Macronodular tuberculoma of the liver: CT and MR findings.
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Aged↗
Biomedical subjects
M Kadoya
Publications and source records attributed to M Kadoya.
Maffucci's syndrome combined with dedifferentiated chondrosarcoma.
We report a rare case of Maffucci's syndrome combined with dedifferentiated chondrosarcoma in the right shoulder girdle developing from pre-existing enchondroma. In this case, magnetic resonance imaging was useful in diagnosing dedifferentiated chondrosarcoma before surgery. T2-weighted imaging was used to distinguish between the cartilaginous component and the dedifferentiated one. Histologically, there was enchondroma in the humerus and grade 2 chondrosarcoma in the scapula. Further, the dedifferentiated tumor had three mesenchymal elements: osteosarcoma, malignant fibrous histiocytoma, and fibrosarcoma. This histological heterogenicity may be due to mesodermal dysplasia of Maffucci's syndrome.
Aged↗
[Clinical features of enterococcal septicemia and antimicrobial susceptibilities for clinical isolates of enterococci in Nagoya University Hospital].
Enterococci are important causative organisms of nosocomial infections as well as methicillin resistant Staphylococcus aureus and Pseudomonas aeruginosa. Enterococcal bacteremia has been increased in Nagoya University Hospital from April 1983 to March 1990. We analyzed the clinical backgrounds, portal of entry and mortality for the patients with Enterococcal septicemia. Thirty-four cases with enterococcal septicemia (24 Enterococcus faecalis, 10 Enterococcus faecium) were subjected in this study. Twenty-seven cases were monomicrobial septicemia and 7 cases were polymicrobial septicemia. As to the portal of entry, intra-abdominal infections in 21 cases, urinary tract infections in 4 cases, respiratory tract infections or chest tubes in 2 cases, decbitus infection in 1 case, intravascular catheter in 1 case, and unknown sources in 5 cases. Total mortality of the septicemia was 44.1%. E. faecium and Enterococcus avium were much more resistant to antimicrobial agents than E. faecalis. Enterococci with high-level resistance to gentamicin (minimal inhibitory concentration, greater than 2000 micrograms/ml) accounted for 35% of the 26 clinical isolates of enterococci.
Adolescent↗
[Bacterial survey of patients with bacteremia during the ten years (1978-1987) in Nagoya University Hospital].
We analyzed the changes of frequency of bacterial positive cases on the basis of blood cultures, clinical background and administrated antibiotics for the patients with bacteremia in Nagoya University Hospital from January 1978 to December 1987. During the ten years, the number of samples increased from 330 in 1978 to 1231 in 1987. Moreover, bacterial positive cases increased from 27 (8.2%) in 1978 to 152 (12.3%) in 1987. Organisms isolated consisted of 138 strains of coagulase negative Staphylococci (CNS), 81 Staphylococcus aureus, 60 Candida sp., 58 Escherichia coli, 47 Pseudomonas aeruginosa, and other species. During the period of 1986-1987, of the 92 patients with bacteremia, 85 patients (92.4%) had underlying diseases including leukemia, solid tumor, cardiovascular disease, diabetes mellitus or other diseases. In addition, 67 patients (73.9%) underwent intravascular catheters, urethral catheters, postoperative drainages or other prosthetic insertions. Fourteen patients died of septicemia within a week after recovery of the organism in the blood culture. The recovery rate for gram positive cocci in blood culture increased in the 1980's. It may partly be due to the prevalent use of these prosthetic insertions, and the preferable use of second and third generation cephalosporin antibiotics.
Adolescent↗
Benign and malignant nodules in cirrhotic livers: distinction based on blood supply.
