). PiZ-Ablagerungen waren bei manchen heterozygoten Merkmalsträgern ebenso umfangreich wie bei homozygoten. Ihr Ausmaß korrelierte positiv mit Entzündungsaktivität und Fibrosegrad der Leber sowie mit dem Patientenalter. Patienten mit konkurrierenden Lebererkrankungen wie Hepatitis oder Alkoholschädigung wiesen eine signifikant stärkere Entzündung, Fibrose und mehr PiZ-Ablagerungen auf als diejenigen ohne zusätzliche Lebererkrankungen. Cholangiokarzinome und kombinierte Hepatocholangiokarzinome traten signifikant häufiger bei Patienten mit PiZ-Mutation als bei genetisch Gesunden (p=0,004) auf. Nur 3 der 19 PiZ-assoziierten Leberkarzinome waren in einer Leberzirrhose entstanden. Patienten mit heterozygotem AAT-Mangel Typ PiZ tragen nach den hier vorgestellten Ergebnissen ein erhöhtes Risiko für chronische Lebererkrankungen einschließlich primärer Leberkarzinome. Wenn überhaupt, manifestiert sich dieser genetische Defekt erst in mittlerem oder höherem Lebensalter. Er kann in seltenen Fällen selbst ohne konkurrierende Lebererkrankung zur Zirrhose führen. PiZ-assoziierte Leberkarzinome sind häufig cholangiozellulär differenziert und entstehen mehrheitlich ohne Leberzirrhose. Hepatische PiZ-Ablagerungen lassen sich immunhistochemisch zuverlässig identifizieren.
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  • 124
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    Der Pathologe 21 (2000), S. 39-54 
    ISSN: 1432-1963
    Keywords: Schlüsselwörter Chronische myeloische Leukämie ; Megakaryozyten ; Fasern ; Erythropoese ; Makrophagen ; Klinische Befunde ; Immunhistochemie ; Knochenmarkbiopsie ; Key words Chronic myelogenous leukemia ; Megakaryocytes ; Fibers ; Erythroid precursors ; Macrophages ; Clinical findings ; Immunohistochemistry ; Morphometry ; Bone marrow biopsies
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary An immunohistochemical and morphometric study was performed on bone marrow biopsies in 604 patients with chronic myelogenous leukemia (CML) to compare morphological and clinical features and to evaluate effects of interferon (IFN) and chemotherapy. Following morphometry significant correlations were calculated between number of CD61+ megakaryocytes, including their precursors with fiber density. This finding is in line with the close functional relationship between megakaryopoiesis and fibroblasts regarding the complex pathomechanism of myelofibrosis. The latter was observed in about 28% of patients already at diagnosis. In a similar way, the frequency of CD68+ macrophages was correlated with the amount of Ret40f+ nucleated erythroid precursors, implicating an involvement of this cell lineage in iron turnover, hemoglobin synthesis, and degradation of the expelled nuclei from normoblasts. The (α-D-galactosyl residue-expressing) Pseudo-Gaucher cells were detectable in 30% of pretreatment specimens. Moreover, significant associations were calculable between reduction in erythropoiesis or increase in fibers with clinical features such as hemoglobin level, percentages of myelo- and erythroblasts in the peripheral blood, and spleen size. These variables are in keeping with more advanced stages of CML. Based on our morphometric evaluations, a classification into three different histological subgroups: granulocytic, megakaryocytic, and myelofibrotic was carried out. This simplified staging system was correlated with corresponding sets of hematological data. Sequential biopsies in 173 patients with monotherapy by IFN, hydroxyurea (HU), or busulfan (BU) revealed a fibrogenic effect of IFN in contrast to a fiber-reducing property of HU. The dynamics of myelofibrosis and changes of major cell lineages during treatment were readily demonstrable by calculating corresponding indices. These included the ratios between quantitative differences of corresponding variables at repeated examinations and time. Thus, in patients with complete hematological remission following IFN administration, regeneration of erythropoiesis was found to be accompanied by an increase in the total number of CD68+ macrophages, including activated subpopulations. Histological subgroups showed a transition from a (nonfibrotic) granulocytic and megakaryocyte pattern to the myelofibrotic subtype in about 40% of patients. This change was opposed to a numerical reduction in the myelofibrotic subtype which occurred in 17 patients (36%), but predominantly in those under HU therapy. In conclusion, the striking heterogeneity of bone marrow features in CML warrants a careful morphological evaluation of trephine biopsies and appropriate means of processing to achieve relevant correlations with clinical data and, thus, allows a more elaborate insight into the dynamics of the disease process.
    Notes: Zusammenfassung Bei 604 Patienten mit einer chronischen myeloischen Leukämie (CML) wurde anhand von Beckenkammbiopsien eine immunhistochemische und morphometrische Studie durchgeführt, um morphologische und klinische Befunde miteinander zu vergleichen und die Auswirkungen der Interferon- (IFN) und Chemotherapie abzuklären. Anhand der morphometrischen Analyse konnten signifikante Korrelationen zwischen der Anzahl CD61+-Megakaryozyten einschließlich ihrer Vorläuferzellen mit der Faserdichte berechnet werden. Dieser Befund spiegelt die enge funktionelle Beziehung zwischen der Megakaryopoese und den Fibroblasten im Hinblick auf den komplexen Pathomechanismus der Myelofibroseentstehung wider. Diese war bei etwa 28% der Patienten bereits zum Diagnosezeitpunkt zu beobachten. In ähnlicher Weise war die Anzahl der CD68+-Makrophagen mit der Menge an Ret40f+-kernhaltigen erythropoetischen Vorläuferzellen korreliert, was durch die Einbindung dieser Zellinie in den Eisenstoffwechsel, die Hämoglobinsynthese sowie den Abbau der ausgestoßenen Normoblastenkerne in Zusammenhang gebracht werden kann. Die (α-D-Galaktosylreste-expremierende) Pseudo-Gaucherzellen ließen sich in 30% der Biopsien vor Behandlung nachweisen. Weiterhin konnten signifikante Beziehungen zwischen einer Reduktion der Erythropoese oder einer Zunahme der Verfaserung mit klinischen Parametern wie dem Hämoglobinspiegel, dem Anteil an Myelo- und Erythro-Normoblasten im peripheren Blut und der Milzgröße berechnet werden. Diese Variablen kennzeichnen offensichtlich mehr fortgeschrittene Stadien der CML. Entsprechend unserer morphometrischen Auswertung wurde eine Klassifikation in drei unterschiedliche histologische Subgruppen vorgenommen: granulozytisch, megakaryozytisch und myelofibrotisch. Dieser vereinfachten histologischen Einteilung waren entsprechende hämatologische Daten zuzuordnen. Sequenzbiopsien an 173 Patienten, die eine Monotherapie mit IFN, Hydroxyurea (HU) oder Busulfan (BU) erhielten, zeigten einen fibrogenetischen Effekt von IFN im Gegensatz zu einer eher faserreduzierenden Eigenschaft von HU. Die Dynamik der Myelofibroseentwicklung und die entsprechende Veränderungen der hauptsächlichen Zellinien während der Behandlung ließen sich am besten durch eine Kalkulation von Indizes verdeutlichen. Diese beinhalteten das Verhältnis aus quantitativen Unterschieden der einzelnen Variablen in den wiederholt durchgeführten Entnahmen und den zugeordneten zeitlichen Differenzen. So war bei Patienten mit einer kompletten hämatologischen Remission nach IFN-Gabe die Regeneration der Erythropoese zusammen mit einem Anstieg in der Anzahl CD68+-Makrophagen einschließlich ihrer aktivierten Subpopulation auszumachen. Die histologischen Subgruppen ließen bei fortlaufenden Untersuchungen einen Übergang sowohl von einem (nicht verfaserten) granulozytären wie auch megakaryozytären Subtyp in eine myelofibrotische Gruppe bei etwa 40% der Patienten erkennen. Dieses Phänomen stand im Gegensatz zu einer anzahlmäßigen Reduzierung des myelofibrotischen Typs vor allem bei Patienten unter HU-Therapie in 17 Fällen (36%). Zusammengefaßt erfordert die auffallende Heterogenität der Knochenmarkbefunde bei der CML eine sorgfältige morphologische Auswertung von Biopsien mit geeigneten Methoden, um relevante Korrelationen zwischen klinischen Daten zu berechnen und somit einen besseren Einblick in die Dynamik der Krankheitsentwicklung zu gewinnen.
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    Der Pathologe 21 (2000), S. 16-23 
    ISSN: 1432-1963
    Keywords: Schlüsselwörter Lymphknötchen ; Reaktive Infiltrate ; Maligne Lymphome ; Histotopographie ; Immunhistochemie ; Retikulinfasern ; Knochenmarkbiopsie ; Key words Lymphoid nodules ; Reactive infiltrates ; Malignant lymphomas ; Histotopography ; Immunohistochemistry ; Reticulin fibers ; Bone marrow biopsies
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Differentiation of focal or extended lymphoid bone marrow infiltrates presents a diagnostic challenge and therefore warrants systematic evaluation of those features which affect this. One of the basic requirements is an appropriate technique of processing the bone marrow specimens. This includes the possibility of enzyme evaluation (naphthol-AS-D-chloroacetate esterase) and immunohistochemistry (set of monoclonal antibodies) and comparison with the corresponding lymph node histology. A number of histological parameters have emerged with a distinctive property for distinguishing between reactive focal lymphoid aggregates and malignant lymphomas. Amongst these the pattern of infiltrates, i.e., histotopography (subcortical infiltrates, paratrabcular–endosteal localization, margination, tandem-like extension between adipocytes and cribriform appearance), content of reticulin fibers, cytology (small lymphocytes versus large blast cells) and, finally, immunohistochemistry (monoclonal versus polyclonal expression of cytoplasmic immunoglobulins, uniform versus mixed population of B or T lymphocytes) are most important. In conclusion, synoptic consideration of several parameters, in particular histotopography and immunohistochemistry provides a most promising approach to differentiate neoplastic from reactive lymphoid lesions in the bone marrow.
    Notes: Zusammenfassung Die Differentialdiagnose herdförmiger oder ausgedehnter lymphoider Knochenmarkinfiltrate stellt noch immer eine diagnostische Herausforderung dar, die eine systematische Analyse entsprechender diskriminierender Faktoren erfordert. Eine der grundsätzlichen Voraussetzungen ist dabei eine Technik mit entsprechender Möglichkeit einer enzym- (Naphthol-AS-D-Chlorazetatesterase) und immunhistochemischen Aufarbeitung (monoklonale Antikörper) des Biopsiematerials und der Vergleich mit der zugeordneten Lymphknotenhistologie. Hinsichtlich der Unterscheidung zwischen reaktiven, herdförmigen lymphoiden Läsionen und malignen Lymphomen hat sich eine Anzahl histologischer Parameter als von wegleitendem diagnostischen Wert herausgestellt. Dazu gehören einmal das Infiltrationsmuster bzw. die Histotopographie (subkortikales Infiltrat, paratrabekulär-endostale Lokalisation, Abgrenzung, tandem-artige Ausbreitung zwischen den Adipozyten und kribriformes Muster), Faserdichte im Infiltrat sowie die Zytologie (kleine Lymphozyten gegenüber großen blastären Zellelementen) und schließlich die Immunhistochemie (mono-gegenüber polyklonaler Expression zytoplasmatischer Immunglobuline, uniforme gegenüber gemischtzelliger B- oder T-Lymphozytenpopulation). Zusammengefaßt verspricht eine gemeinsame Beachtung dieser verschiedenen Merkmale, insbesondere jedoch die Histotopographie und Immunhistochemie, am ehesten eine erfolgreiche Differenzierung zwischen reaktiven und neoplastischen lymphoiden Läsionen des Knochenmarks.
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  • 126
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    Keywords: Schlüsselwörter Harnblase ; WHO-Klassifikation ; Flache und papilläre urotheliale Läsionen/Tumoren ; Histologie ; Immunhistochemie ; Keywords Urothelial bladder tumors ; WHO classification ; Flat and papillary urothelial lesions/tumors ; Histology ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Recently the World Health Organization published a new classification of urinary bladder tumors which is intended to take into account better the biology of the various lesions and to better distinguish between clearly benign and malignant lesions. We examine the possible diagnostic and clinical impact of the new classification, including recent immunohistochemical findings. Papillary urothelial lesions include papillomas, papillary neoplasms of low malignant potential, and papillary carcinomas. Flat urothelial lesions include hyperplasia, reactive atypia/atypia of unknown significance, dysplasia, and carcinoma in situ. Invasive patterns of papillary carcinomas are discussed, with special emphasis on lamina muscularis mucosae substaging. The most important feature of the new classification is its differentiation of two types of low-grade, noninvasive papillary urothelial lesions: papillary neoplasm of low malignant potential vs. papillary carcinoma. Long-term follow-up studies are needed to determine the clinical significance of this differentiation.
    Notes: Zusammenfassung Grund für die Aktualisierung der WHO-Klassifikation urothelialer Läsionen bzw. Tumoren der Harnblase war, der Biologie der verschiedenen Läsionen besser gerecht zu werden sowie eine schärfere Trennung zwischen benignen und malignen urothelialen Prozessen zu vollziehen. Die Bedeutung für Diagnostik und Klinik im Alltag unter Berücksichtigung aktueller immunhistochemischer Befunde wird kritisch betrachtet. Zwei Hauptgruppen werden unterschieden. Papilläre urotheliale Läsionen umfassen Papillome, papilläre urotheliale Neoplasien niedrig malignen Potentials sowie papilläre Karzinome. Flache urotheliale Läsionen umfassen flache Hyperplasien, Atypien (reaktiv oder von unklarer Bedeutung), Dysplasien sowie das Carcinoma in situ (CIS). Verschiedene Invasionsmuster papillärer Karzinome werden unter besonderer Berücksichtigung der Lamina muscularis mucosae diskutiert. Der kritischste Punkt der neuen Klassifikation sowohl für die Diagnostik als auch für die Klinik dürfte die Unterscheidung zweier Gruppen nichtinvasiver papillärer “low-grade”-Tumoren (papilläre urotheliale Neoplasie niedrig malignen Potentials vs. pTa-GI-Tumor) darstellen. Langzeit-follow-up-Studien müssen zeigen, ob diese Unterteilung ihre Berechtigung findet.
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    Der Pathologe 21 (2000), S. 456-459 
    ISSN: 1432-1963
    Keywords: Schlüsselwörter Undifferenziertes kleinzelliges Hepatoblastom ; Immunhistochemie ; Keywords Undifferentiated small-cell hepatoblastoma ; Immunohistochemistry ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Undifferentiated small-cell hepatoblastoma (HB) is a rare malignant tumor of childhood. The cell of origin is supposed to be a pluripotential, probably entodermal, stem-cell. Differential diagnosis of this type of HB is difficult among the group of small round and blue cell malignant tumors of children. The immunohistochemically determined coexpression of cytokeratin 8, 18, and 19 and of vimentin and actin, regularly in the absence of α-fetoprotein expression may be diagnostically helpful. We present the case of an undifferentiated small-cell HB of a 15-month-old girl with agenesis of the right kidney. As morphological peculiarity the tumor presented disseminated histiocytic giant cells.
    Notes: Zusammenfassung Undifferenzierte kleinzellige Hepatoblastome (HB) zählen zu den seltenen malignen Tumoren der Leber im Kindesalter. Da der Tumor in der Regel kein α-Fetoprotein exprimiert, ist der Nachweis von Zytokeratin 8, 18 und 19 sowie Vimentin und Aktin diagnostisch wegweisend. Als Ausgangszelle wird eine pluripotente, wohl entodermale Stammzelle vermutet. In der Gruppe der klein-, rund- und blauzelligen malignen Tumoren des Kindesalters bietet diese Variante des HB differenzialdiagnostische Schwierigkeiten. Wir berichten über ein undifferenziertes kleinzelliges HB eines 15 Monate alten weiblichen Kleinkindes mit Agenesie der rechten Niere. Als morphologische Besonderheit des Tumors werden disseminierte histiozytäre Riesenzellen beschrieben.
