The diagnosis of early pneumoconiosis in dust-exposed workers: comparison of chest radiography and computed tomography.

BACKGROUND: Chest radiography (CR) is employed as the evaluation of pneumoconiosis; however, we sometimes encounter cases in which computed tomography (CT) is more effective in detecting subtle pathological changes or cases in which CR yields false-positive results. PURPOSE: To compare CR to CT in the diagnosis of early-stage pneumoconiosis. MATERIAL AND METHODS: CR and CT were performed for 132 workers with an occupational history of mining. We excluded 23 cases of arc-welder's lung. Five readers who were experienced chest radiologists or pulmonologists independently graded the pulmonary small opacities on CR of the remaining 109 cases. We then excluded 37 cases in which the CT data were not sufficient for grading. CT images of the remaining 72 cases were graded by the five readers. We also assessed the degree of pulmonary emphysema in those cases. RESULTS: The grade of profusion on CR (CR score) of all five readers was identical in only 5 of 109 cases (4.6%). The CR score coincided with that on CT in 40 of 72 cases (56%). The CT score was higher than that on CR in 13 cases (18%). On the other hand, the CT score was lower than that on CR in 19 cases (26%). The incidence of pulmonary emphysema was significantly higher in patients whose CR score was higher than their CT score. CONCLUSION: CT is more sensitive than CR in the evaluation of early-stage pneumoconiosis. In cases with emphysema, the CR score tends to be higher in comparison to that on CT.

Associations among the plasma amino acid profile, obesity, and glucose metabolism in Japanese adults with normal glucose tolerance.

BACKGROUND: Amino acids (AAs) are emerging as a new class of effective molecules in the etiology of obesity and diabetes mellitus. However, most investigations have focused on subjects with obesity and/or impaired glucose regulation; the possible involvement of AAs in the initial phase of glucose dysregulation remains poorly understood. Furthermore, little attention has been given to possible associations between the pattern/degree of fat deposition and the plasma AA profile. Our objective was therefore to determine the relationships between plasma AA concentrations and the type/degree of obesity and glucose regulation in Japanese adults with normal glucose tolerance. METHODS: Eighty-three subjects with normal glucose tolerance were classified as obese or nonobese and as visceral obesity or nonvisceral obesity. Correlations between the plasma levels of 23 AAs and somatometric measurements, visceral fat area (VFA), subcutaneous fat area (SFA), and 75-g oral glucose tolerance test results were analyzed. RESULTS: Obesity or visceral obesity was associated with higher levels of branched-chain AAs (isoleucine, leucine, and valine), lysine, tryptophan, cystine, and glutamate but lower levels of asparagine, citrulline, glutamine, glycine, and serine (p < 0.04). Age- and gender-adjusted analyses indicated that VFA was positively correlated with tryptophan and glutamate levels, whereas VFA and SFA were negatively correlated with citrulline, glutamine, and glycine levels (p < 0.05). The fasting and 2-h plasma glucose levels or the homeostasis model assessment of insulin resistance were positively correlated with valine, glutamate, and tyrosine levels but negatively correlated with citrulline, glutamine, and glycine levels. The homeostasis model assessment for the ß-cell function index was positively correlated with leucine, tryptophan, valine, and glutamate levels but negatively correlated with citrulline, glutamine, glycine, and serine levels (p < 0.05). CONCLUSIONS: The present study identified specific associations between 10 AAs and the type/degree of obesity, and indices of glucose/insulin regulation, in Japanese adults with preserved glucose metabolism. With the growing concern about the increasing prevalence of obesity and diabetes, the possible roles of these AAs as early markers and/or precursors warrant further investigation.

Post-traumatic chylous knee effusion.

Chylous joint effusion is a rare condition in which synovial fluids containing large amounts of lipids take on a milky appearance as a result. We report on a 19-year-old male patient with posttraumatic chylous knee effusion. Several days after striking his knee against the ground because of a traffic accident, his left knee showed obvious swelling. Aspiration of his knee was performed, yielding 70ml of purulent-appearing fluid. To distinguish this condition from purulent or tuberculosis arthritis, arthroscopic biopsy and debridement were performed. Arthroscopic examination visualized distinctive yellow-white soft lesions covering much of the joint capsule, resembling a cobweb. Tissue cultures for bacteria were negative. Pathologically, we identified clusters of xanthoma cells with fibrin exudation due to disruption of the synovium and intra-articular fat pad necrosis. Centrifuging the aspiration fluid yielded a thick creamy lipid layer as the supernatant. A fresh drop preparation showed that the specimen contained innumerable fat globules, which stained red with oil red O stain. The patient was able to walk without difficulty or further swelling of his knee at the end of the second postoperative week. Posttraumatic chylous effusion is self-limited. Purulent arthritis or tuberculosis arthritis, however, should still be the presumptive diagnosis in such cases. Arthroscopic irrigation and debridement should be considered for these traumatic cases to confirm diagnosis and to speed up recovery.

