Prevalence of thoracic diffuse idiopathic skeletal hyperostosis (DISH) in Japanese: Results of chest CT-based cross-sectional study.

BACKGROUND: The epidemiology and etiology of diffuse idiopathic skeletal hyperostosis (DISH) remain obscure. To date, to the best of our knowledge, there is no study that precisely evaluated the prevalence of thoracic DISH based on computed tomography (CT) data in large number of non-operated cohort with wide age distribution. METHODS: The participants of this study were the consecutive patients who have undergone chest CT for the examination of pulmonary diseases in our institute. The patients with previous thoracic spine surgery and younger than 15 years old were excluded. Chest CT data were reconstructed in the condition suitable for bone evaluation by the software application. Definitive diagnosis of DISH was determined according to the criteria established by Resnick and Niwayama. Prevalence and distribution of thoracic DISH were reviewed and the data was statistically analyzed. RESULTS: Total 3013 patients (1261 females and 1752 males) with the mean age of 65 years were recruited. The CT-based evidence of thoracic DISH was noted in 261 individuals (31 females and 230 males) (8.7%), and their mean age was 73 years. Statistical analyses revealed that thoracic DISH had a significant male preponderance. The mean age of thoracic DISH positive individuals was significantly higher than that of thoracic DISH negative individuals. There was significant difference of bone mass index (BMI) between thoracic DISH positive and negative individuals. Thoracic DISH was noted after the age of 40s with the highest distribution found at the age of 70s. No thoracic DISH localizes only higher thoracic region was found. CONCLUSIONS: The CT-based prevalence of thoracic DISH in Japanese was 8.7%. Thoracic DISH has a significant predisposition to elderly male with high BMI.

Prevalence, distribution, and morphology of thoracic ossification of the posterior longitudinal ligament in Japanese: results of CT-based cross-sectional study.

STUDY DESIGN: A cross-sectional study. OBJECTIVE: To gain an insight into the prevalence, morphology, and distribution of thoracic ossification of the posterior longitudinal ligament of the spine (T-OPLL) by computed tomography (CT) and review of the literature. SUMMARY OF BACKGROUND DATA: The epidemiology and cause of T-OPLL remains obscure. To date, to the best of our knowledge, there is no study that has comprehensively evaluated the thoracic spine by CT to assess the prevalence, distribution, and morphology of T-OPLL in a sufficiently large size of sample with wide distribution of age. METHODS: The participants of this study were the patients who have undergone chest CT for the examination of pulmonary diseases in our institute. The patients with previous thoracic spine surgery and younger than 15 years were excluded. Prevalence, distribution, and morphology of T-OPLL were reviewed. RESULTS: A total of 3013 patients (1261 females and 1752 males) with the mean age of 65 years were recruited. The CT-based evidence of T-OPLL was noted in 56 (38 females and 18 males) individuals (1.9%). Most frequently encountered type was liner type, followed by continuous cylindrical type and mixed type. Continuous waveform and beaked type were less frequently encountered. Statistical analyses revealed that T-OPLL was noted at a significantly higher rate among the females. The mean age of T-OPLL-positive males was significantly higher than that of T-OPLL-negative males. Furthermore, there was significant difference of body mass index between T-OPLL-positive and T-OPLL-negative individuals. Most of T-OPLLs were confirmed in higher or middle thoracic regions and the highest peak was found at T3-T4. T-OPLL was noted after the age of 40 years with the peak distribution found at the age of 60 years. CONCLUSION: The prevalence of T-OPLL in Japanese was 1.9%. Further studies that characterize definitive subtypes of T-OPLL on CT are warranted so as to establish possible association between clinical manifestations and size and/or subtypes of T-OPLL. LEVEL OF EVIDENCE: N/A.

Prevalence, distribution, and morphology of thoracic ossification of the yellow ligament in Japanese: results of CT-based cross-sectional study.

