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Objective: To assess the vascularisation of focal hepatic tumours using NC100100, enhanced power Doppler imaging. Methods: Twenty-two patients with focal liver tumours (12 metastases and ten hemangiomas) were studied. Using standardised settings, power Doppler imaging with ATL HDI3000 was performed before and after intravenous administration of NC100100 contrast agent. The video-recorded examinations were digitised for off-line analysis on a personal computer. Regions of interest were defined over the entire tumour and a neighbouring area of the normal liver parenchyma. The temporal changes of the mean power Doppler signal intensity (PDSI) was quantified to provide contrast agent wash-in (PDSI-time) curves for the initial 40 s. Results: Liver metastases were characterised by a rapid increase in PDSI, while the PDSI-time curves within hemangiomas were flat. The PDSI within the tumour increased significantly in ten subjects with liver metastases and only one subject with hemangioma. An enhanced rim around hemangiomas was seen in four subjects. There was no clear relationship between the contrast agent dose and the peak PDSI within metastases. Conclusions: Power Doppler imaging with NC100100 contrast agent enhances tumour visualisation and may aid differential diagnosis of focal liver lesions.

Objective—To determine whether spectral analysis of unprocessed radiofrequency (RF) signal offers advantages over standard videodensitometric analysis in identifying the morphology of coronary atherosclerotic plaques. Methods—97 regions of interest (ROI) were imaged at 30 MHz from postmortem, pressure perfused (80 mm Hg) coronary arteries in saline baths. RF data were digitised at 250 MHz. Two different sizes of ROI were identified from scan converted images, and relative amplitudes of different frequency components were analysed from raw data. Normalised spectra was used to calculate spectral slope (dB/MHz), y-axis intercept (dB), mean power (dB), and maximum power (dB) over a given bandwidth (17-42 MHz). RF images were constructed and compared with comparative histology derived from microscopy and radiological techniques in three dimensions. Results—Mean power was similar from dense fibrotic tissue and heavy calcium, but spectral slope was steeper in heavy calcium (−0.45 (0.1)) than in dense fibrotic tissue (−0.31 (0.1)), and maximum power was higher for heavy calcium (−7.7 (2.0)) than for dense fibrotic tissue (−10.2 (3.9)). Maximum power was significantly higher in heavy calcium (−7.7 (2.0) dB) and dense fibrotic tissue (−10.2 (3.9) dB) than in microcalcification (−13.9 (3.8) dB). Y-axis intercept was higher in microcalcification (−5.8 (1.1) dB) than in moderately fibrotic tissue (−11.9 (2.0) dB). Moderate and dense fibrotic tissue were discriminated with mean power: moderate −20.2 (1.1) dB, dense −14.7 (3.7) dB; and y-axis intercept: moderate −11.9 (2.0) dB, dense −5.5 (5.4) dB. Different densities of fibrosis, loose, moderate, and dense, were discriminated with both y-axis intercept, spectral slope, and mean power. Lipid could be differentiated from other types of plaque tissue on the basis of spectral slope, lipid −0.17 (0.08). Also y-axis intercept from lipid (−17.6 (3.9)) differed significantly from moderately fibrotic tissue, dense fibrotic tissue, microcalcification, and heavy calcium. No significant differences in any of the measured parameters were seen between the results obtained from small and large ROIs. Conclusion—Frequency based spectral analysis of unprocessed ultrasound signal may lead to accurate identification of atherosclerotic plaque morphology. Keywords: tissue characterisation; intravascular ultrasound; spectral analysis; radiofrequency data

