Evaluation of breast tumors with color Doppler imaging: a comparison with image-directed Doppler ultrasound

Preclinical experience has shown that it is possible to maintain and expand hematopoietic cells in liquid culture systems by provision of optimal combinations of colony-stimulating factors (CSF). Ex vivo hematopoietic cell expansion (HCE) would be expected to reduce harvesting time and effort and could also decrease the infusion dose necessary for hematopoietic reconstitution after bone marrow transplantation. In addition, ex vivo expanded cells might be of value for therapeutic gene transfer. The central question in ex vivo HCE is whether the CSF combinations employed provide not only amplification of the late progenitor pools, but also maintenance or expansion of the stem cell compartment to ensure long term engraftment. Choice of CSF and experimental parameters in the culture system appear to be the most critical factors influencing the outcome of strategies for ex vivo HCE. Moreover, it is essential to define the goal of HCE and to adapt the experimental conditions to obtain the required cell populations. In future work, it remains to test the potential applicability of ex vivo expanded cells and to carefully monitor the possibility of the expansion of tumoral cells in ex vivo proliferation systems.     

Diagnostic ultrasound in the evaluation of scrotal masses

Evaluation of 27 patients with scrotal masses was done with gray scale ultrasound. Given the clinical diagnosis ultrasound proved reliable in almost all cases.     

Vascular patterns of gestational trophoblastic tumors by color Doppler ultrasound

BACKGROUND: Destruction of uterine vasculature is a common phenomenon in gestational trophoblastic tumors. The authors categorized such uterine vasculature by color Doppler ultrasound and studied its clinical significance. METHODS: Color Doppler ultrasound was performed in 28 patients with gestational trophoblastic tumors. The vascular morphologic manifestations were recorded, and the peak systolic velocity and resistance index of uterine artery were calculated. Serum beta-human chorionic gonadotropin (hCG) levels were measured periodically to monitor chemotherapy response. Seventeen uneventful postmole uteri were used as controls. Two-tailed Student's t-test and Fisher's exact test were used for statistical analysis. RESULTS: The gestational trophoblastic tumors were categorized as diffuse type (N = 7), lacunar type (N = 16), and compact type (n = 5) according to their vascular patterns. The mean serum beta-hCG level at diagnosis in diffuse type lesions (6608 +/- 6320 mIU/mL) was significantly lower than in the lacunar type (40462 +/- 39735 mIU/mL; P = 0.04) and compact type (212114 +/- 205126 mIU/mL; P = 0.02), whereas the level in compact type lesions was significantly higher than in the lacunar type (P = 0.003). Lacunar type lesions exhibited a significantly lower uterine artery resistance index (0.51 +/- 0.13) than diffuse type (0.66 +/- 0.10; P = 0.03) or compact type lesions (0.70 +/- 0.06; P = 0.02). All lesions exhibited significantly higher peak systolic velocity than control subjects (P < 0.001); however, no significant difference was observed among them. Brief courses (< 5 cycles) of chemotherapy cured more diffuse type (6 of 7) than lacunar type (3 of 15, P = 0.006) or compact type lesions (0 of 5, P = 0.008). Histopathologic diagnosis was available for 11 lesions. They were invasive mole in seven lacunar type lesions and choriocarcinoma in four compact type lesions. CONCLUSION: Vascular morphologic patterns of gestational trophoblastic tumors by color Doppler ultrasound correlated well with beta-hCG levels, uterine hemodynamics, chemotherapy response, and possibly the histopathologic diagnosis.     

Doppler ultrasound evaluation of fetal renal arteries in normal pregnancy

Normal values of the pulsatility index in the fetal renal arteries in a group of 65 uncomplicated pregnancies were established. The measurements were obtained between 28 and 40 weeks of gestation. The values of pulsatility index may be used as a reference for further investigation of pathologic pregnancies.     

Atrioventricular valve dysfunction: evaluation by Doppler and cross-sectional ultrasound

BACKGROUND: A variety of factors can influence the suitability of a congenitally malformed heart for biventricular repair, including size, morphology, function, and dimensions and function of the inflow and outflow, among others. Although certain features have been identified that may indicate a lower probability of successful biventricular repair, our ability to predict whether a particular patient will be able to tolerate completely separate in-series systemic and pulmonary circulations remains imperfect. METHODS AND RESULTS: In this review, we discuss the echocardiographic evaluation of various factors that can influence a patient's suitability for two ventricle repair. We call on our own experience, and illustrate our discussion with a number of echocardiographic images. CONCLUSIONS: In most cases, echocardiography allows for full assessment of the anatomic and functional features that influence whether a patient is a suitable candidate for biventricular repair. Although a number of indices have been developed for determining who can and cannot be expected to undergo successful two ventricle repair, there remains substantial room for progress in this area.     

