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Objective: Improvement in the diagnostic accuracy of lymph node (LN) metastases of colorectal cancer by optimizing the reconstruction parameters was studied, including a phantom study and clinical studies. Methods: In the experimental study, the contrast ratio was evaluated using a standard image quality phantom, changing the iteration number of ordered subsets expectation maximization algorithm from 2 to 6. In the clinical study, 89 patients with preoperative colorectal cancer who received 18F-2-deoxy-2-fluoro-D: -glucose positron emission tomography/computed tomography (PET/CT) were studied. Their LN metastases were visually assessed when systematically changing the iteration number, and the optimal iteration number was determined. After the appropriate cut-off value of maximum standardized uptake value was determined, the improvement of the diagnostic accuracy of LN metastases was evaluated for the proximal nodes and the distal ones using the reconstructed images with the optimal iteration number. This was compared with the conventional method that had an iteration number of 2. Results: In the phantom study, it was confirmed that the contrast ratio improved when the iteration number increased. In clinical evaluation, the optimal iteration number was determined to be 5 by visual assessment. When the cut-off value of 1.5 was used, which happened to be the best number, the sensitivity/specificity/accuracy improved from 52%/91%/72% to 77%/89%/83% for the proximal nodes, and from 63%/90%/84% to 91%85%/87% for the distal nodes, respectively. Conclusions: When the iteration number of the reconstruction algorithm was optimized, the sensitivity of LN metastasis improved by more than 20%, and the accuracy exceeded 80%. Optimization of the image reconstruction parameters in the diagnosis of LN metastases using PET/CT is clinically important. [ABSTRACT FROM AUTHOR]

Objective: We studied the improvement of the detect-ability of lymph node (LN) metastases from colorectal cancer in (18)F-fluorodeoxyglucose positron emission tomography (FDG PET)/computed tomography (CT) by analyzing the acquired counts with a statistical method. Methods: Thirty-nine metastatic LNs from 32 cases with colorectal cancer were included in this study. "Uptake region" was defined as the site where counts were higher than the average plus 3 standard deviations (SDs) on each transaxial image of FDG PET. After the initial uptake regions were selected, these high accumulation areas were automatically excluded from consideration thereafter. This method was repeated and new uptake regions were identified. This method was repeated up to five times. After that, the stacked-up uptake regions were compared with computed tomography (CT) images, and the high accumulation areas that were superimposed on the normal structures, such as intestine, vessels, and ureters, were excluded from the consideration. The remaining uptake regions were diagnosed as metastatic LNs, and the detectability of LN metastases was calculated. We then compared these statistical results with the results obtained on the basis of visual assessments by radiologists. Results: Our proposed method showed the best results when the procedures were repeated three times in the light of detectability. After being repeated three times, this method detected 15/23 (65.2%) metastatic LNs in the first LN group, 16/16 (100%) in the second-third LN groups and 31/39 (79.4%) in the total LNs, whereas the radiologists diagnosed 8/23 (34.8%) of metastatic first LNs, 12/16 (75.0%) in the second-third LNs and 20/39 (51.3%) in the total LNs. A statistically significant difference was observed between the result of iteration number 3 and that by radiologists as for the second-third LNs and the total LNs. Conclusions: This study suggests that our proposed statistical method could improve the detectability of LN metastases from colorectal cancer. Our method will help radiologists to detect small metastatic lesions such as LN metastases. [ABSTRACT FROM AUTHOR]

Marked activation of thrombosis is common in patients undergoing total hip arthroplasty, especially during reaming of the femur and after insertion of the femoral prosthesis. This suggests that management designed to minimize deep vein thrombosis and fatal pulmonary embolism after total hip arthroplasty should be focused on the period during insertion of the femoral component. In some previous studies, a low dose of heparin administered intraoperatively was shown to suppress the formation of fibrin. The present study was performed to evaluate the influence of intraoperative heparin administration on the D-dimer level and on the prevention of pulmonary embolism after total hip arthroplasty. A total of 22 and 26 consecutive patients respectively underwent total hip arthroplasty with and without intraoperative administration of unfractionated heparin. Postoperatively, all patients wore knee-high elastic stockings and were fitted with calf-to-thigh intermittent pneumatic compression devices. Active ankle flexion and extension exercises were commenced as soon as motor function recovered. None of the 48 patients received prophylactic anticoagulants postoperatively. There was a significant difference of the mean D-dimer level on the 1st day between the patients with and without intraoperative administration of heparin (8.9 ± 6.6 vs. 15.7 ± 12.7, P < 0.05). Although there were no patients with symptomatic deep venous thrombosis and pulmonary embolism, asymptomatic pulmonary embolism was detected by pulmonary perfusion scintigraphy in three patients who did not receive intraoperative heparin. The operative blood loss and postoperative drainage were similar in both groups and no bleeding complications were observed. In conclusion, we recommend a safe and inexpensive regimen comprising 1,000 U of intravenous unfractionated heparin intraoperatively, postoperative pneumatic compression, and early active mobilization for prevention of thoromboembolic complications after total hip arthroplasty. [ABSTRACT FROM AUTHOR]

