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Background: Acute community-acquired sinusitis is considered a bacterial complication of the common cold. Radiologic abnormalities in sinuses occur, however, in most patients with upper respiratory virus infections. Objective: Assessment of the occurrence, clinical profile, laboratory findings, and outcome of radiologically confirmed sinusitis was carried out as part of a common cold study in young adults. Methods: Clinical examinations and radiography of the paranasal sinuses were carried out on days 1, 7, and 21 in 197 patients with the common cold. The symptoms were recorded on diary cards on days 1 to 20. Ten viruses and 5 bacteria were studied as etiologic agents of common cold as reported earlier. Serum C reactive protein concentrations, erythrocyte sedimentation rates, and total white blood cell counts with differentials were determined in 40 randomized subjects on day 7. The effect of 6 days of intranasal fluticasone propionate treatment of the common cold in the prevention of sinusitis was analyzed. Results: On day 7, 39% of patients with the common cold in the placebo group ( n = 98) had sinusitis, which we would prefer to call viral sinusitis. The symptoms of patients with sinusitis and those without it were not clinically distinguishable. Viral infection was detected in 81.6% of patients with sinusitis. No significantly increased levels of antibodies to bacteria were detected. Serum C reactive protein concentrations, erythrocyte sedimentation rates, and white blood cell counts were low in patients with sinusitis. All patients made a clinical recovery within 21 days without antibiotic treatment. Fluticasone propionate treatment tended to prevent paranasal sinusitis, especially in rhinovirus-positive subjects. Conclusion: Viral sinusitis frequently occurs in the early days of the common cold, but it is a self-limited illness. The sinuses should not be imaged in patients with the common cold if the signs and symptoms of illness gradually become less severe and no specific signs suggestive of bacterial sinusitis occur. (J Allergy Clin Immunol 1998;102:403-8.)

Midtrimester amniotic fluid cytokines may reflect the function of the maternal immune system in the maternal-fetal interface and thus be predictive of pre-eclampsia. We determined the concentrations of interleukin (IL)-6, IL-8, IL-10, IL-11, IL-12, IL-15, tumour necrosis factor (TNF)-alpha and transforming growth factor (TGF)-beta in amniotic fluid at 14-16 weeks of gestation from women with normal pregnancies and from those who subsequently developed severe pre-eclampsia. The concentrations of the cytokines in amniotic fluid did not significantly differ between patients and normal controls. The median concentration of IL-6 was 950 pg/ml in normal pregnant women and 578 pg/ml in the patient group. The median concentration of IL-8 was 606 pg/ml in normal controls and 294 pg/ml in the patient group. The levels of IL-6, IL-8 and TGF-beta correlated positively with each other. TNF-alpha concentrations were low and similar in both groups. IL-10 and IL-12 were detected at very low levels in 37 and 7% of the samples, respectively. No difference was found in IL-15 concentrations between the groups. IL-11 was found only at low levels in both groups. Although none of the cytokines measured was predictive of pre-eclampsia, this study provides information of cytokines in amniotic fluid during the period when the spiral arteries are remodelled.

Background Eye fundus destruction and type II muscle fiber atrophy in gyrate atrophy of the choroid and retina with hyperornithinaemia (GA) may be mediated by elevated ornithine concentrations which strongly inhibit creatine biosynthesis. This results in deficiency of creatine phosphate (PCr), a key intracellular energy source, as we have demonstrated in skeletal muscle of the patients by 31P magnetic resonance spectroscopy (31P MRS). Materials and methods Possible correction of the relative PCr deficiency by long-term daily exogenous supplementation of creatine or its precursors was investigated in four GA patients receiving creatine and in five patients treated with guanidinoacetic acid-methionine combination. The relative PCr concentration, expressed as PCr/Pi (Pi; inorganic phosphate) or as PCr/ATP ratios, was compared with the values of untreated GA patients, and matched healthy volunteers. Results Muscle PCr/Pi ratios (mean ± SD) of the untreated and creatine supplemented GA patients and controls were 4.9 ± 1.4, 7.9 ± 0.4 and 8.4 ± 1.3. Guanidinoacetate-methionine combination was similarly effective (respective PCr/Pi ratios: 4.9 ± 0.7, 6.3 ± 1.1 and 10.7 ± 2.8). Conclusion Supplementation with creatine or creatine precursors almost normalised low muscle PCr/Pi ratios of patients with GA.