The blood supplies of nodular lesions associated with liver cirrhosis were analyzed in vivo with various imaging modalities. The portal blood supply was evaluated with computed tomography (CT) during arterial portography (CTAP); the arterial blood supply was evaluated with hepatic angiography, CT angiography, CT following intraarterial injection of iodized oil, or ultrasound following intraarterial injection of carbon dioxide microbubbles. A total of 84 surgically confirmed hepatocellular carcinomas (HCCs) (less than or equal to 3 cm) and 25 areas of adenomatous hyperplasia (AH) were included in the study. At CTAP, a portal blood supply was seen in 96% of cases of AH and only 6% of HCCs (chi 2, P less than .005). In contrast, an arterial supply greater than that of the surrounding liver was verified in 94% of the HCCs and only 4% of the cases of AH (chi 2, P less than .005). The blood supply of areas of AH with atypical hepatocytes and the blood supply of well-differentiated HCCs (Edmondson grade 1) tended to be intermediate between that of AH without atypia and that of HCC that was Edmondson and Steiner grade 2 or greater. Evaluation of the blood supply of the nodular lesions associated with liver cirrhosis is considered to be useful in the differential diagnosis and treatment of early-stage HCC.
Carcinoma, Hepatocellular↗
Hepatocellular carcinomas with excessive copper accumulation: CT and MR findings.
Results of orcein staining and findings obtained with non-contrast-medium-enhanced computed tomography (CT) and magnetic resonance (MR) imaging (T1- and T2-weighted images) were compared for 53 histologically confirmed hepatocellular carcinomas (HCCs). HCCs were 5 cm in the largest diameter. Three lesions with diffuse and strong orcein staining were highly attenuating on nonenhanced CT images. Electron x-ray microanalysis of one of them revealed copper. The high attenuation value at nonenhanced CT may have been due to the abundant copper-binding protein in the cancer cells. The difference between orcein staining results and attenuation patterns at CT was statistically significant (chi 2, P less than .001). It could not be concluded that the paramagnetic effects of copper in HCC had an influence on signal intensity on MR images. The difference between orcein staining results and signal-intensity patterns on T1- and T2-weighted images was not statistically significant.
Adult↗
[Diagnosis of hepatocellular carcinomas using CT arterial portography].
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Carcinoma, Hepatocellular↗
Iron-accumulating adenomatous hyperplastic nodule with malignant foci in the cirrhotic liver. Histopathologic, quantitative iron, and magnetic resonance imaging in vitro studies.
Five iron-accumulating adenomatous hyperplastic nodules (AHN) in cirrhotic livers were examined histologically, by quantitation of tissue iron, and by magnetic resonance imaging (MRI) in vitro. Histologically, one AHN was benign, while the other four contained malignant hepatocellular foci. Iron staining and quantitation of tissue iron revealed that AHN were rich in iron, but the malignant hepatocellular foci and surrounding regenerative nodules were relatively poor in iron. The MRI showed that AHN were hypointense while malignant hepatocellular foci and surrounding regenerative nodules were isointense. Thus, malignant hepatocellular foci within AHN corresponded to iron-poor isointense foci. These findings suggest that malignant hepatocellular foci arising in iron-accumulating AHN are resistant to iron accumulation and that iron-accumulating AHN can be recognized with MRI in vitro as hypointense and malignant foci as isointense.
Aged↗
Ciliated hepatic foregut cyst: radiologic features.
Ciliated hepatic foregut cysts (CHFCs) are solitary unilocular cysts in the liver that are histologically similar to bronchogenic cysts. Three cases of CHFC are reported that demonstrated radiologic features similar to those of solid masses. All the lesions were smaller than 3 cm in diameter and were subcapsular. At ultrasonography, one lesion appeared anechoic but the other two were hypoechoic. Unenhanced computed tomography demonstrated the lesions to be hyperattenuating or isoattenuating relative to surrounding liver parenchyma, and no lesions enhanced with administration of contrast material. Magnetic resonance imaging was performed in one case and demonstrated the lesion to be markedly hyperintense with a spin-echo (SE) 2,500/80 (repetition time msec/echo time msec) sequence. All the lesions were resected and found to be filled with viscous mucinous fluid. The CHFCs are not neoplasms and must be differentiated from cystic neoplasms and hypovascular solid tumors. When a subcapsular lesion demonstrated the varied appearance described, a diagnosis of CHFC should be considered.
Aged↗
Osseous hemangioma arising in the facial bone.