Nonuniform rotation of mechanical intravascular ultrasound transducers may give rise to a geometric distortion of the ultrasound image known as the rotation angle artefact. This investigation studied the influence of different degrees and combinations of catheter shaft angulation on image morphology and the quantitative impact of the artefact using a circular perspex phantom and 3.5 F, 30 MHz Boston Scientific “Sonicath” catheters connected to a Hewlett Packard Sonos intravascular scanner. Major and minor diameters, cross-sectional area and circumference of the phantom lumen were measured and a “distortion index” calculated. Visually apparent geometric distortion was graded from 1 (absent) to 4 (severe). As expected, eccentric transducer location was associated much more frequently with identifiable distortion (70%) than was a concentric location (6%). Greater distortion occurred with increasing degrees of catheter shaft angulation, and was more pronounced in images from older catheters. The lumen area measurements in images in which no artefact was identified were accurate to within ±10% in 97% of cases, compared to only 81% of cases when an artefact was noted. The quantitative accuracy of an image in which geometric distortion is identified is thus not reliable. The direction of the quantitative error cannot be confidently predicted in any given case, although the mean lumen area tends to increase as the grade of distortion increases.

Human papillomavirus (HPV) may have a pathogenic role in squamous cell carcinoma of the oesophagus. Tylosis, an inherited thickening of the skin of the palms and soles, was associated with a high risk of developing squamous cell carcinoma of the oesophagus among members of a large family in Liverpool. The resected carcinomas of the oesophagus was examined from four such patients with DNA probes to HPV types 6,11,16,18,31,33 and 35 using in situ hybridisation under conditions of high stringency. No reaction was detected. The oesophageal biopsy specimens from 10 tylotic subjects without carcinoma were also examined. No HPV DNA was detected. It is concluded that there is no evidence that HPV infection has a role in the development of squamous cell carcinoma of the oesophagus in tylosis.

Two patients with light chain nephropathy are described. The diagnosis and management of this rare condition is discussed.

The clinical behaviour of ovarian tumours of low malignant potential (LMP) is unpredictable and it has been suggested that the majority of these lesions have no invasive potential. This study has analysed 92 epithelial ovarian tumours [11 mucinous cystadenomas, 18 mucinous LMP tumours, 15 mucinous carcinomas (9 FIGO stage I), 16 serous cystadenomas, 15 serous LMP tumours, and 17 serous carcinomas (11 FIGO stage I)] for numerical abnormalities of chromosomes 1, 11, 17, and X by interphase cytogenetics. Overall, numerical aberrations were identified in none of the cystadenomas, 15 per cent of serous LMP tumours, 17 per cent of mucinous LMP tumours, 67 per cent of mucinous carcinomas, and 82 per cent of invasive serous carcinomas. In mucinous LMP tumours, chromosome gains were associated with spindled nuclear morphology. Chromosome abnormalities were significantly more frequent in invasive mucinous (overall p0.01; stage I p0.05) and serous (overall p0.001; stage I p0.01) carcinomas than in the corresponding LMP tumours. No significant relationship between either stromal invasion or tumour type and the pattern of chromosome loss or gain was identified, although monosomy X was identified almost exclusively in invasive serous carcinomas. These observations are consistent with the concept that LMP tumours are unlikely to be precursors of ovarian carcinoma, but suggest that chromosome instability is important in the development of the invasive phenotype.

Human papillomavirus (HPV) infection has been implicated as an etiologic factor in most cervical cancers. However, additional genetic alterations are thought to be required for the development of a carcinogenic genotype. In the present study, interphase cytogenetics utilizing pericentromeric probes specific for chromosomes 1, 3, 11, 17, 18, and X was performed on paraffin-embedded tissue sections from 25 high-grade squamous intraepithelial lesions (SILs) and 25 invasive squamous cell carcinomas (ISCCs) of the cervix. HPV infection was determined by both in situ hybridization and broad-spectrum GP5+/GP6+ PCR. HPV was identified in all high-grade SILs (HPV 16, n = 16; 18, n = 2; 26, n = 1; 31, n = 4; 45, n = 1; 66, n = 1) and 23 (92%) ISCCs (HPV 16, n = 19; 18, n = 2; 31, n = 1; 39, n = 1). Aneusomy was identified in 11 (44%) high-grade SILs and 18 (72%) ISCCs. In 18 (62%) of these, relative under-representation of chromosomes 3, 11, 17, and/or 18 was identified (8 high-grade SILs and 10 ISCCs). Tetrasomy of all six chromosomes was present in two high-grade SILs but no ISCCs. Twelve (48%) high-grade SILs and seven (28%) ISCCs were disomic with all six chromosome probes, and there was no relationship between HPV presence or type and chromosome pattern. The presence of distinct patterns of numerical chromosome abnormality in these lesions suggests that progression to high-grade SIL or invasive carcinoma can occur by more than one genetic pathway. The lack of correlation between chromosome pattern and HPV type indicates that these pathways are not HPV type-specific. Whether these patterns reflect differences in early gene expression, possibly related to viral integration, or differences in the biologic properties of HPV type variants remains to be established.

