Contrast-enhanced CISS MRI of vestibular schwannomas: phantom and clinical studies

PURPOSE

The purpose of this work was to assess the changes of signal intensity on constructive interference in steady state (CISS) 3D Fourier transformation (3DFT) MRI after administration of Gd-DTPA and to evaluate the efficacy of contrast-enhanced CISS-3DFT MRI to depict the seventh and eighth cranial nerves affected by vestibular schwannomas.

METHOD

All scans were carried out on a 1.5 T MR unit. First, an experimental study was conducted to evaluate the changes in signal intensity of the CISS-3DFT sequence in relation to the concentration of contrast medium. Second, nine consecutive patients with 11 vestibular schwannomas underwent CISS-3DFT imaging before and after contrast agent administration. Signal intensities of the tumors and nerves were measured and compared between the pre- and postcontrast images. Visualization of the facial and cochlear nerves was rated on pre- and postcontrast CISS imaging independently.

RESULTS

On the phantom study, the CISS-3DFT sequence showed a constant increase in signal intensity as the concentration of Gd-DTPA increased. The contrast between the nerves and tumors significantly increased after contrast agent administration (from 0.1 to 9.0 as mean contrast-to-noise ratio). The ability to depict the nerves was also significantly higher for postcontrast CISS-3DFT imaging than for precontrast.

CONCLUSION

Although the CISS-3DFT sequence offers similar contrast as other heavily T2-weighted sequences, the signal intensity of contrast-enhanced tumors increased on CISS-3DFT imaging. Contrast-enhanced CISS imaging was valuable for evaluating the seventh and eighth cranial nerves affected by vestibular schwannomas.

Parental loss in childhood and social support in adulthood among psychiatric patients. Group for Longitudinal Affective Disorders Study (GLADS)

Psychoanalytic theories hypothesize that early attachment experiences with parents shape the structure and function of adult interpersonal relationships. The present paper aims to examine if parental loss experiences in childhood is related to perceived social support in adulthood. We directly interviewed 1247 patients representative of 31 psychiatric clinics and hospitals all over Japan as to their parental loss experiences in childhood and also administered them Sarason et al.'s Social Support Questionnaire. It was found, to our surprise, that those who had lost the father or mother through death reported as many current support persons as those who had not and that those who had experienced separation from the mother (but not the father) reported greater satisfaction with social support than those who had not. Several hypotheses are advanced to explain these unexpected findings and it is concluded that we must at least entertain some doubt on the direct continuity hypothesis between disruptions of parent-child relationships and the individual's later capacity to enjoy social support.

Results of tracheobronchoplasty for bronchogenic carcinoma

Tracheobronchial reconstruction is a safe and effective procedure for patients with the neoplasms of low grade malignancy and bronchogenic carcinoma. We present herein a series of 18 cases that had tracheobronchial reconstruction, and discuss a postoperative complication and prognosis. From 1981 to 1997, 18 patients (2.8%) of 647 cases had tracheobronchial reconstruction with mediastinal lymph node dissection. The average age of the 13 males and 5 females, was 61 (range 51-72) years. We analyzed clinical features, postoperative complication and prognosis. Seventeen patients underwent sleeve lobectomy and one lobectomy with carinal reconstruction (Barkley's montage type). There were 13 squamous cell carcinomas, and one each of adenocarcinoma, typical carcinoid, adenoid cystic carcinoma, mucoepidermoid carcinoma and undifferentiated carcinoma. Stage was IA in 3, stage IB in 6, stage IIB in 3, stage IIIA in 5, and stage IIIB in 1 patient. Curative resection was achieved in 11 patients and non-curative resection in 7 patient who had radiotherapy. Six patients (33.3%) had postoperative complications. Five-year survival and mean survival time were 92.3% and 126 months, respectively. Tracheoplasty group had significantly better prognosis than pneumonectomy group or lobectomy group (p<0.01). This study suggests that tracheobronchoplasty is a more useful procedure than pneumonectomy for lung cancer.

