Improved control of image optical density with low-dose digital and conventional radiography in bedside imaging

The technical and diagnostic performance of simultaneously acquired low-dose (44% of standard dose) storage-phosphor digital radiographs (system resolution = 0.2 mm, 10 bits) were compared with those of standard-dose conventional bedside radiographs of the chest in 32 patients. The mean optical density (OD) of the lungs (800 measurements) was closer to the ideal density with digital radiography (1.45 OD +/- 0.20 [standard deviation] vs 1.75 OD +/- 0.53) and was less often outside the usable range (2.5% vs 42.5%). Receiver operating characteristic analysis for detection of simulated nodules and monitoring devices (nine readers, 4,608 observations) showed that digital radiography was superior to conventional radiography (P less than .05) for four of the nine readers and equivalent to conventional radiography for five readers. The authors concluded that digital radiography produces more consistent and ideal image density and performs at least as well as conventional radiography under phantom test conditions.

Desmoplastic fibroma arising in fibrous dysplasia. Chromosomal analysis and review of the literature

A desmoplastic fibroma of bone arose in the fibula of a 17-year-old boy with fibrous dysplasia. This may be the second case of this rare histopathologic association reported in the literature. Benign bone tumors have not previously been subjected to cytogenetic analysis. Analysis of this case revealed a primary abnormal clone trisomic for both chromosomes 3 and 5 and two subclones, one trisomic for chromosome 3 and one trisomic for chromosome 5. This case may also present the first description of nonrandom karyotypic abnormalities in a benign neoplasm of bone.

[Chemoembolization of hepatocellular carcinoma--computed tomographic follow-up observation]

The prognosis of unresectable hepatocellular carcinomas is bad. Untreated, survival is 1.6 to 2.5 months. Systemic chemotherapy has little effect and is associated with marked side effects. Tumour cells are supplied almost exclusively by the hepatic artery, whereas normal liver tissue is supplied by the hepatic artery and portal vein. Consequently, interruption of arterial blood flow results in damage to the carcinoma without affecting the rest of the liver. Lipiodol is an oily contrast medium which is taken up selectively by the tumour and can be demonstrated in tumour, in the interstitium and in blood vessels. We used lipiodol emulsified with cisplatin and epirubicin successfully in 22 patients with inoperable liver cell carcinomas. The treatment was well tolerated, apart from some nausea and mild upper abdominal discomfort. Survival time from first diagnosis and the first embolisation was ten months longer than expected survival or that following systemic chemotherapy.

"Single-exposure" dual energy digital radiography in the detection of pulmonary nodules and calcifications

We studied the detectability of mineralized and non-mineralized simulated pulmonary nodules with dual energy digital radiography. "Soft tissue" and "bone" images (pixel size = 0.2 mm, 10 bits deep) were obtained with subtraction image processing after a single simultaneous exposure (100 kVp, 8 mAs, 17 mR skin exposure dose) of two storage phosphors with an interleaved 0.9 mm copper wafer. Three classes of paraffin-based nodules (0.5 to 3.0 cm) of varying mineral concentration (0, 120 and 190 mg/cm3 K2HPO4) were randomly positioned on the chest wall of two healthy volunteers to simulate calcified and non-calcified nodules. The average receiver operating characteristics (ROC) area of six readers (n = 2880 observations) showed that digital "bone" images (ROC area: 0.77 +/- 0.03) were significantly better (P less than 0.04) than conventional radiographs (OC Film, Lanex medium screens, 141 kVp, 19 mR skin exposure dose) (ROC area: 0.71 +/- 0.05) in detecting calcification in nodules. The unsubtracted digital images of lower kilovoltage were not superior to the 141 kVp conventional radiographs in a subgroup of two readers (ROC area: 0.73 +/- 0.02). Digital "soft tissue" images were equivalent to conventional chest radiographs in detecting soft tissue pulmonary nodules (ROC areas: 0.92 +/- 0.04 and 0.92 +/- 0.05, respectively.

[The immunohistochemical growth fraction (Ki-67) of breast cancers: relations to tumor spread, tumor morphology and receptor testing]

245 breast cancer tissues were analysed immunohistochemically, using monoclonal antibody Ki-67, which spezifically reacts with a nuclear antigen of proliferating cells and represents the so-called growth fraction. According to the number of positive cells, three Ki-score categories (I-III) were established. The results were compared with prognostic variables (Histological grading, DNA-cytophotometry), staging parameters, immunocytochemical (ER-ICA, mPRI), and biochemical (DCC) hormone receptor assay. We found a good correlation between Ki-67 and grading (Bloom and Richardson): G 1-tumors had small growth fractions, in contrast to G-III carcinoma, which showed a high percentage of Ki-Score III. Receptor negative cases had a large growth fraction and receptorpositive ones showed an uniform distribution. The comparison between Ki-67 and tumor spread or DNA-Cytophotometry showed no correlation. The majority of 31 recurrent tumors not only had a large number of positive cells, but also a definite dependence was found between Ki-Score and length of the disease-free period. Ki-67 seems to be an important immunohistochemical marker of breast cancer, which contributes to the individual assessment of the disease and can possibly give predictions on tumor development and response to radiation and systemic therapy.

