Preventive effects of self-administered cryotherapy on paclitaxel-induced peripheral neuropathy in patients with early-stage breast cancer: a propensity score analysis.

We hypothesized that suppression of peripheral circulation via cryotherapy may be effective in preventing paclitaxel-induced peripheral neuropathy (PIPN). Therefore, this study aimed to clarify whether self-administered cryotherapy could prevent PIPN in patients with early-stage breast cancer, using real-world data. A single-center, retrospective, observational study was conducted. Data from the electronic medical records of consecutive patients aged ≥ 20 years with early-stage breast cancer who received a regimen containing paclitaxel for 12 cycles with or without self-administered cryotherapy at the National Cancer Center Hospital from March 2018 to May 2019 were evaluated. The primary endpoint was the cumulative dose of paclitaxel until the onset of grade ≥ 2 PIPN. To compare the difference between the two groups, multivariable Cox proportional hazards models adjusted for prognostically important variables were used. Ninety Japanese patients were included in this study. The estimated incidence of grade ≥ 2 PIPN was 26.9% and 37.7% in the self-administered cryotherapy group and control group, respectively (P = 0.314). The multivariable Cox proportional hazards model showed that the self-administered cryotherapy group had a decreased risk of onset of grade ≥ 2 PIPN (hazard ratio: 0.63, 95% confidence interval: 0.25 to 1.39; P = 0.281). Sensitivity analyses using multivariable Cox proportional hazards models along with two propensity score-adjusted methods demonstrated consistent results. The findings suggest that the methods of self-administered cryotherapy may prevent PIPN and should be reinforced appropriately in clinical practice. A randomized controlled multicenter trial of self-administered cryotherapy is warranted.

Posterior circulation and high prevalence of ischemic stroke among young pediatric patients with Moyamoya disease: evidence of angiography-based differences by age at diagnosis.

BACKGROUND AND PURPOSE: At diagnosis, the primary clinical manifestations of pediatric Moyamoya disease are TIA or CSs. CSs are reported to be more prevalent in younger than in older children. We sought to determine whether age-related differences in clinical manifestations are associated with age-related angiographic differences. MATERIALS AND METHODS: We divided 78 patients diagnosed with Moyamoya disease before 16 years of age into four 4-year age groups and examined the relationships between age at diagnosis and clinical manifestations and angiographic and MR imaging findings. RESULTS: Among the 4 diagnostic age groups, in those younger than 4 years of age, the prevalence of CSs and of infarctions on MR images was highest, and along with severity of steno-occlusive lesions of the PCA, the prevalence was significantly higher than that in the next diagnostic age group (4-7 years), though the severity of steno-occlusive lesions in the ICA and the degree of transdural collaterals did not differ significantly. The prevalence of CSs and infarctions did not differ significantly in the 3 oldest diagnostic age groups, whereas ICA and PCA lesions and transdural collaterals correlated positively with diagnostic age. CONCLUSIONS: The high prevalence of CSs and infarctions in patients diagnosed before 4 years of age is associated with advanced steno-occlusive lesions of the PCA. In patients 4 years of age and older at diagnosis, transdural collaterals develop in parallel with advancement of ICA and PCA lesions, which may contribute to the nearly constant prevalence of CSs.

Factors associated with taste dissatisfaction in the elderly.

The purpose of this study was to investigate taste sensation in the elderly, and to determine relationships between subjective dissatisfaction with taste ability and factors such as age, gender and oral status among independently living elderly individuals. Participants were older adults (mean age, 66.0 +/- 4.2 years; 321 men and 319 women) voluntarily attending a Senior Citizen Educational Program supported by local government in 2003 and 2004. The questionnaire included self-assessed items on general health, dry mouth, chewing satisfaction and taste satisfaction. Respondents underwent investigation of salivary flow rate, dental status and gustatory testing using the filter-paper disc method for sweet, salty, sour and bitter. Chi-squared tests showed that the factors associated with dissatisfaction with taste ability were older age, dissatisfaction with chewing, dry mouth during eating and wearing dentures covering the entire hard palate. The sensation for each taste was not significantly related to taste satisfaction by chi-squared test. Multiple logistic regression analysis showed that dry mouth during eating, dentures covering the entire hard palate, dissatisfaction with chewing and discriminatory threshold for the sour taste were associated with dissatisfaction with taste ability. We found a significant association between subjective taste dissatisfaction and certain oral factors; hence, when patients complain about diminished taste, dentists must assess oral status as well as taste sensation.

