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The isolated absence of the azygos vein was incidentally found on computed tomography (CT) examination in a 60-year-old female. The exact anomaly can be evaluated on high-resolution images of 0.4-mm slice thickness with low keV using photon-counting detector CT. The azygos vein, including the azygos arch, was absent, and a mildly dilated hemiazygos vein flowed to the left brachiocephalic vein through the left superior intercostal vein. A hemiazygos vein connected the left renal vein at the level of the first lumbar vertebra. This patient was the second patient to undergo evaluation using volume rendering images. High-resolution maximum-intensity projection images were useful for assessing the anatomy. Radiation dose was decreased compared with that in conventional CT.

Objective: To assess the feasibility of apparent diffusion coefficient analysis in evaluating the inflammatory severity of extracranial abscesses., Methods: This retrospective study included 23 patients with solitary body abscesses (except those in the brain) who underwent 1.5-T diffusion-weighted magnetic resonance imaging (DWI) at b-values of 0 and 1000 s/mm 2 . Three types of the Apparent Diffusion Coefficient (ADC) measurements of abscesses were performed: the mean ADC value in region of interest (ROI), volume of interest (VOI), and histogram analysis of the ADC distribution in the VOI. Furthermore, two different areas were used: high-intensity area on b = 0 and b = 1000 s/mm 2 images. Subsequently, correlations between ADC data and C-reactive protein (CRP) levels were assessed using Pearson's correlation coefficient (R) analyses., Results: The strongest correlation was observed between the mean ADC value in VOI and CRP level (R = 0.78, P < 0.01), followed by ROI (R = 0.77, P < 0.01) by using the high-intensity area on the b = 0 s/mm 2 images., Conclusion: The mean ADC value in the ROI encompassing the abscess at a b-value of 0 s/mm 2 may be useful to assess the inflammatory activity of an abscess in daily practice.

Objective: To evaluate changes in flap volumes for head and neck cancer patients by MRI., Methods: MRI examinations of a total of 21 head and neck cancer patients (13 males and 8 females; average age, 67 years) were performed after surgery to monitor changes in flap volumes, including muscle and fat content, using volumetric analysis of T2-weighted images at 1, 3, 6, and 12 months after surgery., Results: Fat-to-muscle ratios of all flaps at 1 month varied (muscle/fat ratio, 0.04-0.96). Flap volumes in all patients decreased at 12 months after surgery. The average final volumes of overall, muscle, and fat volumes reached 76.9% ± 5.2%, 37.1% ± 3.7%, and 85.5% ± 5.7%, respectively. The average fat volume slightly increased between 6 and 12 months, whereas compared with the fat volume, the average muscle volume significantly decreased (p<0.001)., Conclusions: The final overall flap volume in all patients decreased to approximately 25% of the original volume after surgery, which primarily resulted from muscle atrophy. Therefore fat-rich flaps may maintain flap volumes after surgery. MRI is a useful method to evaluate the size and shape of flaps of the head and neck.

Objective: The aim of this study was to evaluate the relationship between urolithiasis and characteristics of renal shape in adult patients with horseshoe kidney (HSK) diagnosed on multidetector row computed tomography (MDCT)., Methods: We evaluated 36 patients with HSK and urolithiasis (Group A) and 70 patients with HSK without urolithiasis (Group B) whose disease was diagnosed on non-contrast MDCT. Two radiologists measured minimum width of the renal isthmus and maximum length of the renal pelvis and evaluated coexisting neoplastic diseases on axial computed tomographic (CT) images with 5-mm reconstruction, and we compared those measurements between the Groups A and B., Results: The overall mean maximum length of the renal pelvis, 12.7±9.2 mm, did not differ significantly between the 2 groups. Minimum isthmus width was larger in patients with HSK and urolithiasis (11.0±5.6 mm), than those without urolithiasis (9.5±5.1 mm). No patient in either groups had a urological renal tumor., Conclusions: Patients of HSK might have tendency of a high incidence of stone formation. Because urolithiasis is a risk factor for tumors of the renal pelvis, monitoring of patients with HSK requires careful attention to isthmus width on CT images.