D-galactose-based signal-enhanced color Doppler sonography of breast tumors and tumorlike lesions

RATIONALE AND OBJECTIVES: This study sought to evaluate prospectively the diagnostic potential of unenhanced and enhanced color Doppler and power Doppler for the differentiation of tumors and tumorlike lesions of the breast. METHODS: Ninety-two patients with 110 tumors or tumorlike lesions of the breast were investigated by unenhanced and enhanced color and power Doppler ultrasound. The sonomorphologic aspects of vascularization were analyzed. In addition, maximal systolic frequency shift, resistance, and pulsatility indices were determined. RESULTS: In 15 (24%) of 63 primary carcinomas, 15 (68%) of 22 fibroadenomas, and all (100%) of 14 postoperative lesions, the sonomorphologic analysis for the differential diagnosis of breast tumors was improved after contrast enhancement in color Doppler mode. In comparing unenhanced color Doppler to power Doppler, the latter was found to be slightly superior (sensitivity, 60% vs. 67%; specificity, 39% vs. 45%, respectively); after enhancement, both modes were equivalent (sensitivity, 100% vs. 100%; specificity, 95% vs. 95%, respectively). Signal enhancement resulted in a significant improvement in sensitivity and specificity (P < 0.01). Typical signs of malignancy were irregular vessel calibers, serpiginous courses, penetration of the tumor's margin, and irregular reticular vascularization. The quantitative parameters proved not to be helpful for the differential diagnosis of breast tumors. CONCLUSIONS: By improved analysis of the vascularization pattern, d-galactose-enhanced color Doppler sonography was found to provide more reliable differential diagnostic information than unenhanced Doppler ultrasound in tumors and tumorlike lesions of the breast.     

Usefulness of Doppler ultrasound in the evaluation of patients with active Crohn's disease

OBJECTIVES: To assess the usefulness of Doppler ultrasound in the evaluation of the vascular changes in the splanchnic circulation and bowel wall described in patients with active Crohn's disease (ACD). DESIGN: We analyzed prospectively with Doppler ultrasound the mean velocity of portal flow, the resistive index (RI) of the superior mesentery artery (SMA) and we looked for vessels within the bowel wall. PATIENTS: 50 patients with ACD and 30 normal individuals. RESULTS: In comparison with normal individuals, patients with ACD showed a statistically significant difference (p < 0.001) in the mean velocity of the portal flow and in the RI of the SMA. In all patients with ACD, vessels could be seen within the bowel wall using the color Doppler ultrasound. CONCLUSION: Doppler ultrasound can be used as a non-invasive method to evaluate the vascular changes which develop in the splanchnic circulation and bowel wall of patients with ACD.     

Preoperative determination of the structure of pelvic tumors with color-coded Doppler ultrasound and conventional transvaginal ultrasound diagnosis]

In 265 adnexal masses results of conventional transvaginal sonography and coloured doppler sonography were compared with histopathological results. Statistical evaluation was based on lowest PI and RI as well as highest peak systolic velocity from signals derived of all detectable tumour vessels. Cut-off values from actual literature and cut-off values established in Aachen (PI < 0.69, RI < 0.45) were used. Histopathologic evaluation showed 210 (79.2%) benign and 55 (20.8%) malignant ovarian tumours. A cut-off at < 0.69 for the PI led to a sensitivity of 79.6% and a specificity of 58.2%. For RI sensitivity was 66.7% and specificity was 68.7% at a cut-off at < 0.45. The sonomorphologic evaluation following a scale published by Sassone et al. [20] had a sensitivity of 85.2% and a specificity of 67.1%. There was no statistical significant difference between mean values for peak systolic velocity in benign and malignant tumours. The exclusive evaluation with Doppler sonography leads to a high percentage of misdiagnosis. A combination with sonomorphologic evaluation does not lead to an important improvement of preoperative diagnosis as there is a bright overlap between benign and malignant tumours. In contrast Doppler sonography might add important information in the preoperative evaluation of early ovarian cancer.     