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    Pediatric nephrology 14 (2000), S. 629-635 
    ISSN: 1432-198X
    Keywords: Key words Histomorphometry ; In situ hybridization histochemistry ; Molecular morphometry ; Immunohistochemistry ; Bone
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Quantitative histomorphometric assessment of bone biopsies represents a powerful and informative method for the study of metabolic bone diseases. It is the gold standard against which the noninvasive ”diagnostic” markers of bone metabolism as well as newly available therapeutic modalities are tested. With the rapid progress in technology of molecular biology, identification of systemic and local biomolecules known to regulate bone metabolism can now be achieved. The study of localization, levels of expression, and synthesis of these factors in bone and its microenvironment is possible through applications of in situ hybridization histochemistry (ISHH) and immunohistochemistry (IHC). Application of ISHH allows study of specific mRNA expression. IHC determines the presence and distribution of target protein in cells. These two methodologies provide the link between the cellular processes of mRNA transcription and translation to the working protein. Combining the established bone histomorphometric techniques with ISHH and IHC elevates the study of bone to new heights, i.e., cellular and molecular mechanistic issues can now be studied.
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    Der Radiologe 40 (2000), S. 998-1010 
    ISSN: 1432-2102
    Keywords: Schlüsselwörter Virale Enzephalitis ; MRT ; Herpes-simplex-Virus ; HIV ; Keywords Virus encephalitis ; MRI ; Herpes simplex virus ; HIV
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract The diagnostic procedure in viral encephalitis is based on the synopsis of clinical signs and symptoms, serological data, CSF analysis and diagnostic imaging findings. This article summarizes the findings of those viral encephalitides most frequently encountered in Western Europe. MRI is more sensitive than CT for the detection of inflammatory brain lesions due to the higher contrast resolution. The pattern of parenchymal damage is highly specific in only some viral encephalitides (e. g., the frequently hemorrhagic lesions of structures of the limbic system in herpes simplex virus type I encephalitis; the symmetric and confluent lesions of the frontal white matter of progressive diffuse leukoencephalopathy in AIDS). In the majority of viral encephalitides MRI demonstrates the location and extension of parenchymal damage. The specific diagnosis in terms of the causative agent is based on serological studies.
    Notes: Zusammenfassung Die Diagnostik viraler Enzephalitiden basiert auf der synoptischen Auswertung klinischer, serologischer, liquoranalytischer und bildgebend erhobener Befunde. In der vorliegenden Arbeit werden die entsprechenden Befunde der häufigsten in Westeuropa viral verursachten Enzephalitiden dargestellt. Generell ist bei entzündlichen Läsionen des Hirnparenchyms die Kernspintomographie (MRT) aufgrund ihrer hohen Weichteilkontrastauflösung der Computertomographie (CT) hinsichtlich der Nachweissensitivität überlegen. Bei einigen viralen Enzephalitiden ist das kernspintomographisch erfassbare Schädigungsmuster hochspezifisch. Die gilt z. B. für die häufig hämorrhagischen Läsionen der Strukturen des limbischen Systems bei der Herpes-simplex-Virus-Typ-1-Enzephalitis und für die flächenhaft symmetrischen Marklagerläsionen bei der progressiven diffusen Leukenzephalopathie bei AIDS-Patienten. Bei der Mehrzahl der viralen Enzephalitiden weist die MRT zwar die Lokalisation und Ausdehnung der Parenchymschädigung nach, erlaubt jedoch keine sichere Zuordnung zu einem Erreger.
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    Der Radiologe 40 (2000), S. 18-27 
    ISSN: 1432-2102
    Keywords: Schlüsselwörter ; MRT ; Neugeborene ; Cerebrum ; Fetus ; Key words ; MRI ; Neonatal ; Brain ; Fetal
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Magnetic resonance tomography (MRT) has become the most important method in the workup of infantile cerebral complications after primary sonography. Cerebral MR examination and image interpretation during the infantile period require extensive knowledge of morphological manifestations, their pathophysiological background, and frequency. The choice of imaging parameters and image interpretation is demonstrated in infarctions and hemorrhages of the mature and immature brain. A review of the main differential diagnoses is also given. The relevance of MR spectroscopy and fetal MRI is discussed.
    Notes: Zusammenfassung Zur Abklärung zerebraler Veränderungen bei Neugeborenen hat sich die Magnetresonanztomographie (MRT) als wichtigste weiterführende Methode nach der Sonographie entwickelt. Die Durchführung und Auswertung der MR-Untersuchungen erfordern jedoch eine genaue Kenntnis der morphologischen Manifestationen, des pathophysiologischen Hintergrunds und der Häufigkeit bestimmter zerebraler Komplikationen in diesem Lebensalter. Resümee: Ausgehend von zerebrovaskulären Erkrankungen werden diese Fragen behandelt, wobei sowohl auf die Auswahl der adäquaten Untersuchungsparameter als auch auf die Bildinterpretation und die wichtigsten Differentialdiagnosen eingegangen wird. Die Bedeutung von MR-Spektroskopie und fetaler MRT wird diskutiert.
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    Der Radiologe 40 (2000), S. 469-472 
    ISSN: 1432-2102
    Keywords: Schlüsselwörter Nutritialgefäßkanäle ; Os lunatum ; Lunatummalazie ; Ganglion ; Ulnaimpaktionssyndrom ; Key words Nutrient vessel canals ; Lunate bone ; MRI ; Kienböcks disease ; Ulna impaction syndrome ; Carpal ganglia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Purpose: To find and describe potential MRI criteria of nutrient vessel canals of carpal bones. Methods and Material: 16 wrists of 13 patients with pain and radiographic depiction of cystic changes within the lunate were examined. The MRI protocol included coronal and sagittal T1- and T2-weighted SE sequences (4 mm slices, 120 FOV, 256×256 matrix) as well as coronal STIR images. Final diagnosis was confirmed by surgery (n=5) and follow up. 10 cadaveric ossa lunata were studied to describe size, number, location and shape of nutrient vessel canals. Results: Ganglion cysts (n=6) showed characteristic signs. In ulnar impaction syndrome (n=1) small cystic lesions in the lunate were surrounded by a sclerotic rim and located near the proximal ulnar surface. In Kienböck’s disease (n=3) cystic components were irregular and surrounded by bone marrow edema. Nutrient vessel canals (n=7) imaged as 1 to 3 small cystic lesions within the palmar or dorsal subchondral region. Conclusion: MRI can aid in differential diagnosis of cystic carpal lesions. Nutrient vessel canals may not be mistaken for pathologic cystic lesions. Carpal ganglion cysts show distinct diagnostic pattern.
    Notes: Zusammenfassung Fragestellung: Sind karpale Nutritialgefäßkanäle auf MRI Bildern sichtbar und welche differentialdiagnostischen Kriterien lassen sich finden. Material und Methode: In 16 Fällen lagen bei 13 Patienten röntgenologisch wenige mm bis 2 cm große zystische Läsionen im Os lunatum vor. Das MRT-Protokoll umfaßte koronare und sagittale T1- und T2-gewichtete SE-Sequenzen mit 4 mm Schichtdicke, 120 mm Meßfeld und 2562 Matrix sowie koronare STIR-Sequenzen. Die Diagnosesicherung erfolgte durch Operation in 5 Fällen sowie Verlaufskontrollen. 10 mazerierte Ossa lunata wurden auf Form, Lokalisation, Anzahl und Größe der Nutritialgefäßkanäle untersucht. Ergebnisse: Ganglien (n=6) wiesen typische Zeichen auf. Im Falle eines Ulnaimpaktionssyndroms bei Ulna-Nullvariante wurden mehrere kleine zystische Läsionen im Os lunatum gefunden, umgeben von einem Sklerosesaum. Bei 3 Fällen einer frühen Lunatummalazie waren unregelmäßige zystische Komponenten von einem diffusen Ödem umgeben. In 7 Fällen mit sehr kleinen zystischen Defekten waren diese subchondral, palmar und dorsal gelegen und entsprachen aufgrund des klinischen Verlaufs und der Lokalisation Nutritialgefäßkanälen. Schlußfolgerung: Nutritialgefäßkanäle dürfen nicht mit pathologischen zystischen Prozessen des Os lunatums verwechselt werden. Mittels MRT können zystische Läsionen im und am Os lunatum weiter spezifiziert werden. Handgelenksganglien weisen typische MR-Zeichen auf.
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    Der Radiologe 40 (2000), S. 557-560 
    ISSN: 1432-2102
    Keywords: Schlüsselwörter Plasmazell-Osteomyelitis ; Magnetresonanztomografie ; Wirbelsäule ; Key words Plasmacellular osteomyelitis ; MRI ; Spine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract The authors report the case of a young patient suffering from plasmacellular osteomyelitis of the thoracic spine, a unusual localisation of this type of chronic osteomyelitis. They discuss the role of imaging diagnostic modalities in this disease, focussing on MRI.
    Notes: Zusammenfassung Wir berichten über den Fall einer jungen Patientin mit Plasmazell-Osteomyelitis an der Brustwirbelsäule als ungewöhnliche Lokalisation dieser chronischen Osteomyelitis-Form. Dabei wird die Rolle der bildgebenden Diagnostik, insbesondere der Magnetresonanztomografie diskutiert.
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    European radiology 10 (2000), S. 1832-1835 
    ISSN: 1432-1084
    Keywords: Key words: Platyspondyly ; MRI ; Progressive pseudorheumatoid dysplasia ; Bone ; Osteochondrodysplasia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. A rare case of progressive pseudorheumatoid dysplasia (PPD) in a 9-year-old girl is presented. Clinically, chronic painless swollen joints, accompanied by progressive motion restriction and progressive walking difficulties, were found. Radiologically, there was enlargement of the epimetaphyseal portions of the large joints, metacarpal heads, and phalanges, and generalized platyspondyly with irregular delineation of the endplates of the vertebral bodies. The radioclinical features at the peripheral joints were originally misdiagnosed as juvenile rheumatoid arthritis (JRA), and the structural spinal abnormalities were neglected and interpreted as Scheuermann's disease. However, the absence of active inflammatory parameters argues against JRA, whereas the low age of onset of the irregularities at the vertebral endplates is an argument against the diagnosis of Scheuermann's disease. The combination of the dysplastic abnormalities of the spine, with platyspondyly and Scheuermann-like lesions at an unusually low age of onset, and radiological features mimicking JRA of the peripheral joints, is the clue to the diagnosis of this rare autosomal-recessive disease. This case is the first to document the MRI features of PPD of the spine.
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  • 134
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    European radiology 10 (2000), S. 1242-1244 
    ISSN: 1432-1084
    Keywords: Key words: Muscle anomalies ; Median nerve compression ; Wrist ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Muscle anomalies around the wrist, in particular the palmaris longus muscle, may cause effort-related median nerve compression. A search of the medical records at our university hospital between 1994 and 1999 revealed four patients with an effort-related median nerve compression due to a reversed palmaris longus muscle. Magnetic resonance imaging was used in the patient work-up and showed an anomalous muscle in each case that had been missed initially. All four patients were free of pain after simple excision of the anomalous muscle. Awareness of muscle anomalies at the wrist on MR imaging is essential in evaluating patients with nerve compressions at the wrist. The purpose of this article is to heighten this awareness in radiologists.
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  • 135
    ISSN: 1432-1084
    Keywords: Key words: Thorax ; Mediastinum ; Lymphangioma ; CT ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Adult mediastinal lymphangiomas are rare lesions the diagnosis of which is difficult based on imaging studies. A retrospective study of CT, MR, and pathologic findings of mediastinal lymphangioma was performed in order to correlate pathological and imaging findings. Nine cases of adult lymphangiomas were identified in the records of our institution over a 12-year period. The CT, MR, and pathologic findings were reviewed. Lesions were classified pathologically as unilocular, cavernous, and intermediate types. Pathologic examination identified six cases of unilocular lesion, two cases of cavernous type, and one intermediate type. The CT features (n = 9) included a smoothly marginated non-enhancing mass of water attenuation (n = 7), a non-enhancing mass of soft tissue attenuation (n = 1), and an enhancing multiseptated mass (n = 1). Lesions were located in the anterior mediastinum (n = 2), right paratracheal (n = 4), subcarinal (n = 1), aortopulmonic window (n = 1) areas, and below the left hilum extending into the posterior mediastinum (n = 1). The MR features (n = 3) were characterized by an enhancing multicystic and multiseptated appearance, evocative of a cavernous type in two cases. The CT appearance of mediastinal thoracic lymphangioma is variable depending on the pathologic type. The most common unilocular type is a non-enhancing thin-walled mass on CT. A less frequent cavernous type can be suggested based on a multiseptated and loculated mass on CT and/or MR examination.
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  • 136
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    European journal of orthopaedic surgery & traumatology 10 (2000), S. 203-205 
    ISSN: 1432-1068
    Keywords: Cervical spondylotic myelopathy ; Syringomyelia ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A case of syringomyelia associated with cervical spondylotic myelopathy is presented. A decompressive cervical laminectomy was performed. The patient improved gradually after operation. It is concluded that the choice of surgical treatment in cases with syringomyelia associated with cervical spondylotic myelopathy requires a careful neurological and radiological examination based on the findings of magnetic resonance imaging (MRI) and cine-MRI.
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  • 137
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    European spine journal 9 (2000), S. 426-429 
    ISSN: 1432-0932
    Keywords: Key words Osteoid osteoma ; MRI ; Inflammatory reaction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report a case of 14-year-old male patient with osteoid osteoma of the cervical spine. Magnetic resonance imaging (MRI) revealed a large dumbbell-shaped paravertebral tumor in the region of the exiting left C6 nerve. A computed tomographic (CT) scan after myelography showed a much smaller bony defect in the medial aspect of the left C6 pedicle with central calcification and extensive bone sclerosis around the defect, typical of osteoid osteoma. The diagnosis was confirmed postoperatively. The resected specimen exhibited extensive vascularization of the osteoid tissue. The case is presented because MRI did not allow a specific diagnosis of osteoid osteoma, and suggested the tumor was larger than in reality it was, by also depicting the reactive inflammation around the tumor as if it were part of the tumor.
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  • 138
    ISSN: 1432-0932
    Keywords: Key words Chronic low back pain ; Erector spinae muscle ; MRI ; Muscle biopsy ; Fibre type ; distribution
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Many studies have documented an association between chronic low back pain (LBP) and deficits in back muscle strength and endurance. The sub-optimal performance is believed to be the result of alterations in the size and structure of the muscle, although the long-standing issue of whether the observed changes precede or are a consequence of the pain remains unresolved. If consequent to the problem, and predominantly related to disuse of the muscles, then it may be expected that a relationship between muscle structure and symptom duration would exist. Lumbar paraspinal muscle samples were obtained from 59 chronic LBP patients using the percutaneous biopsy technique. The samples were subject to routine histochemical analysis for the examination of muscle fibre type characteristics and cytochemical architectural changes. In 55 of the patients, the gross cross-sectional areas of magnetic resonance images of the trunk muscles were also measured. Multivariate analysis showed that symptom duration was the strongest predictor of the individual proportions of the fast-fatigable type IIX fibres; with age and gender included in the model, nearly 30% of the variance in fibre type distribution could be accounted for. Duration of pain had no influence on fibre size. Gross muscle cross-sectional area correlated directly with lean body mass and inversely with age, but showed no relationship with symptom duration. Pathological changes in the internal fibre structure were more frequently encountered in older patients, and were independent of symptom duration. The results suggest that, over the long term, fibre type transformations rather than alterations in fibre size are the predominant changes to be found in the muscles of chronic LBP patients. The direction of change supports the results of many previous studies that have demonstrated corresponding differences in the fatigability of the muscles. There is a strong case for the early implementation of active measures to attempt to offset the development of these changes in back pain patients.
