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PubMed2003

Thin-section CT findings in 32 immunocompromised patients with cytomegalovirus pneumonia who do not have AIDS.

OBJECTIVE: The aim of this study was to review the thin-section CT findings in 32 immunocompromised patients without AIDS who had proven Cytomegalovirus pneumonia. MATERIALS AND METHODS: The causes of immunocompromise included bone marrow (n = 25) or solid organ transplantation (n = 5) and corticosteroid therapy (n = 2). The patients included 16 men and 16 women ranging in age from 22 to 70 years (mean age, 43 years). The CT scans were retrospectively reviewed by two thoracic radiologists for the presence, appearance, and distribution of parenchymal abnormalities. RESULTS: Bilateral abnormalities were seen in all patients. Areas of ground-glass opacification were seen in 21 (66%) of 32 patients. Ground-glass opacification was the predominant CT feature in nine cases (28%). In 19 of 32 patients, ground-glass attenuation was associated with other abnormalities. Multiple nodules were identified in 19 patients (59%). Nodules were bilateral in 15 patients and unilateral in four patients. Nodules were the only CT finding in three patients (9%). Areas of air-space consolidation were identified in 19 patients (59%). Air-space consolidation was the only CT finding in one patient (3%). Other less common CT findings included thickening of the bronchovascular bundles (n = 7) and the tree-in-bud appearance (n = 4). Pleural effusions were seen in seven patients. CONCLUSION: The thin-section CT manifestations of Cytomegalovirus pulmonary infection usually consist of a mixture of patterns, most commonly ground-glass attenuation, areas of consolidation, and small nodules.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Usefulness of simultaneous acquisition of spatial harmonics technique for MRI of the knee.

OBJECTIVE: Simultaneous acquisition of spatial harmonics (SMASH) is a parallel-imaging technique that uses fewer echoes than conventional techniques to obtain the desired resolution. Images are produced in a shorter time period using the SMASH technique than conventional techniques. This study assesses the usefulness of the SMASH technique in the MRI evaluation of the knee. SUBJECTS AND METHODS. Three experienced musculoskeletal radiologists prospectively interpreted MR images of the knee in 50 consecutive patients. All patients underwent a complete MRI examination of the knee on a 1.5-T MRI scanner. Sagittal proton density fat-saturated and coronal T1-weighted images were obtained. In addition, fat-saturated T2-weighted images were obtained in the coronal, sagittal, and axial planes. SMASH T2-weighted imaging in the coronal, axial and sagittal planes took 6 min 38 sec, whereas fast spin-echo conventional T2-weighted imaging took 11 min 45 sec to obtain images in the same planes. Each radiologist interpreted the knee MR examinations prospectively and was unaware whether the images had been obtained using the SMASH T2-weighted or fat-saturated T2-weighted technique. The radiologists provided a report. The three radiologists independently performed a retrospective review of both the fat-saturated T2-weighted and SMASH T2-weighted images. The radiologists were blinded as to which sequence was fat-saturated T2-weighted and which was SMASH T2-weighted. They were asked to reinterpret the images and determine whether either of the T2-weighted sequences altered the original interpretation. RESULTS: There was no intraobserver variability in MRI interpretations with the use of SMASH imaging as compared with fat-saturated T2-weighted images. Thirty-four patients underwent arthroscopy after imaging. Findings at arthroscopy in those patients were as follows: 28 meniscal tears, 12 anterior cruciate ligament tears, and nine chondral defects. In some patients, multiple abnormalities were detected on MRI. All arthroscopy findings correlated with prospective MRI interpretations. CONCLUSION: The use of SMASH T2-weighted imaging as opposed to fat-saturated T2-weighted imaging results in a significant decrease in imaging time (> 5-min decrease for each knee examination) without affecting the MRI interpretation or patient clinical outcome.

Adult↗
PubMedDate not supplied

[Chylous effusions].