The structure of bacteriorhodopsin at 3.0 A resolution based on electron crystallography: implication of the charge distribution

Electron crystallography has the potential to visualise the charge status of atoms. This is due to the significantly different scattering factors of neutral and ionised atoms for electrons in the low-resolution range (typically less than 5 A). In previous work, we observed two different types of densities around acidic residues in the experimental (|Fo|) map of bacteriorhodopsin (bR), a light-driven proton pump. We suggested that these might reflect different states of the acidic residues; namely, the protonated (neutral) and the deprotonated (negatively charged) state. To evaluate the observed charge more quantitatively, we refined the atomic model for bR and eight surrounding lipids using our electron crystallographic data set between 8.0 and 3.0 A resolution, where the charge effect is small. The refined model yielded an R-factor of 23.7% and a free R-factor of 33.0%. To evaluate the effect of charges on the density map, we calculated a difference (|Fo|-|Fc|) map including data of a resolution lower than 8.0 A resolution, where the charge effect is significant. We found strong peaks in the difference map mainly in the backbone region of the transmembrane helices. We interpreted these peaks to come from the polarisation of the polar groups in the main chain of the alpha-helices and we examined this by assuming a partial charge of 0.5 for the peptide carbonyl groups. The resulting R and free R-factors dropped from 0.250 and 0.341 to 0.246 and 0.336, respectively. Furthermore, we also observed some strong peaks around some side-chains, which could be assigned to positively charged atoms. Thus, we could show that Asp36 and Asp102 are likely to interact with cations nearby. In addition, peaks found around the acidic residues Glu74, Glu194 and Glu212 have different features and might represent positive charges on polarised water molecules or hydroxonium ions.

Laparoscopic resection of submucosal gastric tumors

In order to elucidate the efficacy in gastric surgery, we evaluated seven resected cases of a submucosal gastric tumor in which laparoscopic techniques were used. The patients consisted of 1 man and 6 women. The tumors were located in the upper, middle, and lower third of the stomach in 4, 1, and 2 cases, respectively. Three tumors were located mainly on the anterior gastric wall, 2 were on the posterior wall, and 2 were on the lesser curvature. The resected tumor size averaged 3.2 x 2.6 cm. The tumors were classified as intraluminal type (4 cases) and the extraluminal type (3 cases) according to the classification of growth type. A histopathological examination identified 4 leiomyomas, 1 leiomyosarcoma, and 4 smooth muscle tumors of indeterminate malignant potential. After a tumor resection, no recurrence of the lesions occurred during the postoperative follow-up. An extraluminal growing tumor was easily resected by the laparoscopic method without any additional procedures, and this therefore seemed to be a good indication for the laparoscopic method. In contrast, an intraluminal tumor was found to be more difficult to resect using the laparoscopic method without a companion method, e.g., intraoperative endoscopy, because of the difficulties in the detection and resection of the tumor from the serosal side. A more efficient technique must therefore be developed for this type of tumor.

Finger bougie method compared with pyloroplasty in the gastric replacement of the esophagus

To elucidate the necessity of pyloroplasty for the gastric tube through the posterior mediastinum in esophageal surgery, gastric emptying and duodenogastric reflux (DGR) were evaluated in 16 cases undergoing an anterior pylorectomy (group P) and in 16 cases treated by the finger bougie method (group F). First, the obstruction and reflux symptoms were examined based on a patient questionnaire using a brief scoring system. The median value of the symptom score showed the patients in P to have more symptoms than those in F; however, the difference was not significant (8.0 vs 6.0). Secondly, the swallowed Tc O4- (85MBq) was counted using a gamma camera at three sites on the sternal bone in the upright position based on a gastric transit scintigram. Both the descending time of the RI peak and the clearance rates were similar between the two groups. Thirdly, intragastric 24-h pH monitoring was carried out. Antimony pH sensors were anchored 5 and 15cm below the esophagogastrostomy. We could not find any difference between the two groups in both the %time pH > 4 and %time pH > 7. These findings thus revealed no big difference between groups P and F. The finger bougie method to drain the vagotomized posterior mediastinal stomach was found to achieve results similar to conventional pyloroplasty, while it was also simpler and safer.