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  • 139
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    Journal of neurology 247 (2000), S. II11 
    ISSN: 1432-1459
    Keywords: Key Words Diagnosis ; MRI ; MRS ; Parkinson’s disease ; SPECT ; PET
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This paper reviews the relative abilities of magnetic resonance imaging (MRI), positron emission tomography (PET), single photon emission tomography (SPECT), and proton magnetic resonance spectroscopy (MRS) to detect Parkinson’s disease and monitor its progression. Currently, the main role of MRI lies in its ability to discriminate atypical syndromes from Parkinson’s disease; however, new volumetric approaches may soon allow progression of nigral degeneration to be followed. Proton MRS can also detect reduced levels of putamen N-acetyl aspartate (NAA) in many patients with atypical parkinsonian syndromes. PET and SPECT are both sensitive means of detecting the presence of impaired dopamine terminal function in the striatum and following its progression. PET currently has the greater spatial resolution and provides the added advantages that it also allows extra-striatal dopaminergic function to be monitored.
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  • 140
    ISSN: 1432-1459
    Keywords: Key words Creutzfeldt-Jakob disease ; Alzheimer's disease ; Prion ; Presenilin ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We describe a patient who was clinically diagnosed with familial early-onset Alzheimer disease (AD) carrying both the E318G substitution in presenilin 1 (PSEN1) and an insertion of 7 octapeptide coding repeats in the prion protein gene (PRNP). Neuropathological examination revealed elongated cerebellar prion protein deposits in the absence of AD pathology. Further analysis of other family members showed that the Creutzfeldt-Jakob disease phenotype in this family was caused solely by the PRNP insertion. This observation is consistent with our previous finding that PSEN1 E318G is not causally related to AD.
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  • 141
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    Archives of gynecology and obstetrics 264 (2000), S. 42-44 
    ISSN: 1432-0711
    Keywords: Key words Thecoma ; Ascites ; CA125 ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We report a 34-year-old woman with an ovarian thecoma and ascites who exhibited high serum levels of CA125. Measuring serum tumor markers and imaging are two important diagnostic tools for malignant ovarian tumors. In the present case, a preoperative diagnosis of benign ovarian tumor could not be made due to the elevation of CA125 (895 U/ml) and nonspecific MRI findings.
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  • 142
    ISSN: 1432-1262
    Keywords: Keywords Fecal incontinence ; Constipation ; MRI ; Ultrasound
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  This study assessed the value of common surface coil mag-netic resonance imaging (MRI) in patients with evacuatory disorders including fecal incontinence and constipation. These findings were then compared with those from other standard physiological examinations and/or surgical findings. From July 1996 to June 1997, 14 consecutive patients underwent surface coil MRI for evaluation of either fecal incontinence (n=5) or constipation (n=9). In patients with incontinence we compared the findings from endoanal ultrasound (EAUS), anal MRI, and surgery regarding morphopathological findings of the internal and external anal sphincter components. In constipated patients the findings of videoprography and dynamic pelvic MRI were compared regarding the presence of rectocele, rectoanal intussusception, and sigmoidocele as well as the measurements of anorectal angle and perineal descent. The five incontinent patients were all women, with a median age of 67 years (range 43–77). EAUS revealed an anterior sphincter defect in two patients, a posterior defect in one, and normal anal sphincter images in two. Surgical findings confirmed an anterior external anal sphincter scar in two patients, an internal anal sphincter defect in one, and an anatomically normal anal sphincter in two. In one patient, although anal MRI showed posterior external anal sphincter defect, EAUS and surgery revealed normal external anal sphincter appearance. The accuracy rate between EAUS and anal MRI was only 20%, that between surgery and anal MRI 40%, and that between surgery and EAUS 80%. Thus EAUS was more accurate than anal MRI in incontinent patients. The nine constipated patients were all women, with a mean age of 59 years (range 40–78). Videoproctography revealed an anterior rectocele in six patients, rectoanal intussusception in three, and sigmoidocele in five; no abnormalities were identified in two patients. On dynamic pelvic MRI anterior rectocele was seen in three patients and sigmoidocele in two, and five studies were interpreted as normal. One of the patients underwent sigmoidectomy for sigmoidocele, and five patients were treated by biofeedback. Thus the accuracy rate of dynamic pelvic MRI against videoproctography was 60% for anterior rectocele, 40% for sigmoidocele, and zero for rectoanal intussusception. In conclusion, neither MRI for the evaluation of patients with fecal incontinence nor for the evaluation of patients with constipation added any significant information that would warrant its continued use in these patient groups. Perhaps the more widespread availability of an endoanal coil will alter this conclusion; however, at the present time we cannot routinely endorse the expense, time, or inconvenience of these MRI investigations in patients with these diagnoses. Larger prospective comparative studies are required prior to endorsing the technique.
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  • 143
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    Child's nervous system 16 (2000), S. 200-202 
    ISSN: 1433-0350
    Keywords: Key words Scoliosis ; Syringomyelia ; Chiari malformation ; MRI ; Gardner ; Obex
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The clinical notes of 35 children presenting with scoliosis were reviewed; all 35 had been investigated with MRI. Seven were found to have syringomyelia, and six of these had Chiari malformation. Correction of the syrinx resulted in improvement or stabilisation of the spinal curvature. We recommend that all cases presenting with primary scoliosis should have MRI and should be treated if a syrinx is found.
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  • 144
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    Skeletal radiology 29 (2000), S. 1-9 
    ISSN: 1432-2161
    Keywords: Key words Soft tissue masses ; Hemorrhage ; MRI ; Iron ; Contrast enhancement, MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Hematomas in the extremities can present clinically as a soft tissue mass. Hematomas can usually be distinguished from neoplasia on MR by the signal patterns of hemoglobin breakdown products, which are dependent on the chemical bonding and oxidation state of hemoglobin iron. Beginning with a discussion of relevant atomic electronic structure, this review will examine how oxyhemoglobin, deoxyhemoglobin, methemoglobin, and hemosiderin, the principal iron compounds occurring in the various stages of a hematoma, affect its appearance on MRI.
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  • 145
    ISSN: 1432-2161
    Keywords: Key words Wrist ; MR arthrography ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Purpose.In the wrist, to determine whether passive motion or active exercise yields a better indirect MR arthrographic effect following intravenous gadolinium administration. Design and patients. Twenty-six consecutive patients were studied by indirect wrist MR arthrography. In half active exercise and in half passive motion was performed. Four regions of interest were studied including the distal radioulnar joint, the radiocarpal joint, the midcarpal joint, and the triangular fibrocartilage. Ranges and means of signal intensity were calculated. Surgical follow-up was performed in 22 patients. Results. The joint fluid intensity was greatest in the distal radioulnar joint. Fluid signal intensity was greater and more consistent in the passive motion group although the results did not achieve statistical significance. Imaging accuracy appeared similar in the two groups and was excellent for the triangular fibrocartilage (100%) and scapholunate ligaments (96%). Conclusion. Active exercise and passive motion yield similar degrees of wrist arthrographic effect, but the effect of passive motion is somewhat more consistent. Preliminary data show good accuracy for internal derangements.
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  • 146
    ISSN: 1432-2161
    Keywords: Key words Gaucher disease ; Bone disease ; Extraosseous Gaucher disease ; Bone marrow imaging ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Objective. To investigate the frequency and morphology of extraosseous extension in patients with Gaucher disease type I. Design and patients. MRI examinations of the lower extremities were analyzed in 70 patients with Gaucher disease type I. Additionally, the thoracic spine and the midface were investigated on MRI in two patients. Results. Four cases are presented in which patients with Gaucher disease type I and severe skeletal involvement developed destruction or protrusion of the cortex with extraosseous extension into soft tissues. In one patient, Gaucher cell deposits destroyed the cortex of the mandible and extended into the masseter muscle. In the second patient, multiple paravertebral masses with localized destruction of the cortex were apparent in the thoracic spine. In the third and fourth patient, cortical destruction with extraosseous tissue extending into soft tissues was seen in the lower limbs. Conclusions. Extraosseous extension is a rare manifestation of Gaucher bone disease. While an increased risk of cancer, especially hematopoietic in origin, is known in patients with Gaucher disease, these extraosseous benign manifestations that may mimic malignant processes should be considered in the differential diagnosis of extraosseous extension into soft tissues. A narrow neck of tissue was apparent in all cases connecting bone and extraosseous extensions.
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  • 147
    ISSN: 1432-2161
    Keywords: Keywords Amyloidoma ; Bilateral ; Knee ; Popliteal fossa ; Claudication ; MRI ; MR angiography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The authors report a case of bilateral popliteal amyloidoma causing stenosis of the popliteal artery and vein. This patient had been treated with hemodialysis for 26 years. The diagnosis was made with MR angiography. A popliteal tumor of the right knee was resected surgically and the histologic examination showed deposition of amyloid. After resecting the popliteal tumor, the severe leg pain and intermittent claudication improved. This report suggests that popliteal amyloid tumors should be considered in a patient undergoing long-term hemodialysis who complains of leg pain and intermittent claudication.
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  • 148
    ISSN: 1432-2161
    Keywords: Key words Chordoma ; Sarcomatoid chordoma ; Transitional feature ; Sacrum ; CT ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We report a case of chordoma containing a spindle cell sarcomatoid component with a gradual transition from conventional chordoma. Immunohistochemically, many tumor cells in both conventional chordoma and sarcomatoid components were positive for cytokeratins (AE1/AE3, CAM5.2) and epithelial membrane antigen as well as vimentin. This report provides a rare example of sarcomatoid chordoma. Familiarity with this type of bone tumor should help to avoid confusion with dedifferentiated chordoma and other spindle cell sarcomas or carcinomas.
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    Skeletal radiology 29 (2000), S. 81-84 
    ISSN: 1432-2161
    Keywords: Key words Arthrography ; MRI ; Fluoroscopy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Purpose. To describe a technique for intra-articular injection in the MR suite after conventional fluoroscopic landmarking in order to streamline MR arthrography. Design and patients. This technique was performed on 33 consecutive patients referred for MR arthrography of the shoulder to evaluate the glenoid labrum and on 15 consecutive patients referred for MR arthrography of the hip to evaluate the acetabular labrum. The patients were landmarked in the fluoroscopy suite, followed by a conventional MR examination. The intra-articular injection was then performed on the MR table and the MR arthrographic sequences obtained. Results. One of the 48 injections was extra-articular, requiring a second injection. The other injections were performed without incident, and the average total procedure time for all injections was 10 min. Conclusions. This technique is a reliable method of streamlining intra-articular injections when performing conventional MR imaging prior to the MR arthrographic portion of the examination. It shortens the total MR examination time by eliminating a visit to the fluoroscopy suite in the middle of the MR study, and its use of a straight anterior approach for both the shoulder and hip joints should be familiar to most people who perform conventional arthrography.
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  • 150
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    Skeletal radiology 29 (2000), S. 97-100 
    ISSN: 1432-2161
    Keywords: Key words Transient osteoporosis ; Transient bone marrow edema ; Intra-articular regional migratory osteoporosis ; Knee ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We report a case of lntra-articular regional migratory osteoporosis of the knee in a 53-year-old man. The case demonstrates an unusual pattern of migration of the marrow edema within the knee joint. This phenomenon has received scant attention in the radiological literature.
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  • 151
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    Skeletal radiology 29 (2000), S. 109-111 
    ISSN: 1432-2161
    Keywords: Key words Fat ; Elastofibroma ; Neck ; CT ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Elastofibromas are benign lesions of the chest wall. We describe the first reported case of elastofibroma in the neck. Imaging features as well as location of the lesion were atypical. On computed tomography and magnetic resonance imaging the lesion contained a marked preponderance of fat, because the lesion arose within fat.
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  • 152
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    Skeletal radiology 29 (2000), S. 117-124 
    ISSN: 1432-2161
    Keywords: Key words Osteomalacia ; Metabolic disease ; Hemangiopericytoma ; Fibrohistiocytic tumors ; Radiography ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The clinical, imaging, metabolic, histologic and biochemical aspects of oncogenic osteomalacia are reviewed. The bone and soft tissue tumor and tumor-like lesions associated with this paraneoplastic syndrome are discussed. The radiologist’s role in the diagnosis and evaluation of this entity is presented.
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  • 153
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    Skeletal radiology 29 (2000), S. 165-167 
    ISSN: 1432-2161
    Keywords: Key words Rheumatoid arthritis ; Geode ; Pathological fracture ; Humerus ; X-ray ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We describe the imaging features of a giant geode of the distal humerus in a patient with rheumatoid arthritis, which presented initially as a pathological fracture. The value of magnetic resonance imaging in establishing this diagnosis is emphasized.
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  • 154
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    Skeletal radiology 29 (2000), S. 162-164 
    ISSN: 1432-2161
    Keywords: Key words Retroisthmic cleft ; Stress fracture ; Laminar fracture ; Xray ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The retroisthmic cleft is a rarely diagnosed defect in the lamina of the lumbar spine. It has always been considered a congenital anomaly. This is the first report we are aware of showing radiological changes in a retroisthmic cleft over a period of time. The follow-up of this patient over a period of 6 years, the radiological and scintigraphic appearances and a review of the literature suggests that the retroisthmic cleft is a stress fracture of the lamina.
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  • 155
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    Skeletal radiology 29 (2000), S. 171-175 
    ISSN: 1432-2161
    Keywords: Key words Desmoplastic fibroma ; Bone tumor ; Femur ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Desmoplastic fibroma of bone is a very rare benign tumor, which may be locally aggressive. In contrast to the well-documented radiological appearance, the literature on MR imaging features of this tumor is scarce. The MR imaging characteristics in our case are compared to those previously reported. Although there is a considerable overlap in the MR imaging features with other bone tumors, an interesting MR feature of desmoplastic fibroma is the presence of low to intermediate signal intensity foci on T2-weighted images, which radiographically does not correspond to calcifications. This feature may help narrow the differential diagnosis.
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  • 156
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    Skeletal radiology 29 (2000), S. 168-170 
    ISSN: 1432-2161
    Keywords: Key words Chondromyxoid fibroma ; Acromium ; Soft tissue extension ; CT ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Chondromyxoid fibroma is an unusual, benign tumor of cartilaginous origin and represents less than 1% of all primary bone tumors. It usually involves the long bones around the knee joint or the flat bones of the pelvis or ribs. Soft tissue extension is also thought to be rare in these lesions. They are usually eccentrically located in the metaphyses of the long bones and centrally in the flat bones. The radiographic appearances are characteristically those of a single, lytic lesion with lobulated margins, septations, cortical expansion and a sclerotic rim. Histologically, they display a lobulated pattern with spindle-shaped cells lying within a myxoid matrix with areas of hyaline cartilage. The differential diagnosis includes giant cell tumor, chondroblastoma or enchondroma as well as chondrosarcoma. The rarity of these lesions may render the diagnosis difficult to make, especially when the lesion involves an unusual site such as the acromium.
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  • 157
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    Skeletal radiology 29 (2000), S. 538-542 
    ISSN: 1432-2161
    Keywords: Key words Ancient neurilemmoma ; Pelvis ; Ultrasound ; CT ; MRI ; Venous obstruction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  A 43-year-old man with a large ancient schwannoma of the pelvis, presenting with varicose veins, is reported. Ancient schwannoma (neurilemmoma) is a benign tumour of nerve sheath origin characterised histologically by features of severe degeneration and which rarely can grow to a large size. Malignant transformation, though reported, is extremely rare.
