Radiologists in the IT era: the Saitama experience.

In recent years, intra-hospital computerisation including picture archiving and communication system (PACS) and electronic medical chart system (EMCS) has been rapidly introduced in Japan. The current system has, however, encountered many problems, such as, storage format of images, quality of diagnostic monitors, and compatibility of PACS and EMCS introduced by multi-vendors. In 2003, Saitama Medical University Hospital introduced PACS and EMCS, which can prevent inconsistency and loss of medical care information and can be linked to provide high quality medical care. This paper describes how radiologists should be involved in a hospital information system as specialists of PACS, based on our experience.

Bronchial atresia: three-dimensional CT bronchography using volume rendering technique.

We report a case of asymptomatic bronchial atresia of the anterobasal and laterobasal segments of the right lower lobe. Because of the absence of typical bronchial mucocele on chest radiograph, it was difficult to base the diagnosis on chest radiography alone. Helical CT images demonstrated the characteristic appearance of bronchial atresia, and three-dimensional (3D) CT bronchography using the volume rendering technique helped us to comprehend the spatial relationship between the dilated bronchus distal to the atresia and the more proximal bronchus.

A case of hypervascular renal capsule leiomyoma.

A case of leiomyoma of the kidney is reported. A 54-year-old woman was found incidentally to have a solid left renal mass on abdominal ultrasound examination performed during a follow-up study for chronic hepatitis, type C. Computed tomography (CT), dynamic magnetic resonance imaging (MRI), and angiography revealed the hypervascular mass. Partial nephrectomy was performed under a preoperative diagnosis of renal cell carcinoma. Histopathology diagnosed the mass as renal capsular leiomyoma. We considered that the hypervascularity of the tumor was related to the presence of rich capillary beds.

Contralateral subtraction: a novel technique for detection of asymmetric abnormalities on digital chest radiographs.

A novel contralateral subtraction technique has been developed to assist radiologists in the detection of asymmetric abnormalities on a single chest radiograph. With this method, the lateral inclination is first corrected by rotating and shifting the original chest image so that the midline of the thorax is aligned with the vertical centerline of the original chest image. The rotated image is then flipped laterally to produce a reversed "mirror" image. Finally, the mirror image is warped and subtracted from the original image for derivation of the contralateral subtraction image. The three key techniques which are employed in this study are applied successively to the initial contralateral subtraction technique for acquisition of improved subtraction images. One hundred PA chest radiographs, including 50 normals and 50 abnormals, were used as the database for this study. The percentage of chest images, which were rated as being adequate, good, or excellent quality of subtraction images by employing a subjective evaluation method, was improved from 73% to 91% by use of the three key techniques. The contralateral subtraction technique can be used for detection of any asymmetric abnormalities, such as lung nodules, pneumothorax, pneumonia, and emphysema, on a single chest radiograph, and therefore has potential utility in a high proportion of abnormal cases.

A case of extrahepatic portal vein aneurysm with massive thrombosis: diagnosis with reconstruction images from helical CT scans.

A patient with extrahepatic portal vein aneurysm with massive thrombosis, congenital in nature, is reported. Reconstructed images using curved reformation software and three-dimensional images from helical CT were useful to delineate the shape of the portal vein aneurysm and extension of the thrombi.

[Detection of recurrent rectal cancer using helical CT with SmartPrep: a new technique for obtaining optimal contrast enhancement].

Seven patients with suspected recurrent rectal cancer underwent Helical CT using SmartPrep. SmartPrep is a software application developed by GE in which the ROI is placed at the desired level of the aorta prior to contrast injection. Using a low-dose continuous scan, the time density curve was obtained instantly, and the optimal timing of scanning was judged from the curve. Four patients who demonstrated intense enhancement at the anastomotic site had local recurrence. No intense enhancement was observed in these areas on conventional delayed CT. Thus, SmartPrep appears to be useful for the accurate diagnosis of recurrent rectal cancer.

Atypical nervous lesion in Haemophilus somnus infection of cattle.

Two cows affected with Haemophilus somnus were examined pathologically. Although manifested lesions were composed of fibrinopurulent meningitis without the usual parenchymatous lesions in the central nervous system, Haemophilus somnus was isolated in pure culture from the cerebral cortex of both cases. Presence of this atypical lesion in the nervous system should be kept in mind for the differential diagnosis of the disease.

A case of insulin autoimmune syndrome associated with small insulinomas and rheumatoid arthritis.

Twenty five cases of insulin autoimmune syndrome including this case has been reported so far without having the pathogenesis clarified. This paper describes a case which suggests one aspect of pathogenesis. The patient, a housewife concurrently had insulinoma and severe rheumatoid arthritis, complaining of hypoglycemic syncope attacks. During the attacks her blood sugar levels ranged from 19 to 22 mg%. Her serum extractable immunoreactive insulin (IRI) and insulin binding antibody levels were 557 microunits/ml and 0.390 mU/ml, respectively. gamma-Globulin-bound insulin was also measured electrophoretically. Bio-Gel P 10 column chromatography eluted almost all IRI at the void volume at pH 7.4 and a smaller but significant IRI peak also at pH 3.0. Selective angiography revealed a tumor-like staining in the pancreas body. Pancreatectomy relieved her of hypoglycemic attacks. Histology disclosed two small insulinomas. Insulinoma, rheumatoid arthritis and insulin autoimmune syndrome coexisted in this case, suggesting some causal relationship among them.

[Pharmacology of cornary dilator agent, trapymin. (2) Analysis of its mode of action].

Trapymin (TM) relaxed excised renal, coronary, pulmonary, femoral and mesenteric arteries and this relaxation was not antagonized by propranolol. The dose-response curve of TM was parallel to that of nitroglycerin and papaverine and steeper than that of dipyridamol or adenosine. TM exerted inotropic and chronotropic actions on excised rat atrium. TM was also effective through the oral route and the effectiveness tended to decrease slightly after repeated use for ten days. TM was effective on vasopressin induced angina in rats and electrocoagulation-induced myocardial infarction. TM suppressed adrenaline-induced arrhythmia but not CaCl2-induced arrhythmia. TM reduced catecholamine content in brain, adrenals and heart but had no influence on monoamine oxidase or dopamine-beta-hydroxylase. TM revealed ganglion-blocking and neuron-blocking actions in cervical ganglion in cats. With propranolol, TM-induced hyperglycemia and reduction in glycogen content in liver and heart was antagonized but TM-induced rise in free fatty acid in serum was not antagonized. Na+-K+ dependent ATPase of bovine heart and P/O ratio of mitochondria of rat heart was not influenced by TM. ADP-induced aggregation of platelets was antagonized by TM. These data indicate that TM induced coronary dilation is partly due to a papaverine like action and also to ganglion-blocking, neuron-blocking and anti-adrenergic action. On the other hand, TM possessed catecholamine release and cardiotonic action as related to beta-receptors.