Recognition of variations in size, shape, and density of the normal thymus on computed tomographic (CT) scans is of paramount importance, lest it be misinterpreted as an abnormal mediastinal mass. Studying patients subsequently proved free of active chest disease, we analyzed 154 CT scans of the mediastinum, performed on a fourth-generation scanner, to determine the incidence of visualization and appearance of the normal thymus. The thymus was seen in 100% of patients under age 30, 73% of patients between 30 and 49 years, and in 17% of patients over 49 years of age. The thickness of the thymus showed a definite decrease in size with increasing age; although the width showed a similar general tendency, a wide variation was noted within each age group. In younger patients, the density of the thymus was similar to that of muscle; the attenuation values progressively decreased in older patients, finally approaching that of fat.

Tight control of extracellular and intracellular inorganic phosphate (Pi) levels is critical to most biochemical and physiologic processes. Urinary Pi is freely filtered at the kidney glomerulus and is reabsorbed in the renal tubule by the action of the apical sodium-dependent phosphate transporters, NaPi-IIa/NaPi-IIc/Pit2. However, the molecular identity of the protein(s) participating in the basolateral Pi efflux remains unknown. Evidence has suggested that xenotropic and polytropic retroviral receptor 1 (XPR1) might be involved in this process. Here, we show that conditional inactivation of in the renal tubule in mice resulted in impaired renal Pi reabsorption. Analysis of Pi transport in primary cultures of proximal tubular cells or in freshly isolated renal tubules revealed that this deficiency significantly affected Pi efflux. Further, mice with conditional inactivation of in the renal tubule exhibited generalized proximal tubular dysfunction indicative of Fanconi syndrome, characterized by glycosuria, aminoaciduria, calciuria, and albuminuria. Dramatic alterations in the renal transcriptome, including a significant reduction in NaPi-IIa/NaPi-IIc expression, accompanied these functional changes. Additionally,-deficient mice developed hypophosphatemic rickets secondary to renal dysfunction. These results identify XPR1 as a major regulator of Pi homeostasis and as a potential therapeutic target in bone and kidney disorders.

Preoperative determination of the extent of bronchogenic carcinoma at presentation was assessed by CT using a 4th generation scanner with a 3-second scan time in 98 patients whose disease was later surgically staged. Prospective CT interpretations correctly staged 33 of 35 (94%) resectable lesions, and disease in 41 of 45 (91%) patients who had lesions that were not resectable for cure. No definite opinion was rendered on the scans of the remaining 18 patients. Retrospectively analysis using slightly modified criteria resulted in a correct prediction of resectability in 28 of 30 (93%) patients (scans showed a normal mediastinum with no lymph node larger than 1 cm in diameter), and nonresectability for cure in 34 of 34 (100%) patients (scans showed either direct extension of the primary neoplasm into the mediastinum or mediastinal lymph-node enlargement greater than 2 cm in diameter). However, scans of 34 of 98 (35%) patients showed inconclusive findings (mediastinal lymph-nodes with 1-cm to 2-cm diameters, neoplasms abutting but not definitely invading the mediastinum, pleural or pericardial thickening, or additional noncalcified nodules).

Computed tomography (CT) should be the imaging method of choice following plain chest radiographs when a suspected thymic abnormality requires further evaluation. Based upon a six-year experience, including the evaluation of 25 patients with thymic pathology, CT was found useful in suggesting or excluding a diagnosis of thymoma and in distinguishing thymic hyperplasia from thymoma in patients with myasthenia gravis. The thickness of the thymic lobes determined by CT was found to be a more accurate indicator of infiltrative disease (thymic hyperplasia and lymphoma) than the width. CT was helpful in differentiating benign thymic cysts from solid tumors, and in defining the extent of a thymic neoplasm. On occasion, CT may suggest the specific histologic nature of a thymic lesion.

Recent studies have emphasized the pathophysiological importance of circulating 1,25-dihydroxyvitamin D ((1,25-(OH)2D] in the pathogenesis of hypercalciuria and renal stone formation in primary hyperparathyroidism. Reasoning that phosphate administration might be capable of reducing the plasma concentration of 1,25-(OH)2D in patients with a prominent 1,25-(OH)2D-mediated absorptive component to their disease, 10 carefully selected patients were treated with oral phosphate (1500 mg elemental phosphorus daily) for 1 yr. Phosphate treatment significantly reduced circulating 1,25-(OH)2D levels (84 to 56 pg/ml), the calciuric response to an oral calcium tolerance test (0.30 to 0.21 delta mg calcium/dl GF), and calcium excretion on an unrestricted calcium diet (438-269 mg/day), in essence reversing the absorptive pattern of abnormalities observed before treatment. This response, however, was accompanied by an increase in biochemical hyperparathyroidism, as assessed by circulating immunoreactive PTH and nephrogenous cAMP excretion. In patients with biochemical evidence of an increase in bone resorption before therapy, histomorphometric, radiographic, and biochemical data revealed a trend toward a reduction in bone turnover during phosphorus therapy, with an apparent maintenance of coupled bone resorption and bone formation. This trend, however, was of marginal statistical significance in the patient group as a whole. It is concluded 1) that phosphate therapy represents a viable medical alternative in selected patients with primary hyperparathyroidism, 2) that the net response in treated patients is multifaceted and complex, and 3) that the efficacy of phosphate therapy will ultimately depend upon its long term effects on skeletal homeostasis.