Gadolinium-enhanced three-dimensional magnetization-prepared rapid gradient-echo (3D MP-RAGE) imaging is superior to spin-echo imaging in delineating brain metastases.

BACKGROUND: Precisely defining the number and location of brain metastases is very important for establishing a treatment strategy for malignancies. Although magnetic resonance imaging (MRI) is now considered the best modality, various improvements in sequences are still being made. PURPOSE: To prospectively compare the diagnostic ability of three-dimensional, magnetization-prepared rapid gradient-echo (3D MP-RAGE) imaging in detecting metastatic brain tumors, with that of two-dimensional spin-echo (2D SE) T1-weighted imaging. MATERIAL AND METHODS: A total of 123 examinations were included in this study, and 119 examinations from 88 patients with known malignancies were analyzed. All patients underwent T1- and T2-weighted 2D SE transverse imaging, followed by gadolinium-enhanced T1-weighted transverse and coronal 2D SE imaging and 3D MP-RAGE transverse imaging. Four radiologists interpreted the images to compare the accuracy and the time required for interpretation for each imaging. RESULTS: 3D MP-RAGE imaging was significantly better than 2D SE imaging for detecting metastatic brain lesions, regardless of the readers' experience. The sensitivities of the 3D MP-RAGE and 2D SE imaging for all observers were 0.81 vs. 0.80 (P>0.05), specificities were 0.93 vs. 0.87 (P<0.05), positive predictive values were 0.92 vs. 0.86 (P<0.05), negative predictive values were 0.78 vs. 0.75 (P>0.05), and accuracies were 0.84 vs. 0.78 (P<0.05), respectively. There was no significant difference in the time required for image interpretation between the two modalities (15.6+/-4.0 vs. 15.4+/-4.1 min). CONCLUSION: 3D MP-RAGE imaging proved superior to 2D SE imaging in the detection of brain metastases.

Effects of exposure to a 1950 MHz radio frequency field on expression of Hsp70 and Hsp27 in human glioma cells.

Human glioma MO54 cells were used to investigate whether radio frequency (RF) field exposure could activate stress response genes. Cells were exposed to continuous wave 1950 MHz or sham conditions for up to 2 h. Specific absorption rates (SARs) were 1, 2, and 10 W/kg. For the cell growth experiment, cell numbers were counted at 0-4 days after exposure. Expression of Hsp27 and Hsp70, as well as the level of phosphorylated Hsp27 (78Ser) protein, was determined by Western blotting. It was found that sham exposed and RF exposed cells demonstrated a similar growth pattern up to 4 days after RF field exposure. RF field exposure at both 2 and 10 W/kg did not affect the growth of MO54 cells. In addition, there were no significant differences in protein expression of Hsp27 and Hsp70 between sham exposed and RF exposed cells at a SAR of 1, 2, or 10 W/kg for 1 and 2 h. However, exposure to RF field at a SAR of 10 W/kg for 1 and 2 h decreased the protein level of phosphorylated Hsp27 (78Ser) significantly. Our results suggest that although exposure to a 1950 MHz RF field has no effect on cell proliferation and expression of Hsp 27 and Hsp70, it may inhibit the phosphorylation of Hsp27 at Serine 78 in MO54 cells.

Taiei Miura and Franco-Japanese friendship in psychiatry.

Japanese medicine enthusiastically adopted many aspects of Western medicine, especially German, during and after Japan's modernization. After the war, the policy giving priority to German medicine changed greatly, and American medicine replaced German medicine in postwar days. Some people, however, question whether it is proper to get medical information one-sidedly from a single country. Faced with the situation of whether German or American medicine should occupy the dominant position in Japan, some doctors chose to establish ties with French medicine. Professor Taiei Miura (1901-1995) re-established an intimate relationship, broken off during the war, in the medical field between Japan and France. Much information was to be learned from French medicine, particularly in clinical neurology and psychiatry. In this essay, we relate the details of how Miura became interested in French medicine, went to study in France, then contributed greatly to Franco-Japanese friendship.

An event-related potential study on the impairment of automatic processing of auditory input in schizophrenia.

Mismatch negativity (MMN) and P300 to auditory stimuli was carried out using global field power (GFP) in 25 schizophrenics and 25 normal controls. The peak latencies of MMN and P300 were significantly longer in schizophrenics than in normal controls, and the differences in MMN were marked in the frontal regions. The peak amplitudes of MMN and P300 were significantly smaller in schizophrenics. The scalp distribution of MMN to 1050 Hz tone differed between the two groups, although that to 1100 Hz was similar to each other. The results indicate an impairment in the automatic discrimination process of auditory input in schizophrenics.

Radiotherapy for cervical cancer with high-dose rate brachytherapy correlation between tumor size, dose and failure.