This paper presents 4 patients with chylothorax, and one patient with bilateral chylothorax and chyloperitoneum. The chylous effusions were of benign etiology, developed as a complication of miliary tuberculosis (1 patient), after L-2 vertebral body fracture (1 patient), and idiopathic (2 patients). The diagnosis was confirmed by the presence of chylomicrons and high content of triglycerides in the effusion, ranged 11.9-29.1 mmol/l. Lymphangiography showed multiple abnormalities of lymphatic system, the obstruction of ductus thoracicus, dilatation and convulsion of lymphatic channels, but the site of lymphatic leak was not detected. The treatment included an extended period of pleural and peritoneal drainage with total parenteral nutrition (1 patient), pleurodesis using Corynebacterium parvum (2 patients), and surgical partial parietal pleurectomy with continuous drainage (1 patient). The treatment was successful in all patients.

Adult↗
PubMed1986

Prevention of diabetes in BB rats. I. Evidence suggesting a requirement for mature T cells in bone marrow inoculum of neonatally injected rats.

Injection of major histocompatibility complex (MHC)-compatible bone marrow cells from normal animals into neonatal BB rats resulted in a striking decrease in incidence of diabetes and restoration of concanavalin A (ConA) and mixed lymphocyte responses. However, injection of bone marrow cells pretreated with anti-rat thymocyte antiserum plus complement to remove mature T cells had no effect on incidence of disease, suggesting that mature T cells in the bone marrow inoculum were responsible for prevention of diabetes. Because the decreased incidence of diabetes in rats injected with untreated bone marrow appeared to be unrelated to the extent of lymphopenia in these animals, the involvement of T cells in the onset of diabetes must reflect a defect in the normal function of these cells rather than their absolute number. Approximately 50% of the W3/13+ cells in the spleens of BB rats lacked the OX-8 and W3/25 T cell subset markers. The identity of this W3/13+, OX-8-, W3/25- blank subset remains to be established. Our results, interpreted in light of studies from the other laboratories, suggest the existence of multiple abnormalities in the BB rat, including the presence of T cells as effector or helper cells that augment onset of disease and the absence of a regulatory T cell circuit that could prevent the disease.

Animals↗
PubMed1994

Microalbuminuria precedes the development of NIDDM.

Several studies have indicated that insulin resistance, elevated blood pressure (BP), and dyslipidemia precede the onset of non-insulin-dependent diabetes mellitus (NIDDM). Little data, however, exist on the presence of renal disease in prediabetic subjects. We measured albumin excretion in a cross-sectional population study in subjects 65-74 years of age living in eastern Finland in relation to the risk of developing diabetes 3.5 years later. The prevalence of microalbuminuria (urinary albumin-to-urinary creatinine ratio > or = 2 mg/mmol) was 1.3-, 1.8-, and 2.0-fold higher among subjects with impaired glucose tolerance (n = 242), newly diagnosed NIDDM subjects (n = 92), and previously diagnosed NIDDM subjects (n = 136), respectively, compared with subjects with normal glucose tolerance (n = 826). Nondiabetic subjects with microalbuminuria had multiple abnormalities in cardiovascular risk factors including elevated BP, high triglyceride concentration, high insulin concentration, and a low high-density lipoprotein cholesterol concentration, a cluster of risk factors typical for prediabetic individuals. The relationship between microalbuminuria and the incidence of NIDDM over the 3.5-year follow-up was studied in 891 subjects who were free of diabetes at baseline. Converters to diabetes (n = 69) had a higher prevalence of hypertension (68.1 vs. 54.4%, P < 0.05) and a higher prevalence of microalbuminuria (43.5 vs. 30.4%, P < 0.05) than nonconverters (n = 822). In logistic regression analysis, microalbuminuria predicted the development of NIDDM independently of BP level.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1981

Microcephaly, mental retardation and chromosomal aberrations in a girl following radiation therapy during late fetal life.

A human foetus was heavily irradiated in the thirtieth to the thirty-third week due to carcinoma of the uterine cervix of the mother. Irradiation after 20 weeks of pregnancy is thought not to produce severe abnormalities. However, the child showed microcephaly, mental retardation, stunted growth, microphthalmus, retinal degeneration, cataract and defective dentition. Cytogenetically the frequencies of both chromatid and chromosome breaks were increased.

Abnormalities, Multiple↗
PubMedDate not supplied

Protective effect of selenium against ionizing radiation-induced malformations in mice.