Spectrum of Epstein-Barr virus infection in Japanese children: a pictorial essay.

Epstein-Barr virus (EBV) infection has been associated with infectious mononucleosis, EBV-associated hemophagocytic syndrome (EBV-AHS), chronic active EBV infection (CAEBV), lymphomas, inflammatory pseudotumor, lymphomatoid granulomatosis, and nasopharyngeal carcinoma. EBV-AHS and CAEBV are more lethal than infectious mononucleosis with imaging findings of gallbladder wall thickening, pleural effusion, cardiomegaly, and hepatomegaly. EBV infection is also associated with benign and malignant tumors.

MR evaluation of talonavicular angle in congenital talipes equinovarus.

The talonavicular relationship in 14 patients with talipes equinovarus was quantified using gradient echo sequences. The angle formed between the short axis of the navicular and the long axis of the talus was measured. There is a significant difference in the talonavicular angle between patients who had posteromedial release (PMR) and those who had posterior release (PR) or casting only (P=.0004). This method provides an objective assessment of residual deformity following surgical and conservative management of talipes equinovarus.

Comparison of ipsilateral activation between right and left handers: a functional MR imaging study.

We used fMRI to compare the ipsilateral activation in the sensorimotor region (SMR) during dominant and non-dominant hand motor tasks between right and left handers. In right handers, the ipsilateral activation was significantly greater during non-dominant (left) hand task than dominant (right) hand task, while in left handers, it showed no significant difference. The ipsilateral activation was most pronounced in the precentral subregion (presumably corresponding to the premotor area) during either hand task in both groups. We conclude that the different patterns of ipsilateral activation might be mainly explained by the hemispheric dominance. The skill of the hand and complexity of tasks may be related to the predominant activation of the premotor area.

Spontaneous regression of localized neuroblastoma detected by mass screening.

PURPOSE: To clarify whether and when neuroblastomas identified through screening do regress, and to ascertain how to treat them appropriately, we observed screened patients who had localized tumors, without any therapeutic intervention. PATIENTS AND METHODS: The criteria for the observation program were as follows: disease stage I or II; tumor less than 5 cm in diameter; no invasion to the intraspinal canal or growth to the great vessels; urinary vanillylmandelic acid (VMA) and homovanillic acid (HVA) less than 50 microg/mg creatinine; and informed consent. Of 25 patients identified through screening for 6-month-old infants in Saitama Prefecture, Japan between April 1994 and March 1996, 11 patients who met the criteria and one other patient with stage III tumor were enrolled onto the program. They were examined by abdominal ultrasonography (US) and their urinary VMA and HVA levels were assessed approximately once per month. The observation periods ranged from 4 to 27 months. RESULTS: The 11 tumors decreased in size, although one of these 11 tumors initially enlarged until the patient was 12 months of age and decreased in size thereafter. One other tumor slightly increased in size. Urinary VMA levels decreased in all patients. None of the tumors had completely disappeared by the last observation day. CONCLUSION: Our results suggest that regression of screened neuroblastoma is not a rare phenomenon. At present, it seems reasonable to adopt a wait-and-see strategy, with careful observation, for selected stage I or II tumors identified in infants screened at 6 months of age.

Clockwise whirlpool sign at color Doppler US: an objective and definite sign of midgut volvulus.

