Can radiological technologists serve as primary screeners of low-dose computed tomography for the diagnosis of lung cancer?

BACKGROUND: The Accreditation Council for Lung Cancer CT Screening of Japan established guidelines for the certification of Radiological Technologists in 2009. OBJECTIVE: To analyze the trends in examination pass rates of the Radiological Technologists and discuss the reasons. METHODS: The cohort comprised 1593 Radiological Technologists (as examinees) based on 10-year of data (with a total of 17 examination runs). First, the examinees' written test results were analyzed. Second, an abnormal finding detection test was conducted using >100 client PCs connected to a dedicated server containing low-dose lung cancer CT screening images of 60 cases. The passing scores were correct answer rate >60% and sensitivity (TP) of >90%, respectively. RESULTS: Overall, 1243 examinees passed with an overall rate of 78%. The average pass rate for the written test was 91%, whereas that for the abnormal findings detection test was 85%. There was a moderate correlation between the test pass rate and average years of clinical experience of the examinees for the abnormal findings detection test (R = 0.558), whereas no such correlation existed for the written test (R = 0.105). CONCLUSIONS: In order for accredited Radiological Technologists to serve as primary screeners of low-dose computed tomography, it is important to revise the educational system according to current standard practices.

Participation of periodontal ligament cells with regeneration of alveolar bone.

BACKGROUND: It is important to clarify the participation of periodontal ligament (PDL) cells in the regeneration of alveolar bone to establish a reliable approach for obtaining periodontal regeneration. The aim of this study was to determine whether PDL cells play an important role in alveolar bone repair during the course of periodontal regeneration. METHODS: In an in vitro study, the expression of the osteoblast phenotype, such as alkaline phosphatase activity and parathyroid hormone-dependent 3',5'-cyclic adenosine monophosphate accumulation, was investigated in dog PDL cells (DPLC) and dog bone cells isolated from mandibles (DBC). In a related study, the roots of mandibular third premolars extracted from aged dogs were divided into a PDL(+) group, in which the PDL was preserved, and a PDL(-) group, in which the PDL was removed. These roots were respectively transplanted into surgically created bone cavities with buccal and interproximal bone defects in an edentulous area, prepared in advance by extraction of mandibular fourth premolars. These bone defects with the transplanted roots were completely covered with submerged physical barrier membranes. New bone formation and new connective tissue attachment, which require new cementum and insertion of functionally oriented new collagen fibers of periodontal ligament, were histomorphometrically assessed, and were compared between the PDL(+) and PDL(-) groups 6 weeks after transplantation. RESULTS: Both cultured DPLC and DBC exhibited the osteoblast phenotype. New connective tissue attachment was observed only in the PDL(+) group. However, alveolar bone was almost completely regenerated to the original bone height in both the PDL(+) and PDL(-) groups, and the amount of newly formed bone was not significantly different between the 2 groups. CONCLUSIONS: DPLC retain the capability to differentiate into an osteoblast lineage and may act in the regeneration of periodontal ligament with new cementum formation, whereas these cells may have a limited influence on alveolar bone formation during the course of periodontal regeneration.

Effects of nitric oxide donor and nitric oxide synthase inhibitor on ruminal contractions in conscious sheep.

The present study was planned to evaluate a role of nitric oxide (NO) in the regulation of regular ruminal contractions in conscious sheep. Intravenous infusion of S-nitroso-acetyl-DL-penicillamine (SNAP) at doses of 3-30 nmol kg(-1) min(-1)for 30 minutes inhibited both the amplitude and frequency of ruminal contractions in a dose-dependent manner. However, intravenous infusion of Nomega-nitro-L-arginine-methyl ester (L-NAME) at doses of 0.3-3.0 micromol kg(-1) min(-1)did not alter the basal tone of intraruminal pressure and the amplitude of ruminal contractions. The frequency of contractions was slightly inhibited by L-NAME infusion at 1.0 micromol kg(-1)min(-1). The effects of L-NAME were abolished by simultaneous infusion of L -arginine at 30 micromol kg(-1) min(-1). These results suggest that exogenous NO can diminish the ruminal contractions, while endogenous NO is not involved in the regulatory mechanism of basal tone and regular phasic contractions of the rumen in healthy sheep.

