The accuracy of color Doppler ultrasonography (CDUS) in diagnosing right hepatic artery (RHA) involvement was preoperatively evaluated in 28 patients with biliary tract cancer. When a tumor partially or completely surrounded the RHA, the circumferential involvement was diagnosed as positive. With B-mode ultrasonography imaging alone in the 10 nonsurgical patients, the correspondence rates with angiography for the presence of invasion, absence of invasion, and overall were 33%, 0%, and 10%, respectively. However, CDUS allowed clearer visualization of the RHA than did B-mode imaging, and the correspondence rates of CDUS with angiography were 100%, 43%, and 60%, respectively. In the 13 surgical patients, the accuracy levels of B-mode imaging, CDUS, computed tomography, and angiography for the detection of RHA involvement were 46%, 77%, 58%, and 92%, respectively, when compared with surgical and histopathologic findings. Although the accuracy of CDUS was lower than that of angiography, it can be performed repeatedly and noninvasively. CDUS is expected to be useful for the initial assessment of RHA involvement.

Aged↗

PubMedDate not supplied

Enterococcus faecalis endocarditis presenting as meningitis.

Although Enterococcus faecalis is a relatively common cause of infective endocarditis, it rarely causes meningitis. A case of Enterococcus faecalis endocarditis presenting as meningitis in a 74-year-old diabetic man on chronic hemodialysis is reported. A review of the literature showed that the association of enterococcal meningitis and endocarditis has rarely been reported. This clinical association may be more common than previously recognized and it is suggested that echocardiography be considered for all patients with enterococcal hematogenous meningitis in order to rule out endocarditis.

Endocarditis, Bacterial↗

PubMedDate not supplied

Safe percutaneous canalization of the biliary tree using a sheath in patients with malignant biliary stenosis.

BACKGROUND: Percutaneous canalization of the bile duct is essential for radiologic interventions of the biliary tract. This study discusses technical considerations for safe approaches for canalization of the bile duct when using a sheath. METHODS: During early and late periods, percutaneous canalization was performed in 104 patients and 79 patients with malignant biliary stenosis, respectively. The late period differed from the early period in that the bile duct was canalized with a previously placed sheath to prevent catheter dislodgement during the procedure. RESULTS: During the early and late periods, catheter dislodgement during canalization occurred in three of 104 patients (3%) and none of 79 patients (0%), respectively. The success rate of canalization without cholangioscopy in the late period (99%) was better than that in the early period (89%; p < 0.05). CONCLUSION: Placement of a sheath into the biliary tree increases the safety and success of canalization in patients with malignant stenosis.

Adult↗

PubMedDate not supplied

Catheter dislodgement of percutaneous transhepatic biliary drainage: identification of role of puncture sites and catheter sheath.

BACKGROUND: To identify the appropriate puncture points in the bile duct to avoid catheter dislodgement. METHODS: Percutaneous transhepatic biliary drainage catheters (n = 300) were placed in 242 patients. The frequency of dislodgement (complete dislodgement or bending of the catheter) was prospectively investigated. The puncture site of the bile duct was classified on the ultrasonographic findings as follows: Main-B3, main branch of the lateral inferior segment; peripheral-B3, peripheral branch of the lateral inferior segment; B2, lateral superior segment; left hepatic duct, proximal portion of the left hepatic duct; B8, anterior superior segment; B5, anterior inferior segment; B5 + 8, main bile duct of the anterior segment; B6, bile duct of posterior inferior segment; and right hepatic duct, proximal portion of the right hepatic duct. RESULTS: When a catheter without an outer sheath was used, catheter dislodgement in peripheral-B3 (2/11, 18%) was more common than in main-B3 (0/32, 0%; p < 0.05). In B5, catheter dislodgement (6/12, 50%) was more frequent than in B8 (3/20, 15%; p < 0.05) and in B6 (0/14, 0%; p < 0.005). When a catheter with an outer sheath was used, catheter dislodgement (2/207, 1%) was rare. CONCLUSION: Drainage from B5 and peripheral-B3 is associated with a high risk of dislodgement of the catheter. A catheter with an outer sheath was useful to prevent catheter dislodgement.

Adult↗

PubMedDate not supplied

Hyperechoic lines as a sonographic confirmatory sign during percutaneous transhepatic biliary drainage.