A single dose of sodium selenite (0.5 mg Se/kg b.w.) was injected intraperitoneally into mice on day 9 of pregnancy, either 30 min or 2 h before 1.75 Gy whole body irradiation. Administration of selenite 2 h but not 30 min before irradiation resulted in a significant decrease in the number of malformed foetuses (p less than 0.005). The decrease in foetal malformations occurred proportionally for all the major malformations observed, i.e. short or kinked tail, rib and vertebral malformations, coloboma and deformation of retina and iris. In addition, selenium pretreatment also protected against radiation-induced retardation of the sternum of the foetus.

Abnormalities, Multiple↗
PubMed1990

Natural history of breast cancer.

The natural history of breast cancer has been, and will be, extremely hard to study. Indirect evidence suggests that any cancer cell population may be phenotypically unique with multiple abnormal traits which decisively forge the clinical behavior. Histopathologic grouping will only give a very imperfect reflection of phenotypical individuality. It is proposed that essential determinants of the subsequent behavior have already been fixed during the induction period, i.e. long before the clinical debut. This may to some extent be reflected by the DNA content of the tumor cells. Metastases to axillary lymph nodes is strongly determined by size of primary tumor according to a function which suggests a smooth linear risk for lymphatic spread over a broad size interval. It is suggested that each cell of any given cancer may be endowed with a small chance of dissemination to axillary lymph nodes which may be essentially constant during the entire natural life history. Number of cancer cells of the primary tumor would then be the decisive determinant for risk of metastatic dissemination. It is not necessary to invoke qualitative progression from 'non-metastasibility' to 'metastasibility'. Small differences exist in the natural history of different histological types of breast cancer.

Breast Neoplasms↗
PubMed1992

Hormones and immune responsiveness in chronic lymphocytic leukemia.

Chronic lymphocytic leukemia (CLL) is a B cell disorder with multiple abnormalities in T-cell function. The status of the immune system will depend to some extent upon the net effect of the changes in the equilibrium of various hormones. In order to investigate the association of the defects in the cellular immunity and hormonal dysregulation in CLL, studies were performed in 130 CLL patients with that disorder. Decreased lymphocyte proliferation in response to mitogen stimulation appears to be an early event in CLL pathogenesis and is not always influenced by the clinical stage of the disease or the specific treatment. The dysfunction of T-lymphocytes was accompanied by increased serum cortisol (C) concentrations. Elevated levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), 17 beta-estradiol (E) and testosterone (T) ratio were found in male CLL patients, but not in female patients. In view of our findings, it is conceivable that there are a number of disturbances in the lymphocyte-microenvironmental regulation, which may be responsible for immuno-hormonal imbalance in some patients with CLL.

Adrenocorticotropic Hormone↗
PubMed1994

Neutrophils from patients with myelodysplastic syndromes: relationship between impairment of granular contents, complement receptors, functional activities and disease status.

Myelodysplastic syndromes (MDS) are stem cell disorders of clonal origin in which infections and leukemic transformation are quite frequent. Neutrophils from 28 patients with MDS were analysed by flow cytometry for the expression of the two complement receptors CR1 and CR3, the antigenic reactivity of some granule constituents--myeloperoxidase, lysozyme, elastase, lactoferrin--and functional activities, such as locomotion, respiratory burst and cytotoxicity. The results were correlated with the FAB disease subtypes, grouped as low risk (RA) and high risk patients (RAEB, RAEB-t, CMML) and with 30 healthy subjects. A significant reduction in the percentage of neutrophil CR1, CR3 positivity and chemotaxis induced by endotoxin-activated serum was detected in the high risk group when compared with the low risk group and healthy controls. Furthermore, the high risk group also showed a low amount of myeloperoxidase, elastase, lysozyme and superoxide anion, but both low and high risk groups displayed reduced cellular cytotoxicity in comparison with the control. This work indicates that MDS patients belonging to the more advanced FAB categories frequently show multiple abnormalities in the expression of neutrophil complement receptors, and granular components (> 3), as well as in cell functions, suggesting the possibility of using these phenotypic abnormalities in the monitoring of disease progression.

Chemotaxis, Leukocyte↗
PubMed1986

Radiological and pathological aspects of dural arteriovenous fistulas. Case report.