Reproducibility of the pettersson scoring system. An interobserver study

By means of the Pettersson scoring system, the degree of severity of haemophilic arthropathy in 128 knee, elbow and ankle joints was estimated by 5 radiologists. Their scores varied on average by approximately 3 points. Minimal and maximal joint involvement were scored consistently; exclusion of haemophilic arthropathy was possible with the highest degree of certainty. With regard to changes of a moderate degree agreement was seldom reached. With precisely defined characteristics, a high degree of consistency between observers was evident. Interobserver variation in the scoring was more marked in the ankle joint than in the other joints. Scoring was more consistent with the more experienced observers.

Body fat distribution measured with CT: correlations in healthy subjects, patients with anorexia nervosa, and patients with Cushing syndrome

Computed tomography (CT) was used to study fat distribution in three groups of women of comparable age: 39 healthy volunteers, 15 patients with anorexia nervosa, and seven with Cushing syndrome. Patients with anorexia nervosa had a fivefold decrease in subcutaneous fat and only a twofold decrease in intraabdominal fat compared with the values for the volunteers. Patients with Cushing syndrome had less than a twofold increase in subcutaneous fat and greater than a fivefold increase in intraabdominal fat compared with values for the healthy subjects. These findings suggest that fat in different body compartments responds differently to disease processes and that CT can be used to measure these changes.

[Sonography of the shoulder joint. Study technic, sonomorphology and diagnostic significance]

In the evaluation of the impingement syndrome, conventional radiography can only show secondary bony changes. Sonography is able to demonstrate the anatomy of the musculotendinous structure of the rotator cuff. Lesions can be detected with the same accuracy and specificity as by contrast arthrography. As sonography is a non-invasive method, it should be used routinely to test rotator cuff integrity. Joint effusions and proliferative synovial changes are easily demonstrated by sonography. It is thus possible to perform follow-up studies in a pre-erosive stage of rheumatoid arthritis.

[Projections in conventional shoulder joint diagnosis]

Numerous projections are described in the literature for plain film radiography of the shoulder joint. A review is given of the indications, advantages and disadvantages of the most common views. The significance of special, additional views is discussed.

[Sonographic and computerized tomography study of congenital choledochal cyst]

In the neonatal period ultrasound and hepatobiliary functional scintigraphy are used to diagnose choledochal cysts. Initial sonography demonstrates hepatobiliary anatomy, hepatobiliary function is assessed by subsequent scintigraphy. The diagnosis can be confirmed by additional computed tomography as shown in this case report.

[Hand arteriography. Surgical indications and results]

Based on experience in arteriography of the hand in 108 patients the authors present in a retrospective study the surgical indications (trauma, tumour, angiodysplasia, malformation and embolic lesion) and results of this method. The diagnostic value of arteriography of the hand is shown by means of results and examples.

[Use of 5-F-pigtail catheters (Superflow) in transaxillary arteriography of the pelvis and legs]

Experiences with the 5-F-"Superflow" Pigtailcatheter for transaxillary arteriography of 24 patients are reported and compared with 24 cases where a 7-F-Fröhlich-catheter was used. The advantages of the smaller caliber for transaxillary approach are emphasized.

Improving the predictability of intraocular lens power calculations

We reviewed the intraocular lens power calculations on 512 posterior chamber lens implantations and determined four ways to reduce the estimated 5% incidence of large postoperative refractive "surprises" (greater than 2 diopters [D]): First, preoperatively identify those patients who have greater than a 1-D difference between the theoretical and linear regression formulas. Second, repeat axial length and corneal power measurements in these patients to eliminate random error. Third, develop an individualized theoretical formula that accounts for constant bias. Fourth, encourage manufacturers to improve instrumentation for measuring corneal power and axial length. We also examined the disparity between the linear regression formula and the curvilinear theoretical formula.

[Results of real-time sonography and raster mammography of 200 breast cancers]

The article reports on 200 patients with histologically verified carcinomas of the breast in whom both real time mammasonography and grid mammography were performed. The indications for additional use of real time sonography in the diagnosis of malignant diseases of the female breast were a palpable node or a suspicious finding in mammography. All patients were examined with a high resolution realtime scanner with a 7.5 MHz transducer. The diagnostic criteria of sound deep to the mass (type I-IV), the regularity of the conteur of the mass, and the presence or absence of internal echoes. The typical sonographic features of histologically different types of carcinoma of the female breast are demonstrated by means of case examples. Mammasonography offers a high degree of accuracy in preoperative differential diagnostic assessment of tumour status in malignant processes of the breast. The combined mammographic-sonographic evaluation is the method of choice in clinical evaluation of masses of the female breast.