Endoscopic ultrasound in the evaluation of gastric small lymphocytic mucosa-associated lymphoid tumors

In this study, we examined the effects of recombinant bovine gamma interferon (rIFN-gamma) and nitric oxide (NO) on the interaction of M. avium subsp. paratuberculosis with bovine monocytes. Monocytes pretreated with rIFN-gamma exhibited slightly increased phagocytosis of M. avium subsp. paratuberculosis and modest inhibition of the intracellular growth of this microorganism. The number of viable intracellular bacilli decreased earlier in rIFN-gamma-pretreated monocytes than in control monocytes. After infection with M. avium subsp. paratuberculosis, NO was not constitutively released, but NO release from infected monocytes was induced by treatment with rIFN-gamma or with rIFN-gamma and lipopolysaccharide (LPS). Release of nitric oxide was inhibited by addition of N(G)-monomethyl-L-arginine; however, inhibition of nitric oxide did not alter the pattern of intracellular survival of M. avium subsp. paratuberculosis in rIFN-gamma-treated bovine monocytes. Although chemically generated nitric oxide killed M. avium subsp. paratuberculosis in a cell-free system in vitro, the amount of nitric oxide required was far greater than that released from infected monocytes stimulated with rIFN-gamma and LPS. Our data suggest that rIFN-gamma activates M. avium subsp. paratuberculosis-infected bovine monocytes to release nitric oxide but only modestly increases antimycobacterial activity of monocytes against this organism. This may be due, in part, to the fact that the amount of nitric oxide produced by rIFN-gamma-activated bovine monocytes is insufficient to kill intracellular M. avium subsp. paratuberculosis bacilli in vitro.     

The accuracy of breast ultrasound in the evaluation of clinically benign discrete, symptomatic breast lumps

INTRODUCTION: Recent reports have suggested that breast ultrasound (US) is of value in distinguishing malignant from benign processes. The aim of this study was to establish the accuracy of US in detecting invasive malignancy in clinically benign, discrete, symptomatic breast lumps. METHODS: The US appearances of 205 clinically benign breast masses were documented prospectively and prior to mammography by one radiologist (AJE). The US appearances were then correlated with the fine needle aspiration (FNA), core biopsy and surgical findings and compared with the mammographic findings. RESULTS: The US findings were normal 72 (35%), simple cyst 63 (31%), solid benign 51 (25%), solid indeterminate 15 (7%) and solid malignant four (2%). Ultrasound characterized 13 (93%) of the 14 patients found to have invasive carcinoma as indeterminate or malignant. No patients with normal or simple cyst US findings had invasive malignancy. Ultrasound had significantly better accuracy (97% vs 87%, P < 0.02) sensitivity (93% vs 57%, P < 0.05) and negative predictive value (99% vs 92%, P < 0.002) than mammography in the detection of invasive carcinoma when indeterminate and malignant imaging findings were taken as positive. CONCLUSION: US is a useful adjunct to FNA/core biopsy in confirming the nature of symptomatic, clinically benign breast masses and is superior to mammography in this clinical setting.     

Diagnostic pitfalls in bronchopulmonary tumors

There is growing evidence that proteinuric hypertension of pregnancy (preeclampsia) is associated with endothelial dysfunction. The aim of this study was to evaluate the effects of serum from preeclamptic patients on basal and agonist-stimulated prostacyclin production by human umbilical vein endothelial cells (HUVEC) in culture and to compare these to the effects of serum from normal pregnant and nonpregnant women. During a 24 h incubation of HUVEC with 20% of preeclampsia serum, baseline prostacyclin output was significantly (P < 0.01) increased over the control groups. However, this response was attenuated by extending the exposure to 72 h. Histamine, thrombin and the calcium ionophore, A23187, all acutely increased prostacyclin production, but the increase relative to baseline levels was greatest in HUVEC preincubated for 24 h in normal serum transiently promotes prostacyclin production in HUVEC derived from normal pregnancies, preeclampsia serum transiently promotes prostacyclin production in HUVEC derived from normal pregnancies, and 2) the relative increase in response to agonists is reduced by preeclampsia serum, compared to normal pregnancy sera.     