A case of dural arteriovenous (AV) fistula is presented with detailed radiological and pathological findings. The complex hemodynamic alterations that may result from dural AV fistulas are described. Pathological examination in this case demonstrated widespread occlusion of the superior sagittal sinus with multiple abnormal fistulous communications between abnormal arteries and arterialized veins. A portion of the lesion resembled a recanalized blood clot, in support of the theory proposed by others that dural AV fistulas are acquired lesions.

Adult↗
PubMed2002

Trigeminal neuralgia caused by microarteriovenous malformations of the trigeminal nerve root entry zone: symptomatic relief following complete excision of the lesion with nerve root preservation.

OBJECT: Within a series of 341 consecutive patients who underwent posterior fossa surgery for trigeminal neuralgia (TN), in five the cause was found to be a microarteriovenous malformation (micro-AVM) located in the region of the trigeminal nerve root entry zone (REZ). The surgical management and clinical outcomes of these cases are presented. METHODS: Patients were identified from a prospectively collected database of all cases of TN treated at one institution between 1980 and 2000. Presentation was clinically indistinguishable from TN caused by vascular compression. Preoperative imaging, including computerized tomography scanning (two cases) and magnetic resonance (MR) imaging and MR angiography (three cases), failed to demonstrate an AVM except for one case in which multiple abnormal vessels were identified in the trigeminal REZ on an MR image obtained using a 1.5-tesla magnet. All patients underwent a standard retromastoid craniotomy. In all cases a small AVM embedded in the trigeminal REZ was identified and completely excised, with preservation of the trigeminal nerve. All patients experienced immediate relief of pain following surgery. Postoperatively, in one patient a small pontine hematoma developed, resulting in permanent trigeminal nerve anesthesia in the V2 and V3 divisions. All patients were free from pain at a mean follow-up period of 30 months. CONCLUSIONS: These rare lesions are usually angiographically occult, but may sometimes be identifiable on high-resolution MR images. Total microsurgical resection with nerve preservation is possible, although operative complications are relatively common, reflecting the intimate association between these lesions and the pons. Complete resection is advised not only for symptom relief, but also to eliminate the theoretical risk of pontine hemorrhage.

Adult↗
PubMed2003

Rapid development of Chiari I malformation in an infant with Seckel syndrome and craniosynostosis. Case report and review of the literature.

To illustrate the rapidity with which a child can develop a severe, symptomatic Chiari I malformation, the authors present the case of a 3-month-old infant with Seckel syndrome (microcephaly, micrognathia, craniosynostosis, and multiple other abnormalities) and posterior sagittal and bilateral lambdoid synostosis. The infant underwent magnetic resonance (MR) imaging shortly after birth; the initial image demonstrated the cerebellar tonsils in the posterior fossa, with no herniation. He subsequently developed severe apneic episodes and bradycardia; repeated MR imaging at 3 months demonstrated severe tonsillar herniation with compression of the brainstem. The child underwent posterior fossa remodeling surgery, including release of the posterior sagittal and lambdoid sutures and decompression of the Chiari I malformation. The patient's apnea gradually improved; however, he died of complications of pneumonia and sepsis several weeks later. The authors identified from the literature 21 patients in whom there was a documented MR image or other neuroimage that did not reveal evidence of a Chiari I malformation, followed by a subsequent study with clear documentation of the presence of Chiari I malformation. The interval between the initial study and the development of the tonsillar herniation ranged from 11 days to 18.5 years. In most cases, a lumbar cerebrospinal fluid (CSF) diversion had been performed. This patient developed a severely symptomatic Chiari I malformation during a 3-month period. These reports illustrate that the Chiari I malformation can develop rapidly in the face of increased intracranial pressure, craniosynostosis, and spinal CSF diversion.

Abnormalities, Multiple↗
PubMed2005

Minimal focal steatosis of liver after islet transplantation in humans: a long-term study.