Effect of nitric oxide synthase inhibitors on the temporal coordination of duodenal contractions and pancreatic exocrine secretion in sheep.

The present study evaluated the role of nitric oxide in the regulation of duodenal motility and pancreatic exocrine secretion in conscious sheep. Intravenous infusions of nitric oxide synthase inhibitors, Nomega-nitro-L-arginine-methyl ester (L-NAME) and Nomega-nitro-L-arginine, induced clusters of duodenal contractions like phase III of migrating motor complexes and simultaneously inhibited flow rate, bicarbonate ion and enzyme outputs of pancreatic juice. The effects of L-NAME were inhibited by simultaneous infusion of L-arginine, but not altered by adrenergic blockade using a combined infusion of phentolamine and propranolol. Inhibition of the pancreatic secretion occurred in coincidence with initiation of the duodenal contractions, while the pancreatic secretion was not inhibited when the premature duodenal contractions were abolished by the L-arginine infusion. The initiation of the cluster of duodenal contractions by L-NAME was not abolished by background infusion of atropine, whereas the amplitude of contractions was significantly inhibited by atropine. These results suggest that intrinsic nitric oxide plays a crucial role in the regulation of duodenal tone and maintenance of continuous secretion by the exocrine pancreas in sheep. These results also implied that inhibition of pancreatic exocrine secretion by the nitric oxide synthase inhibitor is presumably mediated in part through the contractile effect on the duodenum.

Effect of prostaglandin E2 on recombinant human bone morphogenetic protein-2-stimulated osteoblastic differentiation in human periodontal ligament cells.

Recombinant human (rh) bone morphogenetic protein-2 (BMP-2) stimulates osteoblastic differentiation in cells isolated from human periodontal ligament (HPLC), and this action of rhBMP-2 may be modulated by prostaglandins (PGs), which are local regulatory factors in the bone metabolism. In the present study, we investigated the effect of prostaglandin E2 (PGE2) on rhBMP-2-stimulated osteoblastic differentiation in cultured HPLC. rhBMP-2 (500 ng/ml)-stimulated alkaline phosphatase (ALPase) activity was enhanced by simultaneous treatment with low concentrations (10(-10)-10(-8) M) of PGE2, whereas a high concentration (10(-6) M) of PGE2 suppressed it. rhBMP-2 did not induce cyclo-oxygenase-2 (COX-2) mRNA expression or subsequent PGE2 production, whereas it remarkably suppressed rhIL-1 beta-induced COX-2 mRNA expression and PGE2 production. The rhBMP-2 action on osteoblastic differentiation in HPLC was also enhanced by co-treatment with 0.25 to 25 ng/ml of rh interleukin-1 beta (IL-1 beta). The ALPase activity stimulated by simultaneous treatment with rhBMP-2 and rhIL-1 beta was partially inhibited by addition of 10(-6) M of indomethacin, which completely inhibited rhIL-1 beta-induced PGE2 production. These results reveal that PGE2 at different concentrations exerts a biphasic effect on BMP-2-stimulated osteoblastic differentiation in HPLC, BMP-2 inhibits IL-1 beta-induced PGE2 production through suppressing COX-2 expression, and the BMP-2-stimulated osteoblastic differentiation may be enhanced by the endogenous PGE2 induced by BMP-2 and IL-1 beta. These suggest that BMP-2 action on osteoblastic differentiation in HPLC may be modulated by PGE2 in autocrine and paracrine fashions.

[Spinal intramedullary cavernous angioma associated with hematomyelia: case report with sequential MRI follow-up and histological verification of hematoidin deposits].