STUDY DESIGN: A cross-sectional study. OBJECTIVE: To gain an insight for the prevalence, morphology, and distribution of thoracic ossification of the yellow ligament (OYL) by computed tomography (CT) and review of the literature. SUMMARY OF BACKGROUND DATA: The epidemiology and etiology of OYL remains obscure. To date, to the best of our knowledge, there is no study that comprehensively evaluated thoracic spine by CT to assess the prevalence, distribution, and morphology of OYL in a large enough sample size with wide age distribution. METHODS: The participants of this study were the patients who have undergone chest CT for the examination of pulmonary diseases in our institute. The patients with previous thoracic spine surgery and younger than 15 years were excluded. Prevalence, distribution, and morphology of thoracic OYL were reviewed. RESULTS: A total of 3013 patients (1261 females and 1752 males) with the mean age of 65 years were recruited. The CT-based evidence of OYL was noted in 1094 (428 females and 666 males) individuals (36%). Single-level involvement was noted in 532 cases, whereas 562 individuals presented multilevel involvement.Statistical analyses revealed that OYL was noted at a significantly higher rate among the males (P = 0.022). Of a total of 2051 OYLs, 779 central type OYLs, a mushroom-shaped ossification localized at the center of laminae, and 1272 noncentral type OYLs were noted. Distribution of the thoracic OYL formed 2 peaks with the highest and second highest peak found at T10-T11 and T4-T5, respectively. Interestingly, OYL is noted at consistent rates after the age of 30; however, its size increased in age-dependent manners. CONCLUSION: The prevalence of thoracic OYL in Japanese was 36%. A further study disclosing the association between clinical manifestations and size and/or morphology of OYL is warranted.

Brain-derived neurotrophic factor from bone marrow-derived cells promotes post-injury repair of peripheral nerve.

Brain-derived neurotrophic factor (BDNF) stimulates peripheral nerve regeneration. However, the origin of BNDF and its precise effect on nerve repair have not been clarified. In this study, we examined the role of BDNF from bone marrow-derived cells (BMDCs) in post-injury nerve repair. Control and heterozygote BDNF knockout mice (BDNF+/-) received a left sciatic nerve crush using a cerebral blood clip. Especially, for the evaluation of BDNF from BMDCs, studies with bone marrow transplantation (BMT) were performed before the injury. We evaluated nerve function using a rotarod test, sciatic function index (SFI), and motor nerve conduction velocity (MNCV) simultaneously with histological nerve analyses by immunohistochemistry before and after the nerve injury until 8 weeks. BDNF production was examined by immunohistochemistry and mRNA analyses. After the nerve crush, the controls showed severe nerve dysfunction evaluated at 1 week. However, nerve function was gradually restored and reached normal levels by 8 weeks. By immunohistochemistry, BDNF expression was very faint before injury, but was dramatically increased after injury at 1 week in the distal segment from the crush site. BDNF expression was mainly co-localized with CD45 in BMDCs, which was further confirmed by the appearance of GFP-positive cells in the BMT study. Variant analysis of BDNF mRNA also confirmed this finding. BDNF+/- mice showed a loss of function with delayed histological recovery and BDNF+/+→BDNF+/- BMT mice showed complete recovery both functionally and histologically. These results suggested that the attenuated recovery of the BDNF+/- mice was rescued by the transplantation of BMCs and that BDNF from BMDCs has an essential role in nerve repair.

Initial experience of uterine fibroid embolization using porous gelatin sponge particles.

The purpose of this study was to prospectively assess the safety and effectiveness of uterine artery embolization (UAE) using porous gelatin particle (PGP; Gelpart; Asuterasu, Tokyo, Japan) for symptomatic uterine fibroids. Twenty-five consecutive premenopausal women underwent UAE with PGP. The angiographic end point of embolization was near stasis of the ascending uterine artery. Pelvic magnetic resonance imaging (MRI) was obtained before and after the procedure. Complications were assessed. The outcomes of technique, infarction rates of all fibroid tissue after UAE with contrast-enhanced MRI, change in symptoms and quality of life using serial Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaires, and additional interventions were evaluated. Bilateral UAE was successfully performed in all patients. Enhanced MRI 1 week after UAE showed that 100% infarction of all fibroid tissue was achieved in 65% (15 of 23) of patients; 90-99% infarction was achieved in 35% (8 of 23) of patients. Mean follow-up was 12 months (range 1-20). Symptom and QOL scores at baseline were 47.2 and 61.7, respectively. Both scores significantly improved to 26.3 (P<0.001) and 82.4 (P<0.001) at 4 months and to 20.4 (P<0.001) and 77.6 (P<0.001) at 1 year, respectively. No additional gynecologic interventions were performed in any patient. There were no major complications. Minor complications occurred in two patients. UAE using PGP is a safe and effective procedure and shows that outcomes after UAE, as measured with enhanced MRI and UFS-QOL questionnaires, seem comparable with those of UAE using other embolic agents. PGP is a promising embolic agent used for UAE to treat symptomatic uterine fibroids. Further comparative study between PGP and other established embolic agents is required.

