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A randomized comparison of pre-and post-experimental design was used to examine the effects of a fall prevention exercise program (FPEP) on muscle strength, ankle flexibility, balance, instrumental activities of daily living (IADLs), and depression for the community-dwelling elderly in Korea. Twenty-two subjects were assigned to an experimental group and twenty-three to a control group. The experimental group participated in a 4-day-per week FPEP of 8 weeks duration, twice a week by direct instruction and twice a week with videotaped instruction by the program instructor at each senior center. The eight-week FPEP turned out to be significantly effective in enhancing muscle strength, ankle flexibility and balance, and in reducing depression, after intervention among community-dwelling elderly in Korea. IADLs, however, was not changed by the intervention. Further research with a larger sample and longer follow up period is needed to expand our understanding about the effects of FPEP. Future study is also recommended to differentiate between the effects of FPEP by direct instruction and by videotaped.

The purpose of this study was to examine bright light as a means of intervention in sleep-wakefulness and behavior disorder among patients with dementia through a review of the relevant literature. Fourteen articles were reviewed in depth for study design, intervention protocols, concurrent control groups, subject characteristics, and outcome measures of behavior and sleep. Previous studies found that behavior disorders improved, although not all the studies reviewed reported a quantitative measure of improvement. The effects on sleep disorders were controversial. As a result of limitations in past studies, the effect of bright light on dementia patients is inconclusive. The current review has revealed areas of weakness in previous research that might profitably be explored in the future.

Purpose: Paclitaxel and cisplatin, active drugs in the treatment of non-small-cell lung cancer (NSCLC), have been found to be synergistic and less myelotoxic in combination when the paclitaxel is given 24 hr prior to the cisplatin. Their antitumor activity and toxicity in patients with advanced NSCLC has been evaluated herein., Materials and Methods: Seventy-four chemonaive patients, with advanced NSCLC, were enrolled. Paclitaxel, 175 mg/m2, was administered on day 1, followed 24 hr later by cisplatin, 75 mg/m2, on day 2., Results: The overall response rate, median time to progression and median survival time were 51%, 7.1 months (95% confidence interval (CI), 5.5~8.7 months) and 13.7 months (95% CI, 11.3~16.1 months), respectively. There were significant differences in the overall survival rates in relation to stage and the ECOG performance status(PS). The toxicity was mainly nonhematological. Grade > or =3 neuropathy occurred in 2 (3%) patients, myalgia in 3 (4%), and bone pain in 3 (4%). The hematological toxicity was mild, and no grade 3 or 4 neutropenia was observed., Conclusion: The combination of paclitaxel and cisplatin is an effective and tolerable treatment regimen for advanced NSCLC during first line chemotherapy. The main toxicity was nonhematological, such as peripheral neuropathy, myalgia and bone pain, whereas the hematological toxicity itself was mild.

The higher incidence of liver disease in the Asian population raises a great concern to clinicians. To understand the gene functions involved in different stages of the disease, microarray expression data of histological progressive grades, starting from the dysplastic nodule in cirrhotic liver to hepatocellular carcinoma Edmonson grade III are analyzed. The statistical procedures are divided into two parts: First, microarray data are suitably normalized, including a method of analysis of variance (ANOVA). There are great differences of opinion regarding the currently used normalization methods. In order to proceed to the second part of statistical analyses of gene-pair associations, these normalization methods need first to be compared. Based on the assumption that a union set of significant genes from these normalization methods includes sufficiently general and well-defined, differentially expressed genes, one must carry out the second part of statistical analyses of searching for evidence of altered gene-gene relationships with progression of the disease. Significantly altered gene-pair associations are identified with the ratio of gene-pair correlations. The methods are illustrated with replicated microarray expression data.