1. The role of blood flow as a determinant of skeletal muscle glucose uptake is at present controversial and results of previous studies are confounded by possible direct effects of vasoactive agents on glucose uptake. Since increase in muscle blood flow can be due to increased flow velocity or recruitment of new capillaries, or both, it would be ideal to determine whether the vasoactive agent affects flow distribution or only increases the mean flow. 2. In the present study blood flow, flow distribution and glucose uptake were measured simultaneously in both legs of 10 healthy men (aged 29 +/- 1 years, body mass index 24 +/- 1 kg m-2) using positron emission tomography (PET) combined with [15O]H2O and [18F]fluoro-2-deoxy-D-glucose (FDG). The role of blood flow in muscle glucose uptake was studied by increasing blood flow in one leg with sodium nitroprusside (SNP) and measuring glucose uptake simultaneously in both legs during euglycaemic hyperinsulinaemia (insulin infusion 6 pmol kg-1 min-1). 3. SNP infusion increased skeletal muscle blood flow by 86 % (P < 0.01), but skeletal muscle flow distribution and insulin-stimulated glucose uptake (61.4 +/- 7. 5 vs. 67.0 +/- 7.5 micromol kg-1 min-1, control vs. SNP infused leg, not significant), as well as flow distribution between different tissues of the femoral region, remained unchanged. The effect of SNP infusion on blood flow and distribution were unchanged during infusion of physiological levels of insulin (duration, 150 min). 4. Despite a significant increase in mean blood flow induced by an intra-arterial infusion of SNP, glucose uptake and flow distribution remained unchanged in resting muscles of healthy subjects. These findings suggest that SNP, an endothelium-independent vasodilator, increases non-nutritive, but not nutritive flow or capillary recruitment.

In gyrate atrophy of the choroid and retina with hyperornithinaemia (GA), a genetically determined deficiency of ornithine delta-aminotransferase activity leads to high ornithine concentrations in body fluids. GA is characterized by centripetally progressing retinal and choroidal destruction and selective atrophy with tubular aggregates in type II skeletal muscle fibres. These findings have been suggested to be mediated by hyperornithinaemia-induced deficiency of high-energy creatine phosphate. As abnormal brain magnetic resonance images and electroencephalograms are found in another disorder of creatine metabolism, guanidinoacetate methyltransferase deficiency, we investigated the central nervous system involvement in GA, which seems to be associated with a milder degree of phosphocreatine deficiency. We compared 23 untreated GA patients with age-matched healthy controls, and with 9 patients who had received creatine or creatine precursor supplementation daily for several years. The mean age of the patients (32 +/- 18 years) was similar to that of the controls (36 +/- 22 years). The MRI or EEG findings of the patients on creatine supplementation did not differ from those of the untreated group. Brain MRI revealed degenerative lesions in the white matter in 50% of the GA patients, and 70% of the patients had premature atrophic changes, with a striking increase in the number of Virchow's spaces. Of the patients whose EEG was recorded, 58% had abnormal slow background activity, focal lesions or high-amplitude beta rhythm (50 microV). The EEG findings were not associated with the MRI changes or with the age or the sex of the patients. Early degenerative and atrophic brain changes and abnormal EEG are thus features of GA, in addition to the well-characterized eye and muscle manifestations.

Background In gyrate atrophy of the choroid and retina with hyperornithinaemia (GA), inherited deficiency of ornithine-δ-aminotransferase leads to progressive fundus destruction and atrophy of type II skeletal muscle fibres. Because high ornithine concentrations inhibit creatine biosynthesis, the ensuing deficiency of high-energy creatine phosphate may mediate the pathogenesis. Materials and methods Relative concentrations of inorganic phosphate (Pi), creatine phosphate (PCr) and ATP in resting calf muscle were recorded in 23 GA patients and 33 control subjects using 31P-magnetic resonance spectroscopy (MRS). Eight patients with autosomal recessive retinitis pigmentosa with matched control subjects constituted an additional reference group. Results The PCr/Pi and PCr/ATP ratios (means ± SD) were lower for the GA patients than for healthy control subjects [4.66 ± 0.37 vs. 9.75 ± 2.17 (P

Purpose: To determine whether low-field MR fat/water separation and magnetisation transfer (MT) techniques are useful in studying the livers of patients with parenchymal liver diseases in vivo. Material and Methods: MR and MT imaging of the liver in 33 patients (14 with primary biliary cirrhosis, 15 with alcohol-induced liver disease, and 4 with fatty liver) was performed by means of the fat/water separation technique at 0.1 T. The relaxation time T1 and the MT contrast (MTC) parameter of liver and spleen tissue were measured, and the relative proton density fat content N(%) and MTC of the liver were calculated from the separate fat and water images. The value of N(%) was also compared with the percentage of fatty hepatocytes at histology. Results: The relaxation rate R1 of liver measured from the magnitude image, and the difference in the value of MTC measured from the water image compared with the one measured from the fat and water magnitude image, both depended linearly on the value of N(%). The value of N(%) correlated significantly with the percentage of the fatty hepatocytes. In in vivo fatty tissue, fat infiltration increased both the observed relaxation rate R1 and the measured magnetisation ratio (the steady state magnetisation Ms divided by the equilibrium magnetisation Mo, Ms/Mo) and consequently decreased the MT efficiency measured in a magnitude MR image. The amount of liver fibrosis did not correlate with the value of MTC measured after fat separation. Conclusion: Our results in studying fatty livers with MR imaging and the MT method show that the fat/water separation gives more reliable parametric results. Characterisation of liver cirrhosis by means of the MTC parameter is not reliable, even after fat separation.