A 61-year-old woman first experienced sudden lower back and right leg pain 3 years prior to surgery. At this time, MRI showed an intramedullary cavernous angioma at Th10-11 with central T2 high and peripheral T2 low signal intensity. However, she completely recovered in two weeks. Four days prior to the present admission (day of the second hemorrhage), she again experienced severe lower back and right leg pain, followed by complete paralysis of the right leg. Despite vigorous medical treatment including administration of steroid, hemostatics and glycerol, her condition became aggravated with complete paraplegia and loss of sphincter control by the 4th hospital day. MRI taken two days after the second hemorrhage showed an increase of peritumoral T2 hypointensity and another area of T2 hypointensity in the lumbar spinal cord at L1-Th12 with cord swelling. MRI 13 days after the second hemorrhage showed that these areas of T2 hypointensity had changed to T1 and T2 hyperintensity suggesting conversion of deoxyhemoglobin to methemoglobin. Subsequent MRI showed longitudinal punctuate propagation of methemoglobin from the angioma down to the lumbar enlargement and into the conus medullaris, where a 30 x 6 mm spindle-shaped area of T1 and T2 hyperintensity indicating hematomyelia had formed. Total removal of the angioma was followed by gradual recovery and decrease in the size and signal intensity of the hematomyelia. Histopathological examination demonstrated the typical features of cavernous angioma with deposition of hematoidin. Propagation of extravasated blood from the ruptured thoracic cavernoma to the conus medullaris, with splitting of spinal cord nerve fibers, was demonstrated by MRI.

Spinal giant intradural perimedullary arteriovenous fistula: clinical and neuroradiological study in one case with review of literature.

BACKGROUND: Giant intradural perimedullary arteriovenous fistula with massive spinal cord compression is rare. The therapeutic difficulties include whether endovascular embolization or direct surgical excision should be selected. We present a patient with the largest giant spinal intradural perimedullary arteriovenous fistula shown by magnetic resonance imaging so far reported, who was successfully treated by a combination of endovascular embolization and direct surgery. CASE DESCRIPTION: A 16-year-old girl presented with a giant intradural arteriovenous fistula (perimedullary Type II) at the C4-5 level, manifesting as progressive cervical myeloradiculopathy. The single-hole fistula was supplied by the anterior spinal artery and an ascending artery arising from both the costocervical and highest intercostal arteries with a rapid transit time, and drained superiorly to the foramen magnum, and inferiorly to the thoracic spinal canal, through a huge venous lake at the site of the arteriovenous connection. The patient was treated by transarterial embolization with platinum coils and silk, followed by surgical excision with excellent results at 12 months' follow-up. CONCLUSIONS: We recommend that such a huge perimedullary arteriovenous fistula with a rapid transit time, and severe cord and root compression, should be treated with embolization followed by surgical excision.

Multiple endocrine neoplasia type 1 associated with spinal ependymoma.

A 51-year-old man was hospitalized with a gait disturbance and hypoesthesia below the level of his chest. These symptoms were due to a spinal tumor which was surgically resected and identified as an ependymoma. Additionally, the patient had hypercalcemia and a family history of insulinoma. An endocrine evaluation revealed parathyroid hyperplasia and a pancreatic islet cell tumor. Magnetic resonance imaging disclosed a pituitary microadenoma. He was diagnosed with spinal ependymoma and multiple endocrine neoplasia type 1 (MEN 1). A review of the literature revealed that chromosome 11q13 abnormalities have been reported in both ependymoma and MEN 1. We discuss the pathogenesis of these diseases.

[Successful treatment with combined chemotherapy (carboplatin, etoposide, adriamycin, bleomycin) and radiotherapy for recurrent intracranial malignant germ cell tumor: case report].

We report a case of a patient with recurrent malignant germ cell tumor who was successfully treated with carboplatin combination followed by radiation therapy. A 13 year-old female presented with diabetes insipidus six years ago. From the homogeneous tumor intensity on CT scan and negative titer of AFP and HCG, we made a diagnosis of suprasellar germinoma, and treated her with radiation therapy (40Gy), which resulted in almost complete disappearance of the tumor. The tumor recurred six years later in the primary region and in the cervical spinal cord with elevated AFP titer (160ng/ml) and HCG titer (404mlU/ml). She was treated with multi-agents chemotherapy consisting of carboplatin (450mg/m2, day 1), etoposide (150mg/m2, days 1-3), adriamycin (30mg/m2, day 1), and bleomycin (20mg/m2, days 1 and 8), followed by radiation therapy to the whole brain (20Gy), the whole spine (30Gy) and the cervical spine (20Gy). The tumors completely disappeared. We discuss treatment failures of clinically diagnosed germinoma without histological verification, and effective aggressive chemotherapy for recurrent malignant germ cell tumors.