Basic kinetics of 15-(p-iodophenyl)-3-R,S-methylpentadecanoic acid (BMIPP) in canine myocardium

BMIPP is a radioiodinated fatty acid analogue used for myocardial single photon emission CT (SPECT) imaging based on high cardiac fatty acid metabolism. In normal dogs, 74% of the injected BMIPP was instantly extracted and was then retained in 65.3%. The washout of the retained radioactivity was low, and most of the washout was alpha- and beta-oxidation metabolites. ATP concentration plays an important role in the myocardial uptake and retention of BMIPP. The ATP-dependent BMIPP uptake at the TG pool was strongly regulated by etomoxir with modifying mitochondrial beta-oxidation and subsequent ATP production. Thus, myocardial viability was reflected on the BMIPP uptake in acute ischemia. In spite of insignificant changes in early extraction and retention. BMIPP back diffusion (r = -0.92) and full-oxidation metabolite (r = 0.78) were correlated with the severity of ischemia. Mismatched region of BMIPP with flow (Tl-201) showed decreased metabolic enzymes such as citrate synthase and 3-hydroxyacyl-CoA dehydrogenase. These data suggest that BMIPP would be feasible for detecting cellular energy state from lipid metabolism.

Trehalose embedding technique for high-resolution electron crystallography: application to structural study on bacteriorhodopsin

Trehalose was compared with glucose in its use as an embedding medium for the preparation of two-dimensional crystals for electron crystallographic structure analysis. Purple membranes (two-dimensional crystals of bacteriorhodopsin) embedded in either sugar were studied in a 'partially hydrated' state as well as after 'drying' of the specimen. Diffraction patterns of the four conditions, all showing spots to a resolution better than 3.0 A, were analysed and merged. In the case of glucose embedded specimens, the merging R-factor obtained from the diffraction patterns of dried specimens was significantly better than the one obtained from partially hydrated specimens. In the case of trehalose embedding, the merging R-factor for partially hydrated specimens was significantly better than the dried one. The trehalose embedded, partially hydrated specimens gave the best merging R-factor in all four cases.

Extended radical resection for bulky N2 small cell lung carcinoma

In three patients with bulky N2 small cell lung carcinomas who received chemotherapy, complete clinical remission at the N2 site was obtained. Extended radical resection including mediastinal lymph node dissection was performed on these three patients, followed by postoperative chemotherapy. Combined resected organs were azygos vein, superior caval vein, and left atrium. We obtained good results with the patients surviving 104, 53, and 38 months respectively, after the initial therapy.

Effects of lung volume on lung and chest wall mechanics in rats

To investigate the effect of lung volume on chest wall and lung mechanics in the rats, we measured the impedance (Z) under closed- and open-chest conditions at various positive end-expiratory pressures (0-0.9 kPa) by using a computer-controlled small-animal ventilator (T. F. Schuessler and J. H. T. Bates. IEEE Trans. Biomed. Eng. 42: 860-866, 1995) that we have developed for determining accurately the respiratory Z in small animals. The Z of total respiratory system and lungs was measured with small-volume oscillations between 0.25 and 9.125 Hz. The measured Z was fitted to a model that featured a constant-phase tissue compartment (with dissipation and elastance characterized by constants G and H, respectively) and a constant airway resistance (Z. Hantos, B. Daroczy, B. Suki, S. Nagy, and J. J. Fredberg. J. Appl. Physiol. 72: 168-178, 1992). We matched the lung volume between the closed- and open-chest conditions by using the quasi-static pressure-volume relationship of the lungs to calculate Z as a function of lung volume. Resistance decreased with lung volume and was not significantly different between total respiratory system and lungs. However, G and H of the respiratory system were significantly higher than those of the lungs. We conclude that chest wall in rats has a significant influence on tissue mechanics of the total respiratory system.

Consumption of vitamin E in coronary circulation in patients with variant angina

OBJECTIVES

The plasma status of vitamin E has been suggested to be linked to the activity of coronary artery spasm. This study was designed to determine whether vitamin E is actually consumed in the coronary circulation in patients with active variant angina having repetitive spasm-induced transient myocardial ischemia and reperfusion.