The blood flow characteristics in borderline ovarian tumors based on both color Doppler ultrasound and histopathological analyses

We previously reported that a macrophage response that increased binding to 125I-radiolabeled soluble denatured collagen (gelatin) was induced by preincubation of macrophage with a 70-kDa amino-terminal fibronectin fragment and soluble nonlabeled gelatin [S. F. Penc, F. A. Blumenstock, J. E. Kaplan (1995) J. Leukoc. Biol. 58, 501-509]. We now report that neither protein synthesis nor recycling of receptors between the cell surface and interior were required for this response. However, removal of cell surface components with trypsin demonstrated that induced gelatin binding required native cell surface constituents. It was found that in the presence of the 70-kDa fibronectin fragment and gelatin, matrix metalloprotease-2 (MMP-2) and matrix metalloprotease-9 (MMP-9) activity in the cell layers was significantly decreased or undetectable, respectively. Similar levels of increased gelatin binding could be reproduced after inhibition of matrix-degrading metalloprotease activity with 1'10-phenanthroline. These results demonstrate that a macrophage specific response that decreased gelatinase activity and increased gelatin binding was initiated by interaction with a 70-kDa fibronectin fragment and gelatin.     

Renovascular disease: Doppler ultrasound

Color Doppler ultrasound (CDUS) seems to be an effective imaging technique for the diagnosis of renal vascular diseases. It is already the modality of choice for the detection of acute renal vein thrombosis and nonocclusive intrarenal vascular disorders including iatrogenic arteriovenous fistula and false aneurysm, particularly in patients with impaired renal function that precludes the use of iodinated contrast agents. Although proximal Doppler interrogation remains an important step in diagnosing renal artery (RA) stenosis, useful hemodynamic information can be obtained from the distal arterial bed. When CDUS fails in identifying proximal RAs, normal waveform velocity and morphology obtained from intrarenal arteries enable one to rule out RA occlusion and most of the severe stenoses (> or = 80%). Such information, which is not subject to a significant risk of technical failure, seems to be particularly useful in studying patients with acute renal failure of suspected vascular origin. Despite the extreme variability in reported performance between studies, CDUS has seemed to be a valuable tool compared with other noninvasive modalities in the diagnosis of RA stenosis. Whereas a CDUS-based strategy is already accepted in numerous specialized centers, a thorough evaluation of diagnostic criteria and extensive training of operators will allow CDUS to be widely accepted for the screening of patients at high risk for renovascular hypertension.     

Diagnostic value of glutathione-S-transferase

The authors evaluated the diagnostic value of the glutathione-S-transferase (GST) enzyme in the medical practice. The GST is widely distributed in human tissues, the majority of the enzyme protein is present in the cytoplasm. GST plays a pivotal protective role against the environmental damages. It can be made a conclusion from the quantity, the localization of the enzyme expression and enzyme forms to the degree of chemical insult suffered by the organism. The increase of alpha GST izoenzyme can reflect the degree of the hepatocellular and renal proximal tubular epithelium damage. The overexpression of pi-class GST represents the injury of bile epithelium and renal distal tubules. Overexpression of GST is associated with tumor appearances and with resistance to cytostatic agents. It was possible to took the enzyme izoenzymes apart, to identify them--hereby to explore their origin--and to detect their quantity with the development of the separation techniques, the immunological and genetical methods. Since the enzyme expression is in direct proportion to the magnitude organs and tissues damage or/and the presence of specific izoenzymes suspects tumor formation, for this reason the monitoring of the GST expression could give a help for the physicians in creating the diagnosis.     

Pulsed Doppler studies in B-mode ultrasound scanning

In B-mode ultrasound abdominal studies, vascular structures may be confused with other tissues. A pulsed Doppler unit was coupled to a B-mode scanner by attaching the Doppler transducer to the B-mode transducer. A standardization procedure was designed to assure that the ultrasound beams from the 2 transducers were properly aligned, and that the Doppler focusing was accurate. The Doppler signal may be obtained from any point in the B-mode image in order to differentiate vascular structure from other tissue types.     

Diagnostic value of albumin gene expression in liver tumors: case report and review of the literature

To test the hypothesis that human cytomegalovirus (CMV) gB genotype may differ with geographic origin or patient demographics, CMV DNA was amplified for gB typing from immunocompromised patients in Italy and Africa and compared with previously reported frequencies in California. Increased gB2 frequency occurred in Italian homosexual AIDS patients, as compared with both Italian heterosexual injection drug users with AIDS and heterosexual Zimbabwe AIDS patients. Occurrence of gB3 in Italy was higher in injection drug users than in homosexual AIDS patients. The incidence of gB4 was higher overall in the Italian as compared with the California patients. Therefore geographic and demographic differences in patients affect gB distribution and should be considered before associations of gB genotypes and virulence are made.