This is a retrospective analysis of 659 patients with cervical squamous cell carcinoma with a minimum follow-up of 2 years at Keio University Hospital between May 1974 and March 1990. All patients were treated with external radiation (50 Gy) and high-dose rate (HDR) intracavitary brachytherapy (20-34 Gy). The 5-year survival rates in each stage gradually decreased with the advance of the stage (I, 84%; II, 71%; III, 47%; and IVa, 12%). When 366 patients with stage III were classified into three groups according to tumor size, i.e. small (S, 102 patients), medium (M, 145) and large (L, 119), a survival gradient of small > medium > large was demonstrated and the differences between them were significant. At follow-up visits conducted between 1 and 2 months after completion of treatment, 135 patients (20%) had physical indications of residual disease. The larger the tumor size, the more likely was residual disease by 2 months. The patients with residual disease had a significantly higher rate of the pelvic failure than those without it. There was no significant correlation between radiation doses by RALS and pelvic failure rates, except in the stage III-L group. In the stage III-L group, intracavitary doses of 24 Gy or less to point A could be correlated with the higher pelvic failure rate and the lower survival rate, in contrast to doses of 27 Gy or more. The incidence of major rectosigmoid complications was 11.8% with doses of 24 Gy or less to point A, 8.1% with 27 Gy and 19.2% with doses of 30 Gy or more.(ABSTRACT TRUNCATED AT 250 WORDS)

[Radiotherapy for cervical cancer patients with high-dose rate brachytherapy: application of shielded colpostats].

Two hundred sixty-six cervical cancer patients with histologically proven squamous cell carcinoma were treated with radiotherapy alone at Keio University Hospital between September 1984 and March 1991. All patients received 30 Gy of external whole pelvic irradiation and 20 Gy of pelvic irradiation with a central shield. After 30 Gy of whole pelvic irradiation, high dose rate intracavitary brachytherapy (24-27 Gy) was applied with the shielded colpostats (3 mm lead). The 5-year cumulative survival rate in each stage decreased with the advance of stage (stage I: 82%, II: 67%, III: 43% and IV: 19%). When patients with stage III cervical cancer were classified into three groups according to tumor size (S, M, L), patients in group L had the worst 5-year survival rate (S: 63%, M: 54% and L: 25%). At follow-up visits conducted between 1 and 2 months after the completion of radiation, patients with stage III L had significantly higher rates of persistent disease (61%) and recurrence (26%). There was no correlation between the incidence of rectosigmoid sequelae and dose given by brachytherapy, and shielded colpostats could not decrease the incidence of rectosigmoid sequelae, compared with that with unshielded colpostats (25% vs. 31%). This result suggests that a higher irradiation dose is necessary to control local tumor in stage III L patients and additional doses administered by brachytherapy (6 Gy) may not increase the incidence of rectosigmoid sequelae.

[Effect of growth rate of monolayer cells on survival after fractionated irradiation].

This study was performed to determine the effect of the growth rate of monolayer cells on survival following fractionated irradiation. HeLa and RMUG cells that had different radiosensitivities and growth rates (Do value: 2.3 vs 1.5 Gy, doubling time: 17 vs 46 hours) were irradiated with 2 Gy every day. The fractions surviving after fractionated irradiation were compared with those given single doses. The dose modifying factor for fractionated irradiation was larger in RMUG than HeLa: 1.7 and 1.2, respectively. Two clones from ADGU cells that had the same radiosensitivity but different growth rates were also given fractionated irradiation, but there was no difference in surviving fractions. When recovery following two split doses was determined in each type of cell, the results of the fractions surviving after fractionated irradiation were correlated only with recovery between split doses. These suggest that the growth rates of monolayer cells may not modify the fractions surviving after fractionated irradiation, and the monolayer cell system is not suitable for determining the effect of growth rates on survival following fractionated irradiation.

[Radiation management of retinoblastoma].

Forty-five patients with retinoblastoma were treated at Keio University Hospital from 1970 to 1990. Thirty-two patients had unilateral lesions and 13 had bilateral lesions. Twenty-nine patients with unilateral and 12 with bilateral lesions underwent enucleation for advanced tumor. As a result, 3 patients with unilateral retinoblastoma and all patients with bilateral disease were treated with radiotherapy (40-50 Gy) combined with or without cryotherapy and/or photocoagulation. One patient with unilateral lesion treated with radiotherapy and chemotherapy had metastases at the first visit to our clinic and was excluded from this analysis. Among 16 eyes (15 patients) treated with radiotherapy, 6 eyes had recurrence and needed retreatment. Cataract occurred in 6 of 12 eyes and good vision was preserved in 5 of 10 eyes in which function could be evaluated.

[A case of chronic toluene intoxication with atrophy of cerebrum, cerebellum and brainstem on CT and MRI].

A 28-year-old man developed neurological disorders consisting of cerebellar symptoms and dementia over a period of 8 years of inhalation of toluene. He also developed bilateral optic atrophy. CT scan and MRI revealed atrophy of cerebrum, cerebellum and brainstem. The severity of neurological symptoms corresponded with the findings of CT and MRI. Furthermore, MRI (T2) showed reduced signal intensity in bilateral thalamus. This patient was also admitted to another hospital 2.5 years ago. Compared with the previous findings, present examinations showed significant progress of the atrophy of cerebrum and brainstem. It was suggested from the results of ABR that the disturbance of the brainstem was aggravated through this period.