Objective: We evaluated the usefulness of radiological reporting that combines continuous speech recognition (CSR) and error correction by transcriptionists., Materials and Methods: Four transcriptionists (two with more than 10 years' and two with less than 3 months' transcription experience) listened to the same 100 dictation files and created radiological reports using conventional transcription and a method that combined CSR with manual error correction by the transcriptionists. We compared the 2 groups using the 2 methods for accuracy and report creation time and evaluated the transcriptionists' inter-personal dependence on accuracy rate and report creation time. We used a CSR system that did not require the training of the system to recognize the user's voice., Results: We observed no significant difference in accuracy between the 2 groups and 2 methods that we tested, though transcriptionists with greater experience transcribed faster than those with less experience using conventional transcription. Using the combined method, error correction speed was not significantly different between two groups of transcriptionists with different levels of experience., Conclusion: Combining CSR and manual error correction by transcriptionists enabled convenient and accurate radiological reporting.

The thoracic outlet syndrome is now generally accepted as an entity that involves all neurovascular compression symptoms of the upper extremities at the tight thoracic outlet. We have treated 19 patients who developed significant symptoms of neurological, arterial or venous compression. Twelve patients presented predominantly and their angiograms demonstrated tight thoracic outlets as the underlying cause of vascular compression. Twenty three first rib resections were performed through the transaxillary approach with apparently complete relief of the syndrome. The similar etiology of the thoracic outlet syndrome and subclavian vein thrombosis was discussed on the basis of angiographic findings. We emphasize to thoracic and cardiovascular surgeons that first rib removal through the transaxillary route is an easy and safe method as a modified thoracoplasty.

Emergency cardiac surgery has been performed on 18 cases of acute cardiac tamponade whose etiologies were as follows: 11 cases of metastatic carcinoma, four cases of idiopathic pericarditis and three with other causes. In most cases, the chief complaint was dyspnea. In many cases, the cardiac silhouette of frontal chest X-ray films showed the shape of a water-filled ice-bag placed on a table. The electrocardiogram showed a low voltage and a flat T-wave in approximately half of the patients. In cases of an echo-free space 1 cm or larger on the M-mode echocardiogram, the average amount of pericardial fluid drained was 850 ml and in those in which the space was less than 1 cm, the average drained was 557 ml. The CT values were 9-40 for patients with malignant pericardial effusion and 20-22 for cases of idiopathic pericarditis. In general, pericardiocentesis was performed in almost all the patients with acute tamponade, but if the drainage was inadequate, the subxiphoid pericardial window procedure was performed under local anesthesia. Surgical invasion in this technique was minimal and the operative results proved effective. For the operation, we resected a 2 X 2 cm pericardial segment. Since two of the patients with malignant pericardial effusion developed postoperative reaccumulation, resection of a 4 X 4 cm segment in the future has been contemplated.

To solve problems arising during angioplastic procedures of the pulmonary artery, experimental studies using canine lungs were performed. Since the lung has dual adjacent components, i.e. pulmonary arteries and bronchi, sleeve resection of the pulmonary artery should be limited in length when not combined with bronchoplastic procedures. In such cases we used Gore-Tex as an artificial graft for replacement of the resected pulmonary artery and obtained good results. During the angioplastic procedures the main pulmonary artery and/or bronchus may be completely occluded, hence the risk of acute pulmonary edema in the remaining lung increases with long operations. From the results of this experiment it appears that the time required for operation with interruption for both perfusion and ventilation is about 2 hours.