The purpose of this study was to evaluate 1/T1rho in relation to 1/T1 and 1/T2 in characterizing normal and diseased muscle. We measured the muscle relaxation rates 1/T1 and 1/T2 at 0.1 T and 1/T1rho at on-resonance locking fields B1 between 10 and 160 microT in myositis patients and normal volunteers. 1/T2 and 1/T1rho of muscle were lower in the patients than in the volunteers, whereas there was no difference in the 1/T1 values. The lower relaxation rates 1/T2 and 1/T1rho in the diseased muscle may be due to fat and connective tissue infiltrations and edema. 1/T1rho contrast between muscle and subcutaneous fat was higher than 1/T2 and 1/T1 contrast. This may be explained by the different B1 dispersion behavior of these two tissue types. 1/T1rho of fat is B1 field independent, whereas 1/T1rho of muscle decreases clearly with increasing B1 field. In conclusion, 1/T1rho provides a useful tool in manipulating contrast in magnetic resonance imaging of diseased muscle.

Gyrate atrophy of the choroid and retina with hyperornithinaemia (GA), an autosomal recessive disease, affects skeletal muscle in addition to the eye. Muscle biopsy samples show prominent type 2 muscle fibre atrophy. Atrophic fibres also contain accumulations of tubular aggregates in electron microscopy. To evaluate skeletal muscle involvement in detail, the thigh muscles of 7 patients with GA were examined using semi-open conchotome muscle biopsies, computed tomography (CT) and ultralow-field magnetic resonance imaging (MRI) at 0.02 T. In MRI, the T1 and T2 proton relaxation times were measured. Type 2 muscle fibre atrophy was found in all biopsy samples (100%) and tubular aggregates in 6 of the 7 samples studied (87%). The CT density of the muscle tissue was increased in the only child of the study, decreased in 3 elderly subjects, and normal in the remaining 3 patients. Mean T1 relaxation times of the patients were decreased (135 +/- 5 ms) as compared to those of 6 healthy controls (157 +/- 12 ms) (p = 0.002). The T2 relaxation time was slightly increased (40 +/- 3 ms) as compared to the controls (35 +/- 7 ms; not significant, p = 0.3). Our findings suggest that the thigh muscles of the patients with GA universally show changes in CT and MRI studies, but relaxation time measurements gave little additional information on the muscle metabolism.

Rationale and Objectives. Tendon xanthomas are atherosclerotic plaquelike collections of lipids that develop with age in the Achilles tendons of patients having familial hypercholesterolemia (FH). We tested a fat—water discrimination technique for imaging Achilles tendon xanthomatosis. Methods. We used the spin-warp imaging technique optimized for low-field magnetic resonance (MR) imaging to obtain separate fat and water images of the Achilles tendon. Seven patients with FII, two patients with normal tendons, and three patients with other tendon pathology were studied. Results. Normal tendons showed an intensity near or equal to that of the noisy background in all images. Compared with the background, the intensity of the FH tendons was approximately fivefold greater in magnitude images, fourfold in fat images, and 10-fold in water images. Conclusion. The method sensitively detected even subtle xanthomatosis in young patients, but differentiation of xanthomas from other pathologic lesions was possible with this method only when the tendons were significantly thickened.

Experimental myonecrosis-induced by injection of notexin into rat tibialis anterior muscle and subsequent regeneration were studied from 1 h to 21) days postinjury with magnetic resonance imaging using conventional and magnetization transfer sequences, and these findings were correlated with histopathology. MR images revealed necrosis within 1 h postinjection. Histopathologically, necrotized fibers enlarged and intercellular spaces widened, indicating intracellular and extracellular edema, which began to decrease after 48 h, whereafter the formation of new myofibers predominated. T 2 increased progressively until 7.5 h, while T 1 increased until 24 h. Magnetization transfer contrast (MTC) and magnetization transfer rate (R wm ) decreased rapidly postinjection; the decrease in R wm lasted longer than in MTC (96 h versus 48 h, respectively). Spin echo, inversion recovery and magnetization transfer sequences revealed the lesions equally effectively. MR images and relaxation parameters reflect well the extent of histopathological injury and edema in the acute phase, whereas specific tissue changes in the regenerative phase were not detectable by MRI. MT imaging and especially magnetization transfer rate are as sensitive as conventional T 2 contrast to alterations in water imbalance

The MR image artifacts caused by minute metallic particles were investigated by imaging small powdered iron quantities from 0.01 mg to 1.7 mg in water phantoms. Images with T1-weighted GRE 3-D and T2-weighted SE 2-D sequences were reconstructed with 5 MR imagers: at 0.04 T., 0.1 T (2 scanners), 1.0 T and 1.5 T. In GRE 3-D images the artifacts were round, clearly demarcated black areas, whereas in SE 2-D images artifact areas were elliptic and surrounded by a bright irregular rim with ghost veils in the direction of frequency encoding. The area of the artifact increased slightly up to 0.1 mg of iron, but grew clearly with larger samples. It appeared to behave independently on the MR imager system for all iron samples. This study shows that even microscopic magnetic particles cause a notable distortion in the MR image independently of the MR equipment used.