We retrospectively reviewed the situation of 235 concussions in players from the Kanto Collegiate American Football League reported from 1991 to 2003. Concussions occurred frequently under the following situations: fine weather, good ground conditions, the second half of the game, defensive back players, running play, and tackling (one on one). In order to prevent concussions, all tackles should be made with the shoulder and never with the head. It is of particular importance to re-check the tackling technique of defensive back players. [ABSTRACT FROM AUTHOR]

Background: While rotational acetabular osteotomy has been reported to be successful for the treatment of osteoarthritis of the dysplastic hip, little is known about its efficacy in the treatment of osteonecrosis of the femoral head.Methods: We retrospectively reviewed the results for a consecutive series of twenty-one patients (twenty-five hips) who had undergone rotational acetabular osteotomy between 1995 and 2001 for the treatment of extensive osteonecrosis of the femoral head associated with collapse. All but two of the patients had a history of steroid therapy as part of a treatment regimen for various diseases. At the time of surgery, the mean age of the five men and sixteen women was 29.0 years. The mean duration of follow-up was forty-nine months. No patient was lost to follow-up. The lesions were classified according to the staging system described by Steinberg et al., and the extent of necrosis was measured with use of the criteria described by Kerboul et al. Clinical evaluation was performed with use of the scoring system of Merle d'Aubigne and Postel. Radiographic evaluation was performed with use of yearly serial anteroposterior and lateral plain radiographs.Results: The mean Merle d'Aubigne and Postel score improved from 11.3 points preoperatively to 14.9 points at the time of the final follow-up (p < 0.001). The mean pain score improved from 3.0 to 5.6 points (p < 0.001). However, the mean mobility score was 5.3 points preoperatively but only 4.9 points postoperatively (p = 0.1). All of the osteotomy sites showed radiographic evidence of osseous union at the time of the latest follow-up. Collapse of the femoral head progressed in seven hips, but in six of these hips the change in the extent of collapse was <2 mm.Conclusions: In the present study of young patients with extensive osteonecrosis and collapse of the femoral head, rotational acetabular osteotomy was associated with symptomatic relief and absence of substantial collapse of the femoral head at the time of early to intermediate-term follow-up. [ABSTRACT FROM AUTHOR]

Improved activities of daily living, psychological state and health-related quality of life for 12 months following lung volume reduction surgery in patients with severe emphysema GOTO Y, KUROSAWA H, MORI N, KUROKAWA Y, HIDA W, KOHZUKI M. Respirology 2004; 9: 337–344 The aim of the present study was to evaluate the effect of lung volume reduction surgery (LVRS), with an emphasis on improvement in activities of daily living (ADL), psychological state and health-related quality of life (HRQL), for 12 months in patients with severe emphysema. Eighteen male patients (mean age ± SD: 65.2 ± 6.4 years) who underwent LVRS following pulmonary rehabilitation (LVRS group) and 12 patients (67.0 ± 8.1 years) who were medicated and underwent pulmonary rehabilitation (non-LVRS group) were studied. LVRS was performed by video-assisted thoracoscopic surgery. Serial measurements of lung function, 6-min walking distance (6MWD), ADL, HRQL and psychological state scores were performed before surgery and 3, 6, and 12 months after surgery (in the LVRS group), or on the day of discharge (in the non-LVRS group). As well as an improvement in FEV1 and 6MWD, ADL scores were significantly improved in the items of ‘face washing and teeth brushing’, and ‘indoor walking’ at 3 months after LVRS ( P < 0.05). At 12 months, an improvement was still found in ‘indoor walking’ and ‘bathing’. HRQL scores were ameliorated at 3–12 months after LVRS. In the non-LVRS group, ADL and HRQL scores failed to improve in any items during the 12 months of observation. Psychological state scores were maintained in the LVRS group and were better than those in the non-LVRS group at 12 months ( P < 0.05). Lung volume reduction surgery improves not only lung function and exercise performance but also ADL, HRQL and psychological state for at least 12 months. [ABSTRACT FROM AUTHOR]

