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In 1957 Teoh observed, in an autopsic series of 31 patients with nasopharyngeal carcinoma, 3 cases of neoplastic spread through the marrow spaces of the base of the skull, without macroscopic bone alterations. In order to demonstrate in vivo this kind of neoplastic spread, CT and MR examinations of 35 patients with nasopharyngeal carcinoma were reviewed. In 3/26 cases the invasion of the marrow spaces of the clivus was demonstrated. In these cases CT showed only minimal alterations in spongiosa and cortices of the clivus, associated with intracranial soft-tissue tumoral components. MR imaging demonstrated, with great accuracy, the replacement of bone marrow in the clivus by neoplastic tissue of intermediate signal intensity on T1-weighted images. Tumor tissue was characterized by high signal intensity on T2-weighted images. The authors stress the greater utility of MR imaging in evaluating the permeative involvement of the base of the skull.

We have retrospectively examined 94 evaluable patients with metastatic osteolysis from breast cancer (BC) and non-small cell lung (NSCLC) cancer, who received RT from Nov. 88 to Nov. 89.27 (15 BC and 12 NSCLC) were in treatment with Clodronate for at least 3 days from the beginning of RT; of the remaining 67 treated with RT alone, 31 had NSCLC and 36 BC. We have evaluated: increase in pain (IP) occurring on the first days of RT, percentages of complete pain relief (CPR) at the end of RT and 4-6 weeks after. A decreased occurrence of IP was observed more in NSCLC patients receiving RT + Clodronate compared to those treated with RT alone (33.3% vs 41.9%). Both at the end of RT and 4-6 weeks after, we registered a significant difference in the percentages of CPR in the RT + Clodronate group (40.7 vs 20.9 and 70.3% vs 53.7%). We believe the points of interest focused in this paper-greater precision in centering and defining the target volume, decreased occurrence of IP during the first days of RT, increase in percentage of CPR--need a prospective confirmation.

Adenocarcinoma is an uncommon gastrointestinal malignancy. Fiberoptic duodenoscopy is the diagnostic procedure of choice, allowing direct visualization as well as biopsy of the neoplasm. Conversely, in the vast majority of cases, CT is unable to demonstrate the duodenal tumor. We describe a technical procedure that has permitted CT visualization of a small ampullary tumor in two cases.

Twenty patients (ten with mitral and/or aortic valve disease and ten with ischemic heart disease, all in the New York Heart Association class IV, aged between 18 and 74 yr, with cardiogenic pulmonary edema unresponsive to drug treatment) were treated with polysulphone membrane ultrafiltration (UF) in a veno-venous circuit. All patients had dyspnea, pulmonary rales, hypoxemia, tachycardia, hypotension, overhydration, radiologic evidence of engorged pulmonary vasculature, and Kerley-B lines. Systemic and pulmonary arterial pressures, cardiac output (by thermodilution), and intrapulmonary shunt fraction (Qsp/Qt) were determined and chest x-ray was obtained at the beginning and the end of UF. Average duration of the treatment was 150 +/- 28 min; UF volume averaged 3000 +/- 170 ml. UF reduced the Qsp/Qt by 58% from control condition, and did not significantly affect hemodynamic variables. Chest x-rays documented clearing of alveolar edema and venous congestion. These changes were associated with unequivocal clinical improvement and no mechanical ventilation was necessary to improve gas exchange. Short-term fluid subtraction did not result in undesired circulatory alternations. Because the ultrafiltrate composition is similar to plasmatic fluid, no modification in the plasma osmolarity was detected. In conclusion, UF may be considered an effective tool for the treatment of acute pulmonary edema refractory to drug therapy, as an alternative to mechanical ventilation, and as a remedy for excessive extravascular lung water.