Several reports have been published on islet transplantation in humans, but few data are available on the effect of islet infusion on the hepatic structure. Our aim was to evaluate in a longitudinal study the impact on the liver of intrahepatic islet transplantation. Clinical outcome and liver imaging were evaluated in 31 cases of islet-kidney transplantation (follow-up 38 +/- 4 months, range 12-96 months). Patients were divided into three groups: full function (FF, 9 cases: established insulin independence); partial function (PF, 16 cases: transient insulin independence, prolonged C-peptide secretion): no function (NF, 6 cases: exhaustion of C-peptide secretion within the first year). Upper abdomen sonogram was regularly performed during the whole follow-up period. Percutaneous liver biopsy was performed in case of echographic abnormalities. Multiple small areas of focal hyperechogenicity were observed in nine cases after 6-12 months. These findings were observed only in FF (two) and in PF (seven) patients. Fasting C-peptide levels at the time of echography were higher in negative than in positive patients (2.42 +/- 0.16 vs. 1.51 +/- 0.10 ng/ml, p = 0,0001). Liver biopsies showed focal macrovesicular steatosis, surrounded by normal liver parenchyma. Normal liver function was maintained. In conclusion, our results indicate that islet transplantation can lead to structural changes of the liver parenchyma (focal steatosis). It is more often observed in patients with partial function. Sonogram can be considered a specific method to reveal liver changes after islet transplantation.

Adult↗
PubMedDate not supplied

Ocular motility in Parkinson's disease.

INTRODUCTION: Parkinson's disease is associated with multiple abnormalities of both the afferent and efferent visual systems. Blepharospasm, paucity of blinking, apraxia of lid opening, visual neglect, reduced vergence, reduced upgaze, and blurred vision are reported findings in these patients. The association of these findings with the disease, and their duration, severity, and treatment have not been systematically investigated. PATIENTS AND METHODS: Patients with Parkinson's disease were prospectively examined. An age-matched control group was recruited from accompanying family members and volunteers. Data recorded included presence of visual complaint, the severity of the Parkinson's disease by Hoehn and Yahr Stage (scale = 1 to 5), duration of disease, pharmacologic therapy, visual acuity, ocular motility, accommodation, convergence amplitudes, and the near point of convergence. RESULTS: Thirty-nine patients were entered into each group, each with 21 men and 18 women. The average patient had had the disease for 8.9 years with a severity index of 2.6. Asthenopia, upgaze deficiency, and convergence insufficiency were significantly more common in the patients with Parkinson's disease than in the controls. Mean geometric visual acuity was poorer in the Parkinson's patients (20/39 compared with 20/28); P < .001). DISCUSSION: Visual complaints were significantly more common in the Parkinson's patients than in the age-matched controls. The frequency of ocular abnormalities was not related to the duration of the disease. Increasing severity seemed to be correlated with the presence of convergence insufficiency and a decline in acuity.

Accommodation, Ocular↗
PubMed2003

Pharmacological management of type 2 diabetes mellitus: rationale for rational use of insulin.

Type 2 diabetes mellitus is a chronic metabolic disorder associated with high morbidity and mortality from long-term microvascular and macrovascular complications. Evidence from randomized controlled trials indicates that aggressive treatment directed at improving glycemic control reduces the incidence of diabetes-related microvascular complications. Traditionally, oral monotherapy for type 2 diabetes is initiated when diet and exercise do not control hyperglycemia, followed by the sequential, stepwise addition of oral agents as glycemic control deteriorates. Insulin is the last therapeutic option used, generally reserved for advanced stages of the disease when multiple oral combination treatment fails. Despite a better understanding of the pathophysiologic disease mechanisms in the past decade, the expanded armamentarium of targeted oral antidiabetic drugs, and the conclusive evidence of the benefits of stringent glycemic control, actual treatment outcomes in clinical practice remain suboptimal relative to established treatment goals (glycosylated hemoglobin A1c level <7%). Earlier detection and aggressive treatment are critical to address the natural progression of diabetes because multiple defects (insulin resistance, insulin insufficiency, glucotoxicity, and lipotoxicity) and vascular complications may be present at the time of diagnosis. Acknowledging the inadequacy of traditional strategies and underscoring the importance of insulin as an integral part of the therapeutic armamentarium, clinical trends are moving toward earlier use of insulin combined with 1 or more oral agents. Such strategies can address the multiple abnormalities present early in the disease course and may restore optimal control. A new treatment paradigm for patients with type 2 diabetes to achieve and maintain near-normal glycemic control is warranted.

Administration, Oral↗