MRI of intracranial subependymomas

OBJECTIVE: We report imaging features of two cases of subependymoma, a relatively rare benign intraventricular neoplasm. MATERIALS AND METHODS: The first case was a lateral ventricular tumor, which grew to a large size before becoming symptomatic. The second case was a fourth ventricular subependymoma with extensive cisternal spread. RESULTS: In Case 1, absence of postcontrast enhancement suggested the correct diagnosis. However, in Case 2 heterogeneous enhancement made the diagnosis uncertain. In both cases, pre- and postoperative MRI was superior to other modalities in defining tumor extent and delineating the surrounding anatomy. CONCLUSIONS: Magnetic resonance imaging is the modality of choice for studying subependymomas. The diagnosis should be placed among differential considerations for intraventricular tumors.     

Clinical significance of insulin resistance

Insulin resistance has emerged in the last 20 years as a concept familiar to clinicians in many specialties. No easily performed laboratory test is available to assess insulin action in routine clinical practice. Several rare syndromes of severe insulin resistance are recognized but most clinicians will encounter insulin resistance as a manifestation of common diseases. Physiological and treatment induced changes in insulin sensitivity influence insulin doses required in insulin-dependent diabetes mellitus. In non-insulin-dependent diabetes mellitus insulin resistance is fundamental to pathogenesis but it is also influenced by standard dietary and pharmacological treatment, and probably mediated by changes in prevailing glycaemia. Antihypertensive agents appear to have diverse effects on the insulin resistance of essential hypertension though the long term significance of these remains unclear. The importance of insulin as a risk factor for coronary heart disease and the concept of an insulin resistance syndrome as a common precursor of conditions with increased vascular risk remains controversial.     

Analysis of the unique hamster cell tropism of ecotropic murine leukemia virus PVC-211

PVC-211 murine leukemia virus (MuLV) is a neuropathogenic variant of Friend MuLV (F-MuLV). Previous studies from our laboratory demonstrated that unlike the parental F-MuLV, PVC-211 MuLV can infect rat brain capillary endothelial cells efficiently and that it has acquired genetic changes responsible for its expanded cellular tropism. To determine if PVC-211 MuLV also has expanded its host range, we tested its infectivity on Chinese hamster ovary-derived CHO-K1 cells, which are generally resistant to ecotropic MuLV. The results indicated that PVC-211 MuLV, but not F-MuLV, was highly infectious for CHO-K1 cells. Studies using glycosylation inhibitors and glycosylation mutants of CHO-K1 cells, as well as interference studies, suggested that PVC-211 MuLV has acquired the ability to interact with the ecotropic MuLV receptor on CHO-K1 cells that has undergone glycosylation-dependent modification. Using chimeric viruses between PVC-211 MuLV and F-MuLV, we were able to localize the viral genetic element crucial for CHO-K1 cell tropism within the env gene of PVC-211 MuLV and show that glycine at position 116 and lysine at position 129 of the envelope glycoprotein SU were important. These viral determinants also appear to confer tropism for other hamster cells resistant to ordinary ecotropic MuLVs. Further studies on the interaction between PVC-211 MuLV and the receptor on hamster cells may provide novel insights into the molecular mechanisms for receptor recognition and binding by viral envelope glycoproteins.     

CT of the extraperitoneal space: normal anatomy and fluid collections

Knowledge of the appearance and location of the normal fascial structures surrounding the kidneys and the bladder is the key to proper CT analysis of extraperitoneal fluid collections. Recent studies have shown that the renal fascia and the perirenal space are more complex than previously recognized. An extracapsular renal hematoma, confined against the kidney by the posterior renorenal septum within the perirenal space, can entirely simulate a subcapsular hematoma. Pancreatitis fluid can dissect between the discrete layers that constitute the posterior renal fascia, allowing fluid in the anterior pararenal space to extend posterior to the kidney without directly involving the posterior pararenal space. The umbilicovesical fascia separates the small perivesical space from the potential large reservoir of the prevesical space in the extraperitoneal portion of the pelvis. Fluid in the prevesical space can communicate directly with the retroperitoneal spaces surrounding the kidney. In addition to compartmental localization, CT features of the fluid itself or the presence of ancillary findings such as aortic aneurysm, enlarged pancreas, renal mass, or hydronephrosis will frequently indicate the cause and the extent of most extraperitoneal fluid collections.     

Current status and future possibilities of transjugular intrahepatic portosystemic shunts in the management of portal hypertension

Transjugular intrahepatic portosystemic shunt (TIPS) is an exciting new method for treating complications of cirrhosis. Technical advances have allowed TIPS to be widely applied in the treatment of variceal bleeding. This article presents and discusses the results of recent experiences in TIPS placement. TIPS can be successfully placed in almost all patients. The complication rate of the procedure is low. TIPS is an effective means of controlling variceal bleeding and is especially useful for controlling bleeding in patients awaiting liver transplantation. It may also have a role in the treatment of ascites and other conditions related to portal hypertension. The most important issue facing TIPS is the long-term patency of the shunt. Potential solutions to the problem of long-term shunt patency are discussed.