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  • 158
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    Skeletal radiology 29 (2000), S. 543-547 
    ISSN: 1432-2161
    Keywords: Key words Neurofibromatosis ; Segmental plexiform neurofibromatosis ; Schwannomatosis ; Malignant peripheral nerve sheath tumor ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Segmental neurofibromatosis is a rare disease characterized by neurofibromas with or without café au lait spots localized to one segment of the body. The majority of reported cases have had cutaneous neurofibromas, and patients with deep involvement have rarely been described. We report on two patients with deep-seated segmental plexiform neurofibromatosis and review the literature. All reviewed cases including the present two had no café au lait spots, axillary freckling, Lisch nodules, family history or malignant progression of disease. Differential diagnoses from neuro-fibromatosis 1 (von Recklinghausen disease) and malignant peripheral nerve sheath tumor are important for genetic counseling and avoiding overtreatment.
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  • 159
    ISSN: 1432-2307
    Keywords: Key words VMAT2 ; Stomach ; ECL cell ; Tumors ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The vesicular monoamine transporter 2 (VMAT2) facilitates the ATP-dependent accumulation of biogenic amine inside the secretory granules of endocrine cells and neurons and was demonstrated in the histamine-producing enterochromaffin-like (ECL) cells of the stomach. In the present investigation, VMAT2 immunohistochemistry was tested in 85 endocrine tumors, of which 60 were well differentiated gastrointestinal and pancreatic growths, 5 poorly differentiated (neuro)endocrine carcinomas (PDEC) and 1 mixed PDEC/ECL cell carcinoma of the stomach, 12 pheochromocytomas/paragangliomas, 3 adrenocortical lesions, 2 parathyroid and 2 lung neuroendocrine tumors. Extensive and intense VMAT2 immunoreactivity was observed in 16 of 16 gastric ECL cell tumors, 6 of 6 adrenal pheochromocytomas, 2 of 2 chromaffin paragangliomas and in 3 of the 4 carotid body paragangliomas investigated. Rare VMAT2-positive cells were observed in 12 of 21 intestinal enterochromaffin (EC) cell tumors, in 9 of 11 pancreatic neuroendocrine tumors, and in the mixed PDEC/ ECL cell carcinoma of the stomach (differentiated cells only). No VMAT2 immunoreactivity was observed in five gastrin, four somatostatin and three enteroglucagon/peptideYY tumors of the gastrointestinal tract, in six gastric PDECs, in three adrenocortical growths, and two parathyroid and two lung neuroendocrine tumors. These data support VMAT2 immunohistochemistry as being a useful tool for the diagnosis of gastric ECL cell tumors, separating them from all other endocrine tumors arising in the gastroduodenal area i.e., gastrin, somatostatin, EC cell and PDEC tumors, all of which proved essentially negative.
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    Virchows Archiv 436 (2000), S. 224-228 
    ISSN: 1432-2307
    Keywords: Key words Apoptosis ; bax ; bcl-2 ; Colon carcinoma ; CyclinD1 ; Immunohistochemistry ; p21 ; p53 ; pRb
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Tumour growth is regulated by a balance between proliferation, growth arrest and programmed cell death (apoptosis). Until recently, the majority of the studies dealing with oncogenesis has been focused on the regulation of cell proliferation. There is now growing understanding that control of growth arrest and apoptosis play key roles in the development of human cancer and in cancer treatment. Some of the more heavily studied proteins of importance for the control of growth arrest and apoptosis are p53, p21, bcl-2 and bax. Alterations in the p53 protein may lead to malignant transformation and defect therapy response, most likely as a result of defective p53-dependent apoptosis. In addition, p21 (WAF1/CIP1) is involved in cell-cycle arrest and probably in induction of p53-dependent apoptosis. Proteins belonging to the bcl-2 family are also important for normal apoptosis. Overexpression of bcl-2 protein is thought to reduce the apoptotic capacity, while bax protein seems to be necessary for induction of apoptosis. In this study, we have immunostained tissues from 93 primary colon carcinomas and have examined the expression of p53, p21 (WAF1/CIP1), bcl-2 bax, pRb and cyclin D1 for evaluation of their roles in colon-cancer progression. A highly significant association between p53 accumulation and downregulation of p21 (WAF1/CIP1) was seen. We also found a strong association between reduced/absent p21 and the development of metastases and death due to cancer disease. Cyclin D1, bcl-2 and bax protein failed to have independent prognostic impacts. Bcl-2 and bax protein levels showed an inverse relationship. The results of the present study indicate that reduced p21 protein levels play an important role in progression of colon cancer. We concluded that evaluation of p21 expression in primary colon carcinomas at the time of surgery might be a valuable tool in defining patients with a high risk of developing metastases.
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  • 161
    ISSN: 1432-2307
    Keywords: Key words Clinical course ; Immunohistochemistry ; Morphology ; Primary gastric T-cell lymphoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  In contrast to primary gastric lymphomas of B-cell type, little is known about primary gastric T-cell lymphomas. We describe three cases with remarkably similar features: diffuse growth, epitheliotropism, medium too large cell size, high apoptotic rates, and a CD3+, CD4+, CD8+, CD45RO+ immunophenotype. Clonal TCRγ gene rearrangement was shown in two cases. Epstein-Barr virus infection was excluded in two cases. Taking advantage of fresh-frozen material, we analyzed two cases further, revealing CD5–, CD16+, CD56–, CD57–, CD25+, CD30+, CD103 (αEβ7)+, bcl-2 protein+, CD95+, CD95 ligand(L)–. CD95L, however, was detected in histiocytic and fibroblastoid by stander cells. The lymphomas expressed granzyme B, perforin, and the TIA-1 antigen in various combinations. All three cases had a very unfavorable clinical course characterized by local recurrence and/or dissemination to other epithelial sites, leading to death within 6–12 months after the initial diagnosis despite surgery and aggressive antineoplastic treatment. These data suggest a novel variant of peripheral T-cell lymphoma operationally characterized as primary gastric, apoptosis-rich, CD103+, EBV-, T-cell lymphoma co-expressing CD4, CD8, CD16 and cytotoxic molecules.
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  • 162
    ISSN: 1432-2277
    Keywords: Key words Liver transplantation ; Rejection ; ICAM-1 ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Acute rejection (AR) is a frequent complication following liver transplantation (LT). ICAM-1 may be involved in its pathogenesis. High doses of glucocorticoids are the standard treatment in these patients. The aim of this study was to describe corticoid effects on ICAM-1 tissue expression in liver biopsies of patients with LT and AR. The study included liver biopsies performed before and after treatment in 12 patients with LT and proven AR. In 10 patients AR was reversible and in 2, was steroid resistant. For immunohistochemistry, an indirect immunoperoxidase technique was used. Each histology section was semiquantitatively evaluated as follows: 0: 〈 10 % staining, 1: 10–25 %, 2: 25–50 %, 3: 〉 50 %. The control group comprised nine patients with LT and normal liver biopsies. In pre-treatment liver biopsy samples, ICAM-1 was markedly expressed on sinusoidal cells (2.41 ± 0.66), and there was also expression on periportal (0.66 ± 0.65) and perivenular hepatocytes (0.83 ± 0.57). By contrast, in the liver tissue from the control group, sinusoidal ICAM-1 reactivity was significantly lower (0.88 ± 0.33; P 〈 0.05), and hepatocytes showed no reliable ICAM-1 expression. After steroid treatment the intensity of ICAM-1 decreased significantly in sinusoids (1.5 ± 0.67; P 〈 0.05) and in perivenular hepatocytes (0.25 ± 0.86; P 〈 0.05). Additionally, we also observed a decreased ICAM-1 reactivity in portal hepatocytes (0.25 ± 0.62), but these differences did not reach statistical significance. Remarkably, after treatment, hepatocytes did not show ICAM-1 reactivity in resolved AR, but in corticoid-resistant patients AR did not change or increase. In conclusion, in patients with LT and AR, ICAM-1 was expressed in hepatocytes and with more intensity in sinusoid cells. Additionally, a down-regulation of the ICAM-1 tissue expression after corticoid treatment may exist, although in corticoid-resistant AR no modulation on ICAM-1 tissue expression was observed.
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  • 163
    ISSN: 1432-2307
    Keywords: Key words Cervix ; Peripheral primitive neuroectodermal tumour ; Ewing’s tumour pathology ; Immunohistochemistry ; Cytogenetics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Peripheral primitive neuro-ectodermal tumours (PNET) of the cervix are very rare. Here, we report the clinical, pathological, immunohistochemical and genetic features of a case of a PNET located in the cervix. Hysterectomy revealed a cervical tumour. On microscopic examination, a vaguely lobular arrangement of uniformly appearing neoplastic cells, with round to oval nuclei, distinct nuclear membranes and a clear, moderately glycogen-rich cytoplasm was seen. Cells stained positive for LEU 7, S 100, monoclonal NSE and particularly for MIC2. Neurogenic differentiation was also seen by electron microscopic examination. The genetic hallmark of PNET, a 22q12 rearrangement was demonstrated by fluorescence in situ hybridisation experiments, supporting the diagnosis. Awareness of the existence of primary PNET of the cervix is important to avoid confusion with other tumours of the cervix.
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  • 164
    ISSN: 1432-2307
    Keywords: Key words Nitric oxide ; Nitric oxide synthase ; Colorectal cancer ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  There is growing evidence that nitric oxide (NO) has an important role in tumor growth. However, information on the expression of NO synthase (NOS) in colorectal cancers is scanty. We therefore investigated the distribution and expression of NOS in human colorectal cancers. The expression of three types of NOS, inducible (iNOS), endothelial (eNOS) and neuronal (nNOS), was examined by immunohistochemistry in 25 cases of colorectal cancer. The expression of iNOS was also investigated at the mRNA level using the reverse transcriptase polymerase chain reaction (RT-PCR) in 6 cases. Correlations were made between iNOS expression and the histopathological findings. Immunoreactive iNOS was detected in the tumor cells in 22 cases (88%) with diffuse cytoplasmic reactions. Expression of iNOS-mRNA detected by RT-PCR in three tumor tissues was over five-fold that in normal mucosa. Intensified immunoreactivity of iNOS was associated with vascular invasion. iNOS expression did not correlate with pathological staging, tumor size, lymph node metastasis, p53 expression or tumor vessel density. Immunoreactive eNOS stained more strongly in the endothelial cells of microvessels within and around the tumor than in the areas remote from the tumor. There is enhanced expression of iNOS and eNOS in human colorectal cancers, which may correlate with tumor growth and vascular invasion.
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  • 165
    ISSN: 1432-2307
    Keywords: Key words Adhesion molecule ; Integrins ; Meningiomas ; Macrophages ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  This study assessed the expression of leukocyte integrins and macrophage-associated antigens in meningiomas. Fourteen benign meningiomas, ten atypical/anaplastic meningiomas, two hemangiopericytomas and one solitary fibrous tumour (SFT) were included. Frozen sections were immunostained using antibodies directed against leukocyte integrins, CD68, CD14, CD2, CD1a, DRC1 and CD34. Their expression was evaluated semi-quantitatively. Ki67 positive cells were counted. Arachnoid membranes served as controls. Arachnoid cells expressed the β2-integrin subunit and KP1. Beta2 was detected in the tumour cells of 14 meningiomas. In nine cases, this was associated with an α-integrin subunit. There was no statistical difference in the expression of β2 between benign and atypical/anaplastic meningiomas. KP1 was constantly expressed by the tumour cells of meningiomas. It was not expressed by other meningeal tumours. CD34 was detected in the fibrous meningiomas, hemangiopericytomas and the SFT. In each tumour, macrophages were more numerous than T lymphocytes. There was no statistical difference in the density of macrophages and T lymphocytes between the benign and atypical/anaplastic meningiomas. There was no correlation between the Ki67 proliferation index and macrophage infiltration. Meningiomas, through the expression of leukocyte antigens, have a very particular phenotype. The expression of β2 integrins could play a role in the attraction of immunocompetent cells in the stroma of meningiomas.
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  • 166
    ISSN: 1432-2307
    Keywords: Key words Breast ; Adenomyoepithelioma ; Metastasis ; Thyroid ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We describe a patient who was admitted to our hospital with an enlarged left lobe of the thyroid gland. Since fine-needle aspiration showed atypical follicular cells, a surgical exploration followed. Owing to extensive tumor infiltration into the surrounding tissues curative surgery was not possible, and only an incisional biopsy was taken. Histological examination of this biopsy revealed a mixed tumor composed of epithelial and myoepithelial cells. A primary thyroid tumor, metastasis of a salivary gland, and a skin appendage tumor could be excluded based on clinical examination, conventional histology, and immunohistochemistry. A tumor of the left breast treated 12 years earlier had originally been classified as an intraductal/intracystic carcinoma with focal invasion, but was re-examined. Using immunohistochemistry, the breast tumor was reclassified as a malignant adenomyoepithelioma. The current tumor was apparently a metastasis from this primary breast tumor. An updated review of the literature is given, including current knowledge on histological and immunohistochemical features of adenomyoepithelioma of the breast, with special attention to the reported pathological characteristics of recurrent and malignant tumors. Based on the reported pathological characteristics of recurrent and metastatic tumors we offer a diagnostic tool for identifying potentially malignant and recurrent tumors.
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  • 167
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    Virchows Archiv 436 (2000), S. 305-311 
    ISSN: 1432-2307
    Keywords: Key words Rhabdomyosarcoma ; Soft tissue tumours ; Adults ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Rhabdomyosarcoma in adults represents a rare soft tissue neoplasm which is seen most frequently in its pleomorphic subtype in this age group. Very rarely, clear cell and spindle-cell variants have been reported. In this study we describe three cases of rhabdomyosarcoma in adult patients, characterised by prominent hyaline sclerosis and a pseudovascular growth pattern. All cases were identified in the consultation files of one of the authors and routinely processed. Immunohistochemical studies were performed on paraffin sections with the alkaline phosphatase–antialkaline phophatase method. The patients, two women and one man, were 40, 41, and 56 years old. One developed a deep-seated soft tissue mass in the left lower leg, and one, a tumour of the left upper jaw. In one patient a bone tumour in the proximal body of the sacrum without extension into soft tissues was seen. The patients were treated by wide excision, piecemeal excision and incomplete excision in one case each; additional radiotherapy was performed in all three cases, and chemotherapy in two patients. In one patient multiple pulmonary metastases were noted, which showed progression despite systemic chemotherapy. Histologically, the neoplasms were composed of round/polygonal and spindle-shaped tumour cells including typical rhabdomyoblasts. In all cases a pseudovascular pattern and prominent hyaline sclerosis of the intercellular matrix was seen. Immunohistochemically, tumour cells stained positively for desmin and muscle actin (HHF35) and also for markers of striated muscle differentiation (myogenin, MyoD1, fast myosin). In this paper an unusual morphological variant of rhabdomyosarcoma arising in adult patients is described, which should be added to the morphological spectrum of these neoplasms.
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  • 168
    ISSN: 1432-2307
    Keywords: Key words Ameloblastoma ; Transforming growth factor-beta ; Desmoplasia ; Type-IV collagen ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Desmoplastic ameloblastoma (DA) is an unusual subtype of ameloblastoma histologically characterized by the pronounced collagenized stroma. In the present study, the immunolocalization of transforming growth factor beta (TGF-β), one of the most potent local factors for modulating extracellular matrix formation, was observed in DA in order to study its participation in the stromal desmoplasia. Seven cases of DA, including a ”hybrid” lesion, were studied together with ten cases of ordinary follicular and plexiform ameloblastomas as the control. In contrast to ordinary ameloblastomas, marked immunoexpression was observed in all DAs but one. In the ”hybrid” lesion, TGF-β was not expressed in the area of follicular ameloblastoma but in that of DA. These results show that TGF-β produced by tumor cells of DA plays a part in the desmoplastic matrix formation.