Malfunction of bone marrow-derived osteoclasts and the delay of bone fracture healing in diabetic mice.

It is well known that bone fracture healing is delayed in diabetes mellitus, but the mechanism remains to be elucidated. Since several studies have demonstrated that diabetes causes abnormalities in bone marrow-derived cells, we used the streptozotocin (STZ)-induced diabetic mouse model after bone marrow transfer from green fluorescent protein (GFP) transgenic mice, and examined fracture healing. Compared with nondiabetic mice, diabetic mice at 3 weeks after fracture showed a decrease in mineralized callus, with the remainder consisting of cartilage. Bone formation parameters and mineralization rate were not altered in the STZ mice, but bone resorption parameters were significantly decreased. Therefore, the delayed bone formation in the STZ mice may have resulted from an impairment of cartilage resorption. Interestingly, we found that 80% of the osteoclasts in the callus were derived from bone marrow and the sizes of the osteoclasts as well as the resorption pits formed were significantly smaller in the diabetic mice. Moreover, transcript analysis using RNA isolated by laser capture microdissection (LCM) showed that the expression of DC-STAMP, a putative pivotal gene for osteoclast fusion, was decreased in osteoclasts from diabetic mice. Since the sustainability of osteoclast function depends on the controlled renewal of multinuclear osteoclasts, impaired osteoclast function in diabetes may contribute to decreased cartilage resorption and delayed endochondral ossification.

MR venography of deep veins: changes with uterine fibroid embolization.

Deep veins (DVs) can be compressed by a uterus enlarged with fibroids. The purpose of this study was to assess the degree of luminal narrowing of DVs caused by a myomatous uterus, and the change in DV narrowing in women with symptomatic fibroids after embolization using time-of-flight (TOF)-magnetic resonance venography (MRV). Twenty-nine consecutive women with symptomatic uterine fibroids underwent TOF-MRV and pelvic MRI before and 4 months after embolization. Based on the TOF-MRV, we evaluated the luminal narrowing of three DVs, including the inferior vena cava, and the bilateral common and external iliac veins, and divided the findings into three grades. The scores for each DV were added for each patient (lowest, 0; highest, 6). DV scores and symptom severity (SS) scores were compared between the baseline and 4 months after embolization using the paired t-test. The relationship between DV scores and uterine volume was investigated using Pearson's test. DV scores decreased significantly, from 1.52 +/- 1.70 at baseline to 0.93 +/- 1.56 at 4 months after embolization (p = 0.004). The uterine volume decreased from 948 +/- 647 mL at baseline to 617 +/- 417 mL at 4 months after embolization (p < 0.001). DV score correlated with uterine volume (r = 0.856, p < 0.001). SS scores decreased from 54.5 +/- 14.6 at baseline to 26.8 +/- 15.4 at 4 months after embolization (p < 0.001). In conclusion, the degree of luminal narrowing of DVs caused by a uterus with fibroids is correlated with the uterine volume. Uterine artery embolization may induce an improvement of luminal narrowing of DVs due to a reduction of the myomatous uterus volume.

Amenorrhea and resumption of menstruation after uterine artery embolization for fibroids.

OBJECTIVES: To determine whether women will experience permanent amenorrhea following uterine artery embolization for fibroids, and whether rates of onset differ in the long term according to age at the time of the procedure. METHODS: Over 77 months, 211 consecutive eligible women were grouped by age (group A, <40 years [n=39]; group B, 40-44 years [n=98]; and group C, > or =45 years [n=74]) and the cumulative rates of onset of permanent amenorrhea were compared between the groups. RESULTS: The likelihood of incurring permanent amenorrhea was significantly higher in group C. The cumulative rates in groups A, B, and C were 0%, 1.4%, and 19.7% at 3 years and 0%, 11.2%, and 40.4% at 6 years. CONCLUSION: The rates of onset of permanent amenorrhea changed over time and differed according to age at the time of the procedure, with little likelihood of permanent amenorrhea at 6 years for women younger than 40 years at the time of the procedure.

