Complete MR angiography and Doppler ultrasound as the sole imaging modalities prior to carotid endarterectomy

OBJECTIVE: To assess the combination of duplex Doppler ultrasound (DUS) and complete carotid magnetic resonance angiography (MRA) for the non-invasive imaging of carotid disease and their effect on outcomes. Determine inter-reader agreement of carotid MRA. MATERIALS AND METHODS: One-hundred and ten carotid bifurcations were evaluated using DUS, 2D and 3D time-of-flight MRA from the aortic arch to the Circle of Willis in 55 patients. Percentage stenoses were determined by two blinded readers using standardized criteria. Clinical follow-up was by chart review. RESULTS: Correlation of Doppler and MRA was excellent (r=0.903, P<0.001). Inter-reader agreement (K) for MRA was good: internal carotid artery (ICA) (0.750), external carotid artery (ECA) (0.674) and common carotid artery (CCA) (0.410). Differences in CCA readings were due to minor differences in categorizing lesions as CCA versus ICA or ECA. MRA and Doppler detected nine occluded ICAs. Two DUS occlusions had ICA flow by MRA; one due to a reconstituted precavernous ICA, one a near occluded vessel. Five patients (9%) had surgical management modified by MRA with four not having surgery: three distal ICA/Siphon occlusions and one less severe stenosis by MRA. One tandem lesion not visualized by DUS was surgically significant. Nine aortic arch abnormalities had no surgical impact, possibly due to small sample size. Of 41 endarterectomies, there were no complications from errors of diagnosis. CONCLUSION: Carotid MRA correlates well with DUS with good inter-reader agreement. MRA confirms Doppler findings, expands anatomical information and identifies tandem lesions from the aortic arch to the Circle of Willis which can affect surgical management. This approach to carotid artery imaging appears to have no negative effect on surgical outcome.     

Dilated fallopian tubes: MR imaging characteristics

A complex of four proteins isolated from neuronal membranes has ligand binding sites for N-methyl-d-aspartate (NMDA) receptor agonists and antagonists and forms NMDA-activated ion channels upon reconstitution into lipid membranes. In this study, the cDNA of a subunit of this complex containing binding sites for the competitive antagonists of NMDA receptors was cloned. The cDNA clone coded for a protein of 719 amino acids (78.9 kDa). The expressed protein had binding activity for the agonists l-[3H]glutamate and [3H]glycine, the antagonist (+/-)-[3H]-(E)-2-amino-4-propyl-5-phosphonopentanoic acid ([3H]CGP 39653), but not the ion channel inhibitors. The cloned cDNA had no homology to other cloned cDNAs. Northern blot analyses indicated high expression of an 3.8 kb poly(A+) RNA in brain, but not in other tissues. These findings indicate that proteins that have recognition sites for NMDA receptor activators and inhibitors and that differ from the well-characterized NMDA receptor proteins NR1-3 are expressed in mammalian brain.     

Restorative dentistry. Crown therapy

Not one post, core, margin, impression material, cement, or final restoration can be used in all clinical situations. This article does not discuss the merits and shortcomings of the numerous restorative concepts and techniques that exist, but rather has concentrated on those that the author believes are valid and applicable today. If one third or more of the anatomic crown remains, or if this is achieved by crown lengthening, a post may not be necessary; however, a crown restoration should definitely be considered. Veterinary dentistry cannot limit those variables that occur daily in clinical practice. Veterinarians must learn to work with these variables and spend less time trying to find the one that applies to all cases. When the basic concepts of how to retain the various restorative components and how to protect remaining tooth structure are understood, the ability to answer numerous questions that arise during the restorative process is facilitated and results in final restorations that are based on sound design principles.     

VH gene analysis of primary cutaneous B-cell lymphomas: evidence for ongoing somatic hypermutation and isotype switching

Primary cutaneous B-cell lymphomas are B-cell non-Hodgkin's lymphomas that arise in the skin. The major subtypes discerned are follicle center cell lymphomas, immunocytomas (marginal zone B-cell lymphomas), and large B-cell lymphomas of the leg. In this study, we analyzed the variable heavy chain (VH) genes of 7 of these lymphomas, ie, 4 follicle center cell lymphomas (diffuse large-cell lymphomas) and 3 immunocytomas. We show that all these lymphomas carry heavily mutated VH genes, with no obvious bias in VH gene usage. The low ratios of replacement versus silent mutations observed in the framework regions of 5 of the 7 lymphomas suggest that the structure of the B-cell antigen receptor was preserved, as in normal B cells that are selected for antibody expression. Moreover, evidence for ongoing mutation was obtained in 3 immunocytomas and in one lymphoma of large-cell type. In addition, in 1 immunocytoma, both IgG- and IgA-expressing clones were found, indicative of isotype switching. Our data provide insight into the biology of primary cutaneous B-cell lymphomas and may be of significance for their classification.     