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  • 169
    ISSN: 1432-2307
    Keywords: Key words Multifocal micronodular pneumocyte hyperplasia (MMPH) ; Tuberous sclerosis ; Postmenopausal woman ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We report a peculiar case of multifocal micronodular pneumocyte hyperplasia (MMPH) without association of pulmonary lymphangioleiomyomatosis (LAM) in a 56-year-old postmenopausal woman with tuberous sclerosis. This case is surmised to be a forme fruste of tuberous sclerosis. Computed tomography demonstrated multiple micronodules, measuring up to 5 mm in size, present in the bilateral lung fields, but no cystic changes. A proliferation of pleomorphic type-II pneumocytes lining the thickened alveolar septa in an adenomatoid pattern, with an associated increase in alveolar macrophages, was observed without typical nuclear atypia. In fully developed lesions, the ingrowth of more proliferating type-II pneumocytes into the thickened alveolar septa and macrophages filling the alveolar lumens were characteristic findings. Proliferation of immature smooth muscle cells suggesting LAM was not observed. Positive immunohistochemical stains for cytokeratin, epithelial membrane antigen, and surfactant apoproteins A and B, and negative staining for HMB45, alpha-1 smooth muscle actin, desmin, and carcinoembryonic antigen confirmed the characteristics of alveolar lining cells in each MMPH lesion. MMPH associated with tuberous sclerosis in the postmenopausal woman appears to be similar to that described in premenopausal women. The present case is familial rather than sporadic and suggests no relationship between the development of MMPH and the underlying hormonal state.
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  • 170
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    Virchows Archiv 436 (2000), S. 602-607 
    ISSN: 1432-2307
    Keywords: Key words Thyroid ; Hashimoto thyroiditis ; Oxyphil cell ; Immunohistochemistry ; bcl-2 ; Bax ; Fas
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Immunoreactivity for bcl-2, Bax and Fas was analysed in 16 cases with Hashimoto thyroiditis. Bcl-2-expression was constantly seen in regular thyrocytes and in the mantle-zone of lymphofollicular infiltrates. However, thyrocytes in the vicinity of lymphoid infiltrates and, especially, mitochondria-rich oxyphil cells exhibited reduced staining or none at all for bcl-2. Bax was found to be weakly reactive or negative in normal thyrocytes and was not up-regulated in bcl-2-deficient epithelial cells. In contrast, expression of Fas was markedly increased both in typical thyrocytes and in oxyphil cells within areas of lymphocytic infiltration. In conclusion, focal lack of bcl-2 expression together with up-regulation of Fas is a constant feature of Hashimoto thyroiditis. The reaction pattern of oxyphil cells is identical to that of affected typical thyrocytes without proliferation of mitochondria. Loss of bcl-2 with up-regulation of Fas is therefore likely to precede oncocytic change. Whether these alterations are involved in the process of oncocytic transformation remains to be clarified, however.
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  • 171
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    Virchows Archiv 436 (2000), S. 628-633 
    ISSN: 1432-2307
    Keywords: Key words Prostate adenocarcinoma ; Endocrine cells ; Immunohistochemistry ; FSH ; Electron microscopy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We report an unusual variant of prostatic adenocarcinoma with marked endocrine differentiation (mixed endocrine-exocrine adenocarcinoma). Endocrine cells accounted for 60% of the tumour cells, were positive with silver impregnation and for chromogranin A, synaptophysin, and neuron-specific enolase, and coexpressed the exocrine antigens prostatic acid phosphatase and prostatic-specific antigen. Most of the endocrine cells were basophilic with haematoxylin-eosin and proved immunoreactive for alpha subunit of human chorionic gonadotropin and follicle-stimulating hormone. The remaining endocrine cells were represented by eosinophilic cells positive for serotonin, and by calcitonin and serotonin-immunoreactive cells not identifiable in haematoxylin-eosin-stained sections. On ultrastructural analysis, two types of endocrine cells were identified. The most frequent cell type showed abundant cytoplasmic round, electron-dense neurosecretory granules, either small (212±44 nm) or large (471±114 nm), resembling those of gonadotropic pituitary cells. The second type of endocrine cells contained irregular electron-dense granules similar to those of serotonin-storing enterochromaffin cells.
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  • 172
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    Child's nervous system 16 (2000), S. 731-734 
    ISSN: 1433-0350
    Keywords: Keywords Children ; Brain ; Tumour ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The author reviews the progress made during the last 25 years in noninvasive diagnosis of brain tumours in children. MRI has replaced all other modalities available at that time. The diagnosis is still based on a precise anatomical analysis of the lesion rather than on other specific findings. New techniques, such as spectroscopy and diffusion, may help to characterise further brain tumours in children preoperatively.
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  • 173
    ISSN: 1433-0350
    Keywords: Keywords Angiogenesis ; Glioblastoma multiforme ; Immunohistochemistry ; Tenascin-C
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Tenascin-C (TN-C) plays an important part in the growth of neoplastic tissue, leading to new vessel development. TN-C has been assessed in adult glioblastoma multiforme (GBM) and has been evaluated as anti-neoplastic therapy. No studies have focused on this tissue in paediatric GBM. Tissues were obtained from six paediatric supratentorial GBMs. Immunohistochemistry was performed using a mouse antibody directed against human TN-C, and expression in tumour vasculature was described on the basis of TN-C immunoreactivity. The expression was minimal in three, moderate in two, and intense in one specimen. TN-C was not correlated with clinical history, neurological findings, or with tumour site. Although based on a limited number of patients, this study provides additional insights into tumour growth modulation and cytogenetic profile of paediatric GBM. The detailed understanding of events responsible for GBM growth is a prerequisite for the development of therapeutic modalities leading to improved prognosis and cure.
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  • 174
    ISSN: 1432-2102
    Keywords: Schlüsselwörter Mammatumor ; MRT ; Markierung ; Biopsie ; Keywords Breast lesion ; MRI ; Localization ; Biopsy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Purpose. MRI-guided interventional maneuvers in the breast, when closed MRI scanners are employed are relatively complex and time consuming. The purpose of our investigations was to develop a special device for the localization and biopsy of breast lesions using an open low-field MRI Scanner (Magnetom Open, Siemens, Erlangen, Germany) permitting free access to the patient. Materials and Methods. Due to its particular material and construction characteristics, a newly developed device for localization and biopsy of breast lesions is appropriate to remain within the magnetic field during the examination without degrading image quality. We performed 125 tests in a phantom and 31 investigations in patients including 26 wire-localizations and 5 biopsies. Results. The interventional maneuvers in the phantom could be performed very precisely. In all 125 phantom studies, the needle (14G coaxial biopsy cannula, Bard) was positioned close to the simulated lesion. In 25 out of 26 patients the needle was positioned within a distance less than 5 mm from the lesion. When using the 14G coaxial biopsy cannula (Bard, Karlsruhe, Germany) the needle tip was found adjacent next to the lesion in all 12 cases (7 wire-localizations, 5 biopsies). Conclusions. Our results indicate that our device allows very precise preoperative localization of breast lesions within the Magnetom Open. Using MRI-compatible, large-core needles, biopsy under direct MRI control resulted in good results.
    Notes: Zusammenfassung Zielsetzung. Am geschlossenen MRT-Gerät sind Interventionen an der Mamma relativ aufwendig und zeitintensiv. Ziel unserer Untersuchungen war es, eine Lokalisations- und Biopsieeinrichtung für das offene MRT-Gerät (Magnetom Open, Siemens) zu entwickeln und zu erproben, das Patienten und Methode. Es wurde eine Lokalisations- und Biopsieeinrichtung entwickelt, die aufgrund ihrer Bauart während der Intervention im Magnetfeld des MRT-Gerätes verbleiben kann und die Bildgebung nicht nachteilig beeinflusst. Um die Tauglichkeit dieses Gerätes zu überprüfen wurden 125 Untersuchungen am Phantom und 31 Patientenuntersuchungen (26 Drahtlokalisationen, 5 Biopsien) durchgeführt. Ergebnisse. Die Interventionen am Phantom konnten sehr genau gesteuert werden. In allen 125 Fällen lag die Interventionsnadel (14 G-Coaxial-Biopsiekanüle, Bard) direkt der Läsion an. Bei den Patientenuntersuchungen lag die Interventionsnadel in 25 von 26 Fällen weniger als 5 mm von der Läsion entfernt. Bei Verwendung der 14 G-Coaxial-Biopsie-Kannüle (Bard, Karlsruhe, Germany) lag die Interventionsnadel in allen 12 Fällen direkt der Läsion an (7 Drahtlokalisationen, 5 Hochgeschwindigkeitsbiopsien). Schlussfolgerung. Die Untersuchungen zeigen, dass mit der von uns entwickelten Zieleinrichtung sehr genaue präoperative Lokalisationen am Magnetom Open durchführbar sind. Durch die stabile Nadelführung sind bei Verwendung lumenstarker Materialien (14G) zudem exakte MRT-kontrollierte Biopsien möglich.
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  • 175
    ISSN: 1432-2102
    Keywords: Schlüsselwörter Gelenkknorpel ; MRT ; Arthrose ; Keywords Hyaline cartilage ; MRI ; Osteoarthritis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract MRI is the most accurate noninvasive technique available for assessment of normal articular cartilage and cartilage lesions. MRI cannot only provide morphologic information about the area of damage, but can also provide unique insight into the biochemical composition of the articular cartilage. New image processing techniques such as three-dimensional mapping of cartilage thickness will help to establish automated analysis of cartilage loss. Theses techniques are ideally suited for monitoring patients who undergo treatment with new chondroregenerative drugs.
    Notes: Zusammenfassung Die MRT ist die beste verfügbare Untersuchungsmethode zur Darstellung des normalen und geschädigten Gelenkknorpels. Sie gibt nicht nur Aufschluss über die Morphologie des geschädigten Areals, sondern auch über die biochemische Zusammensetzung des Gelenkknorpels. Neue Bildverarbeitungstechniken wie die dreidimensionale Erfassung/Darstellung der Knorpeldicke werden bei der Entwicklung einer automatisierten Analyse des Knorpelverlustes helfen. Diese Techniken sind auch ideal zur Verlaufsbeobachtung von Patienten, die sich einer Behandlung mit knorpelregenerierenden Substanzen unterziehen.
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  • 176
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    Der Radiologe 40 (2000), S. 688-693 
    ISSN: 1432-2102
    Keywords: Schlüsselwörter Knochenmark ; Physiologie ; Verteilungsmuster ; MRT ; Keywords Bone marrow ; Physiology ; Distribution pattern ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Physiology and age dependant changes of human bone marrow are described. The resulting normal distribution patterns of active and inactive bone marrow including the various contrasts on different MR-sequences are discussed.
    Notes: Zusammenfassung Die physiologischen, altersabhängigen Prozesse im Knochenmark des Menschen werden beschrieben. Die daraus resultierenden Verteilungsmuster zwischen hämatopoetisch aktivem und inaktivem Knochenmark werden dargestellt und die Bedeutung für die MR-tomographische Abbildbarkeit mittels der verschiedenen MR-Sequenzen erörtert.
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  • 177
    ISSN: 1432-2102
    Keywords: Schlüsselwörter Lymphom ; MRI ; Keywords Lymphoma ; Bone neoplasms ; Diffusion coefficient ; ADC
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Purpose. Skeletal manifestation of Non-Hodgkin's lymphoma is rare in pediatric patients. Objective of the study was to determine imaging features, before and after treatment, and to correlate these features with clinical outcome. Methods. A retrospective analysis of 1246 patients from two therapy studies (NHL-BMF-90 and 95) was performed. Imaging studies of 63 patients with bone involvement of lymphoma were reevaluated. Results. Incidence of initial bone involvement in Non-Hodgkin's lymphoma was 6.8%. Distribution was best assessed by bone scan, MRI revealed larger areas of marrow involvement and detected additional lesions. Sites of prediliction were long bones of the lower extremities with epiphyseal involvement in 39%. Residual signal alterations in MRI after succussful therapy remained in 71%. Osteonecrosis after therapy was a common finding. Clinical outcome war not correlated to the presence of bone involvement. Conclusions. Since clinical outcome is not effected by bone involvement in childhood NHL, value of screening may be limited. Knowledge of imaging characteristics is mandatory for inital evaluation of primary osseous lymphomas and symptomatic lesions as well as for therapy controlls.
    Notes: Zusammenfassung Fragestellung. Skelettale Manifestationen des Non-Hodgkin-Lymphoms sind selten. Ziel der Studie waren die Analyse charakteristischer Veränderungen in der Bildgebung vor und nach Therapie sowie die Korrelation mit dem Therapieerfolg. Methode. Die retrospektive Analyse von 2 Therapiestudien (NHL-BMF-90 und 95) schloss 1246 Patienten ein. Die bildgebenden Untersuchungen von 63 Patienten mit skelettalem Lymphombefall wurden reevaluiert. Ergebnisse. Die Inzidenz des initialen Skelettbefalls beim Non-Hodgkin-Lymphom lag bei 6,8%. Die Verteilung der Skelettherde wurde durch die Szintigraphie am sichersten erfasst, die MRT detektierte im Vergleich größere Markraumbeteiligungen sowie zusätzliche Herdbildungen im Skelett. Prädilektionsorte waren die langen Röhrenknochen der unteren Extremitäten mit epiphysärer Beteiligung in 39% der Fälle. Residuale Signalveränderungen im MRT verblieben trotz kompletter Remission in 71% der Fälle. Osteonekrosen nach Chemotherapie waren häufig. Die therapeutische Ergebnisse wurden durch das Vorhandensein eines Skelettbefalls nicht beeinflusst. Schlussfolgerungen. Aufgrund der Beobachtung, dass die Therapieergebnisse vom Nachweis eines Skelettbefalls nicht wesentlich beeinflusst werden, erscheint der Wert der Screeninguntersuchung begrenzt. Die Kenntnis des Erscheinungsbilds vom NHL in der Bildgebung ist aber für die Beurteilung der primär ossären Lymphome und symptomatischer Herdbildungen sowie in der Therapiekontrolle notwendig.
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    Der Radiologe 40 (2000), S. 1017-1029 
    ISSN: 1432-2102
    Keywords: Schlüsselwörter Hirnabszess ; Zerebritis ; Metastatische Herdenzephalitis ; Endokarditis ; MRT ; Gd-DTPA ; Keywords Brain abscess ; Cerebritis ; Metastatic focal encephalitis ; Endocarditis ; MRI ; Gd-DTPA
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract The hematogenous spread of bacteria, fungi and protozoa may also reach the brain vessels, which happens mostly through septic emboli. From such an embolus a metastatic focal encephalitis and later a septic-embolic brain abscess may arise. The most frequently underlying infections that may cause septic emboli are bacterial endocarditis as well as bacterial infections of artificial heart valve prostheses. Congenital heart malformations with a right-to-left shunt also play here a certain role. Basically, however, all septic conditions and bacteriemias may cause septic-embolic brain abscesses. They occur frequently as multiple lesions. MRI is superior to CT in depicting the different stages of evolution from focal encephalitis, through the hardly encapsulated early abscess, to the formation of a membrane and later a dense fibrous capsule. The medical treatment of a brain abscess requires properly performed CT or MRI follow-up examinations in order to realize early enough a possible growing of such a lesion.
