Diagnostic performance of general dental practitioners after lecture in identifying post-menopausal women with low bone mineral density by panoramic radiographs

OBJECTIVES

Mandibular cortical erosion detected on panoramic radiographs may be useful for identifying post-menopausal women with low skeletal bone mineral density (BMD). The purposes of this study were to calculate the diagnostic performance of general dental practitioners (GDPs) who attended a lecture on identifying post-menopausal women with low BMD from findings on panoramic radiographs and to evaluate the influence of GDPs' age on diagnostic performance.

METHODS

After a 1 h lecture, 111 GDPs were asked to classify the mandibular cortex (normal or eroded) on panoramic radiographs obtained from 100 post-menopausal women who have had skeletal BMD assessment. Low BMD was defined as a BMD T score of -1.0 or less. Diagnostic performance was analysed by comparing two groups classified by mandibular cortex (women with normal cortex and women with any eroded cortex) with those classified by BMD (women with normal BMD and women with low BMD).

RESULTS

The mean sensitivity, specificity, positive predictive value, negative predictive value, accuracy and likelihood ratio for a positive risk result were 73.0% (95% confidence interval [CI]; 71.3 to 74.7%), 49.0% (95% CI; 46.4 to 51.5%), 66.9% (95% CI; 66.0 to 67.8%), 57.0% (95% CI; 55.8 to 58.2%), 62.9% (95% CI; 62.1 to 63.7%) and 1.51 (95% CI; 1.44 to 1.58), respectively. GDPs' age did not influence diagnostic performance.

CONCLUSIONS

Our results suggest that 73.0% of women who had low skeletal BMD can be identified by GDPs after a lecture on the use of panoramic radiographs as an aid in diagnosing low BMD; however, the diagnostic performance may not be influenced by GDPs' age.

Effect of weight loss using formula diet on renal function in obese patients with diabetic nephropathy

OBJECTIVE

To evaluate the effect and safety of treatment with low-calorie formula diet on renal function and proteinuria in obese patients with diabetic nephropathy.

DESIGN

Prospective study on safety and efficacy of a 4-week low-calorie (11-19 kcal/kg/day) normal-protein (0.9-1.2 g/kg/day) diet partly supplemented with formula diet.

SUBJECTS

In all, 22 obese patients with diabetic nephropathy (BMI: 30.4+/-5.3 kg/m(2), HbA1c: 7.1+/-1.4%, serum creatinine: 172.4+/-57.5 micromol/l, urinary protein: 3.3+/-2.6 g/day).

RESULTS

The mean body weight decreased by 6.2+/-3.0 kg. The mean systolic blood pressure, creatinine, blood urea nitrogen, urinary protein, and 8-hydroxydeoxyguanosine decreased significantly by 7.5+/-12.7 mmHg, 41.6+/-23.9 micromol/l, 1.50+/-1.61 mmol/l, 1.8+/-1.7 g/day, and 3.1+/-3.6 ng/mg creatinine, respectively. No patient had increased serum creatinine and urinary protein. Mean creatinine clearance (40.6+/-17.9 to 46.1+/-14.6 ml/s/1.73 m(2)) and serum albumin showed no significant changes. Delta serum creatinine and Delta urinary protein correlated with Delta body weight (r=0.62 and 0.49, respectively) and Delta visceral fat area (r=0.58 and 0.58, respectively), but did not correlate with Delta systolic blood pressure, Delta fasting blood glucose and Delta subcutaneous fat area.

CONCLUSION

These results suggested that weight reduction using formula diet might improve renal function and proteinuria safely for a short term in obese patients with diabetic nephropathy.

Computer-aided system for measuring the mandibular cortical width on dental panoramic radiographs in identifying postmenopausal women with low bone mineral density

INTRODUCTION

Mandibular inferior cortical width manually measured on dental panoramic radiographs may be useful for identifying postmenopausal women with low skeletal bone mineral density (BMD). Automatic measurement of cortical width may enable us to identify a large number of postmenopausal women with suspected low skeletal BMD. The purposes of this study were to develop a computer-aided system for measuring mandibular cortical width on dental panoramic radiographs and clarify the diagnostic efficacy of this system.

METHODS

Panoramic radiographs of 100 postmenopausal women who had had BMD assessments of the lumbar spine and the femoral neck were used in this study. Experienced oral radiologist determined the position of the mental foramen on 100 digitized dental panoramic radiographs. After determination of the mental foramen, mandibular cortical width below the mental foramen was measured automatically with a computer-aided system by identifying the area of interest, enhancing the original image, determining inner and outer margins of the cortex, and selecting an appropriate point. Cortical width measured by this system was compared with BMD of the lumbar spine and the femoral neck.