BACKGROUND: In ultrasonically guided percutaneous transhepatic biliary drainage, we often can recognize hyperechoic lines at the tip of the needle when the duct is penetrated successfully. We evaluated the frequency of this phenomenon and analyzed whether it was a useful sign for confirming successful bile duct puncture. METHODS: In 65 patients with biliary tract diseases, 84 catheters were placed in the course of 108 attempts at puncture. Results of puncture and the presence of hyperechoic lines were investigated prospectively. RESULTS: When the ultrasonographic findings showed hyperechoic lines, successful puncture was significantly more frequent than when the findings did not show hyperechoic lines (53/55, 96%, vs. 31/59, 53%; p < 0.0001). When we judged the hyperechoic lines as the sign of successful puncture, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 63%, 93%, 96%, 48%, and 71%, respectively. CONCLUSION: Hyperechoic lines are a useful confirmatory sign of successful puncture. However, absence of these lines was not invariably associated with unsuccessful puncture.

Aged↗

PubMedDate not supplied

Intraductal ultrasonography for evaluating the patency of biliary metallic stents: correlation with cholangioscopic findings.

BACKGROUND: This is the first study to correlate intraductal ultrasonography (IDUS) with cholangioscopy in evaluating the patency of biliary metallic stents. METHODS: The findings of IDUS (probe 2.0 mm in diameter and 20-MHz frequency) through a percutaneous transhepatic (n = 24) or transpapillary (n = 2) approach were retrospectively reviewed without other information. Criteria for IDUS are as follows: type 1, the inside of the stent is free; type 2, the inner edge is smooth; type 3, the inner edge is irregular; type 4, the inside of the stent is totally occupied; type 5, the solid echo is connected to the outside mass; type 2+D, a hypoechoic line is seen between the bile duct wall and the inside solid component and the inner edge of the bile duct wall is smooth; type 3+D, an irregular hypoechoic line is seen between the bile duct wall and the inside solid component. RESULTS: In the control group (n = 11), IDUS showed type 1 (n = 9) or type 2 (n = 2). In the occluded group (n = 15), when IDUS showed type 3 or 5, the patients (n = 5) required additional stents (n = 3), microwave coagulation of the tumor (n = 1), or transient external drainage (n = 1). When IDUS showed type 4 (n = 5), after washing, the findings changed to type 2+D (n = 4). When IDUS after washing showed a smooth inner edge (type 2+D), the patients were treated without additional stents more frequently than the other groups (eight of nine vs. two of six), a significant distinction (p < 0.05). CONCLUSION: IDUS is useful in assessing the patency of metallic stents. When the inside of the stent is totally occupied, however, examination after washing is necessary.

Aged↗

PubMedDate not supplied

Utility and limitations of intraductal ultrasonography in distinguishing longitudinal cancer extension along the bile duct from inflammatory wall thickening.

BACKGROUND: We wanted to distinguish wall thickening caused by cancer extension from that caused by inflammation after placing a biliary catheter on intraductal ultrasonography (IDUS). METHODS: We studied 51 patients with biliary tract malignancies who had undergone placement of biliary drainage catheters before IDUS. IDUS was performed from a transhepatic (n = 34) or transpapillary (n = 17) route with a thin-caliber ultrasonic probe (2.0 mm in diameter, 20-MHz frequency). At the hepatic side of the tumor, the thickness, asymmetry, outer margin, inner margin, and internal echoes of the bile duct wall were reviewed prospectively and correlated with the histologic findings of the surgically resected specimens in all cases. RESULTS: When IDUS showed wall thickening in a semicircular fashion, notched outer margin, rigid inner margin, papillary inner margin, and heterogeneous internal echoes, each finding had a positive predictive value for diagnosing cancer extension (100%, 100%, 83%, 100%, and 90%, respectively). When these factors were used as the diagnostic criteria of cancer extension, IDUS accurately demonstrated suitable surgical margins in 76% of all patients and 71% of patients with bile duct carcinoma. CONCLUSION: Wall thickening in a semicircular fashion, notched outer margin, rigid or papillary inner margin, and heterogeneous internal echoes are specific for cancer extension. However, surgical margins can be inaccurately assessed in some patients.

Aged↗

PubMedDate not supplied

Prediction of the histologic type of bile duct cancer by using intraductal ultrasonography.

BACKGROUND: Patients with papillary adenocarcinoma survive longer than do patients with other histologic types of bile duct tumors. We evaluated the usefulness of intraductal ultrasonography (IDUS) for predicting the histology. METHODS: Preoperative tumor assessment was performed by using IDUS through a percutaneous tract or the transpapillary route in 37 patients with extrahepatic bile duct cancer. In 30 of 37 patients, imaging results were compared prospectively with histologic findings in resected specimens. Probes 2.0 mm in diameter and 20 MHz in frequency were mainly used. When IDUS showed a "narrow-based polypoid pattern" or a "papillary surface pattern," the patients were judged as having papillary adenocarcinoma. RESULTS: The accuracy, sensitivity, and specificity of IDUS in predicting papillary adenocarcinoma were 90%, 89%, and 90%, respectively. When intraductal ultrasonography showed a papillary surface pattern or a narrow-based polypoid pattern, lymph node metastases and perineural invasion were rarely seen when compared with other patients with bile duct cancer (p < 0.05). CONCLUSION: IDUS is useful for assessing the histologic type of bile duct cancer.

