Interpretation of Knee Anterior Pain in Handball Players Focusing on the Infrapatellar Fat Pad / 日本農村医学会雑誌

The infrapatellar fat pad is functionally deformed with joint movement and is involved in adjusting the internal pressure of the knee joint. On the other hand, it can also become a source of anterior knee pain due to inflammation and degeneration. A young female handball player experienced anterior knee pain. No obvious abnormality was observed on basic X-ray and magnetic resonance images. Dynamic observation using ultrasonic diagnostic imaging showed poor kinetics with infiltration of the infrapatellar fat pad into the patellar ligament and the tibial condyle, with the knee joint in extension on the affected side compared with the normal side. Knee joint range of movement (affected side vs. normal side) was restricted to 140° p / 150° flexion and extension - 10° p / 5°, and there was infrapatellar tenderness in the affected region. Patella baja was confirmed compared with the normal side. In addition, the flexibility of the infrapatellar fat pad was reduced. From these findings, it was inferred that the cause of pain was restriction of knee joint extension due to reduced flexibility of the infrapatellar fat pad. Treatment of the infrapatellar fat pad, joint range training exercises, and muscle strengthening training exercises were carried out. Pain and restricted range of joint movements improved and the patient could returned to competitive sports.

Interpretation Ability of Auxiliary Radiology Technicians in Emergency Medical Care / 日本農村医学会雑誌

    Expansion of the work of medical radiology technicians has made it possible for them to assist in interpreting medical images. Questionnaire surveys have reported that such assistance is particularly needed in emergency medical care. This paper describes the results of a computerized tomography (CT) image interpretation test that was administered to 45 medical radiology technicians working in Gifu Prefecture, to assess and identify factors that may improve their interpreting ability. The test results revealed that a relatively higher percentage of correct answers were obtained when reviewing CT images of critical cases, while a lower percentage was observed when reviewing less critical cases such as small tumors or tumors in the digestive tract. Also, the overall percentage of correct answers increased slightly with the number of years of experience, but interpreting scores dropped dramatically among radiology technicians with less than 3 years of experience. Statistical analysis further revealed that those radiologists who exhibited higher abilities in CT image interpretation were certified with various CT-related skills, had report writing skills, or were full-time CT staff. These are factors that can help improving CT image interpreting ability for medical radiology technicians.

Use of 3D Arterial Spin Labeling (3D ASL) / 日本農村医学会雑誌

　　With the recent upgrade of the MRI system, it has become possible to use 3D arterial spin labeling (3D ASL), which is an MR perfusion imaging technique without use of any contrast material. In this paper, we report the effects of imaging conditions on the cerebral blood flow (CBF) level (the amount of cerebral blood flow per unit brain tissue〔ml/min・100g〕) . We also report our clinical experience with 3DASL. In respect of the imaging conditions, changes in CBF values were examined when the arm and the number of excitations (NEX) were variable. The results showed that there were no significant differences in CBF values between different regions in the brain. This was due probably to the fact that the spin of the labeled blood was unaffected although the arm influenced the spatial resolution of images and NEX affected SN ratio.

Hand-Scanning Ultrasound Mass Screening for Breast Cancer in Women Aged Under 50 / 日本農村医学会雑誌

A total of 82 cases of breast cancer detected by hand-scanning ultrasound massscreenig (hereafter referred to as US screening) over the past 15 years were divided into two groups--one aged under 50 and the other aged 50 or over at the time of examinaton. The accuracy and capacity of US screening and the rate of patients with subjective symptoms were studied for each group. As a result, we discovered that the groupaged under 50 was significantly higher in the rate of “further examination needed”, and the rate of “having subjective symptoms”, and was significantly lower in “positive predictivevalue” than the older age group. In the detection rate, sensitivity and specificity, there was no difference between the two groups. Thus, we concluded that US screening were beneficial to both groups.<BR>Dividing the 15 years of US screening into three periods (each 5 years), we investigated the caliber of detected breast cancers, and found the tumor size became smaller year after year. As a result, the cases of non-palpable breast cancer came to form 26.6%, of which 72.3% was accounted for by invasive breast cancer. Further more, we found that in the group aged under 50, because of stiffness of their breast gland, the ratio of non-palpable breast cancer came to 30.2%, which was larger than in the older age group, and 69.2% cases out of them were invasive breast cancer. We are afraid that mass-screening by physical examination alone will overlook many cases of breast cancer, and we recommend that in view of the increasing mortality rate of breast cancer in women in their50s the safe and useful US screening program should be implemented without delay on the younger age group.