RESULTS

There were statistically significant correlation between cortical width measured by the computer-aided system and spinal BMD (r=0.50) and femoral neck BMD (r=0.54). These correlations were similar with those between cortical width by manual measurement and skeletal BMD. Sensitivity and specificity for identifying postmenopausal women with low spinal BMD by the computer-aided system were about 88.0% and about 58.7%, respectively. Those for identifying postmenopausal women with low femoral neck BMD by this system were about 87.5% and about 56.3%, respectively.

CONCLUSION

Our results suggest that our computer-aided system may be useful for identifying postmenopausal women with low skeletal BMD.

Atelectasis of the right medial basal segment mimicking primary lung cancer in an asthmatic patient

A segmental collapse due to mucous plug in the bronchus tree may mimic malignant pathological conditions. We present a case of 58-year-old asthmatic patient with an obstruction of right medial basal bronchus due to mucous plug, which was simulating mediastinal mass. To the best knowledge, a similar case is not reported in the English medical literature.

Significantly lower rate of smoking in female compared to male patients with lung adenocarcinoma

To examine the relationship between smoking and lung adenocarcinoma in female patients, we performed a retrospective chart review for 470 patients with lung adenocarcinoma at our hospital. The proportions of non-smokers were higher in female patients than those of male patients. A significant difference in smoking history was found between female and male patients. Not only active smoking but also passive smoking may influence the development of female lung adenocarcinoma, which reinforces the need for effective programmes aimed refraining from smoking and cessation among men as well as women.

Isolation and characterization of three genes paralogous to mouse Ring3

Syntenic chromosomal areas share paralogous genes which are believed to have been generated by repeated duplication of an ancestral gene. The human RING3 gene is known to have paralogous relationships with the ORFX, BRDT, and HUNK1 genes. In addition to the mouse Ring3 cDNA clones previously reported, we isolated mouse Orfx, Brdt, and Hunk1 cDNA clones using mouse testis RNA. Among these four paralogous genes, structure and expression profiles were compared. The proteins encoded by these genes exhibited similar amino acid sequences including two conserved bromodomains. While the Ring3, Orfx, and Hunk1 genes were ubiquitously expressed in various tissues of adult mouse, the Ring3, Orfx, and Brdt genes produced testis-specific transcripts and the Hunk1 gene produced a striated muscle-specific transcript. The diversification of expression patterns of Ring3-related genes during evolution may reflect nucleotide variations in regulatory elements associated with ubiquitous or tissue-specific gene expression.

Bone metastasis as the first manifestation of lung cancer

Bone metastasis usually occurs late in the course of the disease, but in some patients it is the first manifestation of lung cancer. To evaluate the characteristics of patients with bone metastasis as a first manifestation of lung cancer, the medical records of 1063 patients with lung cancer between 1976 and 2001 were reviewed retrospectively. Twenty-four (2.3%) lung cancer patients presented symptoms of bone metastasis as a first manifestation; 11 patients had bone metastasis as the only site of spread in lung cancer; 16 had adenocarcinoma; five had a primary lesion <30 mm, and nine had N0-1 disease. Patients with sole bone metastasis did not have a more favourable survival rate than patients with bone and other systemic metastases (p=0.2938). Whether metastasis is the first manifestation of lung cancer or not, the occurrence of bone metastasis generally means a poor prognosis.

Results of surgical treatment for intrahepatic cholangiocarcinoma and clinicopathological factors influencing survival

BACKGROUND

The results of surgical treatment for intrahepatic cholangiocarcinoma (ICC) and specific factors influencing survival are still unclear.

METHODS

Between 1984 and 2001, 62 patients with ICC underwent laparotomy, with a 77 per cent (48 patients) resectability rate. The tumours in these 48 patients were reviewed retrospectively to examine the relationship between gross appearance (mass forming, periductal infiltrating, intraductal growth, and mass forming plus periductal infiltrating) and patient survival, as well as the manner of recurrence. In patients with mass-forming and mass-forming plus periductal infiltrating types, univariate and multivariate analyses of potential prognostic factors were performed.

RESULTS

The 1-, 3- and 5-year survival rates were 62, 38 and 23 per cent respectively. All patients with the intraductal growth type remained alive after intervals ranging from 8 to 72 months. Univariate analysis showed multiple hepatic lesions, liver capsule invasion, presence of cancer cells in the resection margin, and high serum carbohydrate antigen (CA) 19-9 level to be significant negative prognostic factors. Lymph node involvement, however, was not identified as a significant prognostic factor. With multivariate analysis, multiple hepatic lesions and high serum CA19-9 concentration were found to be significantly related to prognosis. The most frequent recurrence site was the remnant liver.