METHODS

Blood samples were obtained simultaneously from the aortic root, coronary sinus and right atrium in 12 patients with variant angina due to spasm of the left coronary artery, nine patients with stable effort angina and nine control subjects. Plasma vitamin E (alpha- and gamma-tocopherol) concentrations were determined by use of high-performance liquid chromatography and plasma lipid peroxides were measured as thiobarbituric acid-reactive substances (TBARS).

RESULTS

At baseline, both plasma alpha- (p < 0.01) and gamma- (p < 0.05) tocopherol levels were significantly lower in the coronary sinus (5.50 +/- 0.50 and 0.55 +/- 0.07 mg/l, mean +/- SEM) than in the aortic root (6.63 +/- 0.57 and 0.63 +/- 0.08 mg/l) and also in the right atrium (6.44 +/- 0.61 and 0.63 +/- 0.09 mg/l) in the variant angina group. The TBARS level was significantly (p < 0.05) higher in the coronary sinus than in the aortic in this group. In contrast, these levels were not significantly different between the samples from the coronary sinus and the aortic root or the right atrium in the control group and also in the stable effort angina group. The coronary sinus-aortic difference in plasma vitamin E levels in the variant angina group was not significantly altered after left coronary artery spasm induced by intracoronary injection of acetylcholine. Also, the plasma vitamin E levels in the aortic root, coronary sinus and right atrium all remained unchanged in the stable effort angina group after pacing-induced angina and in the control group after intracoronary administration of acetylcholine.

CONCLUSIONS

Transcardiac reduction in plasma vitamin E concentrations concomitant with lipid peroxide formation was demonstrated in patients with active variant angina, suggesting actual consumption of this major endogenous antioxidant. Oxidative stress and vitamin E exhaustion may be involved in the pathogenesis of coronary artery spasm.

Usefulness of diffusion-weighted MRI with echo-planar technique in the evaluation of cellularity in gliomas

The purpose of this study was to evaluate the utility of diffusion-weighted magnetic resonance imaging (MRI) with echo-planar imaging (EPI) technique in depicting the tumor cellularity and grading of gliomas. Twenty consecutive patients (13 men and 7 women, ranging in age from 13 to 69 years) with histologically proven gliomas were examined using a 1.5 T superconducting imager. Tumor cellularity, analyzed with National Institutes of Health Image 1.60 software on a Macintosh computer, was compared with the minimum apparent diffusion coefficient (ADC) and the signal intensity on the T2-weighted images. The relationship of the minimum ADC to the tumor grade was also evaluated. Tumor cellularity correlated well with the minimum ADC value of the gliomas (P = 0.007), but not with the signal intensity on the T2-weighted images. The minimum ADC of the high-grade gliomas was significantly higher than that of the low-grade gliomas. Diffusion-weighted MRI with EPI is a useful technique for assessing the tumor cellularity and grading of gliomas. This information is not obtained with conventional MRI and is useful for the diagnosis and characterization of gliomas.

Usefulness of diffusion-weighted MRI with echo-planar technique in the evaluation of cellularity in gliomas

The purpose of this study was to evaluate the utility of diffusion-weighted magnetic resonance imaging (MRI) with echo-planar imaging (EPI) technique in depicting the tumor cellularity and grading of gliomas. Twenty consecutive patients (13 men and 7 women, ranging in age from 13 to 69 years) with histologically proven gliomas were examined using a 1.5 T superconducting imager. Tumor cellularity, analyzed with National Institutes of Health Image 1.60 software on a Macintosh computer, was compared with the minimum apparent diffusion coefficient (ADC) and the signal intensity on the T2-weighted images. The relationship of the minimum ADC to the tumor grade was also evaluated. Tumor cellularity correlated well with the minimum ADC value of the gliomas (P = 0.007), but not with the signal intensity on the T2-weighted images. The minimum ADC of the high-grade gliomas was significantly higher than that of the low-grade gliomas. Diffusion-weighted MRI with EPI is a useful technique for assessing the tumor cellularity and grading of gliomas. This information is not obtained with conventional MRI and is useful for the diagnosis and characterization of gliomas.