Patients with heterozygous familial hypercholesterolaemia (FH) are at high risk for the development of coronary artery disease. Achilles tendon xanthomata are often the first clinical manifestation of FH, but are seldom palpable earlier than during the third decade. Twenty-one FH children aged 3-18 years underwent high-frequency ultrasound examination of the achilles tendon. Hypoechoic infiltration of the normal tendon structure was demonstrated in 8 of 21 (38%) of the FH children. The findings were similar in boys and girls. Control subjects (n = 68) aged 1-25 years had no sonographically detectable tendon abnormalities. The thickness of the achilles tendon of the FH children was (mean +/- SD) 7.1 +/- 1.5 mm (range 5-10 mm). The respective values for the controls were 5.8 +/- 1.0 mm (3-7 mm. We conclude that ultrasound examination sensitively detects cholesterol accumulation in the achilles tendon of FH children before tendon xanthomata are clinically evident.

The feasibility of magnetic resonance imaging and the magnetization transfer technique for measurement of diurnal fluid changes in lumbar discs was studied with the use of 13 healthy subjects. The diurnal height loss of the subjects ranged from 13 to 21 mm. The disc signal in T2-weighted magnetic resonance imaging increased as much as 25% after overnight bed rest, presumably due to the enhanced influx of water. The change in magnetization transfer parameters also suggested increased hydration of the disc after bed rest. Magnetic resonance imaging techniques can be used for indirect measurement of the changes in fluid content and the interaction of water with macromolecules in the disc.

We studied a xanthomatous Achilles tendon and a normal Achilles tendon with the proton magnetic resonance imaging (MRI) and spectroscopy (MRS) at 1.5 T in a standard head coil. TheT2 maps and the localized proton spectra of the Achilles tendon were reconstructed. The normal tendon revealed no MR signal, whereas the xanthomatous tendon image consisted of variable signal intensities, for which the value ofT2 was significantly shorter (p=0.0002) than that of adipose tissue. The proton spectrum of this tendon xanthoma showed an increased water peak and unsaturated olefinic group intensity compared with the spectrum of the normal Achilles tendon area. The complex cholesterol molecule itself cannot be proven directly in a xanthomatous tendon, but its presence can be revealed with the help of the increased methyl and methylene groups of the fatty acids of the cholesteryl esters. This and other typical features describedin vitro for atheromatous tissue can be detectedin vivo in xanthomas.

Preoperative and postoperative magnetic resonance imaging (MRI) of the lumbar spine was performed on 41 patients treated either microsurgically or with percutaneous nucleotomy for lumbar disc herniation. On the first postoperative day, MRI revealed an edematous mass effect at the level of surgery in 25 (61%) patients. The mass effect caused compression of the anterior dural sac mimicking preoperative disc herniation. After the follow-up of 6 months, the mass effect had disappeared in all patients, and the MRI finding in the operated disc space was that of a prolapse in six (15%) patients and that of a protrusion in 16 (39%) patients. Postoperative scarring was detected in 23 (56%) patients. The amount of the epidural scar tissue was significantly (p = 0.0002) associated with the extent of the early postoperative hemorrhagic changes detected in these patients with MRI. No association was observed between these MRI findings (mass effect, disc herniation, epidural scarring) and the clinical outcome of the patients.

We evaluated the incidence of postoperative extradural hematomas by means of magnetic resonance imaging (MRI) technique in 44 patients who underwent successful surgery for a virgin lumbar disc herniation. Of these patients, 28 were treated with microdiscectomy and 16 with percutaneous nucleotomy. Postoperative hematoma proved to be a universal MRI finding in the microsurgically treated patients: hematomas were found in all patients in the microdiscectomy group. In 12 (43%) patients the hematoma extended into the dural sack. The incidence of hematomas was significantly (p = 0.001) lower in the patients treated with percutaneous nucleotomy: hematomas were detected in only 10 (63%) of the 16 patients in the nucleotomy group. The hematomas in these patients were also smaller in size and none of them connected with the dural sac. Correlation between the hematomas and clinical findings showed that the presence of a hematoma had no obvious effect on the immediate postoperative recovery of a patient.