    Notes: Zusammenfassung Die hämatogene Ausbreitung von Bakterien, Pilzen oder Protozoen bis in die Hirngefäße erfolgt meist durch eine septische Embolie. Es entstehen eine metastatische Herdenzephalitis und im weiteren Verlauf daraus ein septisch-embolischer Hirnabszess. Die häufigste Grunderkrankung die zu septischen Embolien führt ist die bakterielle Endokarditis sowie die bakterielle Infektion von Herzklappenprothesen. Eine besondere Bedeutung kommt hier den angeborenen kardialen Fehlbildungen mit Rechts-Links-Shunt zu. Grundsätzlich können jedoch alle Bakteriämien zu septisch-embolischen Hirnabszessen führen. Septisch-embolische Hirnabszesse treten aufgrund ihres Entstehungsmechanismus häufig multipel auf. Die CT und besser noch die MRT erlauben die Darstellung aller Entwicklungsstadien von der Herdenzephalitis über den kaum abgegrenzten Abszess, die Membranbildung bis zur Entstehung einer dicken, die eitergefüllte Höhle allseits umgebenden Abszesskapsel. Die medikamentöse Therapie von Hirnabszessen erfordert Verlaufsuntersuchungen, um einer eventuellen Größenzunahme der Läsion(en) frühzeitig durch Umstellung der antibiotischen Medikation oder durch operative Abszessentfernung zu begegnen.
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  • 179
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    Knee surgery, sports traumatology, arthroscopy 8 (2000), S. 120-126 
    ISSN: 1433-7347
    Keywords: Key words Anterior cruciate ¶ligament ; Reconstruction ; Growth factor ; Remodeling ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Sports Science
    Notes: Abstract This study was designed to examine localization of the growth factors in the autogenous patellar tendon graft used to reconstruct the anterior cruciate ligament (ACL) in the canine model. Among the various growth factors, basic fibroblast growth factor, transforming growth factor-β1, and platelet-derived growth factor were selected for analysis as potential factors that regulate graft remodeling processes. In the control patellar tendon and the ACL only basic fibroblast growth factor was positively stained. In the reconstructed graft increased levels of staining for all the three factors were observed in the early postoperative period, reaching the greatest expression 3 weeks after implantation. Thereafter immunoreactivity of these growth factors decreased and returned to the preoperative levels, which were similar to that of the control ACL 12 weeks postoperatively. This rapid reduction in the level of their localization indicates that once the extrinsic cells are infiltrated to the graft and revascularization completed, these growth factors may have less significance for subsequent remodeling.
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  • 180
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    Knee surgery, sports traumatology, arthroscopy 8 (2000), S. 61-65 
    ISSN: 1433-7347
    Keywords: Key words Collagen ; Meniscal ¶insertions ; Knee joint ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Sports Science
    Notes: Abstract The medial meniscus of the rabbit knee joint attaches to the tibial plateau via anterior and posterior insertions. Intact meniscal tibial insertions are essential for meniscal function. In the present study the distributions of types I, II, and X collagen in meniscal tibial insertions were investigated by indirect immunohistochemistry in a rabbit model. Four tissue zones were histologically identified in the anterior insertion site, including the ligamentous zone, uncalcified and calcified fibrocartilaginous zones and bone; the ligamentous zone was not observed in the posterior insertion site. Labeling for type I collagen was found to be strong in the ligament tissue and bone, and weak in the fibrocartilages which were also labeled for type II collagen. Tissues positive for different types of collagen overlapped and formed an irregular interface with various angles and depths, especially at the interface between the calcified fibrocartilage and bone. Positive labeling for type X collagen was identified only in the calcified fibrocartilage zone. The coexistence of types I and II collagen in the meniscal tibial insertions may indicate that this structural unit is subjected to both compressive and tensile loads. Type X collagen may play a role in maintaining the calcifying status of this tissue zone, so that its mechanical stiffness is kept between that of uncalcified fibrocartilage and hard bone. Restoration of the insertional structure including the distinct collagen distribution should be considered for a functional meniscal substitution.
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  • 181
    ISSN: 1433-0350
    Keywords: Keywords Syringomyelia ; Chiari I malformation ; Foramen magnum decompression ; Children ; Scoliosis ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The authors studied the role of the sole posterior fossa bony decompression in the management of symptomatic children affected by Chiari type I anomalies. The series in the pediatric literature on this subject were reviewed and compared with that presented in this article. From May 1994 to December 1998, 53 patients (3 months to 26 years) were observed. They were divided into: asymptomatic patients (27), who received no surgical treatment and were only subject to clinical observation; symptomatic patients (brain stem compression 16, syringomyelia 10, including 7 with holocord). All the symptomatic patients were treated with the same surgical approach: bony decompression of posterior fossa with removal of the posterior arch of C-1 and the outer layer of the dura without dural opening. In all 16 (100%) of the 16 patients with brain stem compression the symptoms resolved or improved; in patients with syringomyelia the symptoms were resolved or improved in 94.4% of cases. Two children required further surgery after 13 and 24 months, respectively.This series seems to demonstrate that even a simple extradural surgical approach, with a lower rate of postoperative complications and short stay in hospital, is sufficient to arrest the disease and to improve the symptomatology in a high percentage of cases (97.2%), which is comparable to that achieved with other, more aggressive, procedures.
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  • 182
    ISSN: 1433-0350
    Keywords: Key words Hydrocephalus ; Endoscopic III ventriculostomy ; Outcome ; MRI ; Cine-MRI ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  In order to analyze the surgical outcome according to clinical characteristics and to evaluate the correlation between clinical improvement and neuroimaging changes, we retrospectively reviewed 32 children who had undergone endoscopic III ventriculostomy (ETV) from February 1994 to May 1998. There were 15 boys and 17 girls, with a mean age of 5.2 years (range: 1 month to 13 years). The etiology of the hydrocephalus was primary aqueductal stenosis in 18 patients, secondary aqueductal stenosis caused by tumors in 5, IV ventricle outlet obstruction in 5, and hydrocephalus associated with meningomyelocele in 4. The mean duration of follow-up was 19.4 months (range 1–50 months). Overall, surgical outcome was regarded as good in 21 of 29 patients. Surgical outcome was poor in patients younger than 1 year (P〈0.05). Neuroimaging 1 month after ETV showed a decrease in ventricular size in 11 of the 16 patients with good surgical outcomes. Five showed minimal changes only. In patients with good outcomes, ventricular size tended to decrease as time passed. Resolution of periventricular edema, flow void in the III ventricle on T2-weighted axial images, and cine-MR imaging were sensitive indicators of good outcome. We suggest that ETV be considered as a primary treatment option in patients older than 1 year of age with noncommunicating hydrocephalus. In addition, time factors should be taken into consideration when surgical outcome is judged. Changes in ventricular size could not predict surgical outcome completely in themselves. Therefore, a comprehensive postoperative assessment should be made with the help of T2-weighted MRI and cine-MRI.
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  • 183
    ISSN: 1438-2199
    Keywords: Keywords: Amino acids ; Nerve lesion ; Neuropathic pain ; Heme oxygenase ; Carbon monoxide ; Cell injury ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary. The influence of carbon monoxide (CO) on chronic spinal nerve lesion induced spinal cord neurodegeneration was examined using immunohistochemical expression of the constitutive isoform of its synthesising enzyme, hemeoxygenase-2 (HO-2) in a rat model. Spinal nerve lesion at L-5 and L-6 level was produced according to the Chung model of neuropathic pain and rats were allowed to survive for 8 weeks. Sham operated rats, in which the spinal nerves were exposed but not ligated, served as controls. Ligation of spinal nerves in rats resulted in an upregulation of HO-2 expression which was most pronounced in the ipsilateral gray matter of the spinal cord compared to the contralateral side. In these rats, morphological investigations showed distorted neurons, membrane disruption, synaptic damage and myelin vesiculation. Sham operated rats did not show an upregulation of HO-2 expression and the structural changes in the spinal cord were absent. These observations strongly suggest that spinal nerve lesion is associated with an increased production of CO which is somehow contributing to the neurodegenerative changes in the spinal cord, not reported earlier.
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  • 184
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    Herz 25 (2000), S. 417-430 
    ISSN: 1615-6692
    Keywords: Key Words Myocardial viability ; MRI ; Spectroscopy ; Dobutamine ; Contrast agents ; Schlüsselwörter Myokardvitalität ; MRT ; Spektroskopie ; Dobutamin ; Kontrastmittel
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Myokardvitalität ist definiert als das Vorliegen lebender Myozyten. Bei Patienten mit ischämischer Herzkrankheit läßt sich die kontraktile Dysfunktion des Herzmuskels sowohl in vitalen als auch in avitalen Gebieten beobachten. In Gebieten mit vitalem Myokard kann sie durch Revaskularisation mit Thrombolytika, perkutaner transluminaler Koronarangioplastie (PTCA) oder koronarer Bypassoperation (CABG) rückgängig gemacht werden. In nekrotischen Arealen ist die kontraktile Dysfunktion dagegen irreversibel, und Revaskularisationsmaßnahmen können aufgrund ihres kleinen, aber eindeutigen Risikos kontraindiziert sein. Die Unterscheidung zwischen vitalen und avitalen Herzmuskelarealen ist daher eine klinisch wichtige Frage. Eine direkte Untersuchung von Patienten auf das Vorliegen bzw. Fehlen lebender Myozyten ist nicht möglich. Daher wird die Myokardvitalität indirekt mit klinischen Verfahren beurteilt. Beispielsweise erfaßt die Echokardiographie mit Dobutaminen Kontraktilitätsänderungen nach inotroper Stimulation, und die 99mTc-Sestamibi bestimmt die Myokardperfusion. Kernspintomographische Methoden zur Vitalitätsprüfung umfassen spektroskopische und bildgebende Verfahren. Die Phosphor-31- und Wasserstoff-1-MR-Spektroskopie aus Kreatin sowie die Natrium-23- und Kalium-29-Bildgebung liefern unmittelbar mit dem Zellstoffwechsel verbundene Informationen. Die räumliche und die zeitliche Auflösung dieser Verfahren sind jedoch aufgrund des schwachen MR-Signals begrenzt. Bei Wasserprotonen ist das MR-Signal dagegen verhältnismäßig stark und ermöglicht eine Darstellung des Herzens mit hoher räumlicher und zeitlicher Auflösung. Die Bildgebung mit Protonenresonanz beinhaltet die Untersuchung von Änderungen der intrinsischen MR-Relaxationszeiten (T1 und T2), Wanddicke und Verschwielung, Cine-MRT mit niedrigdosiertem Dobutamin sowie First-pass- und verzögerte Kontrastverstärkungsmuster. Berichten zufolge kommt es nach ischämischer Schädigung sowohl in vitalen wie in nekrotischen Myokardgebieten zu Änderungen der intrinsischen Relaxationszeiten, was den Nutzen dieses Verfahrens einschränkt. In ähnlicher Weise stehen Änderungen der Wanddicke und/oder Verschwielung nur in begrenztem Zusammenhang mit der Myokardvitalität. Die Cine-MRT mit niedrig dosiertem Dobutamin scheint das intakte Myokard zumindest ebenso gut zu erfassen wie die klinisch bereits etablierte Dobutamin-Echokardiographie. Die regionale Durchblutung, wie sie mittels First-pass-MRT erfasst wird, mag vom Vorhandensein vitalen Myokards abhängen. Die zugrunde liegende Physiologie legt aber nahe, dass Perfusion und Vitalität oft nicht in direkter Beziehung stehen. Neuere Forschungsergebnisse zur verzögerten Kontrastverstärkung weisen auf eine mögliche Definition vitalen Myokards als “Gebiete ohne starke Kontrastmittelaufnahme” hin. Derzeit liegen nur begrenzte klinische Daten vor, die diesen Ansatz unterstützen. Zusammenfassend liegen die aussagekräftigsten klinischen Daten derzeit für die Cine-MRT mit niedrig dosiertem Dobutamin zur Diagnose vitalen Myokards vor. Neueste Ergebnisse lassen vermuten, dass die verzögerte Aufnahme von Kontrastmitteln die transmurale Ausdehnung vitalen Myokards unabhängig von der kontraktilen Funktion gut abbildet und dass diese Technik auch in der Klinik zum Einsatz kommen sollte.
    Notes: Abstract Distinguishing between viable and non-viable myocardium is an important clinical issue. Several magnetic resonance (MR) techniques to address this issue have been proposed. Spectroscopy of phosphorus-31 and hydrogen-1 from creatine as well as imaging of sodium-23 and potassium-39 reflect information related to cellular metabolism. The spatial and temporal resolutions of these techniques are limited, however, by the small magnitude of the MR signal. Proton imaging techniques include examination of pathologic alterations in MR relaxation times (T1 and T2), wall thickness and thickening, cine MRI combined with low-dose dobutamine, first-pass contrast enhancement patterns, and delayed contrast enhancement patterns. Of the proton imaging approaches, cine MRI combined with low-dose dobutamine is supported by the largest body of clinical evidence supporting the hypothesis that the technique yields useful information regarding myocardial viability. Recent data suggest that delayed contrast enhancement examines the transmural extent of viable myocardium irrespective of contractile function and that this technique should also be considered in a clinical setting.
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  • 185
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    Klinische Neuroradiologie 10 (2000), S. 13-17 
    ISSN: 1615-6706
    Keywords: Schlüsselwörter: Leigh-Syndrom ; MRT ; Pathologisch-anatomische Befunde ; Key Words: Leigh syndrome ; MRI ; Patho-histological findings
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract: We report on 3 children suffering from Leigh syndrome as diagnosed on clinical and laboratory results. In each child there were some deviations from the reported typical morphological picture on MRI. However, the lesions reported here fit very well to the patho-histological findings in Leigh syndrome.
    Notes: Zusammenfassung: Wir beschreiben drei Kinder, bei denen klinisch und laborchemisch ein Leigh-Syndrom diagnostiziert wurde. Bei jedem dieser Kinder lagen in der Bildgebung unterschiedliche Abweichungen von den typischen, bisher beim Leigh-Syndrom berichteten Läsionen in der MRT vor. Die gefundenen Veränderungen in der MRT passen allerdings sehr gut zu den pathologisch-anatomischen Befunden bei dieser Erkrankung.
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  • 186
    ISSN: 1615-6706
    Keywords: Schlüsselwörter: Pseudotumor cerebri ; Venöse Kongestion ; MRT ; Meningeom ; Key Words: Pseudotumor cerebri ; Venous congestion ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract: Chronic benign intracranial hypertension may have a variety of causes. Most frequent is this syndrome found in obese young women (“pseudotumor cerebri”), still of unknown etiology. However, venous congestion due to sinus occlusion has to be ruled out. We report a young woman with an intrasinusal meningioma of the transverse sinus and hypoplasia of the transverse sinus contralaterally. Diagnosis was achieved by MRI and angiography. Imaging signs of increased intracranial pressure comprised dilated perioptic sheaths and an empty sella. Abnormalities of the brain parenchyma or the CSF spaces were absent.
    Notes: Zusammenfassung: Eine chronische, benigne intrakranielle Hypertension kann vielfältige Ursachen haben. Neben dem ätiologisch ungeklärten Auftreten bei adipösen jungen Frauen (“Pseudotumor cerebri”) ist eine venöse Abflußbehinderung als Ursache möglich. Diese muß deshalb ausgeschlossen werden. Wir berichten über eine Patientin, deren intrakranielle Drucksteigerung wahrscheinlich durch ein Meningeom im Sinus transversus bei gleichzeitiger kontralateraler Sinushypoplasie verursacht wurde. Die Diagnose wurde mit Magnetresonanztomographie und Angiographie erstellt. Als Zeichen der chronischen intrakraniellen Drucksteigerung fanden sich in der MRT gestaute perioptische Liquorscheiden und eine “empty sella”, dagegen keine Hirnparenchymveränderungen oder veränderte intrakranielle Liquorräume.