Infarction of uterine fibroids after embolization: relationship between postprocedural enhanced MRI findings and long-term clinical outcomes.

PURPOSE: To retrospectively evaluate the relationship between the degree of infarction of uterine fibroids on enhanced MRI after embolization and long-term clinical outcomes. METHODS: During 92 months, 290 consecutive patients with symptomatic uterine fibroids were treated with embolization; 221 who underwent enhanced MRI before embolization and 1 week after embolization were included in this study. The infarction rates of all fibroid tissue were assessed using enhanced MRI after embolization. Patients were divided into three groups according to the infarction rates: group A (100% infarction, n = 142), group B (90-99% infarction, n = 74), group C (<90% infarction, n = 5). The cumulative rates of clinical outcomes were compared among groups using the Kaplan-Meier limited method. RESULTS: Group A had a significantly higher rate of symptom control than groups B and C. The cumulative rates of symptom control at 5 years were 93%, 71%, and 60% in groups A, B, and C, respectively. Group A had a significantly lower rate of gynecologic intervention after embolization than groups B and C. The cumulative rates of additional gynecologic intervention at 5 years were 3%, 15%, and 20% in groups A, B, and C, respectively. CONCLUSIONS: The degree of infarction of uterine fibroids after embolization on enhanced MRI was related to long-term clinical outcomes. Complete infarction of all fibroid tissue can induce a higher rate of symptom control, with a lower rate of additional gynecologic intervention in the long term compared with incomplete infarction of fibroid tissue.

Hemodynamics of ovarian veins: MR angiography in women with uterine leiomyomata.

PURPOSE: The passive reflux into ovarian veins (OVs) is well known as a common finding in normal asymptomatic women. The purpose of this study was to investigate the hemodynamics of OVs in women with myomatous uterus. MATERIALS AND METHODS: Thirty-two women with symptomatic uterine leiomyomata underwent time-of-flight MR (TOF-MR) angiography, including venography and arteriography, and contrast-enhanced MRI. The frequency of reflux into OVs on TOF-MR angiography was retrospectively assessed with uterine volume, and compared to that of normal women in previous publication. The statistical evaluation was performed using Fisher's exact test. RESULTS: The mean uterine volume was 932 +/- 612 ml (range, 301-2627 ml). The reflux into left OVs was observed in 4 of 32 women (13%) and that into right OVs was noted in 0 of 32 women (0%). These rates were significantly lower than those of normal asyptomatic women in the previous publication (p<0.05). The reflux into OVs was observed in 0 of 19 women (0%) with 600 ml or larger myomatous uterus, whereas it was noted in 4 of the remaining 13 women (31%) with less than 600 ml myomatous uterus, with significant difference between the two groups (p=0.02). CONCLUSIONS: We found that reflux into OVs was infrequent in the vast majority of women with myomatous uterus, especially those with larger uterus due to leiomyomata on the basis of TOF-MR angiography. These findings suggested myomatous uterus could affect the flow direction of OVs, and passive reflux into OVs might be prevented due to the influence of antegrade flow of OVs.

Magnetic resonance angiography of uterine artery: changes with embolization using gelatin sponge particles alone for fibroids.

PURPOSE: To assess uterine artery recanalization, together with tumor devascularization, after embolization using gelatin sponge particles alone for fibroids. METHODS: Twenty-seven patients underwent uterine artery embolization (UAE) for fibroids using only gelatin sponge particles. The angiographic endpoint of embolization was defined as near stasis of contrast medium in the ascending segment of the uterine artery. All patients underwent contrast-enhanced magnetic resonance angiography (MRA) before and 4 months after UAE, and contrast-enhanced magnetic resonance imaging (CE-MRI) before, 1 week after, and 4 months after UAE. The visualization of the uterine arteries before and 4 months after UAE was assessed using MRA. The infarction rates of the largest tumor were assessed using CE-MRI 1 week after UAE. RESULTS: MRA 4 months after UAE showed 100% (53/53) of the descending and transverse segments, and 88% (43/49) of the ascending segments that had been noted on baseline MRA. The visualization of the ascending segments on MRA 4 months after UAE was identical to that on baseline MRA in 20 of 27 patients (74%). CE-MRI showed complete infarction of the largest tumor in 22 of 27 patients (81%), and 90-99% infarction of the largest tumor in the remaining 5 of 27 patients (19%). CONCLUSION: Based on the MR study, in most cases uterine artery recanalization occurred, together with sufficient devascularization of fibroids, after UAE using gelatin sponge particles alone.