CONCLUSION

These results suggest that the intraductal growth type of tumour should be treated as a distinct entity compared with other types of ICC. Multiple tumours and high serum CA19-9 level were signs of dismal prognosis, whereas not all patients with lymph node involvement had a poor prognosis.

Possible mechanism of gene transfer into early to mid-gestational mouse fetuses by tail vein injection

Our aim is to develop a simple gene transfer method into egg cylinder and mid-gestational murine embryos. We examined whether plasmid/lipid complexes injected into the tail veins of pregnant transgenic mice can be transferred to fetuses at E 4.5-13.5. When pregnant CETZ-17 mice carrying a transgene consisting of a ubiquitous promoter, floxed EGFP/CAT and the LacZ gene, were injected with a Cre expression vector DNA/lipid complex, Cre-mediated excision of the transgenes, as evaluated by X-gal staining, occurred in 10-50% of fetuses treated at E 11.5-13.5. Although younger embryos remained unstained, PCR analysis revealed low levels of the Cre vector DNA and recombined transgene. To examine the fate of a solution given intravenously, we injected trypan blue or fluorescence-labeled plasmid DNA/lipid complexes into females at E 5.5-11.5 and E 6.5, respectively. Both collected in the visceral endoderm (VE) lineage, but were undetectable in the embryo proper. These findings suggest that substances in maternal blood are delivered to post-implantation embryos via cells of the VE lineage and placenta, but that most are trapped in the VE. If significantly improved, gene transfer to fetuses by injection into the maternal circulation may become a promising tool in fetal gene therapy and embryological studies.

Conserved CDR 3 region of T cell receptor BV gene in lymphocytes from bronchoalveolar lavage fluid of patients with idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis (IPF) is an inflammatory lung disease characterized by the accumulation of inflammatory cells and deposition of collagen, resulting in lung remodelling. High numbers of T cells are present in bronchoalveolar lavage fluid (BALF) of IPF patients, although the characteristics of these cells are yet to be determined. To elucidate the pathogenic mechanisms of IPF, we analysed the T cell receptor (TCR) of BALF lymphocytes in three patients with IPF and three healthy subjects as control. TCR repertoire of BALF lymphocytes and T cell clonality were examined by family PCR and Southern blot analysis, and single-strand conformation polymorphism (SSCP), respectively. We observed that the TCR repertoire in the lung was heterogeneous, both in the control subjects and three patients with IPF. SSCP analysis demonstrated an increase in the number of accumulated T cell clones in BALF of two of the three patients, but not in the healthy subject. Furthermore, junctional sequence analysis showed the presence of conserved amino acid motifs (ETGRSG, LAxG, QGQ, GxQP, GRxG, VAR, PGT, GTI, GGT, TGR, LxLxQ, SGQ) in the TCR-CDR 3 region of BAL lymphocytes in patients with IPF, whereas only two amino acid motifs (VTTG, GGE) were found in the control. Our findings suggest that T cells in BALF of patients with IPF expand oligoclonally in the lung, suggesting antigen stimulation of these cells.

Serum sialyl Lewis X-i antigen in lung adenocarcinoma and idiopathic pulmonary fibrosis

BACKGROUND

Sialyl Lewis X-i antigen has been used as a diagnostic tool for lung adenocarcinoma. However, serum levels of the antigen are also raised in some patients with idiopathic pulmonary fibrosis (IPF) without coexistent malignancy. Expression of the antigen in serum samples of patients with lung adenocarcinoma was evaluated and compared with that of patients with IPF by Western blotting in order to establish a specific laboratory test to differentiate lung adenocarcinoma from IPF.

METHODS

The pattern of antigen expression in serum samples from 23 patients with either lung adenocarcinoma or non-malignant lung disease in whom serum levels of sialyl Lewis X-i antigen (>50 U/ml) were significantly increased was studied by Western blotting.

RESULTS

Thirteen of the 14 serum samples from patients with lung adenocarcinoma had a molecular weight band at 120 or 130 kD, while five of the six patients with IPF had two or three bands at <97.4 kD. The pattern of antigen expression was apparently different between the two diseases. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of this test in 20 patients with lung adenocarcinoma and IPF were 92.9%, 83.3%, 5.57, and 0.09, respectively.

CONCLUSIONS

Western blotting analysis of serum samples from patients with raised levels of sialyl Lewis X-i antigen provides some clinical information for a differential diagnosis between lung adenocarcinoma and IPF.