AIMS: To determine whether the recommended methods for the handling of breast excision biopsy specimens from screening patients cause more laboratory work than those used for non-screening patients. METHODS: All breast excision biopsy specimens from 1990 were identified. Ninety one came from patients identified during the prevalent round of breast screening. These were compared with 127 from non-screening patients operated on by the same surgeon. The workload in terms of initial blocks taken, cases which needed extra blocks or other additional work, and the time taken for delivery of slides to the pathologist were assessed. RESULTS: The screening cases required significantly more initial blocks than the non-screening cases (8.03 v 4.95; p = 0.000001). When looking at the malignant diagnoses this difference was maintained (7.74 v 6.02; p = 0.00014). CONCLUSIONS: Excision biopsy specimens from screening patients require more laboratory work per case than those from non-screening patients. The reasons for these differences lie in the nature of the specimens and their subsequent diagnoses, and in the initial indications for biopsy.

Two patients with light chain nephropathy are described. The diagnosis and management of this rare condition is discussed.

(1996). Spontaneous uterine rupture in the first trimester of pregnancy. Journal of Obstetrics and Gynaecology: Vol. 16, No. 3, pp. 174-175.

We have studied doppler recordings of flow velocity waveform of the umbilical artery in 380 high-risk pregnancies and 160 patients with uncomplicated pregnancies. The results were not used in clinical management. In 24 cases, all in high-risk pregnancies, there was absence of end diastolic flow (AEDF). Four babies died, 22 out of 24 weighed less than the 5th centile for gestation and 20 were delivered by Caesarean Section. With only four exceptions, all fetuses showed other evidence of antenatal fetal compromise, though this was delayed in some cases for up to 24 days. AEDF does not appear to prejudice neonatal outcome. All six babies born weighing 750–999 g survived. In addition, 4 patients continued their pregnancy for 3–6 weeks after the first doppler with AEDF. Only one of the 4 developed other evidence of fetal compromise and two had vaginal deliveries. In our experience, AEDF is found only in abnormal pregnancy, and is a very serious sign of likely fetal compromise. It is an indication for extremely careful surveillance but not necessarily an indication for delivery.

Using an immunoperoxidase method we have demonstrated carcinoembryonic antigen (CEA) in more than half of a series of 62 tumors of minor salivary glands. CEA was present in both benign and malignant tumors. Its presence was related mainly to the formation of well differentiated ductal tissue in the neoplasms rather than to the histologic type of tumor. Although of only limited diagnostic value, the histologic presence of CEA in a particular tumor may indicate the possibility of postoperative monitoring of saliva and plasma, particularly where residual tumor, metastases or recurrences arc considered likely.

Serum profiles of both oestradiol and prolactin were measured during the luteal phase in normal women, in women with cyclical breast pain and in women with recently biopsied benign breast disease. The results suggest that, in women with benign breast disease, the concentration of both hormones may be increased, when compared to the normal controls, during the evening in the latter part of the luteal phase.

Summary A case of an unusual, benign, melanotic cyst of the ovary is described. Its relationship with the so-called “retinal anlage” tumour and its histogenesis are discussed.