Twelve men and 18 women with a mean age of 22(15-32)years who underwent anterior cruciate ligament(ACL) reconstruction using semitendinosus muscle tendon were studied. The quadriceps strength was isokinetically measured during concentric and eccentric contractions before and after ACL reconstruction. Before surgery, tilt injured Io uninjured ratio was 72.9% for eccentric contraction, which was significantly lower than the 81.4% for concentric contraction. For postoperative muscle, the injured to uninjured ratio was 98.6% for eccentric contraction and 80.6% for concentric contraction, showing better recovery of muscle strength for eccentric contraction. Observation of lower muscle strength fur eccentric contraction is more important than for concentric contraction in knees before ACL reconstruction because movements such as stop and turn become difficult due to ACL dysfunction. Thus, ACL deficient patients avoid exerting eccentric knee extension and contraction forces even in daily living activities. On the other hand, once the joint instability is improved by ACL reconstruction, patients do not need to avoid movements such as stop and climbing down stairs that require eccentric contraction strength. This may account for good recovery of the muscle strength for eccentric contraction. [ABSTRACT FROM AUTHOR]

This study evaluates high school football injuries in tile Kanto High School Football League during the 1996 to 2000 seasons. The total number of injuries reported was 465 in 456 games (1.02 injuries/game). The injuries occurred most frequently in the fourth quarter of a game {31.4%). Injury by player position showed that Running backs (14.8%) and Linebackers (13.5%) had a higher incidence of injury than other positions. The most common areas for injury were the ankle (14.8%), the knee (12.9%), and the abdomen (11.4%). Ankle ligament injury (13.5%) abdominal blow (11.4%) and knee ligament injury (9.9%) were common injuries in high school football players. [ABSTRACT FROM AUTHOR]

The present study aimed to prove the effectiveness of low-load resistance muscular training under moderate restriction of blood flow. Twelve limbs of 6 healthy male adults were studied. In each subject, one lower limb was subjected to blood flow restriction (group R) and the other lower limb was not subjected to blood flow restriction (group N), and low-load resistance lower limb muscular training was conducted 3 times weekly for 8 weeks. Knee extensor torque, muscular discharge at the M. vastus lateral is and M. vastus medialis, and the cross-sectional area of the knee extensor muscle group were measured before training and after training for 8 weeks. and the results were evaluated. Results of knee extensor torque (isometric contraction at 60° knee flexion) showed significant augmentation (p<0.05) of muscular strength in group R compared to group N. In the M. vastus lateralis, a significant increase (p<0.05) in muscular discharge was observed in group R compared to group N. No significant difference in the pre- / post-training ratio of the muscular cross-sectional area was observed between the two groups. These results confirmed that low-load resistance muscular training under moderate restriction of blood flow is an effective muscular training for healthy adults without muscular atrophy. [ABSTRACT FROM AUTHOR]

A prospective study was conducted to examine the effects of introducing low load muscular training under moderate restriction of blood flow during the first 16 weeks after anterior cruciate ligament (ACL)reconstruction. Forty-two subjects with a mean age of 29 years(18 to 52 years)were randomized into a group in which training under blood flow restriction (group R, n=22)was conducted and a group in which training under no restriction(group N, n=22) was conducted, with both groups following the same training schedule. Evaluations of knee extensor torque and knee flexor torque(isometric contraction at 60° knee flexion, isokinetic contraction at angular velocities of 60° and 180° per sec) before surgery and 16 weeks after surgery showed a significant increase in muscular strength in group R compared to group N. The preoperative 16-week postoperative ratio of the cross-sectional area of knee extensor muscles showed a significant enlargement in group R compared to group N. At week 16 after surgery, the short diameters of type 1 fibers and type 2 fibers of M. vastus lateralis tended to be larger in group R(n=8)compared to group N(n=8), although the differences were not significant. These results demonstrate that low-load resistance muscular training under moderate restriction of blood flow is an effective exercise method for early muscular training after ACL reconstruction. [ABSTRACT FROM AUTHOR]