RATIONALE AND OBJECTIVES The variation of measured magnetic resonance T1 relaxation times of autopsied human muscle samples is confusing. Hence, the authors studied rats' muscles to evaluate the effect of fiber type, the relative area of nonmyofiber space, fat and water content, cell death, and the mechanism of death on proton T1. METHODS Rats were studied on a 0.1 T magnetic resonance device. We studied how death by cervical dislocation, pentobarbital injection, or a combination of these methods, as well as the amount of time lapsed after death, variably affected T1. RESULTS Death itself did not affect T1, but the mechanism of death did: rats killed by cervical dislocation after ether anesthesia had longer T1 than those killed with an overdose of pentobarbital. T1 was significantly shorter 1 day after death than at 4 hours after and returned to baseline levels within 4 days after death. Repeated warming caused variation in T1 and obscured other possible changes. CONCLUSIONS Investigation methods should be strictly controlled and standardized before measurements of the relaxation time, T1, of muscle tissue will provide consistent results.

A method for windowing specific T1 values is presented. A 1.0 T imager with two routine pulse sequences was employed: A T1-weighted spin echo (SE) sequence and a short tau inversion recovery STIR sequence (fat-suppressed IR). A T1 window for fat was obtained by subtracting the STIR image from the SE image. Negative values were coded black. The method was tested on a normal human thigh, on a human liver with confirmed fatty infiltration, and on the livers of four live burbots. The fat-containing tissues of the two human volunteers were well depicted. The differences in fat concentration among the burbot livers were also clearly shown. The fat intensity seen in the images correlated well with the chemically measured fat concentration. This subtraction method for windowing T1 values proved feasible for fat. The method could be used for tissues with other short T1 values as well.

SUMMARY Pregnancy is a unique situation for the maternal immune system. We have studied and identified a CD4+CD25+ regulatory T (Treg) cell population isolated from the human decidua. This mucosal surface in the uterus is in direct contact with semiallogenic fetal cells. We observed that about 14% of the decidual CD4+ T cells have the CD4+CD25+ phenotype. The decidual CD4+CD25+ T cells expressed high frequency of intracellular CTLA-4 (CTLA-4i). The majority of CD4+CD25+CTLA-4i+ cells were also positive for GITR and OX40, typical markers for human Treg cells. The frequency of CD4+CD25+ T cells in the peripheral blood from pregnant women was found to be increased during the first and second trimester of gestation when compared to nonpregnant controls. Being an important molecule for Treg cells, the role of CTLA-4 in the regulation of indoleamine 2,3-dioxygenase (IDO) expression was also examined. The stimulation with CTLA-4Ig did not increase IDO mRNA expression in CD14+ cells from pregnant women, while IFN-γ was observed to up-regulate IDO expression. The presence of Treg cells in the human decidua suggests that these cells are important in protecting the fetus from alloreactive immune responses at the maternal–fetal interface.

Summary. Screening of the skeleton by plain radiography was compared to magnetic resonance imaging (MRI) of the lumbar spine in 41 patients with multiple myeloma. In the lumbar spine, myeloma lesions were detected in 15 patients with radiography and in 28 patients with MRI. Radiography of the lumbar spine was not positive in any of the 13 cases with negative MRI, but in two of them radiography was positive elsewhere in the skeleton. We suggest that plain radiography is the most suitable method for screening all bone areas in multiple myeloma, but MRI of the lumbar spine is needed to study patients with normal radiographs.

Summary Pregnancy is a challenge to the immune system, which not only has to protect the mother and the fetus from invading pathogens but to also maintain immunological tolerance against the fetus. However, the mechanisms inhibiting local immune responses in the maternal decidual tissue are poorly understood. We have studied decidual CD14+ macrophages, which may be important in the maintenance of a tolerance against the developing fetus. Decidual macrophages expressed HLA-DR, but lower levels of costimulatory molecule CD86 than peripheral blood CD14+ monocytes from pregnant and non-pregnant women. Decidual macrophages produced spontaneously high levels of interleukin-10. Our findings suggest that decidual macrophages could represent an inhibitory type of APCs. Supporting this conclusion indoleamine 2,3-dioxygenase (IDO), suggested to have an immunosuppressive role in pregnancy, was expressed in decidual macrophages. Furthermore, decidual macrophages were not able to differentiate into dendritic cells under the influence of IL-4 + GM-CSF. These results suggest an immunoinhibitory function of decidual macrophages at the maternal–fetal interface.

Background Accurate diagnosis of maxillary sinusitis is difficult on the basis of clinical examination only because the signs and symptoms of sinusitis are nonspecific. A simple, rapid, and readily available method for diagnosing maxillary sinusitis in primary care would increase the accuracy of the diagnoses and thus reduce unnecessary antibiotic treatment. Objective To investigate the validity of ultrasonography compared with radiography and magnetic resonance imaging (MRI) in detection of maxillary sinusitis. Design Ultrasonography and plain-film radiography of the paranasal sinuses were performed on all patients and MRI was performed on 40 randomly selected patients on day 7 of the study. Setting Study office at the Department of Pediatrics of Turku University Hospital, Turku, Finland. Patients One hundred ninety-seven young adults who contacted the study office within 48 hours of the onset of symptoms of the common cold. Main Outcome Measures Detection rates of maxillary sinusitis by ultrasonography, radiography, and MRI. Results Acute maxillary sinusitis was diagnosed in 24% of the sinuses by radiography and in 28% by MRI. Compared with MRI findings, the sensitivity of ultrasonography for detection of maxillary sinusitis was 64% (specificity, 95%). Using a 2-step diagnostic approach in which radiological findings were additionally considered in cases of negative ultrasound findings, a sensitivity of 86% (specificity, 95%) was observed. Conclusions The high specificity of ultrasonography indicates that a positive ultrasound finding can be regarded as evidence of maxillary sinusitis. The addition of plain-film radiography in cases of negative ultrasound findings increases the diagnostic sensitivity to clinically acceptable levels without loss in specificity. Active use of ultrasonography would substantially decrease the need for radiological imaging of the sinuses and also help reduce unnecessary antibiotic treatment in primary care.