Caffeine enhancement of the initiation of DNA replication in benzo[a]pyrene diol epoxide damaged cells

We have used a newly developed pH stepwise alkaline elution method to show that caffeine enhances DNA initiation (DNA replication in sub-replicon size nascent strands) in (+/-)-7 beta,8 alpha-dihydroxy-9 alpha,10 alpha-epoxy-7,8,9, 10-tetrahydrobenzo[a]pyrene (BPDEI) damaged mouse primary epidermal cells. Caffeine alone caused a dose-dependent increase in DNA initiation without an effect on DNA elongation (joining of replicon-sized nascent DNA). BPDEI alone inhibited DNA elongation as shown by a relative increase in sub-replicon size nascent DNA. When BPDEI treated cells were incubated with caffeine, there was a dose-dependent increase in sub-replicon size nascent DNA without a significant effect on the proportion of joined replicons. Therefore, caffeine can enhance DNA initiation in mammalian cells damaged with a reactive form of the carcinogen benzo[a]pyrene and this may account for the biological interaction between caffeine and the ultimate carcinogenic form of benzo[a]pyrene.

LNCaP model of human prostatic carcinoma

The LNCaP cell line was established from a metastatic lesion of human prostatic adenocarcinoma. The LNCaP cells grow readily in vitro (up to 8 x 10(5) cells/sq cm; doubling time, 60 hr), form clones in semisolid media, are highly resistant to human fibroblast interferon, and show an aneuploid (modal number, 76 to 91) human male karyotype with several marker chromosomes. The malignant properties of LNCaP cells are maintained. Athymic nude mice develop tumors at the injection site (volume-doubling time, 86 hr). Functional differentiation is preserved; both cultures and tumor produce acid phosphatase. High-affinity specific androgen receptors are present in the cytosol and nuclear fractions of cells in culture and in tumors. Estrogen receptors are demonstrable in the cytosol. The model is hormonally responsive. In vitro, 5 alpha-dihydrotestosterone modulates cell growth and stimulates acid phosphatase production. In vivo, the frequency of tumor development and the mean time of tumor appearance are significantly different for either sex. Male mice develop tumors earlier and at a greater frequency than do females. Hormonal manipulations show that, regardless of sex, the frequency of tumor development correlates with serum androgen levels. The rate of the tumor growth, however, is independent of the gender of hormonal status of the host.

Concentration dependent alterations of DNA replication initiation and elongation by benzo[a]pyrene diol epoxide

Vero cells treated with various concentrations of (+/-)7 beta, 8 alpha-dihydroxy-9 alpha, 10 alpha-epoxy, 7,8,9,10-dihydrobenzo[a]pyrene (BP-diol epoxide I) exhibited dose-dependent inhibition in both the rate of DNA synthesis and in the size of nascent DNA. The maximum inhibition was seen 2--3 h after addition of BP-diol epoxide I. A recovery in both the rate of synthesis and size of nascent DNA was observed 5--10 h after treatment. The pH step alkaline elution assay which separates different nascent DNA replication intermediates was used to investigate whether the inhibition and recovery noted above could be accounted for by alterations in DNA replication initiation (DNA synthesis within a replicon) or elongation (rejoining of replicons). At lowest dose studied (0.166 muM BP-diol epoxide I) a reversible inhibition in DNA initiation was observed. At the higher dose levels (0.66 muM and 1.66 muM BP-diol epoxide I) inhibition of both DNA initiation and elongation were observed and inhibition of elongation predominated. The inhibition in elongation was detected by an increase in the relative amount of low molecular weight nascent DNA associated with DNA synthesis within a replicon and a relative decrease in the higher molecular weight elongated DNA. A reversal in the inhibition of both initiation and elongation was noted.

Sperm Density During Active Spawning of Pacific Herring (Clupea harengus pallasi)

Discharge of milt by spawning Pacific herring (Clupea harengus pallasi) produces a milky discoloration in the water which is readily observed under favorable conditions of weather and light. Echo-sounder tracings showed that only the inshore part of a spawning school that was in contact with the bottom participated in the early stages of spawning. Sperm densities at the surface for two spawnings averaged 148 and 129 sperm/ml (range 80–210 for 16 subsamples). This density is considered more than ample for high fertilization success but is only one-tenth that normally used for artificial fertilization in the laboratory at Nanaimo.

Prostatic cancer. Transcortin levels during treatment with estramustine phosphate

Plasma transcortin and cortisol levels, which are significantly elevated by estrogens, were determinied in a group of patients with prostatic cancer who were on estramustine phosphate (Estracyt) therapy. In a series of 44 male patients studied transcortin and corticol levels became elevated above normal and were maintained at these high levels as long as the patients were on estramustine phosphate therapy. The levels observed in this study may serve as reliable indices to monitor patients who are on this drug.