The size of gelatin sponge particles: differences with preparation method.

PURPOSE: To assess whether the size distribution of gelatin sponge particles differed according to the method used to make them and the type of original sheet. METHODS: Gelatin sponge particles of approximately 1-1.5 x 1-1.5 x 2 mm were made from either Spongel or Gelfoam sheets by cutting with a scalpel and scissors. Particles were also made of either Spongel or Gelfoam sheets by pumping with two syringes and a three-way stopcock. The size distribution of the particles in saline was compared among the groups. RESULTS: (1) Cutting versus pumping: When Spongel was used, cutting produced lower rates of smaller particles < or = 500 microm and larger particles > 2000 microm compared with pumping back and forth 30 times (1.1% vs 37.6%, p < 0.0001; 2.2% vs 14.4%, p = 0.008). When Gelfoam was used, cutting produced lower rates of smaller and larger particles compared with pumping (8.5% vs 20.4%, p = 0.1809; 0% vs 48.1%, p < 0.0001). (2) Spongel versus Gelfoam: There was no significant difference in the size distribution of the particles between Spongel and Gelfoam (p = 0.2002) when cutting was used. CONCLUSION: The size distribution of gelatin sponge particles differed according to the method used to make them. More uniform particle sizes can be achieved by cutting than by pumping.

Long-term outcomes of uterine artery embolization using gelatin sponge particles alone for symptomatic fibroids.

OBJECTIVE: The purpose of this study was to evaluate the long-term outcomes of uterine artery embolization using only gelatin sponge particles for symptomatic fibroids. MATERIALS AND METHODS: As part of an ongoing study of the procedure for fibroids, prospective data of the initial 96 consecutive women treated between December 1997 and December 2001, were collected in January 2005. It had been more than 3 years since embolization in all cases. The follow-up period ranged from 4 to 60 months (mean, 37.4 months). On the basis of serial questionnaires, we investigated the cumulative rates of symptom control, gynecologic interventions, and overall failure, using the Kaplan-Meier product limit estimator. Symptom control was defined as meaning patients whose symptoms had improved as indicated on the last questionnaire and who had not undergone any further gynecologic intervention because of symptoms. Overall failure was defined as meaning the patients who indicated that there had been no symptom improvement or recurrence or that they had undergone further gynecologic interventions. RESULTS: Of all 96 women, 16 (17%) were lost to follow-up during the period. Cumulative rates of symptom control were 96.9% at 1 year, 89.5% at 3 years, and 89.5% at 5 years. Cumulative rates of complications related to the gynecologic intervention and overall gynecologic interventions were 2.1% and 4.2%, respectively, at 1 year, 2.1% and 5.4% at 3 years, and 2.1% and 10.5% at 5 years. Cumulative rates of overall failure were 4.2% at 1 year, 12.7% at 3 years, and 12.7% at 5 years. Major complications were noted in 3.1% (3/96). Of these three women, two required hospitalization for transvaginal resection of sloughing fibroids and one developed sexual dysfunction. Two women became pregnant, but both pregnancies resulted in miscarriage. CONCLUSION: Uterine artery embolization using gelatin sponge particles alone can achieve long-term symptom control for fibroids in most cases.

Economic impact of real-time teleradiology in thoracic CT examinations.

Conventional teleradiology is a useful tool, but sometimes we have found it to be an insufficient means of investigation because the radiological specialists cannot indicate the imaging protocol during the investigation. The purpose of our study was to evaluate the efficacy of real-time teleradiology, which will improve the quality of medical management. Ten radiologists evaluated thoracic CT scans of 50 patients transmitted through teleradiology retrospectively. We evaluated whether or not the contrast enhancement study was performed effectively on the basis of the clinical data and after interpretation of the pre-contrast scans. The clinical data showed that 47.6% of the CT contrast enhancement examinations were not necessary. After interpretation of the pre-contrast CT scans, 66.6% of the contrast-enhanced scans were considered unnecessary. Real-time teleradiology will improve the quality of medical management providing the virtual presence of radiologists, and will save medical costs.