The human S-cone electroretinogram and its variation among subjects with and without L and M-cone function

PURPOSE: To examine the S-cone ERG in subjects with and without L and M-cone function. METHODS: Ganzfeld spectral flashes in the presence of strong Ganzfeld adapting fields are used to elicit S-cone ERGs. RESULTS: The S-cone ERG b-wave ranges from 0.2 to 4 mV in amplitude and 38-45 msec in implicit time. There is a progressive decrease in amplitude with age. The response is similar in subjects with or without L and M cone function. CONCLUSION: The S-cone ERG is detectable in subjects of all ages, but intersubject variability limits its diagnostic usefulness. The S-cone ERG is slightly later than but does not appear to be obviously influenced by the L and M-cone ERG.     

Recurrent endometrial adenocarcinoma after surgery alone: prognostic factors and treatment

Twenty-six patients with a local and/or regional relapse of a previously surgically treated adenocarcinoma of the endometrium were referred to the Dr. Daniel den Hoed Cancer Center (DDHCC) in Rotterdam, The Netherlands between 1965 and 1985 for external radiotherapy (ERT) and/or brachytherapy (BT). The 5-year overall survival was 44%. Tumour volume seemed to be an important prognostic factor in locoregional control; 1 out of 17 patients with tumour sizes smaller than or equal to 4 cm relapsed locoregionally, while in 3 out of 9 patients with tumour sizes of more than 4 cm a locoregional recurrence developed. Another important finding is the impact of RT on treatment outcome: none of the 16 patients treated with a combination of ERT and BT failed locoregionally, while 4 out of 10 patients treated with either ERT or BT relapsed.     

Gastrointestinal and nutritional aspects of eating disorders

Anorexia nervosa (AN) and bulimia nervosa (BN) are potentially fatal eating disorders which primarily affect adolescent females. Differentiating eating disorders from primary gastrointestinal (GI) disease may be difficult. GI disorders are common in eating disorder patients, symptomatic complaints being seen in over half. Moreover, many GI diseases sometimes resemble eating disorders. Inflammatory bowel disease, acid peptic diseases, and intestinal motility disorders such as achalasia may mimic eating disorders. However, it is usually possible to distinguish these by applying the diagnostic criteria for eating disorders and by obtaining common biochemical tests. The primary features of AN are profound weight loss due to self starvation and body image distortion; BN is characterized by binge eating and self purging of ingested food by vomiting or laxative abuse. GI complications in eating disorders are common. Recurrent emesis in BN is associated with dental abnormalities, parotid enlargement, and electrolyte disturbances including metabolic alkalosis. Hyperamylasemia of salivary origin is regularly seen, but may lead do an erroneous diagnosis of pancreatitis. Despite the weight loss often seen in eating disorders, serum albumin, cholesterol, and carotene are usually normal. However, serum levels of trace metals such as zinc and copper often are depressed, and hypophosphatemia can occur during refeeding. Patients with eating disorders frequently have gastric emptying abnormalities, causing bloating, postprandial fullness, and vomiting. This usually improves with refeeding, but sometimes treatment with pro-motility agents such as metoclopromide is necessary. Knowledge of the GI manifestations of eating disorders, and a high index of suspicion for one condition masquerading as the other, are required for the correct diagnosis and management of these patients.     

Detection of specific and 'constitutive' antibody secreting cells in the gills, head kidney and peripheral blood leucocytes of dab (Limanda limanda)

The relative immunological importance of the gills of fish was investigated in terms of antibody production by enumerating antibody secreting cells (ASC) in the gills, head kidney and blood of dab (Limanda limanda) using the ELISPOT assay. The contribution of 'constitutive' ASC in the gill appeared more substantial than that of elicited specific ASC. The gills were found to contain a mean (+/- SD) of 4227 +/- 1029 'constitutive' ASC/10(6) cells which was fewer than the head kidney which contained a mean (+/- SD) of 15617 +/- 3723 'constitutive' ASC/10(6) cells but more than peripheral blood leucocytes which contained a mean (+/- SD) of 2650 +/- 212 'constitutive' ASC/10(6) cells. The number of specific anti-human gamma globulin (HGG) ASC following parenteral or oral administration of HGG was also determined. Anti-HGG ASC were detected in all three tissues following parenteral immunization, peaking simultaneously, 4 weeks post-immunization. The strongest response was found in the head kidney. After oral immunization, responses were much weaker: again the head kidney was the most active but the gill response was barely detectable. These data were complemented by measurement of specific antibody in the serum by ELISA. Serum antibody titres following immunization were found to correlate closely with the number of specific ASC in the head kidney following parenteral immunization whereas serum antibody titres after oral administration of antigen most closely followed the number of specific ASC in the blood. In the light of these data it is suggested that the primary immunological role of the leucocytes in the gill may be in the earliest stages of defence against infection.