Acute response of the lung mechanics of the rabbit to hypoxia

We measured the change in total lung resistance (RL) and that in total lung elastance (EL) induced by hypoxia (n = 7) and compared the results with those by intravenous histamine bolus (n = 5) at three different positive end-expiratory pressure (PEEP) levels (2, 5, and 8 hPa) in open-chest and vagotomized rabbits. The percent increase ratio of RL (PIRR) and EL (PIRE) was defined as the change in RL and EL, respectively, induced by hypoxia compared with that in the normoxic condition, expressed as a percentage. PIR values for the change in RL and EL induced by bolus injection of histamine were also calculated. The PIRR and PIRE induced by hypoxia and by histamine were positive by a statistically significant amount at every PEEP level, except for the PIRE value at 8-hPa PEEP in the hypoxic challenge. The PIRE-to-PIRR ratio values in the hypoxic challenge at 2-hPa PEEP were significantly larger than those in the histamine challenge (hypoxia: 0.91 +/- 0.23%; histamine: 0.37 +/- 0. 065%, P < 0.05). The increase in EL induced by histamine in the acute phase has been reported to be mainly derived from tissue distortion secondary to bronchial constriction. Thus our results suggest that a part of the increase in EL by hypoxia was originated in different parenchymal responses from histamine and imply that this hypoxic response of lung parenchyma is sensitive to the increase in parenchymal tethering at high PEEP levels.

Early parental separation experiences among patients with bipolar disorder and major depression: a case-control study

BACKGROUND

Although the association between childhood parental loss and later development of mood disorder has received much research interest in the past, the results obtained and conclusions drawn have been various, and inconsistent with each other. The present study aims to examine this old, yet unresolved, question among the Japanese.

METHODS

Patients with bipolar disorder (n = 73) and unipolar depression (n = 570) and community healthy controls (n = 122) were examined as to their psychopathology and childhood parental loss experiences with semi-structured interviews.

RESULTS

Stratified for sex and age, no statistically significant difference was observed in the incidence of paternal or maternal death or separation before age 16 between bipolar patients and healthy controls. Female patients with unipolar depression under the age of 54 experienced significantly more maternal loss than the corresponding controls. This excess in loss appeared to be largely due to the patients experiencing separation from their mothers.

CONCLUSION

Our findings concerning bipolar disorder have replicated the previous two studies reported in the literature. Those concerning unipolar depression appear to be in line with several recent studies on the subject but, as stated, many discrepant findings can also be found in the literature.

A structural feature in the central channel of the bacterial flagellar FliF ring complex is implicated in type III protein export

The FliF ring complex, which consists of the M-S ring and a proximal portion of the rod of the flagellar basal body, is the base structure for the bacterial flagellar assembly. The FliF ring is also thought to be part of the export apparatus for flagellar proteins from its amino acid sequence homology to proteins involved in type III protein export systems. We established a new purification procedure for the FliF ring particles and carried out electron microscopic image analyses in their two distinct forms: well-dispersed single particles in the presence of salt and ordered monolayer arrays of hexagonal packing formed in the absence of salt. In both cases, the axial projection maps showed a common feature, a pair of concentric rings: the inner ring corresponds to the proximal rod; the outer ring represents the thick, edge portion of the M-S ring. However, the central channel of the FliF ring, the putative pathway for the flagellar protein export, appeared to show distinct structural features in the two forms. This suggests that a domain of FliF partially occupies the central channel to be involved in the export and gate mechanism, and the domain changes its conformation depending on the ionic strength.