To clarify immune response of regional lymph nodes in 30 patients with lung cancer, the T cell population, phytohemagglutinin (PHA) and Concanavalin A (ConA) stimulation and the T cell subpopulation bearing Ig-G Fc receptors (Tg cells) were tested concerning the clinical stage, histology and the lymph nodes locations. The T cell population, and PHA and ConA response rates in lymph nodes of stage I patients were grossly the same as those of benign lung diseases, but were statistically higher than those of stage III patients (p less than 0.025, p less than 0.005). Among the three histological types of lung cancer, regional lymph nodes of adenocarcinoma had the greatest T cell populations, and PHA and ConA responses. Concerning the location of lymph nodes, the closer the lymph nodes was to the tumor, the greater was its T cell population, and vice versa. However there was no difference in PHA and ConA responses. All lung cancer patients revealed a significant increase of Tg cells in regional lymph nodes and in their peripheral blood lymphocytes compared with peripheral blood lymphocytes in normal subjects (p less than 0.005).

Eight cases of bronchogenic carcinomas which underwent angioplastic procedures were reported. We believe that the angioplastic procedure, as in the case of the bronchoplastic procedure, is a useful operative method to preserve normal lung tissue particularly in patients of advanced age and/or limited respiratory reserves. With this procedure we can avoid pneumonectomy and assure patients a good postoperative life. With respect to angioplastic procedures caution must be exercised concerning the following items. 1) Infection may cause ruptures or stenosis at the site of the suture line. 2) It is necessary not to cause stenosis in the suture line of the pulmonary artery since the pulmonary artery is in a low pressure system and the wall is thin.

The application of computed tomography to cardiovascular diagnosis was attempted. One hundred and four consecutive patients with various cardiovascular diseases were studied with a third-generation computed tomographic three-second whole body scanner. Identification and evaluation of abnormalities of the great vessels, atria, ventricles and interventricular septum were possible by cardiac computed tomography. Sizes and locations of intracardiac thrombi were accurately assessed by computed tomography. Computed tomography was valuable for the evaluation of pericardial effusion because distribution of the effusion as well as the gross nature of the fluid could be estimated by the CT number.

Over the last six years at the Tokai University Hospital, 104 patients were operated on for the primary lung cancer. Twenty nine of these patients were submitted to extended operations, because cancer had invaded the heart and/or great vessels. In three cases, the left pneumonectomy with partial resection and suture repair of the descending thoracic aorta was performed. In 26 cases, intrapericardial ligation of the pulmonary vessels was carried out: nine of these patients underwent intrapericardial pneumonectomy with partial resection of the atrial wall and one patient underwent sleeve resection of the superior vena cava with graft (Gorétex) replacement. No extracorporeal apparatus was used in any cases of extended operations. The postoperative course was mostly uneventful and there were no cases of operative death. We believe that excision of lung cancer extending into the heart and great vessels can offer the patient every chance for a longer life, especially in the case of squamous cell carcinoma.

A case of leiomyoma of the lung appearing in a 28-year-old female with a history of supracervical hysterectomy for uterine leiomyoma 10 years previously is reported. She had no symptoms but chest X-ray film showed a single nodule in the right upper lobe which slowly increased in size over a 3 year interval. At thoracotomy the tumor measured 4 cm in size and was sharply demarcated from the lung parenchyma without any connection with the bronchial tree. Histological findings proved this tumor to be a leiomyoma with no atypical cells or mitoses showing a close resemblance to uterine leiomyoma. Metastasizing uterine leiomyoma is very rare. Because these leiomyomas behave clinically as a low grade malignancy despite a histologically benign appearance, careful long term follow-up is necessary.

The ABH blood group antigens were studied in resected specimens from patients with lung cancer employing monoclonal antibodies against A, B and H antigens by the immunoperoxidase technique. There were no differences between paraffin-processed and fresh-frozen materials in detectability of ABH antigens. Comparing specimens at operation with those at autopsy from the same patient, the loss of A and B antigens in the latter was demonstrated more frequently than H antigen. Concerning the relation between the prognoses and the expression of ABH antigens, the group with good prognosis preserved more ABH antigens than that with poor prognosis. In contrast, the group with poor prognosis showed less ABH antigens. There were also statistical differences in antigen detectability and prognosis, particularly in stage 1 patients, adenocarcinomas and well-differentiated lung cancers.