Background: To evaluate cardiac sympathetic activity, a simple method should be developed to replace such complex methods as the spillover rate of tritiated norepinephrine (3H-norepinephrine) or microneurography of sympathetic nerve activity. The goal of this study is to evaluate cardiac sympathetic activities by analyzing the washout of I-123 meta-iodobenzylguanidine (123I-MIBG), a radiolabeled norepinephrine analogue, in Dahl salt-sensitive (DS) rats as it relates to the progression of hypertension.Methods and Results: Dahl salt-resistant (DR) rats and DS rats were fed an 8 % salt diet starting at age 5 weeks. Marked hypertension and cardiac hypertrophy developed in the DS rats, whereas DR rats remained normotensive. Then the time-activity curves of 123I-MIBG from 15 to 200 minutes were obtained from both DS and DR strains at ages 8, 11, and 13 weeks using dynamic scintigraphic analysis. We also examined the nonneuronal washout of 123I-MIBG using dynamic scintigraphic studies in desipramine pretreated normal rats. In the preliminary study with desipramine pretreatment, the majority of the nonneuronal 123I-MIBG washout occurred by 90 minutes after injection. Therefore the late-phase washout in the control rats was found to reflect the neuronal washout. We then applied exponential curve fitting to the time activity curves acquired in the 90- to 200-minute period after 123I-MIBG injection in both DR and DS rats. When we compared the coefficients of these washout curves in the DS and DR rats as an index of cardiac sympathetic activities, the coefficient values remained high during all stages in DS rats, whereas they decreased with age in DR rats.Conclusion: Measurement of late-phase 123I-MIBG washout may be a useful tool for assessing the change in sympathetic activity in the progression of hypertension without the influence of extraneuronal washout of 123I-MIBG and left ventricular hypertrophy. [ABSTRACT FROM AUTHOR]

The effects of 1 alpha-hydroxyvitamin D3 [1 alpha(OH)D3] on bone mineral density, fracture incidence, and bone metabolism were evaluated by a double-blind, placebo-controlled study. Eighty postmenopausal osteoporotic Japanese women (71.9 +/- 7.3 years, mean +/- SD) were randomly assigned to 1 microgram of 1 alpha(OH)D3 daily or inactive placebo for 1 year. All patients were given supplemental calcium (300 mg of elemental calcium daily). Lumbar (L2-L4) bone mineral density (BMD) determined by dual energy X-ray absorptiometry increased 0.65% with 1 alpha(OH)D3 treatment and decreased 1.14% with placebo (P = 0.037). BMD in both the femoral neck and Ward's triangle did not yield any significant differences between the two groups, whereas trochanter BMD in the 1 alpha(OH)D3-treated group increased 4.20% and decreased 2.37% with placebo (P = 0.055). X-ray analysis demonstrated that new vertebral fractures occurred in two patients with 1 alpha(OH)D3 and in seven patients with placebo. The vertebral fracture rate in the treated group was significantly less (75/1000 patient years) than in the control group (277/1000 patient years; P = 0.029). Hypercalcemia (12.1 mg/100 ml) occurred in one patient receiving 1 alpha(OH)D3; however, the serum calcium level in this patient promptly decreased to the reference range after cessation of the treatment. There were no significant changes in serum creatinine level in either group. A significant increase in urinary excretion of calcium was found but there was no significant change in urinary excretion of hydroxyproline in the treated group. The serum level of bone-derived alkaline phosphatase activity significantly decreased by -26 +/- 26 (mU/ml) after the treatment (P = 0.003).(ABSTRACT TRUNCATED AT 250 WORDS) [ABSTRACT FROM AUTHOR]