[A ruptured peripheral, superior cerebellar artery aneurysm: a case report and a review of the literature as to surgical approaches].

The authors described the case of a normotensive 40-year-old female with severe headache and vomiting. Neurological findings on admission to our hospital revealed no deficits, but plain CT findings indicated subarachnoid hemorrhage in the ambient, supracerebellar, quadrigeminal, and right lateral pontine cisterns. Left vertebral angiograms made through a transfemoral catheter revealed a saccular aneurysm (6 x 4mm) arising from the medical hemispheric branch of the right superior cerebellar artery (SCA). On the 34th day after onset of her symptoms, the aneurysm was successfully clipped by using an infratentorial supracerebellar approach. She was discharged with no deficits. Based on our experience and a review of the literature, a peripheral SCA aneurysm is best clipped by using one of the following surgical approaches: (1) a subtemporal transtentorial approach for an aneurysm arising from the anterior or lateral pontomesencephalic segment, (2) a subtemporal or occipital transtentorial approach for an aneurysm arising from the cerebellomesencephalic segment or the proximal cortical branch, or (3) an infratentorial supracerebellar approach for an aneurysm arising from the distal cortical branch.

A new, rolled-sponge technique for transoral exposure of C1 and C2.

Instead of the general use of a catheter attached to the uvula or of catheters passed through the nasal cavity to the mouth for elevation of soft palate, the authors describe a new technique utilizing two rolled sponges producing maximum elevation of soft palate and good perioral cosmetic results for transoral exposure of C1 and C2.

[An evaluation of temporary clipping during aneurysmal surgery: a retrospective study].

A temporary clipping of a parent artery has been found convenient in facilitating an aneurysmal dissection. This is because it controls the bleeding from an unexpected rupture and keeps the sac collapsed during the operation. Such a temporary arterial occlusion, however, involves the risk of a focal ischemia that may lead to permanent postoperative neurological deficits. Therefore, to evaluate the influence of a temporary clipping on the outcome of an operation, a retrospective study of 302 patients who underwent an operation for a ruptured supratentorial aneurysm between 1981 and 1990 has been conducted. This study has revealed the information that follows: 1) Overall outcomes In patients given no temporary clipping, their postoperative activity in daily living (ADL) grade was good in 70.7%, i.e. ADL 1 or 2, whereas only 46.4% of the patients given a temporary clipping achieved a similar ADL. 2) Influence of the preoperative Hunt and Kosnik neurological classification on the outcome Irrespective of whether a temporary clip had been used, patients with a Hunt and Kosnik grade of 1 or 2 made a good recovery, whereas patients with a grade of 4 or 5 did not. The application of a temporary clip in grade 3 patients led to a poor result, whereas in grade 3 patients given no temporary clipping the results were good. This would seem to indicate that Hunt and Kosnik grade 3 rating is a critical factor in consideration whether a temporary clip should be used or not. 3) Influence of the operative timing on the outcome.(ABSTRACT TRUNCATED AT 250 WORDS)

[Coexistence of intracranial and spinal cavernous angiomas: case report].

A case of a 43-year-old man with coexistence of intracranial and spinal cavernous angiomas is presented. The patient had a 2-year history of severe back pain incurred by neck flexion, and he became aware of weakness of the right lower extremity and paresthesia of the left lower extremity. Neurological examinations at the time of the first admission demonstrated incomplete Brown-Séquard syndrome. Myelograph, myelo-CT and contrast enhanced CT showed an intramedullary mass at the Th3-Th5 level. The patient received laminectomy with total removal of the lesion. Pathological diagnosis was cavernous angioma. Six years later, the patient complained of subacute weakness and numbness of the left upper extremity. Head CT demonstrated a high density lesion of about 2cm in diameter in the right frontal lobe. MRI showed a mixed signal intensity lesion with a marked low-intensity rim in the same area. Total extirpation of the lesion was performed. Pathological diagnosis of the intracerebral lesion was also cavernous angioma. Intramedullary cavernous angioma is very rare. Furthermore, bifocal cavernous angiomas involving both the spinal cord and the brain are extremely rare, and, only 5 cases have been reported in the literature. To our knowledge, this is the first case diagnosed by surgical specimens of coexisting intramedullary and intracerebral lesions.