Hemangiomas of bone are rare tumors in the facial region. In our own case, magnetic resonance imaging showed unique linear high-signal-intensity internal components in T1-weighted images. The histological study demonstrated that adipose tissue occurring in the stroma of the tumor caused the high signal intensity in T1-weighted images. We employed a vascularized calvarial bone flap to reconstruct the malar eminence after resection of the tumor.
Aged↗
MR imaging of hepatic adenoma.
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Adenoma↗
[Idiopathic enlargement of the right atrium with persistent superior vena cava].
A 69-year-old male, who had been found (during a routine roentgenogram of the chest at an annual check-up) to have cardiomegaly, had been asymptomatic until 63 years of age, when DOE and swelling of the legs appeared. He visited our hospital because these symptoms has become more severe. Physical examination revealed JVD, third heart sound and a grade 3 holosystolic murmur, hepatomegaly and edema in the lower legs. His ECG showed atrial fibrillation. His chest X-P showed marked cardiomegaly and rt pleural effusion. His echocardiography and MRI revealed a marked enlargement of the right atrium and a slight enlargement of the right ventricle. The latter also showed persistent left superior vena cava. The cardiac catheterization, angiocardiography and intracavitary electrocardiography revealed no organic cardiac disease which induced enlargement of the right atrium. The idiopathic enlargement of the right atrium is a rare disease. Patients suffering from this disease are asymptomatic in most cases. We reported the idiopathic enlargement of the right atrium with persistent left superior vena cava in this paper.
Aged↗
[Angiographic anatomy of arterial branches to the caudate lobe of the liver with special reference to its effect on transarterial embolization of hepatocellular carcinoma].
The arterial branches to the caudate lobe of the liver have been little studied angiographically, so it has been thought that the branches can be rarely recognized on the hepatic angiogram. We evaluated it with the stereo or stereo-magnification angiograms in 106 cases. They were identified in 90 cases (84.9%), one branch in 75 cases, two branches in 15 cases. The branches had a variable origin. In 50%, it originated from the right hepatic artery. In some cases, it came from both the right and left hepatic arteries. Recently we treated 10 cases of hepatocellular carcinoma in the caudate lobe with transcatheter arterial embolization (TAE), the results were poor in them except for one. We think that the proximal and variable origins of the caudate lobe arteries are the main cause of the poor effect of TAE.
Angiography↗
"Moustache" appearance in craniopharyngiomas: unique magnetic resonance imaging and computed tomographic findings of perifocal edema.
This report describes two cases of craniopharyngioma with perifocal edema. In both patients, computed tomography and magnetic resonance imaging (MRI) revealed that the tumors occupied the suprasellar cistern, invaginated the floor of the 3rd ventricle and were tightly adherent to the ventricular walls. The intraventricular portions of the tumors were cystic, containing protein-rich fluid as suggested by MRI and confirmed by operative findings. There was perifocal edema in the hypothalamus adjacent to the intraventricular tumor, the optic tracts, and the posterior limbs of the internal capsules, resembling the shape of a moustache on axial computed tomographic and MRI scans. The perifocal edema subsided after treatment of the intraventricular tumor by surgical resection or radiation therapy. The "moustache" appearance seems a unique, characteristic feature of perifocal edema, which is observed infrequently with certain craniopharyngiomas.
Adult↗
Ciliated hepatic foregut cyst. A mucus histochemical, immunohistochemical, and ultrastructural study in three cases in comparison with normal bronchi and intrahepatic bile ducts.
We describe herein the morphologies of three cases of ciliated hepatic cysts and compare them with those of normal bronchi and intrahepatic bile ducts. Grossly, the hepatic cysts were located in the subcapsular region. They were solitary, unilocular, and rather small (less than 4 cm in diameter). Histologically, the cyst wall consisted of four layers: pseudostratified ciliated columnar epithelia with mucous cells, subepithelial connective tissue, smooth-muscle bundles, and an outermost fibrous capsule. The epithelial cytoplasm contained neutral, carboxylated, and sulfated mucus. We noted moderate immunoreactivity to keratin, epithelial membrane antigen, carcinoembryonic antigen, DU-PAN-2 and secretory component; weak immunoreactivity to cytokeratin CAM 5.2, cytokeratin AE1 + 3, and carbohydrate antigen 19-9; and faint or negative immunoreactivity to IgA and IgM. Cilia were immunoreactive to actin and tubulin; smooth muscles were immunoreactive to actin and desmin. Ultrastructural observations revealed definite cilia arranged in a 9 + 2 pattern as well as mucous cells. These morphologic features of the hepatic cysts were similar to those of normal bronchi but different from those of normal bile ducts. Our findings suggest that ciliated hepatic cysts arise from the embryonic foregut and differentiated toward bronchial structures in the liver.