Primary peripheral adenoid cystic carcinoma of the lung and literature comparison of features.

Adenoid cystic carcinoma arising from the peripheral lung is rare. Here, we describe adenoid cystic carcinoma that developed in the peripherally in S(9) of the right lower lobe of an 84-year-old woman. Cell blocks prepared from the bronchial wash specimens exhibited the cribriform formation. An immunohistochemical examination of the surgically resected tumor revealed positive thyroid transcription factor-1 and c-kit staining. Exons 9 and 11 of c-kit in tumor cells were not mutated. We compared the clinical features of this patient with those of 10 others described in the English-language literature.

Preoperative MRI analysis of patients with idiopathic scoliosis: a prospective study.

STUDY DESIGN: A prospective trial of preoperative MRI study in patients with "idiopathic" scoliosis. OBJECTIVES: To investigate the prevalence of neural axis malformations and the clinical relevance of MRI in the evaluation of patients with idiopathic scoliosis undergoing surgical intervention. SUMMARY OF BACKGROUND DATA: With the development of MRI, neural axis abnormalities such as syringomyelia or Chiari malformations are increasingly being found in patients with "idiopathic" scoliosis. The risk of neurologic complications during correction of scoliosis without prior decompression surgery for syringomyelia has been documented; however, there have been no prospective studies for identifying the risk of neurologic complications as a result of scoliosis surgery in patients with asymptomatic neural axis malformations. METHODS: A total of 250 patients who were classified as having "idiopathic" scoliosis at first presentation and admitted for spinal surgery were evaluated. All patients were examined for neural axis abnormalities using MRI. The presence of neurologic symptoms and abnormal neurologic signs was also examined before and after surgical intervention. Neurologic complications during scoliosis surgery were reviewed in patients with neural axis abnormalities. RESULTS: There were 44 (18%) patients (13 males and 31 females) who had neural axis abnormalities on MRI, including syringomyelia with Chiari malformations in 22 patients, syringomyelia with tonsillar ectopia in 2, Chiari malformations in 13, tonsillar ectopia in 6, and low conus medullaris in 1. On clinical examination, 44 (18%) patients had abnormal neurologic signs and 26 (7%) patients complained of headache or back pain. There were significant differences between patients with and without neural axis abnormalities regarding the age at first visit, gender, curve pattern, sagittal profile of thoracic spine, presence of neurologic deficit, and complaint of pain. Only 12 of 44 patients needed neurosurgical treatment for foramen magnum decompression before correction of scoliosis. Neurologic status temporarily worsened in 3 patients, including 2 patients with neurosurgical treatment and 1 patient without neurosurgical treatment; however, there were no permanent neurologic complications as a result of scoliosis surgery. All patients without neurologic deficits or complaints of pain did not receive neurosurgical treatment, while they had no permanent neurologic complications. CONCLUSIONS: Foramen magnum decompression for neural axis malformations could prevent permanent neurologic complications during scoliosis surgery. There is little risk of neurologic complications in patients with "idiopathic" scoliosis whose neurologic status is normal, even if these patients have a neural axis malformation on MRI.

Diagnostic usefulness of bronchoalveolar lavage in Hermansky-Pudlak syndrome: a case with double lung cancers.

A 65-year-old man was admitted to our hospital because of dyspnea on exertion. He had oculocutaneous albinism innately and his parents were consanguineous. His chest roentgenogram on admission showed reticulo-nodular infiltrates and cystic changes throughout both lung fields, and 7 cm mass in the left middle field. Cytology of bronchoalveolar lavage fluid (BALF) revealed macrophages containing ceroid. The diagnosis of HPS was made clinically and the tumor was diagnosed as poorly differentiated adenocarcinoma of the lung. He died of respiratory failure. By autopsy, additional well-differentiated adenocarcinoma was detected. Cytology of BALF was useful to confirm ceroid accumulation in the lung.

