A case of gallbladder carcinoma diagnosed preoperatively by the detection of human telomerase reverse transcriptase mRNA in endoscopically obtained gallbladder bile.

It is difficult to accurately diagnose the nature of polypoid lesions in the gallbladder. To increase diagnostic accuracy, we have developed an endoscopic technique for obtaining gallbladder bile, termed endoscopic transpapillary catheterization into the gallbladder (ETCG). We describe here a case of gallbladder carcinoma diagnosed preoperatively by the detection of human telomerase reverse transcriptase (hTERT) mRNA, a catalytic subunit of telomerase, in gallbladder bile obtained using the ETCG technique. A patient with a polypoid lesion 15 mm in diameter in the gallbladder was admitted to our hospital for further examinations. Gallbladder bile collected by the ETCG technique was evaluated cytologically and also analyzed for telomerase activity and hTERT mRNA. Although the results for cytology and telomerase activity were negative, that for hTERT mRNA was positive. Open surgery was carried out and it was confirmed that the lesion was an adenocarcinoma invading the subserosa. The molecular biological analysis of gallbladder bile collected using the ETCG technique was shown to be effective for diagnosing the nature of the polypoid lesion in the gallbladder.

Superresolution modeling using an omnidirectional image sensor.

Recently, many virtual reality and robotics applications have been called on to create virtual environments from real scenes. A catadioptric omnidirectional image sensor composed of a convex mirror can simultaneously observe a 360-degree field of view making it useful for modeling man-made environments such as rooms, corridors, and buildings, because any landmarks around the sensor can be taken in and tracked in its large field of view. However, the angular resolution of the omnidirectional image is low because of the large field of view captured. Hence, the resolution of surface texture patterns on the three-dimensional (3-D) scene model generated is not sufficient for monitoring details. To overcome this, we propose a high resolution scene texture generation method that combines an omnidirectional image sequence using image mosaic and superresolution techniques.

Increased bcl-2 expression in lymphocytes and its association with hepatocellular damage in patients with autoimmune hepatitis.

The proto-oncogene product bcl-2 is known to inhibit apoptotic cell death, and its dysregulation might play a critical role in the development of autoimmune disease. To elucidate the role of bcl-2 in autoimmune hepatitis (AIH), its expression in peripheral blood mononuclear cells (PBMC) and in liver-infiltrating lymphocytes (LIL) was investigated. Increased bcl-2 expression in PBMC was found in AIH patients compared with that in chronic hepatitis C (CHC) patients and in healthy controls. The level of bcl-2 expression significantly correlated with serum ALT level. Further analysis showed that CD4+ T cells are enriched in bcl-2-expressing PBMC. To characterize the Th1/Th2 profile of bcl-2-expressing CD4+ T cells, intracellular interferon-gamma (IFN-gamma) and IL-4 were analysed. The results revealed that most of the bcl-2-expressing cells were found to be IFN-gamma-secreting Th1 cells. In three patients for whom their clinical courses could be followed, bcl-2 expression was decreased after the initiation of immunosuppressive therapy with corticosteroids. However, the level of IFN-gamma + cells was not altered. Immunohistochemical analysis also showed that large amounts of bcl-2+ cells were observed in periportal area in the liver. In conclusion, bcl-2-expressing cells were shown to be increased in peripheral blood and liver in AIH and the bcl-2 product was expressed mainly in CD4+ Th1-type cells, suggesting that these cells might promote the cellular immune response and contribute to the development of hepatitis and hepatocellular damage in AIH.

[IS&C image viewing and conversion software for Macintosh computer].

Although standardized data-transmission protocols such as DICOM are very beneficial, on-line transmission on images is often difficult to establish because of cost or security concerns. On the other hand, media-based data exchange is simple and adequate for the private use of medical images. We developed a viewing software program for medical images stored in magneto-optical disks with IS&C standard format. It displays images with gray-scale tone and stores them in Macintosh PICT format. The software is available for personal use from the first author.

Endoscopic lithotomy of common bile duct stones with sublingual nitroglycerin and guidewire.

OBJECTIVE: In 21 patients, our objective was the endoscopic removal of common bile duct stones by sphincter dilation with the application of sublingual nitroglycerin. METHODS: Nitroglycerin 0.3-0.6 mg was needed for proper dilation of the orifice and for successful cannulation of the Dormia basket into the bile duct. Cannulation of the Dormia basket was simplified by placing the guidewire in the common bile duct beforehand. Because of possible stone impaction, a mechanical lithotriptor was applied smoothly in two patients. RESULTS: Complete stone removal was successful in 18 of the 21 (86%) patients. One patient who developed a mild form of acute pancreatitis recovered in a few days by conservative management with drip infusion of protease inhibitor. Blood pressure dropped transiently in a patient receiving nitroglycerin, but the general condition of the patient was stable. CONCLUSIONS: This procedure was found to be safe, easy, and effective in extracting common bile duct stones.