Adult↗
Intrahepatic periportal abnormal intensity on MR images: an indication of various hepatobiliary diseases.
The frequency and degree of intrahepatic periportal abnormal intensity (PAI) on magnetic resonance images in patients with or without various hepatobiliary and pancreatic diseases were analyzed. In 63 patients without hepatobiliary disease, except for a small metastatic liver tumor or cavernous hemangioma, no definite PAI was seen. Definite PAI was seen in all patients with obstructive jaundice, cholangitis, and cholangiocellular carcinoma. It was also clearly seen in all four cases of malignant lymphadenopathy in the hepatoduodenal ligament, in one of two cases of acute hepatitis, and in four of 47 cases of liver cirrhosis. However, in patients with bile duct dilatation or with gallstone or pancreatic disease without obstructive jaundice or cholangitis, no definite PAI was seen. Histologic studies of the liver performed in 23 patients with definite PAI showed edema, ductular proliferation, dilatation of lymph vessels, and inflammatory cell infiltration in portal tracts. It is concluded that definite intrahepatic PAI is a useful sign that indicates the presence of biliary or diffuse hepatic disease.
Adult↗
Adenomatous hyperplastic nodules in the cirrhotic liver: differentiation from hepatocellular carcinoma with MR imaging.
Differentiation of hepatocellular carcinomas from adenomatous hyperplastic nodules (AHNs) is important for the early and precise detection of hepatocellular carcinoma in the cirrhotic liver. For this purpose, the authors compared findings on magnetic resonance (MR) images of surgically resected AHNs (n = 7) with those of hepatocellular carcinoma (n = 47). AHNs were divided into two histologic groups: those without atypia (n = 5) and those with atypical hepatocytes or malignant foci (n = 2). All AHNs without atypia were hyperintense on T1-weighted spin-echo images and hypointense on T2-weighted spin-echo images relative to the surrounding liver. However, almost all hepatocellular carcinomas, except for two lesions with massive coagulation necrosis, were demonstrated as hyperintense on T2-weighted images. MR imaging may be useful in the differentiation of AHN without atypia from hepatocellular carcinoma in the cirrhotic liver.
Carcinoma, Hepatocellular↗
Combined effect of disopyramide and bethanechol: use of bethanechol to prevent anticholinergic side effects of disopyramide without reduction of antiarrhythmic efficacy.
Because bethanechol chloride (B) relieves the anticholinergic side effects of disopyramide (D), we examined the combined effects of D and B on the heart and urinary bladder. B was confirmed to counteract dose dependently the effect of D on the dog bladder. In the ventricular muscle, the combined electrophysiological effects (D + B) were additive, with no reduction in the effect of D. With the control value set as 100%, the decrease in the maximum rate of depolarization with 5 X 10(-6) g/ml D (90 +/- 6%) was not affected by the same dose of B (D + B: 84 +/- 14%). Moreover, the effective refractory period (ERP) was larger with D + B (128 +/- 12%) than with either B (109 +/- 9%, p less than 0.01) or D (115 +/- 11%, p less than 0.05). In contrast, in the atrial muscle and AV and SA nodes, B had marked acetylcholine-like effects. These were completely suppressed by the addition of D except for the atrial ERP with the highest tested concentration of B (5 X 10(-6) g/ml). In the latter case, the prolongation of ERP was minimal (B + D: 105 +/- 14%) as compared with D alone (130 +/- 15%). Since the plasma concentration of B after oral administration of a clinical dose is expected to be on the order of 10(-7) g/ml, no practical effect is anticipated. We conclude that B can be expected to counteract urination disorders caused by D without reducing D's antiarrhythmic efficacy.
Anesthesia↗