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  • 187
    ISSN: 1615-6706
    Keywords: Schlüsselwörter: Morbus Crohn ; Zerebrale Vaskulitis ; MRT ; Angiographie ; Key Words: Crohn's disease ; Cerebral vasculitis ; MRI ; Angiography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract: Crohn's disease or regional enteritis is a granulomatous, primarily intestinal inflammatory disorder with possible extraintestinal manifestations. Affection of the eyes, liver, joints and urinay tract have been reported. Neurological symptoms are rare. We report the case of a 18-year-old woman with an unusually severe course of Crohn's disease, who developed intracerebral lesions. To discriminate between a granulomatous encephalitis and a vasculitis a cerebral angiography was performed. Multiple microaneurysms of the small cerebral arteries were found which had escaped detection with magnetic resonance angiography. Because of the angiographic diagnosis of a cerebral vasculitis a brain biopsy could be avoided.
    Notes: Zusammenfassung: Die Enteritis regionalis Crohn ist eine Darmerkrankung, die mit extraintestinalen Manifestationen vergesellschaftet sein kann. Neben okulären, hepatischen, urologischen und artikulären Symptomen werden selten auch neurologische Komplikationen beschrieben. Wir berichten über eine 18jährige Patientin mit einem schweren Verlauf einer Enteritis regionalis, die zunächst eine Läsion im Mittelhirn entwickelte. Zur Differenzierung zwischen einer granulomatösen Enzephalitis und einer Vaskulitis, die bei Morbus Crohn extrem selten ist, wurde eine zerebrale Angiographie angefertigt. Dabei zeigte sich eine Vaskulitis der kleinen Hirnarterien mit multiplen Mikroaneurysmen, die in der MRT nicht nachweisbar gewesen waren. Durch die angiographische Klärung konnte eine Biopsie zur Diagnosefindung vermieden werden.
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  • 188
    ISSN: 1615-6706
    Keywords: Schlüsselwörter: Liquordynamik ; Aquädukt ; Quantifizierung ; MRT ; Phasenkontrast ; Normalwerte ; Key Words: CSF dynamics ; Aqueduct ; Quantification ; MRI ; Phase contrast ; Normal values
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract: With the 2D-phase-contrast technique the volume flow of the CSF via the cerebral aqueduct can be quantified by MRI-means. In this study the stroke volume of CSF via the aqueduct per cardiac cycle (SVcc) is used to measure the extent of the volume flow. Normative values for the SVcc are not yet defined, however, they are indispensable for the clinical utility of this non-invasive method. The aim of the presented investigation is to evaluate, if the interthalamic width of the third ventricle is useful as a reference system for the extent of the SVcc via the aqueduct and if a normal CSF-flow can be defined. Hundred and seven patients (56 female, 51 male; age distribution 8 to 89 years) without clinical or imaging findings of a CSF-flow disturbance were examined on a standard 0.5 T MRI-scanner (Gyroscan, Philips). The measurements of the SVcc via the aqueduct were performed in a single slice perpendicular to the aqueduct in the level of its median third with a retrospective cardial-gated quantitative 2D-phase-contrast sequence. The interthalamic width of the third ventricle was measured in a transversal slice (bicommissural orientation, standard T1-weighted spin-echo sequence) in the level of the upper margin of the tectorial membrane. In 83 patients with a normal heart rate and without any further abnormalities in their imaging studies the SVcc is essentially dependent (r = 0.822) on the interthalamic width of the third ventricle (between 1 and 16 mm). Eleven patients with either a subcortical atrophy without leucencephalopathy, megacisterna magna, Dandy-Walker variant or bradycardia showed a significant increase of the SVcc (p 〈 0.05). On the other hand a significant decrease of the SVcc (p 〈 0.05) is seen in 13 patients with either tachycardia, Arnold-Chiari Type-1 malformation, relative aqueductal stenosis and/or severe periventricular leucencephalopathy. These results are in good agreement with the current conceptions on the physiology of the CSF-flow. As the above mentioned criterias of influence have ho pathological significance concerning a CSF-flow disturbance requiring therapy, we used the linear regression with y = B1*× +b0 (b1 = 22.2 ± 2.9; b0 = 43,5 ± 21.1) in all 107 patients to evaluate the extent of the SVcc (y) versus the interthalamic width of the third ventricle (x). This correlation offers the possibility to differentiate a hyperdynamic (above +3 standard error SE), a hypodynamic (below −3 SE) and a normodynamic (between ± 3 SE) CSF-flow via the cerebral aqueduct for the first time. Additional imaging findings and the heart rate must find their influence in the evaluation.
    Notes: Zusammenfassung: Mit Hilfe der 2D-Phasenkontrasttechik kann der Volumenfluss des Liquors über dem Aquädukt magnetresonanztomographisch quantifiziert werden. Als Maß für die Höhe des Volumenflusses dient in vorgestellter Untersuchung das Schlagvolumen pro Herzzyklus (SVcc). Normwerte für die Höhe des SVcc konnten bislang nicht definiert werden. Sie sind jedoch für eine klinische Nutzung dieses nichtinvasiven Verfahrens unerläßlich. Ziel vorliegender Untersuchung ist es zu prüfen, ob die interthalamische Weite des dritten Ventrikels als Bezugssystem für die Höhe des SVcc über dem Aquädukt geeignet ist und sich ein normaler Liquorfluss definieren läßt. Die Untersuchungen erfolgten bei 107 Patienten (56 Frauen, 51 Männer im Alter von acht bis 89 Jahren) ohne klinische und bildmorphologische Hinweise auf eine Liquorzirkulationsstörung an einem Standardsystem 0,5 T (Gyroscan, Fa. Philips). Die Messung des SVcc über dem Aquädukt wurde in einer Eizelschicht senkrecht zum Aquädukt in Höhe des mittleren Drittels mit einer retrospektiv kardial getriggerten 2D-quantitativen Phasenkontrastsequenz durchgeführt. Die Messung der interthalamischen Weite des dritten Ventrikels erfolgte im Transversalschnitt (Bikommissuralebene, Standard-T1-gewichtete SE-Sequenz) in Höhe des Oberrandes der Lamina tecti. Für 83 kardial normofrequente Patienten ohne zusätzliche bildmorphologische Auffälligkeiten wird die Höhe des SVcc maßgeblich von der interthalamischen Weite des dritten Ventrikels (1 bi 16 mm) bestimmt (r = 0,822). Bei elf Patienten mit einer subkortikal betonten Atrophie ohne Leukenzephalopathie, Megacisterna magna, Dandy-Walker-Variante oder Bradykardie ist das SVcc signifikant erhöht (p 〈 0,05). Dagegen ist das SVcc für 13 Patienten mit Tachykardie, Arnold-Chiari-Malformation Typ 1, relativer Aquäduktestenose und/oder fortgeschrittener periventrikulärer Leukenzephalopathie signifikant erniedrigt (p 〈 0,05). Diese Ergebnisse lassen sich gut mit den geltenden Vorstellungen über die Physiologie des Liquorflusses in Einklang bringen. Da den vorgenannten Einflusskriterien keine pathologische Bedeutung hinsichtlich einer therapiebedürftigen Liquorzirkulationsstörung beigemessen werden kann, nutzen wir zur Bewertung der Höhe des SVcc (y) gegenüber der interthalamischen Weite des dritten Ventrikels (x) die lineare Regression mit y = b1*× + b0 (b1 = 22,2 ± 2,9; b0 = 43,5 ± 21,1) für alle 107 Patienten. Diese Beziehung gibt erstmals die Möglichkeit, einen hyperdynamen (〉 +3 SE), hypodynamen (〈 −3 SE) und normodynamen (in den Grenzen ± 3SE) Liquorfluss über dem Aquädukt zu differenzieren. In die Bewertung müssen das Vorliegen zusätzlicher bildmorphologischer Einflussfaktoren und die Höhe der Herzfrequenz einfließen.
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  • 189
    ISSN: 1615-6706
    Keywords: Schlüsselwörter: Medulloblastom ; Pubertas praecox ; MRT ; Kontrastmittel ; Key Words: Medulloblastoma ; Subarachnoid metastases ; Precocious puberty ; MRI ; Contrast enhancement
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract: Medulloblastoma, the most frequent pediatric brain tumor, has known propensity for subarachnoid dissemination. Spinal metastases indicate a poor prognosis. Intraventricular spread is much less common. We report a case of primary intraventricular dissemination with precocious puberty as the first clinical symptom due to a metastasis at the infundibulary stalk. This has not been reported so far as initial symptom of a medulloblastoma. Furthermore, we encountered an unusually mild contrast enhancement of the spinal and intraventricular metastases. Delayed scanning after contrast administration and FLAIR sequences proved to be particularly valuable in this case.
    Notes: Zusammenfassung: Medulloblastome des Kleinhirns sind die häfigsten malignen Hirntumoren im Kindesalter. Ihre Neigung zur Ausbreitung im Subarachnoidalraum ist bekannt und Prognose bestimmend. Wir berichten über den ungewöhnlichen Fall eines Medulloblastoms mit ausgeprägter intraventrikulärer Aussaat. Eine Metastase im Reccessus infundibularis führte hierbei zum Auftreten einer Pubertas praecox als initiales Krankheitssymptom, eine Beobachtung, die bisher nicht beschrieben wurde. Bemerkenswert war zudem die ungewöhnlich schwache Kontrastmittelaufnahme der intraventrikulären und spinalen Metastasen. Für die Diagnostik erwiesen sich FLAIR-Sequenzen und Spätaufnahmen nach Kontrastmittelgabe als besonders wertvoll.
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  • 190
    ISSN: 1615-6706
    Keywords: Schlüsselwörter: Vena ophthalmica superior ; Thrombose ; Sinus caverosus ; Computertomographie ; Kernspintomographie ; Key Words: Superior ophthalmic vein ; Thrombosis ; Sinus cavernosus ; CT ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract: A 65-year-old woman with persistant headache since a few weeks is presented. The day before hospitalization there was a sudden onset of protrusio bulbi and progredient swelling of the soft-tissue of the left eye. In the clinical examination left side protrusio bulbi, double-vision, chemosis and swelling of the eye-lid were found. Blood sample showed an elevation of inflammation indicators. MRI and CT revealed a thrombosis of the left superior ophthalmic vein with partial thrombosis of the left cavernous sinus.
    Notes: Zusammenfassung: Eine 65-jährige Patientin stellt sich mit seit Wochen bestehenden Kopfschmerzen vor. Am Tag vor der Aufnahme war morgens akut eine Protrusio bulbi mit einem periorbitalen Ödem aufgetreten. Klinisch fanden sich eine Protrusio bulbi mit Chemosis und Oberlidschwellung links, Doppelbildern sowie einer Erhöhung der Entzündungsparameter. Kernspintomographisch und computertomographisch ließ sich eine Thrombose der Vena ophthalmica superior links mit Teilthrombose des linken Sinus cavernosus nachweisen.
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  • 191
    ISSN: 1619-7089
    Keywords: Key words: Cardiomyopathy ; Doxorubicin ; Iodine-131 metaiodobenzylguanidine ; Immunohistochemistry ; Protein gene product 9.5
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Doxorubicin is one of the most useful anticancer agents, but its repeated administration can induce irreversible cardiomyopathy as a major complication. The purpose of this study was to investigate doxorubicin toxicity on cardiac sympathetic neurons using iodine-131-metaiodobenzylguanidine (MIBG) and protein gene product (PGP) 9.5 immunohistochemistry, which is a marker of cardiac innervation. Wistar rats were treated with doxorubicin (2 mg/kg, i.v.) once a week for 4 (n=5), 6 (n=6) or 8 (n=7) weeks consecutively. Left ventricular ejection fraction (LVEF), calculated by M-mode echocardiography, was used as an indicator of cardiac function. Plasma noradrenaline (NA) concentration was measured by high-performance liquid chromatography (HPLC). 131I-MIBG uptake of the left ventricular wall (24 ROIs) was measured by autoradiography. 131I-MIBG uptake pattern was compared with histopathological results, the neuronal population on PGP 9.5 immunohistochemistry and the degree of myocyte damage assessed using a visual scoring system on haematoxylin and eosin and Masson’s trichrome staining. LVEF was significantly decreased in the 8-week group (P〈0.05). The serum NA level also showed no statistical difference until 4 weeks and was significantly increased in the 8-week group (P〈0.05). MIBG uptake was decreased in the 6- and 8-week groups (P〈0.05), and was closely correlated with the reduction in the number of nerve fibres on PGP 9.5 stain. Myocyte damage was seen only in the 8-week group. Neuronal population and the 131I-MIBG uptake ratio of subepicardium to subendocardium were significantly increased (P〈0.05) in the 8-week group as compared with the control group. It may be concluded that radioiodinated MIBG is a reliable marker for the detection of cardiac adrenergic neuronal damage in doxorubicin-induced cardiomyopathy; it detects such damage earlier than do other clinical parameters and in this study showed a good correlation with the reduction in the neuronal population on PGP 9.5 stain. The subendocardial layer appeared to be more vulnerable to doxorubicin than the subepicardium.
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  • 192
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    Springer
    European journal of applied physiology 83 (2000), S. 363-369 
    ISSN: 1439-6327
    Keywords: Key words Achilles tendon moment arm ; MRI ; Maximum voluntary contraction ; In vivo ; Tendon excursion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The aim of the present study was to estimate and compare in vivo measurement-based Achilles tendon moment arm lengths at rest and during isometric plantarflexion maximum voluntary contraction (MVC) using the centre-of-rotation (COR) and the tendon-excursion (TE) methods. Both methods were based on morphometric analysis of sagittal-plane magnetic resonance images of the foot. Using the COR method, moment arms were obtained at ankle angles from 15° of dorsiflexion to 30° of plantarflexion in steps of 15°, digitizing the perpendicular distance from a moving centre of rotation in the tibio-talar joint to the Achilles tendon action line. The TE method was based on measurement of calcaneal displacement along the tibial axis during 15° rotations of the ankle joint, from 30° of dorsiflexion to 45° of plantarflexion. The two methods gave similar estimations at rest varying from 4.3 to 5.6 cm. Using the COR method, the Achilles tendon moment arm during MVC was larger by 1–1.5 cm (22–27%, P 〈 0.01) than the respective resting value. In contrast, no difference (P 〉 0.05) was found between the resting and MVC moment arm estimations of the TE method. The disagreement in moment arms during MVC may be attributed to differences in the assumptions made between the two methods. The TE method has more limitations than the COR method and its estimations during MVC should be treated with caution. Resting Achilles tendon moment arm estimations of the COR method should be multiplied by 1.22–1.27 when maximal isometric plantarflexion joint moments, musculotendon forces and stresses are predicted using modelling.
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  • 193
    ISSN: 1573-7373
    Keywords: SCLC ; brain matastases ; neurologic asympotomatic ; MRI ; prophylactic radiotherapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Purpose. In this study we evaluated the usefulness of MR-imaging in the detection of asymptomatic brain metastases (BM) at the initial diagnosis in patients with small cell lung cancer (SCLC) and studied the follow-up of these patients. Patients and methods. One-hundred and twenty-five patients with SCLC were investigated with MR-imaging. Results. In 112 patients with normal neurological findings, MR-imaging of the brain demonstrated BM in 17 patients (15%). Six of these 17 patients were therefore upgraded to extensive disease (ED). Two of these 17 patients died during chemotherapy because of progressive disease and 3 patients became neurologic symptomatic with progressive disease on MR-imaging of the brain. After completion of chemotherapy a repeated MR-imaging of the brain in the remaining 12 patients showed 1 complete remission, 4 partial remission and 7 progressive disease of the BM. Conclusion. This study showed that at presentation an unexpectedly high percentage of SCLC patients had asymptomatic BM on MR-imaging. We propose that MR-imaging of the brain should be included in the staging of SCLC patients as well for staging, prognosis and therapy.