To analyze in vivo brain creatine (Cr) content in gyrate atrophy of the choroid and retina with hyperornithinemia (GA).GA is caused by inherited deficiency of ornithine-delta-aminotransferase activity. Patients lose their vision by middle age and develop selective atrophy of type II skeletal muscle fibers. As demonstrated by MRS, the patients' skeletal muscles have diminished stores of high-energy Cr phosphate. Minor structural and electrophysiologic abnormalities in the brain of these patients also imply that the CNS may be affected.The authors acquired proton MR spectra of the basal ganglia of 22 healthy control subjects and 20 GA patients. Nine patients received supplementary Cr or its precursors, and one child was on an arginine-restricted diet to normalize plasma ornithine concentration. The ratios of N-acetylaspartate (NAA) to Cr, NAA to choline (Cho), and Cho to Cr, and the ratios of NAA, Cho, and Cr to tissue water were calculated.NAA/Cr (Cho/Cr) in the untreated and treated patients and control subjects were (mean +/- SD) 3.3+/-0.4, 2.0+/-0.4, and 1.5+/-0.7 (1.9+/-0.3, 1.3+/-0.4, and 0.9+/-0.2), indicating that Cr content in untreated GA patients was proportionally and markedly diminished, and partially corrected by therapy (p0.0001). NAA/Cho was similar in all three groups. Cr/water in the untreated patients was only 46%, and increased to 75% of the control ratios in the treated patients (p0.0001).Hyperornithinemia-associated Cr deficiency in GA also affects the CNS, further supporting the possibility that Cr deficiency also has a pathogenetic role in the retina. The deficiency was partially corrected by Cr supplementation and an arginine-restricted diet.

Red blood cell aggregates are mainly responsible for the echogenicity of flowing blood. Thus, ultrasound can be used to observe the degree of red blood cell aggregation in slow flow conditions. We quantified blood echogenicity to study aggregation tendency of red blood cells in blood of patients with claudication, patients with suspected venous thrombosis, and normal volunteers without and with in vitro addition of naftidrofuryl (10(-6) M). Normal volunteers showed lower original echogenicity than any group of patients, and claudication patients showed the highest echogenicity. Naftidrofuryl caused a fall in mean echogenicity in all groups, and its effect was pronounced on blood samples with a high original echogenicity.

Purpose To report a very rare presentation of a stress fracture in a golfer: a stress fracture of the ulnar diaphysis. Case summary A 44-year-old woman had a 4-week history of a sore left wrist. She had been playing golf daily and had had no sudden trauma. Extensor tendinitis was suspected. Symptomatic treatment was given. Radiographs showed a spiculated periosteal reaction of the distal ulnar diaphysis with no signs of fracture or bone destruction. The suggestion of a malignant lesion was raised. Magnetic resonance imaging showed a healing ulnar fracture and edema of the interosseous membrane. Discussion In golfers, stress fractures may be seen in ribs laterally and in tibias. We believe supination together with overuse of the hand flexor muscles caused the stress fracture presented, which has not previously been reported in golfers. Relevance Physicians should be aware of the potential for ulnar stress fracture in golfers with wrist pain.

S onogr~phic contrast media are used to increase signal-to-noise ratio in clinicai sonography. Enhanced blood echogenicity is usually achieved by intravenous injection of various solutions with stabilized microbubbles, micropartides, or albumin microspheres [1], although other types of sonographic contrast media also have been developed. The increased echogenicity depends greatly on the concentration of the solution of contrast material. Although the backscatter coefficient is linearly proportional to scatterer concentration at low concentrations [2], it has been shown that above a certain concentration of sonographic contrast medium, the backscattered ultrasonic intensity decreases [3]. It remains unclear whether this is true for variable shear rate and whether variable flow velocity would affect the echogenicity of a bolus of sonographic contrast medium in blood. In this study we investigated the effect of variable shear rates on the echogenicity of sonographic contrast media in blood.