PURPOSE: To evaluate the clockwise whirlpool sign at color Doppler ultrasound (US) in the diagnosis of midgut volvulus. MATERIALS AND METHODS: Pediatric patients (160 boys, 76 girls; age range, 0 day to 14 years) with possible midgut volvulus underwent abdominal gray-scale US and color Doppler US. Midgut volvulus was diagnosed by recognition of the whirlpool sign (wrapping of the superior mesenteric vein and the mesentery around the superior mesenteric artery). If the whirlpool rotated clockwise with caudal movement of the transducer, the direction of the whirlpool was defined as clockwise. RESULTS: Color Doppler US showed a whirlpool sign that was clockwise in 12 of 13 patients with surgically confirmed midgut volvulus and counterclockwise in three patients without midgut volvulus. Sensitivity, specificity, and positive predictive value of clockwise whirlpool sign for midgut volvulus were 92%, 100%, and 100%. CONCLUSION: The clockwise whirlpool sign is diagnostic of midgut volvulus. Color Doppler US should be performed as an initial imaging study in children suspected of having midgut volvulus.

Hypomelanosis of Ito associated with neuroblastoma.

We report a patient with hypomelanosis of Ito associated with neuroblastoma. Though not previously reported, the association is plausible since both conditions are forms of "neurocristopathy".

[Making a backlight display panel using a personal computer and a laser imager: a less expensive and less time-consuming method].

To make a backlight display panel for a scientific exhibit, we used a commercially available laser imager. The MR image was directly transferred from the MR apparatus to a personal computer, and other image information was transferred through an image scanner or digital camera. Text for the presentation was made on the commercially available presentation software Persuasion. It took approximately 10 minutes to print out all the panels needed for one exhibit, and cost only 3,600 Yen (600 Yen a film).

A simple maneuver in follow-up digital subtraction angiography for multiple coronary-aorta bypass grafts.

A simple maneuver in intraarterial digital subtraction angiography (DSA) is proposed to improve the images of left internal thoracic artery bypass grafts (LITAGs). A contrast flush in the left subclavian artery, using a catheter that had been percutaneously introduced from the left brachial artery, was carried out in 14 patients with multiple coronary-aorta bypass grafts (CABGs) after aortic DSA. The side-hole portion of the catheter tip was positioned in the proximal left subclavian artery as the coiled portion remained in the aortic arch. Nonionic contrast medium (350 mg/ml of iodine) was injected with an automatic injector in a volume of 6-8 ml and at a flow rate of 3-4 ml/sec. Left subclavian arterial flush DSA delineated the LITAGs excellently in 11, well in 3, and fairly or poorly in none of the 14 cases. There were no complications in any of these cases. A supplemental contrast flush of the left subclavian artery with a pigtail catheter following aortic DSA improves the diagnosis of multiple CABG patency.

[MR imaging findings of nonketotic hyperglycinemia. 2 cases of neonatal onset].

We presented MR (magnetic resonance) images findings of the brain in nonketotic hyperglycinemia (NKH) from 2 patients of neonatal onset. MR findings in our cases of NKH are compatible with the pathological alterations described in the literature; MR images revealed delayed myelination of the cerebral white matter and hypoplasia of the corps callosum. The latter finding particularly seemed to be relatively characteristic to NKH. MR examination is the imaging modality of choice for this disease because it can demonstrate the degree of myelination, and development of the corpus callosum particularly on sagittal section.

[CT and MR imaging findings of sphenoidal masses].

CT and MR imaging findings of 57 sphenoidal masses were retrospectively reviewed to assess the possibility of differential diagnosis between them. Various kinds of masses such as pituitary adenoma, epipharyngeal cancer, mucocele, chordoma, chondroma, chondrosarcoma, distant metastasis, multiple myeloma, fibrous dysplasia, craniopharyngioma, hemangiopericytoma, giant cell tumor, primary sphenoidal cancer, malignant melanoma, leukemia, histiocytosis X, and giant cell tumor were included in this series. CT scanning was performed in all cases, while MR images were obtained in 48 cases using a spin-echo pulse sequence. The relative density of the masses, bony changes and calcification were evaluated on CT, and on MR images, signal intensity of the masses relative to the normal gray matter, contrast enhancement and extension/contour were evaluated. Although no single feature appeared to be specific to the masses, detection of calcification on CT, identification of the normal pituitary gland as deformed or displaced on T1-weighted images, signal intensity on T2-weighted images, and extension of the masses seemed to be useful and should be examined in terms of their ability to assist in differential diagnosis. Finally, accommodative classification of sphenoidal masses primarily based on presumed origin or mode of extension was attempted.