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  • 194
    ISSN: 1573-7365
    Keywords: Ethanol ; GLUT1 ; GLUT3 ; Glucose ; Cerebral Metabolism ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In the normal adult brain, glucose provides 90% of the energy requirements as well as substrate for nucleic acid and lipid synthesis. In the present study, effects of ethanol on glucose transporters (GLUT) and glucose utilization were examined in rat brain. Male Sprague-Dawley rats weighing 250-300 gms were given either ethanol 3 gm/kg BW or saline IP 4 hrs prior to the animal sacrifice and removal of the cerebral cortical tissue. The cortical plasma membranes analyzed by cytochalasin B binding assay showed a decrease in GLUT number but not in GLUT affinity in the ethanol treated rats as compared to the control rats. The estimated Ro values were 70 ± 8.9 Vs 91 ± 8.9 pmoles/mg protein (p 〈 0.05 N=4) and the estimated Kd values were 0.37 ± 0.03 and 0.28 ± 0.05 μM (p: NS) in ethanol and control experiments respectively. Immunoblots of purified cerebral plasma membranes and low density microsomal fraction showed 17% and 71% decrease for GLUT1 and 54% and 21% (p〈0.05 or less; n=6) for GLUT3 respectively in ethanol treated rats than in control animals. Immunofluoresence studies also showed reduction of GLUT1 immunoreactively in choroid plexus and cortical microvessels of ethanol treated rats as compared to control rats. The effect of ethanol on regional cerebral metabolic rates for glucose (CMRGle) was studied using [6-14C] glucose and showed statistically insignificant decrease in brain glucose utilization. These data suggest that ethanol invivo decrease GLUT number and protein content in rat cerebral cortex
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  • 195
    ISSN: 1573-7373
    Keywords: astrocytoma ; 201thallium SPECT ; MRI ; MR spectroscopy ; chemotherapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Purpose To compare chemotherapy treatment monitoring in astrocytoma by 201thallium single photon emission computed tomography (SPECT) and photon magnetic resonance spectroscopy (1H-MRS) with magnetic resonance imaging (MRI), and to evaluate the influence of morphological tumor changes on cerebral 201thallium uptake and metabolic changes in 1H-MRS. Materials and methods Six patients with highly malignant astrocytomas were followed with quantitative 201thallium SPECT, MRI, and 1H-MRS during chemotherapy. Maximum follow-up included six examinations per patient by either method during 18 months. Criteria were set for: (1) regression (≥ 25% tumor reduction), (2) status quo (〈 25% reduction and 〈 25% increase), and (3) progression of disease (≥ 25% tumor increase). Results were compared with the clinical state of disease. Changes of tumor volume, contrast enhancement, necrosis, hemorrhage and edema on MRI were compared to changes in 201thallium uptake volumes and 1H-MRS metabolite ratios. Results Six patients were followed with a total of twenty-four examinations with 201thallium SPECT, MRI and 1H-MRS, respectively, between February 1997 and October 1998. Five patients developed clinical progression of disease, 4 out of 5 cases showed SPECT progression, 4 out of 5 cases MRI progression, and 1 out of 2 interpretable cases 1H-MRS progression at final assessment before clinical deterioration. During the phase of clinically stable disease; (A) the criterion for regression or status quo was met in 10 out of 13 assessments with SPECT, 11 out of 13 with MRI, and 8 out of 9 interpretable 1H-MRS; (B) the criterion for progression was met in 3 out of 13 with SPECT, 2 out of 13 with MRI, and 1 out of 9 interpretable 1H-MRS. The accuracy of SPECT, MRI, and 1H-MRS in identifying changes of tumor burden concordant with patients' clinical course was 78%, 83%, and 82%, respectively. SPECT regression was associated with MRI decrease of tumor size, contrast enhancement, edema and hemorrhage. SPECT progression was associated with MRI increase of the same parameters and the increase of necrosis. 1H-MRS regression was associated with decrease of edema. 1H-MRS progression was associated with increase of tumor size, hemorrhage, and increase or decrease of contrast enhancement. Conclusions Both 201thallium SPECT and 1H-MRS evaluation showed sensitivity for detection of astrocytoma progression. We did not find a higher accuracy of SPECT or MRS than of MRI in astrocytoma chemotherapy monitoring. Treatment induced MRI changes were associated with 201thallium uptake variations. 1H-MRS was difficult to apply for astrocytoma treatment monitoring. Improvements regarding size of measurement area such as multivoxel MRS and fat suppression pulses appeared desirable, and also the use of functional techniques with superior resolution such as dual isotope SPECT. However, our results suggest that 201thallium SPECT and 1H-MRS can provide additional information to MRI for chemotherapy efficacy evaluation in selected cases.
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  • 196
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    Journal of neuro-oncology 47 (2000), S. 195-210 
    ISSN: 1573-7373
    Keywords: MRI ; spinal cord ; tumor ; intramedullary
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The advent of MRI has significantly changed the diagnosis of spinal cord tumors. Standard imaging provides excellent localization and characterization of the tumor in a noninvasive fashion. Exact histologic diagnosis of the two most common tumors, ependymoma and astrocytoma, remains elusive but there are some suggestive imaging characteristics. It is hoped that some of the newer MR imaging sequences will improve characterization of the tumor and thereby influence therapy. Several of these pulse sequences are already used routinely in brain imaging. Evaluation of new imaging sequences in the spine has lagged behind brain MR imaging, mainly due to technical factors. Work on animal spine models and extrapolation from brain imaging studies suggest that it is only a matter of time before some of these techniques become clinically relevant.
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  • 197
    ISSN: 1573-7373
    Keywords: brain ; brain tumors ; MRI ; MR spectroscopy ; diffusion imaging ; glioma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This study sought to correlate quantitative presurgical proton magnetic resonance spectroscopic imaging (1H- MRSI) and diffusion imaging (DI) results with quantitative histopathological features of resected glioma tissue. The primary hypotheses were (1) glioma choline signal correlates with cell density, (2) glioma apparent diffusion coefficient (ADC) correlates inversely with cell density, (3) glioma choline signal correlates with cell proliferative index. Eighteen adult glioma patients were preoperatively imaged with 1H-MRSI and DI as part of clinically-indicated MRI evaluations. Cell density and proliferative index readings were made on surgical specimens obtained at surgery performed within 12 days of the radiologic scans. The resected tissue location was identified by comparing preoperative and postoperative MRI. The tumor to contralateral normalized choline signal ratio (nCho) and the ADC from resected tumor regions were measured from the preoperative imaging data. Counts of nuclei per high power field in 5–10 fields provided a quantitative measure of cell density. MIB-1 immunohistochemistry provided an index of the proportion of proliferating cells. There was a statistically significant inverse linear correlation between glioma ADC and cell density. There was also a statistically significant linear correlation between the glioma nCho and the cell density. The nCho measure did not significantly correlate with proliferative index. The results indicate that both ADC and spectroscopic choline measures are related to glioma cell density. Therefore they may prove useful for differentiating dense cellular neoplastic lesions from those that contain large proportions of acellular necrotic space.
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  • 198
    ISSN: 1615-6692
    Keywords: Key Words Coxsackievirus B3 (CVB3) ; Myocarditis ; Inducible nitric oxide synthase (iNOS) ; Nitric oxide (NO) ; Reverse transcriptase polymerase chain reaction (RT-PCR) ; In-situ-hybridization ; Immunohistochemistry ; Schlüsselwörter Coxsackie-Virus B3 (CVB3) ; Myokarditis ; Induzierbare Stickoxidsynthase (iNOS) ; Stickoxid (NO) ; Reverse Transkriptions-Polymerasekettenreaktion (RT-PCR) ; In-situ-Hybridisierung ; Immunhistochemie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Stickoxid (NO) ist ein wichtiges bioaktives Molekül mit regulatorischen, zytotoxischen oder zytoprotektiven Eigenschaften. Bei der viralen Myokarditis vermittelt NO einerseits Wirtsabwehr gegen die virale Infektion, andererseits jedoch kardiale Dysfunktion. Stickoxid wird synthetisiert aus L-Arginin durch das Enzym Stickoxidsynthase (NOS). Die Expression der induzierbaren Stickoxidsynthase (iNOS) wird durch Zytokine reguliert, die in die komplexe Immunantwort des Myokards auf Enterovirusinfektionen involviert sind. Die vorgestellten Untersuchungen charakterisieren die Rolle von iNOS und NO in einem murinen Modell der viralen Myokarditis, induziert durch Coxsackie-Virus B3. Wir untersuchten den zeitlichen Verlauf der iNOS-Induktion in Korrelation zur Zytokin-mRNA-Expression von TNF-α, IL-1α, IFN-γ und TGF-β im Myokard von NMRI-Mäusen nach CVB3-Infektion mittels RT-PCR. Virale RNA konnte in der akuten und chronischen Phase der Erkrankung mit der seminested PCR nachgewiesen werden, was die Persistenz des viralen Genoms belegt. Wir fanden eine deutliche Expression von iNOS zu allen untersuchten Zeitpunkten (ein, zwei, drei, vier, sieben, 14, 28, 56, 98 Tage post infectionem [p. i.]). Basierend auf einer densitometrischen Auswertung waren erhöhte iNOS-Spiegel am siebten, 14. Und 28. Nach Infektion nachweisbar im Vergleich zu den Tagen 56 und 98 p. i. Die mRNA-Expression der inflammatorischen Zytokine TNF-α, IL-1α, IFN-γ war am ersten, vierten bzw. siebten Tag p. i. nachweisbar, erreichten am siebten Tag p. i. ihr Maximum und persistierte bis zum 98. Tag p. i. Ähnlich wie die iNOS-mRNA-Expressionsmuster waren die von TGF-β. Mittels In-situ-Hybridisierung und Immunhistochemie konnte iNOS in Infiltraten, Gefäßendothel- und glatten Muskelzellen, in Myozyten und im Interstitium des Myokards lokalisiert werden. Erhöhte Werte von NO, bestimmt als Gesamtnitrat/-nitritkonzentration, wurden an den Tagen 7, 14 und 28 p. i. gemessen.
    Notes: Abstract Nitric oxide (NO) is an important bioactive molecule with regulatory, cytotoxic or cytoprotective properties. In virus-induced myocarditis, NO mediates host defense mechanisms against the infection or causes cardiac dysfunctions. NO is synthesized from L-arginine by the enzyme nitric oxide synthase (NOS). The expression of the inducible form of the nitric oxide synthase (iNOS) is regulated by cytokines, involved in the complex myocardial immune response to enterovirus infections. The present study was undertaken to characterize the role of iNOS and NO in the murine model of viral myocarditis induces by coxsackievirus Be (CVB3). In response to CVB3 infection we investigated the time course of iNOS induction in correlation with cytokine mRNA expression (TNF-α, IL-1α, IFN-γ, TGF-β) in the heart of NMRI mice by RT-PCR. Positive PCR signals for viral RNA were found in the acute and chronic stage of disease by seminested PCR, indicating the persistence of viral genome. We found distinct expression of iNOS at all time points (1, 2, 3, 4, 7, 14, 28, 56, 98 days post infection [p. i.]. Higher iNOS mRNA levels were identified between days 4 until 28 p. i. in comparison to day 56 and 98 p. i. using densitometric values. The mRNA of the inflammatory cytokines TNF-α, IL-1α, IFN-γ appeared at days 1, 4, and 7 p. i., peaked at day 7 p. i. and persisted until day 98 p. i. Similar like the iNOS mRNA pattern was the expression profile of TGF-β. Using in situ hybridization and immunohistochemistry iNOS was localized in infiltrates, vascular endothelial cells, smooth muscle cells, myocytes and throughout the interstitial spaces between myocardial fibers in the heart sections of NMRI mice. Increased levels of NO were measured as total nitrate/nitrite concentration in the sera of mice from day 7 until day 28 p. i.
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  • 199
    ISSN: 1615-6692
    Keywords: Key Words Cardiac imaging ; MRI ; Heart ; Ventricular function ; Schlüsselwörter Kardiale Bildgebung ; Magnetresonanztomographie ; Herz ; Ventrikelfunktion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Die kardiale Dysfunktion ist eine der Hauptursachen kardiovaskulärer Morbidität und Mortalität. Eine genaue und reproduzierbare Bestimmung der Herzfunktion ist essentiell für die Diagnosestellung, Prognoseabschätzung und Beurteilung des Therapieeffekts beim einzelnen Patienten. Die kardiovaskuläre Magnetresonanztomographie (CMR) bietet eine Messmethode für die globale und regionale Herzfunktion, die nicht nur genau und reproduzierbar, sondern auch nichtinvasiv, ohne ionisierende Strahlung und unabhängig von geometrischen Annahmen und einem akustischen Fenster ist, das den Einsatz der Echokardiographie limitiert. Mit der Verfügbarkeit schnellerer MR-Scanner und automatisierter Analysesysteme sowie mit zunehmender Verbreitung und reduzierten Kosten wird CMR bald den Referenzstandard für die Messung der Herzfunktion darstellen.
    Notes: Abstract Cardiac dysfunction is a major cause of cardiovascular morbidity and mortality. Accurate and reproducible assessment of cardiac function is essential for the diagnosis, the assessment of prognosis and evaluation of a patient's response to therapy. Cardiovascular Magnetic Resonance (CMR) provides a measure of global and regional function that is not only accurate and reproducible but is noninvasive, free of ionising radiation, and independent of the geometric assumptions and acoustic windows that limit echocardiography. With the advent of faster scanners, automated analysis, increasing availability and reducing costs, CMR is fast becoming a clinically tenable reference standard for the measurement of cardiac function.
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  • 200
    Electronic Resource
    Electronic Resource
    Springer
    Herz 25 (2000), S. 724-728 
    ISSN: 1615-6692
    Keywords: Key Words: Pericarditis ; Myocarditis ; Inflammation ; Immunohistochemistry ; Schlüsselwörter: Perikarditis ; Myokarditis ; Entzündung ; Immunhistologie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Obwohl Perikarderkrankungen lange Zeit nicht im Vordergrund des Interesses der Pathologen standen, ermöglichen neue Techniken zur Entnahme von Perikardgewebe die Anwendung neuer diagnostischer Methoden der Immunhistochemie und Molekularpathologie, die sich in der Myokarditisdiagnostik bereits bewährt haben. In diesem Zusammenhang stellt sich die Frage, ob die Diagnose einer Entzündung nur auf der Grundlage von morphologischen Veränderungen gestellt werden kann. Eine endgültige Diagnose einer Perikarditis oder Myokarditis erscheint aber ohne morphologische Kriterien kaum möglich.
    Notes: Abstract In medicine, and thus in pathology, there are areas/topics of fashion and they shift from time to time. Pericardial diseases are not fashionable. Myocarditis is, and has been for a long time. Due to new ways of retrieving tissue samples from the pericardium the modern diagnostic tools such as immunohistochemistry and molecular pathology can be applied in this context as they have been in myocarditis for a long period. The diagnosis of inflammation rests on many other findings than morphological alterations and it is indeed questionable if inflammation is solely a morphological diagnosis. The methodologies of pathology can be improved and used in a better and more purposeful way even under routine conditions. It is concluded that morphology is still mandatory to make a final diagnosis of peri- and myocarditis.
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