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This study analyzes patient participation in athletic activities after meniscectomy. Seventy simple menis cus lesions in 68 patients without ligamentous insuf ficiency were studied by means of a detailed question naire and clinical and radiological examinations. Fol low-up ranged from 1 to 18.4 years, averaging 4.5 years. These cases are classified into two groups, depending on the intensity of athletic activities.Group 1 consisted of international class athletes and Group 2 consisted of both competitive and rec reational athletes. None of those studied have given up sports following meniscectomy. Results were worse in Group 1 than in Group 2 in both clinical and subjective evaluation. In Group 1 volleyball players presented results worse than those of football (Amer ican style) players and wrestlers. In Group 2 there was no significant difference in results among athletes of various sports. We conclude that the results after meniscectomy are influenced by the quality and fre quency of postoperative athletic activities. [ABSTRACT FROM PUBLISHER]

When porosity and macro-pore size differ in the same ceramic, the mode of bone regeneration and the degradation of ceramics in vivo is said to be different. However, the reactions in vivo of ceramics that have a different microstructure with the same porosity and the same macro-pore size, are not so far known. In this study, two kinds of β-tricalcium phosphate (TCP) that had different microstructures but the same porosity and macro-pore size, were manufactured. These TCP were implanted in the distal femurs of 20 mature male rabbits, and their respective areas of ceramics and of regenerated bone were measured after 4, 12 and 24 wk. In both TCPs, the regenerated bone similarly decreased from 4–24 wk in a different way. The area of ceramics in one of these TCPs significantly decreased gradually throughout the observation period. On the other hand, the other TCP showed no marked decrease during the same period. This suggested a possibility that the difference in micro-structure has a large effect on the reaction of the ceramics in the bone. [ABSTRACT FROM AUTHOR]

Twelve amateur veteran soccer players (average age 40.1 +/- 5.4 years), who began playing in their teens and who were admitted with symptoms most likely to be related to cervical spondylosis, were examined by cervical radiography. Abnormal radiographic findings included: calcification of anterior longitudinal ligament (25%), anterior (75%) and posterior vertebral spurs (75%), ossicle between spinous processes (75%), calcification of nuchal ligament (Barsony) (58%), ossicle on spinous process (25%), and bony spur of Luschka's joints (83%). It was shown in the stress distribution by finite element method analysis that the stress in heading the ball was applied mainly to the lower parts of the cervical spine. The results of this analysis also corresponded well with some of the radiographic findings. [ABSTRACT FROM AUTHOR]

The central pulmonary artery was studied angiographically 1-10 years after a palliative operation in 56 patients (mean age 6 years, range 1-20) with congenital heart disease and pulmonary atresia. All of them had originally had a central pulmonary artery that was common to both the right and left pulmonary arteries. Juxtaductal obstruction of the left pulmonary artery had developed in 70% of the patients; in 40% the obstruction was atretic unilaterally. Atresia developed at the right junction to the ductus where there was a shunt to the right pulmonary artery and at the left junction where there was a shunt to the left pulmonary artery. Stenosis causing a reduction of more than 50% of the inner diameter developed at the anastomotic site in 10% of 30 patients with a functioning Blalock shunt. In contrast, there was occlusion of the pulmonary artery or its upper branch in 73% of 11 patients with a non-functioning anastomosis. [ABSTRACT FROM PUBLISHER]

The morphology of the central pulmonary artery was studied by selective angiography in 21 previously unoperated patients (aged 11 days-21 years, median 4 years) with pulmonary atresia associated with various types of congenital heart disease. Angiographic findings were confirmed at operation in 10 patients. There was juxtaductal obstruction of the left pulmonary artery in two thirds of the patients with complete atresia in a quarter. Six of seven patients without juxtaductal obstruction had pulmonary valve atresia, but all nine patients with juxtaductal stenosis had truncal atresia. No patient had stenosis of the right pulmonary artery. [ABSTRACT FROM PUBLISHER]

A youth of 16 years of age died suddenly and quite unexpectedly while walking to school. The necropsy disclosed a quadricuspid aortic valve with complete isolation of the left coronary artery by an adherent aortic valve cusp. The left ventricular myocardium showed subendocardial contraction band necrosis suggesting that critical ischaemia had triggered a state of hypercontraction, in keeping with ventricular fibrillation as the immediate cause of death. The site of the anomaly in the aortic root showed dysplasia of the aortic wall and the affected valve cusp, histologically similar to the changes that characterise supravalvar aortic stenosis. The findings suggest a developmental anomaly, possibly a forme fruste of supravalvar aortic stenosis, rather than a postnatally acquired condition. [ABSTRACT FROM PUBLISHER]