Maintenance of the differentiated type II cell characteristics by culture on an acellular human amnion membrane

We have developed a Culture system for guinea pig alveolar type II cells using an epithelium-denuded human amnion membrane as a substratum. The differentiated morphology was maintained for 3 wk by both air-interface feeding and immersion feeding when type II cells were cultured on the basement membrane side of the amnion with fibroblasts on the opposite side (coculture). Functionally high levels of surfactant protein B (SP-B) and C (SP-C) messenger ribonucleic acids (mRNAs) were expressed even after the 3-wk cultivation and surfactant protein A mRNA was detected on day 10 of the culture. The differentiation was also maintained when fibroblasts were cultured on lower chambers of the culture plates (separate culture). In contrast, culture of type II cells without fibroblasts (monoculture) could not preserve the mature morphology. When the monoculture was supplemented with keratinocyte growth factor or hepatocyte growth factor, a monolayer of rather cuboidal type II cells with apical microvilli was maintained. However, the percent area of lamellar bodies in these cells was significantly less than that in freshly isolated type II cells, and mRNA expressions of SP-B and SP-C were also considerably suppressed. These findings suggest that other growth factors or combinations of these factors are necessary for the maintenance of the differentiated phenotype. As substratum, a permeable collagen membrane or a thin gel layer of Engelbreth-Holm-Swarm mouse sarcoma extracts did not preserve the mature characteristics. This culture system using an acellular human amnion membrane may provide novel models for research in type II cells.

Lung cancer patients with cardio- and cerebrovascular diseases

Cardio- and cerebrovascular diseases (CCVD) and cancer are the leading causes of death for humans. The aim of this study was to demonstrate clinicopathological features of lung cancer patients with CCVD. Nine hundred and sixty-six patients with lung cancer were consecutively admitted to our division over a 24-year period. Among them, 254 (26.3%) patients were diagnosed as having CCVD based on medical records. One hundred and ninety-one were men and 143 were 70 years of age or older. There was a difference in smoking habit (p=0.0029) and 30 pack year or more history of smoking (p<0.0001) between lung cancer patients with or without CCVD. Among the 254 patients, 97 patients had stage IA-IIIA disease, however, 27 patients received chest irradiation or supportive care because of coexistence of CCVD. In 157 patients with locally advanced or metastatic disease, 58 patients had less intensive therapy. In multivariate analysis, existence of CCVD in patients with non-small cell lung cancer (NSCLC) was proven to be a prognostic factor (p=0.0466). Our results imply that existing CCVD do adversely affect the outcome of NSCLC. When we decide whether or not to offer an intensive therapy which may increase treatment-related mortality, patients' medical condition including CCVD should be taken into consideration.

Peritoneal carcinomatosis in lung cancer patients

Metastatic involvement of the peritoneum is not a very rare autopsy finding. Clinically, however, peritonitis carcinomatosis from a lung cancer is infrequently encountered and the pattern of the metastasis has not been studied. A total of 1041 patients with lung cancer who were admitted to our division over a 26-year period were retrospectively analyzed. Twelve (1.2%) of the 1041 patients with advanced lung cancer developed peritoneal carcinomatosis in their clinical courses. The incidence of peritoneal carcinomatosis was high in patients with large cell carcinoma and adenocarcinoma. Six and 9 of the 12 patients had metastases in intra-abdominal sites and pleural seeding, respectively. The median survival time from the diagnosis of peritoneal carcinomatosis was 2 months. Ascites accompanying metastasis to abdominal organs and pleural seeding in a patient with a known lung cancer would be regarded as a metastasis.

[Basic techniques in vascular surgery]

The procedure for vascular resection and reconstruction includes exposure of the diseased vessel, temporary interruption of blood flow, resection of the diseased segment, vascular repair or anastomosis and restoration of blood flow. Adequate exposure, including the healthy portions on both the afferent and efferent sides of the diseased segment, facilitates subsequent steps in the procedure. Since the temporary interruption of blood flow could lead to ischemic and reperfusion injuries, it is necessary to take measures to protect organs that receive blood flow from diseased vessels. The basic principles in vascular suturing are single sutures through all layers and intima-to-intima approximation. Continuous simple sutures are often used for vascular repair and anastomoses. In the case of anastomoses between small arteries, however, interrupted simple sutures are preferred to prevent stenosis. Twisting, stenosis, and overstretch at the point of anastomosis are errors that result in failure of vascular reconstruction. The methods for overcoming size differences between anastomosed vessels should be understood. Topical heparinization is easy and a useful method to prevent the production of thrombus. Systemic administration of anticoagulants is not always needed.