Childhood parental loss and schizophrenia: evidence against pathogenic but for some pathoplastic effects

Childhood parental loss has been associated with a number of psychiatric disorders in adulthood. The present article aims to examine, firstly, the etiologic relationship between early parental loss and later development of schizophrenia and, secondly, the pathoplastic effect of the former on the symptomatology of the latter. We have administered semi-structured interviews inquiring into psychopathology and early separation experiences to a representative sample of first-visit patients to the 31 hospitals and clinics all over Japan (n=1963) and also to a community sample in a small city in Japan (n=218). When 225 patients diagnosed with schizophrenia according to DSM-III-R criteria were compared with 122 healthy control subjects without any lifetime psychiatric disorder, controlled for sex and age, there was no statistically significant difference in the rates of childhood parental loss (death or separation). As regards the pathoplastic effects, it was found that schizophrenic men were less likely to present with negative symptoms if they had experienced separation from the father, and were more likely to show panic attacks if they had experienced separation from the mother. Schizophrenic women were more likely to present with hallucinations if they had suffered any loss of the father. Childhood parental loss is not pathogenic of schizophrenia but appears to exert some pathoplastic influences on its presenting symptoms.

Correlation of MR imaging-determined cerebral blood volume maps with histologic and angiographic determination of vascularity of gliomas

OBJECTIVE

Our purpose was to evaluate the relationships between the ratio of maximum relative cerebral blood volume (rCBV) (rCBV ratio = rCBV[tumor]/rCBV[contralateral white matter]) and histologic and angiographic vascularities of gliomas using the gradient-echo echoplanar MR imaging technique. We also evaluated the usefulness of rCBV maps for grading gliomas.

SUBJECTS AND METHODS

We examined 30 patients with histologically verified gliomas. Gliomas were classified as glioblastoma, anaplastic glioma with enhancement, anaplastic glioma without enhancement, and low-grade glioma. The maximum rCBV ratio of each glioma was compared with both histologic and angiographic vascularities, and the relationship between the maximum rCBV ratios and each type of glioma was established.

RESULTS

The maximum rCBV ratios of the gliomas significantly correlated with both histologic and angiographic vascularities (p < .001). Mean values and SDs of maximum rCBV ratios of each type of tumor were 7.32+/-4.39 for glioblastomas, 5.84+/-1.82 for anaplastic gliomas with enhancement, 1.53+/-0.75 for anaplastic gliomas without enhancement, and 1.26+/-0.55 for low-grade gliomas. The maximum rCBV ratios of the glioblastomas were significantly higher than those of the anaplastic gliomas without enhancement (p = .002) and the low-grade gliomas (p < .001). The maximum rCBV ratios of the anaplastic gliomas with enhancement were higher than those of the anaplastic gliomas without enhancement and the low-grade gliomas, but the differences were not statistically significant (p = .08 and p = .03, respectively).

CONCLUSION

The results of perfusion-sensitive MR imaging with gradient-echo echoplanar technique correlated with both histologic and angiographic vascularities.

[Long-term survival in surgical cases of non-small cell lung cancer with mediastinal nodal involvement]

We studied long-result of the patients with mediastinal lymph node metastasis (N2) in lung cancer. From 1981 to 1991 in National Sanatorium Nishi-Gunma Hospital, we have performed a lobectomy or pneumonectomy with mediastinal lymph node dissection for 306 patients with non-small cell lung cancer. Six operative deaths were excluded (operative death rate: 2.0%). Of these, 53 patients (17%) were diagnosed as adenocarcinoma or squamous cell carcinoma with N2 disease pathologically. The patient consisted of 31 men and 22 woman whose ages ranged from 18 to 73 years, with a mean age of 58.1 years. The results were: Mean survival period was 39 month. Five-and 10-year survival rates were 18.9% and 12.6%, respectively. By motive of detection, the group of following other disease had a better prognosis than the group of having symptom. By pT-factor, T1 had a better prognosis than T3. By the number of nodal involvement level, 1 level had a better prognosis to compared to 3 or more than 4 levels. There were 10 patients of 5-year or over survivors after surgery, none of whom had primary site in left upper lobe. Analysis with a Cox's proportional hazard model demonstrated that the number of nodal involvement level was a useful factor in prognosis.

The number of metastatic lymph nodes: a promising prognostic determinant for gastric carcinoma in the latest edition of the TNM classification

BACKGROUND

The number of metastatic regional lymph nodes determines the new pN categories in the 5th edition of the TNM classification.