[Endoscopic lithotomy using sublingual nitroglycerin].

After medical sphincter dilation using sud-lingual nitroglycerin, endoscopic removal of common bile duct stones in 15 patients was carried out. Complete stone removal was obtained in 14 of 15 patients. Only 0.3 mg to 0.6 mg nitroglycerin was needed to give an enough dilation of the orifice for cannulating the basket catheter into the bile duct. Mechanical lithotriptor was smoothly cannulated in one patient because of possible impaction. Blood pressure was dropped transiently in one patient by nitroglycerin, however, the general condition of the patient was stable. This procedure is safe, easy and effective in preserving sphincter function. Acute cholecystitis, a common complication of persistent gallbladder stone after endoscopic sphincterotomy, may be avoided by employing this method. More clinical studies, on long term and in a large scale of patients, are necessary to reduce complications that usually occur after sphincterotomy.

PACS in Kochi Medical School Hospital.

We have evaluated clinically CRT-based diagnosis and the performance of a picture Archiving and Communication System (PACS) in the Department of Radiology, Kochi Medical School. The important requirements of PACS are a good human interface with the diagnostic workstation and a long-term image archiving device. Because the style of image management varies from hospital to hospital, an analysis of the image management policies of each hospital is also important for the configuration of PACS.

[Malignant ovarian tumor invasion to the uterus and bladder: assessment with magnetic resonance imaging].

Twenty-nine patients with ovarian malignant tumor were studied by means of magnetic resonance (MR) imaging. The findings were compared with surgical findings concerning tumor invasion to the bladder and to the uterus. The bladder invasion was evaluated with MRI and classified as follows: (1) Huge amount of fat, colon or small intestine between the tumor and the bladder. (2) Thin fat layer between the bladder and the tumor, (3) No fat layer, and the bladder was smoothly compressed by the tumor, (4) No fat layer with local deformity of the bladder caused by the tumor existed, or tumor protruded into the bladder. In group (4), 4 of 5 cases were proved to have bladder invasion. However in group (3), half of the 14 cases showed bladder invasion and the others showed no invasion. Criteria used in MRI analysis of uterine invasion was as follows: (1) Fat layer between the uterus and the tumor, (2) Fat layer between the tumor and the bladder, and the uterine contour was indistinct, (3) No fat layer and deformity of the uterus was apparent. In group (3), many cases showed uterine invasion, but 4 cases out of 12 cases did not. In the group (2), 3 out of 11 cases showed uterine invasion. The diagnostic ability of uterine invasion was not as accurate as in cases of the bladder invasion. The MRI sagittal plane can directly show the relationship between the uterus, the bladder and tumor, so that diagnosis of tumor invasion by MRI is superior to CT. However MRI could not differentiate between adhesion and invasion.

[Ovarian cancer--a comparison between CT diagnosis and serum tumor markers].

In 40 patients undergoing pre-treatment for an ovarian tumor, a CT scan of the pelvis and measurements of their CA 125, CA 19-9, IAP (immunosuppressive acidic antigen), and TPA (tissue polypeptide antigen were performed. The specificity and sensitivity of the CT diagnosis was found to be better than any of other tumor markers measurements. Comparison of the 4 markers showed that the CA 125 testing had the greatest sensitivity in detecting an ovarian cancer. Moreover, the sensitivity of CA 125, was better than a combination of the 4 markers. Thus, a CT scan still remains necessary for the diagnosis of an ovarian cancer.

Compensation of motion blur in CCD color endoscope images.

Color CCD endoscopes with sequential three-color illuminations have the advantage of high spatial resolution but are sensitive to object motion. A digital method is proposed for the restoration of images color-shifted by the object motion. The method makes use of phase-only matching followed by a resampling operation to compensate for a space-variant shift between different primary color images. Restored images are suitable for further image processing such as color emphasis and structure enhancement.

Automatic analysis of moving images.

Cine film and videotape are used to record a variety of natural processes in biology, medicine, meteorology, etc. This paper describes a system which detects and tracks moving objects from these records to obtain meaningful measures of their movements, such as linear and angular velocities. Features of the system are as follows. 1) In order to detect moving objects that are usually blurred, temporal differences of gray values (differences between consecutive frames) are used to separate moving objects from stationary objects, in addition to spatial differences of gray values. 2) The results of previous frames are used to guide feature extraction process of the next frame so that efficient processing of moving pictures which consists of a large number of frames is possible. 3) Uncertain parts in the current frame, such as occluded objects, are deduced using information of previous frames. 4) Misinterpreted or unknown parts in previous frames are reanalyzed using the results of later frames where those parts could be found.