Adenocarcinoma, Papillary↗

PubMedDate not supplied

The lipid-lowering profile in rodents. AZ-1355, a new dibenzoxazepine derivative.

The lipid-lowering profile of ethyl 10,11-dihydro-4-methoxydibenz[b,f]-(1,4)oxazepine-8-carboxylate (AZ-1355) has been evaluated using clofibrate as a reference compound. This compound is structurally unrelated to any other hypolipidemic agent. AZ-1355 was selected not only for its effect in reducing serum lipids, but also because it inhibits platelet aggregation in vivo and elevates the prostaglandin I2/thromboxane A2 ratio in vitro. It lowers serum total cholesterol in Triton-treated hyperlipidemic mice, and also lowers serum total cholesterol and triglyceride in dietary hyperlipidemic rats. In golden hamsters chosen for further evaluation, AZ-1355 reduced serum, liver and cardiac lipids, improved the beta/alpha-lipoprotein ratio and increased the HDL cholesterol. Thus, it is apparent that the lipid-lowering profile of AZ-1355 differs from that of clofibrate.

Animals↗

PubMedDate not supplied

Augmentation of the radiation-induced antiproliferative effect in combined use of a derivative of nitrosourea, ACNU, with recombinant human tumor necrosis factor.

The effect of combined use of a derivative of nitrosourea, ACNU, with recombinant human tumor necrosis factor (rhTNF) on the radiation-induced antiproliferative effect was examined using Meth A tumor cells. The radiation-induced antiproliferative effect was slightly augmented by the simultaneous addition of ACNU at 10 micrograms/ml in 5 Gy and 15 Gy irradiated groups. The antiproliferative effect was augmented in parallel with the radiation dose by the addition of rhTNF. Further augmentation of the proliferation inhibition was observed when both of ACNU (10 micrograms/ml) and 10 U/ml of rhTNF were added in combination with irradiation. Similar augmentation was observed when the target cells were treated with ACNU prior to irradiation and the addition of rhTNF.

Animals↗

PubMedDate not supplied

Application of stains-all staining to the analysis of axonemal tubulins: identification of beta-tubulin and beta-isotubulins.

The cationic dye, Stains-all, is known to stain brain beta-tubulin blue and alpha-tubulin red (Serrano, L. et al. (1986) J. Biochem. Biophys. Methods 12, 281-287; Serrano, L. et al. (1989) Biochem. Int., 19, 235-246). The present experiments show that this stain can also be applied to detect beta-tubulin in axonemal tubulins from various sources such as cilia of protozoa, sperm flagella of echinoderm, and sperm flagella of mollusc. Furthermore, these experiments showed that it selectively stains isoforms of axonemal beta-tubulin blue following isoelectric focusing, whereas those of alpha-tubulin are stained red. These results indicate that Stains-all staining is a useful tool for electrophoretic analysis of axonemal tubulins.

Animals↗

PubMedDate not supplied

Absence of spinal N13-P13 and normal scalp far-field P14 in a patient with syringomyelia.

Short latency somatosensory evoked potentials to median or ulnar nerve stimulation were recorded in a patient with syringomyelia. Scalp-recorded far-field P14 was clearly preserved, but spinal N13-P13 components disappeared. Our findings support the hypothesis that spinal N13-P13 is generated by structures intrinsic to the cervical cord, most likely in the ventral central gray matter.

Adult↗

PubMedDate not supplied

Origin of scalp far-field N18 of SSEPs in response to median nerve stimulation.

To identify the origin of scalp-recorded far-field negativity of short-latency somatosensory evoked potentials to median nerve stimulation (designated N18), direct records were made from the thalamus and ventricular system during 4 stereotaxic and 3 posterior fossa operations. In the thalamus a negative potential with almost the same latency as the scalp N18 was restricted to the Vim nucleus, but there was a large positive potential in the VC nucleus and medial lemniscus. Vim negativity increased in amplitude when high frequency stimulation was given to the median nerve, indicative of a facilitation effect. In contrast, the amplitude of scalp N18 decreased at high frequency stimulus. Direct recordings made through the medulla oblongata to the mid-brain showed a negative potential with gradually increasing latency. Above the upper pons, there was stationary negativity with no latency shift. The similarity between this negative potential and N18 is shown by their having the same latency and same response to the amplitude reduction and latency prolongation produced by high frequency stimulus. Our data suggest that scalp N18 comes from brain-stem activity between the upper pons and the mid-brain rather than from the thalamus.

Adult↗