Observation of biological materials by X-ray photoelectron-conversion contact microscopy.

Dried biological specimens, such as fossil diatoms, collagen, nerve tissue and spicule of Trepang, were observed by X-ray photoelectron-conversion contact microscopy. A spatial resolution of 0.2 microns was attained. The fossil diatom image shows a clear difference below and above the carbon K-absorption edge (4.46 nm).

[A case of aortitis syndrome].

A 57 years old woman was admitted for the investigation of anginal chest pain. Her coronary angiography didn't show any typical finding seen in the aortitis syndrome, but coronary sclerosis and stenosis seen in the usual atherosclerotic patients. The cerebral angiography was performed, too. The right vertebral artery, which was tortuous and dilated, was seen, but the other three cerebral vessels were not seen. These rare findings were reported in this report. We added the discussion about the relation between the aortitis syndrome and angina pectoris.

[Expanded indication of percutaneous transluminal coronary angioplasty to the infarcted zone--using thallium-201 exercise scintigram after rehabilitation].

In some cases of old myocardial infarction (OMI), left ventricular wall motion was improved after revascularization, though viability of the infarcted myocardium was not detected by left ventriculography (LVG) and exercise thallium-201 myocardial scintigraphy (EX-Tl). So to obtain more correct information of the viability, EX-Tl was performed again after ergometer rehabilitation for an OMI patient whose myocardial viability of the infarcted zone could not detected by LVG and EX-Tl. Incomplete fill in was showed in the EX-Tl after rehabilitation. So percutaneous transluminal coronary angioplasty (PTCA) was performed. Left ventricular wall motion was improved after three months. EX-Tl after rehabilitation is useful to evaluate the viability that could not detected by LVG and EX-Tl.

[Diagnosis of aortic arch aneurysm--a case report of the utility of MR imaging].

We reported a case of syphilitic aortic arch aneurysm, which was examined by IADSA, X-ray CT and MR Imaging. A large aneurysm with the thick mural thrombus and central narrow lumen was clearly shown by MR Imaging. MR Imaging is an useful modality for the diagnosis of the aortic arch aneurysm with a very narrow lumen, which cannot be easily pointed out by IADSA.

Digital radiography in an intensive care unit.

Mobile chest radiographs obtained in the intensive care unit with a computed radiography system (one of the digital radiography systems) and a conventional screen-film technique were initially compared in 54 pairs. Features such as the air spaces and interstitium of the lungs, the mediastinum, pulmonary vessels, the tracheobronchial tree, and catheters and other devices were compared in both methods. The computed radiography system demonstrated good visualisation of the mediastinum, pulmonary vessels, the tracheobronchial tree, catheters and other devices. Automatic adjustment of the sensitivity and the wide dynamic range of this system were thought to be responsible for the decrease in the number of retakes even in patients with massive fluid collections. The few artefacts created by digital processing were mostly overcome by a routine use of simultaneous display of two different types of image processing.

[Prognostic significance of pretreatment CT scans in supratentorial astrocytomas receiving radiotherapy].

Pretreatment brain CT scans of 61 patients receiving radiation and chemotherapy for supratentorial gliomas (23 low-grade astrocytomas, 21 grade III astrocytomas and 17 glioblastomas) were reviewed, and their prognoses were analyzed. Almost all gliomas with no CEA (contrast enhanced area) were low-grade, and their prognosis was promising. Benign and malignant gliomas with regular CEA were found in equal proportions, and their prognosis was relatively good. A majority of cases with irregular or ring-like CEA were malignant, and their prognosis was extremely poor.