STUDY DESIGN

Our retrospective study was conducted to compare the new method of defining lymph node status with the conventional classification, consisting of the anatomic extent of lymph node metastases, a well-established prognostic factor. The study was based on clinical data for 493 patients with gastric carcinomas who underwent potentially curative operations and had histologically confirmed nodal metastases. These patients were stratified into 1) n categories according to the Japanese Classification of Gastric Carcinoma, 2) the new pN categories, and 3) the pN categories determined by the number of metastatic perigastric nodes resected by standard D1 gastrectomy. Survival data were analyzed for each group.

RESULTS

The number of metastatic nodes after D2 lymphadenectomy reflected prognosis well and was shown by multivariate analysis to be a strong independent prognostic factor. When the classification was performed limited to the metastatic perigastric nodes, stage migration was evident, but the variable remained competent as a prognostic indicator.

CONCLUSIONS

The number of metastatic nodes is a promising determinant in the new international stage classification.

A possible association between paternal longevity and major depression among elderly men

Ancestral longevity is sometimes thought to contribute to psychosocial well-being in late life. The present paper aims to examine if parental longevity is associated with mental health among the elderly. The age at death of the parents was compared between 68 patients with major depression who were aged 65 or over and 40 subjects of the same age range without any history of psychiatric disorder. Cox regression revealed that the fathers of the elderly men with unipolar depression died at a significantly younger age than those of the control group. Several hypotheses are advanced to explain this unexpected and intriguing association.

Ultrasonographic screening for arterial occlusive disease in the pelvis and lower extremities

PURPOSE

To evaluate the accuracy of pulsed Doppler ultrasound (PDUS) and color Doppler ultrasound (CDUS) for the screening of arterial occlusive disease in the pelvis and lower extremities.

METHODS

We studied 52 patients with intermittent claudication or lower extremity "coolness." Pulsed Doppler waveforms were measured in the inguinal and popliteal regions and were classified according to their pattern. Patients with abnormal waveforms underwent subsequent CDUS evaluation from the aortic bifurcation to the popliteal arteries. All patients also underwent conventional angiography.

RESULTS

All stenoses (> 50%) and occlusions on angiography were detected by PDUS. The combination of PDUS and CDUS allowed detection of 78.0% of stenotic lesions (> 50% narrowing) and 96.6% of occlusive lesions in the iliofemoral regions and in 100% of stenotic lesions (> 50% narrowing) and occlusive lesions in the femoropopliteal regions. PDUS required approximately 3 min. About more 5 min are required when CDUS was added.

CONCLUSION

Combined PDUS and CDUS appears to be a rapid, highly sensitive means of screening for arterial occlusive disease in the pelvis and lower extremities.

Modified Bagolini striated glass test: clinical applications of starlight test in binocular visual field screening

AIM

To introduce the "starlight" test which was devised to check binocular vision in normal conditions of seeing in a rapid, easy, and cost effective manner and to estimate the possibility of its clinical use in screening the binocular visual field of patients.

METHOD

The Bagolini striated glass test consists of optically plano lenses with imperceptible parallel scratches that barely blur the environment but produce two perpendicular luminous stripes (right eye stripe of 45 degrees and left eye stripe of 135 degrees) when subjects with normal binocular vision view one light source. Unlike the original Bagolini test, the starlight test uses three light sources in horizontal or vertical lines according to the testing purposes and the subject is asked to fixate upon the centre light. Through Bagolini glasses, the subject observes the resulting grid-like pattern and the state of binocular visual field of the subject can be roughly estimated.

RESULTS

Normal subjects and patients with strabismus, visual field loss from intracranial diseases, glaucoma, retinitis pigmentosa, and functional visual loss were examined using the starlight test and findings from each case were discussed.

CONCLUSIONS

The starlight test, which was made by hand at a low cost, is a simple test that can be used clinically. It provides information about the state of binocular vision of patients in normal conditions of seeing. It is also useful because it enables the examiner to share similar experiences with the examinee. The results suggest it can be effective in visual field screening.