We assessed in this study the potential development of postoperative muscle atrophy in the operation area in 39 patients treated by either microdiscectomy or percutaneous nucleotomy for lumbar disc herniation. The cross-sectional areas of the lumbar muscles were measured on magnetic resonance images created on the day preceding the operation and 6 months postoperatively. The cross-sections of the lumbar muscles remained unchanged during the observation period in all treated patients indicating that no muscle atrophy had developed in the operation area. Since peroperative tissue trauma may correlate with subsequent muscle denervation and atrophy, this finding may be due to the tissue sparing nature of microdiscectomy and percutaneous nucleotomy, thus encouraging the use of these techniques in the treatment of lumbar disc herniation.

Kallio T, Alanen A, Bondestam S, Kormano M. Echoicity of ultrasonic contrast media in solutions of variable concentration. Invest Radiol 1994;29:S137–S138.

Objectives. Tendon xanthomas cause thickening of the tendon and are an important sign in monogenic familial hypercholesterolaemia (FH). The aim of our study was to investigate the usefulness of achilles tendon sonography in detecting FH patients. Special attention was paid to structural abnormalities of the achilles tendon. Design. A clinical study with methodological testing. Setting. Patients suspected of having FH were sent to the out-patient Department of Medicine from other departments of Turku University Central Hospital and from primary care units. The patients were studied by high-frequency ultrasound before more exact typing of the lipid disorder. An additional study of normolipidaemic volunteers and a phantom study were also carried out. Subjects. Forty FH patients, 51 non-FH hypercholesterolaemia patients and 41 normolipidaemic volunteers were included in the study. Main outcome of measures. The thickness of the tendon was measured and the tendon structure and its echogenicity were recorded. Results. Twenty-five out of 40 (63%) FH patients had distinctly thickened tendons (men more than 10 mm, women more than 9 mm). Thirty-six (90%) had a typical structural alteration of low or mixed echogenicity of the tendon. Three non-FH patients were found to have xanthomas on sonography. Conclusions. We conclude that ultrasonography is a sensitive method of detecting xanothomas that reveals the altered tendon structure even in xanthomatous tendons of normal thickness.

Six live burbot fish (Lota lota) were examined on the 1st, 7th and 15th day after capture. The echo intensity of the liver tissue was correlated with chemically measured fat and water content and with the tissue cytology. At the end of the study, the collagen and total protein contents of the livers were also measured. The increasing size of fat droplets and clustering of droplets correlated well with the echo intensity (p = 0.0012), but there was no statistically significant correlation between echo intensity and chemically measured fat concentration (p = 0.1989). These results indicate that the echogenicity is a function of the liver histomorphology. No significant correlation was found between the echo intensity and liver collagen, total protein content, or amounts of water. The burbots tolerated transport and repeated anesthesia and appear well suited for experimental ultrasound studies.

A reconstructed separate fat image was used for studying the fat content of the liver of 12 dead and six living fasting burbots (Lota lota) in a 0.04 T magnetic field with olive oil as a reference. The correlation between the MR intensities and the results of the cytological, histological and chemical fat measurements, as well as chemically measured water, collagen and total protein contents were examined. The MR signal intensity in reconstructed fat images correlated well with the changes in fat content of the liver in living fish (r = 0.69, P = 0.0014). Also the contents of water (r = -0.66, P = 0.003) and total protein (r = -0.91, P = 0.013) correlated significantly with the MR signal intensity. The reconstructed fat image is thus a reliable method for following the changes in tissue fat content. The living burbot is an applicable test animal for studying the hepatic fat content with MR.

Twenty-two patients with acute abdominal symptoms were studied by abdominal sonography and by sonographically guided aspiration of intraperitoneal fluid. The colour of the fluid was found to be diagnostically valuable: a green colour indicated gallbladder perforation, a yellow colour was found in a variety of infectious diseases, a red colour in haemorrhagic pancreatitis or haemorrhage. Aspirating fluid from the peritoneal cavity under ultrasound guidance in connection with any routine ultrasound examination is a valuable and easy method for studying patients with symptoms of acute abdomen.

The accuracy of plain films, excretory urography and ultrasound for the clinical work-up of renal colic for detecting urinary calculi was evaluated prospectively in 49 patients. Excretory urography was the most sensitive and specific test. Plain films and sonography each had a sensitivity of approximately 60%, but combined yielded a sensitivity of 80%; specificity did not improve. A diagnostic algorithm where sonography was performed first followed by an excretory urography in case of a negative sonography was highly sensitive (93%) and rather specific (79%). This algorithm appears also to have a good cost-benefit rate.

Magnetic resonance imaging (MRI) was performed on 35 young competitive gymnasts and 10 control subjects in order to detect the number of degenerated discs and other lumbar spinal disorders. Lumbar radiographs were obtained from all gymnasts who showed evidence of disc abnormality on MRI. Eleven gymnasts had suf fered from episodes of low back pain during exercises and eight were found to have evidence of back trauma. Only 3 of the 35 gymnasts had MRI evidence of degen erated discs associated with Scheuermann's manifes tations and spondylolysis. Lumbar radiographs con firmed the diagnosis in these three cases. The results indicate that despite the excessive range of motion and strong axial loading of the lumbar spine that are asso ciated with gymnastic maneuvers, incurable primary damage to the intervertebral discs is uncommon in young gymnasts dunng growth.