Experimental omento-myelo-synangiosis.

In 18 cats the omentum was mobilized, transposed, and placed directly upon the pia mater of the spinal cord. Within 2 months, vascular anastomoses developed at the omento-spinal cord interface and, as demonstrated by India ink perfusion, communicated widely with the cord's intramedullary vessels. Light and scanning electron microscopy (SEM) of the interface revealed the development of a "fibrous coat" of Goldsmith in continuity with the edges of the dura mater. It consisted mainly of a matrix of collagen fiber and fibroblasts, well vascularized with sinusoids, capillaries, arterioles and venules. The sinusoids, as identified by SEM, were present in both the fibrous coat and adjacent omentum, were lined with attenuated endothelium, and had multiple communications. The possible significance of the sinusoidal formation is discussed in this report.

Magnetic resonance imaging of human spinal cord infarction.

Magnetic resonance images obtained in two cases of spinal cord infarction are described: one with hemorrhagic thoracic cord infarct, the other with ischemic cervical cord infarct with sequential magnetic resonance imagings. An enlarged cord with strand-shape or longitudinal hypointensity on both T1- and T2-weighted images was noticed in the hemorrhagic infarct; hypointensity on the T2-weighted image was thought to be due to hemosiderin, which shortens T2 relaxation. In the ischemic infarct, a small, round area of hypointensity on T1-weighted images, and of hyperintensity on T2-weighted images, noted 9 hours postictus ("early infarct") changed on the 22nd day to a cephalocaudal strandlike hypointensity on T1-weighted image, which was enhanced by Gd-DTPA. The hypointensity suggested "pencil-like softening" in "medium" age infarct. On postictal day 49, it showed an extensive homogeneous hypointensity involving several segments of the cord on T1-weighted images and hyperintensity on T2-weighted images with negative Gd-DTPA enhancement suggesting "late transverse infarct." We considered that these changes are of value in diagnosing spinal cord infarcts on magnetic resonance imagings.

[Omentum transplantation to the cervical cord with microangioanastomosis].

Transplantation of omentum to the cervical cord was done in three cases with incomplete transection (Case 1) with posttraumatic progressing cervical myelopathy (Case 2) and with complete transection due to multisegmental, late cervical cord infarction (Case 3). Anastomoses were made between the occipital artery and the gastroepiploic artery of transplanting omentum and between the occipital vein and the gastroepiploic vein. In Case 2 and 3, omentum was maintained in tissue culture medium in an incubator (37 degrees C, 5% CO2) for about five hours following perfusion of the omentum with low molecular dextran containing urokinase, heparin, vitamin B12 until exploration of the dural tube and preparation of the occipital vessels were accomplished. Although complete transection with late infarct (Case 3) showed extremely slow improvement in follow-up period of 8 months, the incomplete traumatic lesions (Case 1 and 2) showed less slow but steady improvements in follow-up periods of 24 and 22 months with almost complete recovery of Case 2. Angiography showed patent anastomosis in all the cases. Dynamic CT at 4 (Case 1) and 6 (Case 2) months showed good perfusion in the compromised cord through the transplanted omentum.

[Atlanto-axial interspinous articulation--a histological study].

Three cases of atlanto-axial interspinous articulation (AIA) were reported. In a case, the articulating C1 posterior arch and C2 spinal process were removed en bloc during surgery. In an other case, articulating parts of C1 and C2 arches were excised by chisel. These had facets with glistening smooth surfaces and were consisted of fibrocartilage histologically. The facets were connected by a membrane containing the synovial layer, loose connective tissue layer with small vessels and the dense fibrous layer. With review of X-ray findings of present cases and cases reported in the literature, the AIA was classified into (1) simple type and (2) hyperplastic type. It was stressed that the hyperplastic type of AIA can produce definite cord compression.

Symmetrical thalamic low densities in descending transtentorial herniation.

In a case with descending transtentorial herniation due to an acute subdural hematoma, symmetrical round low densities located bilaterally in the anterior thalamus are reported in addition to a diffuse low density in the territory of one posterior cerebral artery. The possible mechanism involved is discussed.