Idiopathic scoliosis as a presenting sign of familial neurologic abnormalities.

STUDY DESIGN: Familial cases of "idiopathic" scoliosis associated with neurologic abnormalities are reported with a review of the literature. OBJECTIVE: To investigate the prevalence of neurologic abnormalities such as syringomyelia, Chiari 1 malformation, and tonsillar ectopia in patients with genetically determined "idiopathic" scoliosis. SUMMARY OF BACKGROUND DATA: Idiopathic scoliosis is widely considered to be a genetic disorder of unknown etiology. Magnetic resonance imaging (MRI) studies have shown that several cases of "idiopathic" scoliosis show neurologic abnormalities including syringomyelia and Chiari 1 malformation. Recently, several familial cases of either syringomyelia or Chiari malformation were reported, and it is suspected that genetic factors may influence the development of the craniovertebral malformation. It was hypothesized that some cases of "idiopathic" scoliosis include a craniovertebral malformation that is genetically determined. METHODS: This study, using clinical examinations and MRI, investigated 71 patients with scoliosis and a family history of "idiopathic" scoliosis in third-degree relatives for the presence of neurologic abnormalities. If neurologic abnormalities were confirmed with MRI, the relatives affected with scoliosis were also examined. RESULTS: Nine (13%) patients showed neurologic abnormalities on MRI. Magnetic resonance imaging showed syringomyelia with Chiari 1 malformation in four patients, Chiari 1 malformation in three patients, and tonsillar ectopia in two patients. Among the relatives of these patients, 4 of 15 individuals affected with scoliosis also showed neurologic abnormalities on MRI. CONCLUSIONS: It is suggested that familial neurologic abnormalities may have a wide range of expression, and that some patients with "idiopathic" scoliosis present with genetically determined craniovertebral malformations such as syringomyelia, Chiari 1 malformation, and tonsillar ectopia.

Association between estrogen receptor gene polymorphisms and curve severity of idiopathic scoliosis.

STUDY DESIGN: Analysis of the estrogen receptor gene of girls with idiopathic scoliosis. OBJECTIVES: To determine whether estrogen receptor gene polymorphisms correlate with curve severity of adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Studies suggest that idiopathic scoliosis is a familial condition and that curve progression is related to genetically determined factors, such as skeletal and sexual growth. METHODS: A total of 304 girls with idiopathic scoliosis were followed until growth maturation. Height, arm span, menarcheal age, and age at growth maturation were recorded, and curve severity was measured using Cobb's method. The estrogen receptor gene, which contains polymorphic PvuII and XbaI sites, was amplified from lymphocyte deoxyribonucleic acid by polymerase chain reaction. RESULTS: The mean maximum Cobb measurements for patients with genotypes XX and Xx were greater than for those with genotype xx (P = 0.002). The risk of curve progression, defined as progression of >5 degrees from initial evaluation, was higher with genotype Xx than with xx (P = 0.03). Patients with genotypes XX and Xx had a significantly higher risk for operative treatment than those with genotype xx (21.4%, 24.7% vs. 7.6%, P< 0.001). Growth examination around the time of the growth spurt revealed that the XbaI site polymorphism was also related to the age of growth maturation. The frequency of patients with growth maturation at >or=16 years was higher for genotypes XX and Xx than for genotype xx (33.3%, 29.9% vs. 16.8%, P= 0.013). CONCLUSION: Our results suggest that the XbaI site polymorphism is associated with curve severity. DNA analysis may predict curve progression.

Prediction of curve progression in idiopathic scoliosis from gene polymorphic analysis.

Three hundred and four girls with adolescent idiopathic scoliosis were investigated to determine if DNA polymorphisms in the vitamin D receptor (VDR), estrogen receptor (BR), and CYP17 gene were related to curve progression of idiopathic scoliosis. The results suggested that XbaJ site polymorphism in the ER gene was associated with curve progression. The Cobb's curve angle with genotype XX and Xx was statistically greater than that with genotype xx. The curve progression risk (approximately 5 degrees) was higher for genotype XX and Xx than for genotype xx. Furthermore, patients with genotype XX and Xx had a higher risk of receiving operative treatment than those with genotype xx. In conclusion, DNA analysis may predict curve progression, although other polymorphisms were not associated with curve severity.