The brains of 42 newborn infants were examined with MRI at 0.02 T field, and regional variations of T1 relaxation time were measured from the images. There were three groups: 1. full term infants (9), 2. preterm infants (10) and 3. SGA (= small for gestational age) infants (20). Relaxation times showed a correlation to myelination of the brain. The brain of SGA infants showed a large variation in their T1 values.

Both normal and experimentally hydronephrotic rabbits were imaged at 0.02 T using partial saturation (PS 160/30) and inversion recovery (IR 1000/200/40) sequences. The signal intensity of normal renal medulla and cortex markedly increased after the injection of 0.1 mmol/kg of Gd-DOTA. In the unilateral total hydronephrosis the dilated renal pelvis did not contrast enhance after 15 and 35 min of Gd-DOTA injection. The enhancement pattern was similar in 1- and 3-week-old hydronephrosis. The effect of Gd-DOTA on renal T1 times at 0.02 T was studied using rats. Fifteen minutes after the Gd-DOTA injection (0.1 mmol/kg) the T1 times of excised rat kidneys decreased from 311 to 90 ms. The authors conclude that the enhancement of the MR signal of the kidney by Gd-DOTA at an ultralow magnetic field (0.02 T) is similar to its enhancement at higher fields (greater than 0.15 T).

Comparison of the radiographic signs of Scheuermann disease and the corresponding disc degeneration on thoracolumbar magnetic resonance (MR) images was made in 21 young patients. Marginal sclerosis, Schmorl nodes and narrowed disc spaces, but not irregular or wedge-shaped end-plates, were significantly associated with disc degeneration. Fifty-five percent of the discs in the patients with Scheuermann disease were abnormal on MRI, compared with 10% in asymptomatic controls. Our study confirms that thoracolumbar disc degeneration is enhanced in 20-year-old patients with low back pain who have radiological evidence of Scheuermann disease.

The echogenicity of blood varies with the conditions of flow. This study introduces a new technique for quantifying blood echogenicity and includes digitalization of the signal from an A-mode ultrasound scanner, integration, subtraction, and computer analysis of the signal. Shear rate (directly proportional to velocity) had an inverse relationship to the blood echogenicity. Hemodilution with Ringer's solution and with low-molecular-weight dextran 1 decreased blood echogenicity, whereas the addition of a macromolecular protein (dextran 70) increased blood echogenicity. This technique makes possible a quantitative analysis of the factors affecting blood echogenicity.

Erythrocytes at various concentrations were examined with a sensitive A-mode ultrasonic scanner; simultaneous measurements were made under light microscopic control. Individual erythrocytes caused weak (about 1 dB) echoes while erythrocyte aggregates (ten to 100 cells) produced stronger echoes (up to 15 dB), grossly proportional to the size of the aggregates. The latter type echoes were characteristic of higher erythrocyte concentrations (hematocrit 0.1 - 0.8). It is concluded that these echoes originate from red cell aggregates within the stagnant blood.

Blood echogenicity was measured in four patient groups with circulatory disturbances (myocardial infarction, stroke, claudication, and deep venous thrombosis) at hospital admission and one week later. The recording was done by an A-mode ultrasonic method at three shear rates down to 4.1 s −1 . The rheological effects of adding an anti-aggregatory drug, naftidrofuryl, was tested in vitro at concentrations ranging from 10 −8 –10 −6 M. Echogenicity was lowest in blood from healthy volunteers and significantly greater in blood from patients with claudication. The in vitro addition of naftidrofuryl significantly lowered the echogenicity of blood samples taken from patients with venous thrombosis in the lower extremities. The authors suggest that increased blood echogenicity, which can be pharmacologically manipulated, may be a nonspecific indicator of disease.

We investigated the effect of radiographic contrast media (RCM) on red blood cell (RBC) aggregation by analyzing echogenicity of flowing blood before and after the addition of 2%, 20%, 50% or 95% volume of undiluted meglumine diatrizoate, iohexol, sodium meglumine ioxaglate, or iopamidol and equiosmolar volume concentration of saline. This was done both by stepwise increasing the concentration with minimal mixing and by stepwise decreasing the concentrations with more efficient mixing. All contrast media caused a drop in blood echogenicity after a proper mixing when compared with saline addition. After minimal stirring, both meglumine diatrozoate and iohexol caused a significant increase in blood echogenicity at volume concentrations over 50%. The paper demonstrates that earlier findings of both increased and decreased RBC aggregation following exposure to RCM can be reproduced and that the result depends on experimental setup. In diatrizoate and iohexol RBC aggregates disappear after mixing (increasing the shear rate) or when the RCM/blood mixture is diluted. After dispersement, the abnormal RBC aggregates will not reform.