We studied in humans during total cardio-pulmonary by-pass the effects of positive alveolar pressure on systemic to pulmonary bronchial blood flow. Systemic to pulmonary bronchial blood flow is the entire bronchial blood flow to the lung and was measured as the volume of blood which accumulates in the left heart when there is no pulmonary flow. Systemic to pulmonary bronchial blood flow was vented by gravity via a cannula (18 French) introduced in the upper superior pulmonary vein and advanced into the lower most portion of the left heart. In Group A (10 patients) systemic to pulmonary bronchial blood flow was measured with alveolar pressure constant at 4.0 +/- 0.4 cm H2O for 53.5 +/- 6.2 min (range 25 to 95 min), and ranged between 0.32 and 2.76% of cardiac output (pump flow) remaining constant with time. In Group B (10 patients) systemic to pulmonary bronchial blood flow was measured for 2 periods of 20 min each with alveolar pressure equal 4.1 +/- 0.2 and 14.1 +/- 0.4 cm H2O respectively. The increase of alveolar pressure reduced systemic to pulmonary bronchial blood flow by almost 40%. The reduction of systemic to pulmonary bronchial blood flow we observed may be deleterious for the survival of the lung parenchyma particularly in some circumstances. This is the case of pulmonary embolism, when bronchial blood flow is the major source of blood to the lung parenchyma and serves to prevent pulmonary infarction, or the case of acute respiratory distress syndrome, when pulmonary flow is compromised and systemic to pulmonary bronchial blood flow increases.(ABSTRACT TRUNCATED AT 250 WORDS)

The primary structure of thioredoxin f from spinach chloroplasts was determined by standard amino acid sequencing and furthermore by sequencing the corresponding nuclear genome region. The protein, with a calculated molecular mass of 12,564 Da and a molar absorption coefficient at 280 nm of 17,700 M-1 cm-1, consists of 113 residues and exhibits 24% residue identities with spinach chloroplast thioredoxin mb or Escherichia coli thioredoxin. A monospecific antibody elicited against thioredoxin f has been used to select recombinant phage from spinach cDNA libraries in lambda gt11. The inserts of positive clones were sequenced. They code for a polypeptide of 190 amino acids, composed of the thioredoxin f sequence (113 residues) and an upstream element (77 residues) which most probably constitutes the N-terminal transit peptide that directs the polypeptide into chloroplasts. In vitro transcription and translation of this construct generates a polypeptide of approximately 21 kDa, which is imported by isolated spinach chloroplasts and processed to the mature 12.5-kDa protein.

The parapharyngeal space is a fat-filled region situated deep in the head between the basicranium and the oral floor. It can be divided in two parts: the prestyloid and the poststyloid space. The mandibular nerve is contained in the prestyloid space, while the carotid artery, jugular vein, IX, X, XI, XII cranial nerves, cervical sympathetic chain and junctional lymph nodes are situated in the poststyloid compartment. The normal CT anatomy and CT findings in 22 patients with proven lesions of the parapharyngeal space are described. Three different groups of neoplastic processes can be distinguished: primary tumours, secondary tumours and enlarged lymph nodes. The nature of the lesions developing in the parapharyngeal space can be diagnosed by CT in many cases.

The perineural space is a well recognized pathway of tumor spread of head and neck cancer. We report a case of perividian metastasis studied with magnetic resonance imaging.

More than 60% of the patients with recurrent rectal carcinoma complain of pain after radical surgery. Pelvic carcinomatous neuropathy (PCN) is a frequent cause of pain in such patients. Although the effectiveness of radiotherapy in the palliative treatment of local recurrences of rectal carcinoma is well recognized, its results in PCN are less known. The authors have evaluated the results of high-energy radiotherapy in 12 patients with recurrent rectal carcinoma and PCN, who were treated with doses between 35 and 55 Gy. Although the survival of these patients is always poor, about 50% of them achieved a significant and prolonged palliative result by radiation treatment. In patients with PCN, CT is an effective tool to detect recurrences, define their volume and relationship to critical organs, show sites of neural involvement, and optimize radiation treatment planning.