Purpose: To determine the number of researchers who fulfill the International Committee of Medical Journal Editors (ICMJE) authorship criteria and to evaluate individual contributions., Materials and Methods: The author contribution lists of Radiology articles published between 1998 and 2000 with at least three authors were reviewed. The fulfillment of ICMJE criteria for authorship and the contribution percentage were assessed according to each researcher's position in the byline and nationality (American vs international), number of researchers per article, and year of publication., Results: Sixty-eight percent of researchers fulfilled the ICMJE authorship criteria. Position in the byline indicated a significant difference in fulfillment (P <.001): 98.9% and 85.3% for the first and second authors, respectively, and 52.8% and 66.5% for the middle and last authors, respectively. American researchers had a higher percentage (78%) of fulfillment than did international researchers (57%) (P <.001). Fulfillment decreased as the number of authors per article increased (P <.001), although there was no significant change throughout 1998-2000. The mean contribution percentages decreased greatly from first to second to last to middle authors. American researchers had a significantly larger mean contribution percentage than did international researchers. Of the total 6,686 researchers, 2,316 (35%) contributed to one or two categories. This rate was higher for middle and international authors., Conclusion: The 68% fulfillment of criteria for authorship was closely related to the large number of researchers contributing to one category or to categories belonging to the same ICMJE criterion., (Copyright RSNA, 2002)

This study was conducted to investigate the efficacy of the induction chemotherapy followed by radiotherapy in anal cancer. Twenty-three patients diagnosed with anal cancer between March 1991 and February 1999 were treated with induction chemotherapy with 5-fluorouracil based regimens followed by external beam radiation. After a median follow-up of 78 months, the overall survival and the disease-free survival at 5 years was 71.3 and 67.5%, respectively. The colostomy-free survival at 5 years was 91%, as the inguinal lymph nodes were the most frequent site of relapse. Serious side effects did not occur and late complications did not develop either. Induction chemotherapy followed by radiotherapy in patients with anal cancer is effective in terms of its response and preserving the anal sphincter without serious acute and late complications.

Glypicans are a family of heparan sulfate proteoglycans that are bound to the cell surface by a glycosyl-phosphatidylinositol anchor. Six members of this family have been identified in mammals. In general, glypicans are highly expressed during development, and their expression pattern suggests that they are involved in morphogenesis. One member of this family, glypican-3, is mutated in the Simpson-Golabi-Behmel syndrome. This syndrome is characterized by overgrowth and various developmental abnormalities that indicate that glypican-3 inhibits proliferation and cell survival in the embryo. It has consequently been proposed that glypicans can regulate the activity of several growth factors that play a critical role in morphogenesis.

Purpose: To evaluate the efficacy and safety of ifosfamide, carboplatin and epirubicin (ICE) combination chemotherapy for extensive disease small cell lung cancer (SCLC) patients, who had received no previous chemotherapy, we performed phase II trial between August 1998 and January 2001., Materials and Methods: The study group comprised of 21 patients. Ifosfamide, 1,500 mg/m2, was given with mesna, 900 mg/m2, intravenously for 12 hours on days 1, 2 and 3, and carboplatin, 4.5 mg/ml/min, for target AUC, and epirubicin, 60 mg/m2, were given intravenously for 90 minutes on day 1. The cycle of treatment was repeated at 4 week intervals., Results: Twenty-one patients with extensive disease SCLC were treated at Hallym University between August 1998 and January 2001. One patient was unable to be evaluated because of lost to follow-up. Of the 20 patients able to be evaluated, an objective response was observed in 13 (65%). There were no complete responses. The median response duration, time to progression and median overall survival were 15.4, 18.3 and 34 weeks, respectively. Toxicities were acceptable, with dose reduction for myelosuppression necessary in only a minority of the patients. A total of 85 cycles of chemotherapy were given to the patients. The median number of cycles completed was 4. Grade III and IV hematological toxicities included anemia (4.7%), neutropenia (3.5%) and thrombocytopenia (3.5%). Most non-hematological toxicities were grade I or II., Conclusion: These results suggested that ICE combination chemotherapy for extensive disease SCLC is effective, and can be safely administered with acceptable toxicities.

Purpose: The Philadelphia (Ph) chromosome is a well- known chromosome abnormality in adults with B-lineage ALL, and is associated with a poor prognosis. This study compared the clinical manifestations and prognosis in adult Ph-positive and Ph-negative ALL patients., Materials and Methods: We retrospectively analyzed the clinical records of adult patients newly diagnosed as B-lineage ALL, between January 1995 and February 2001. Fifty five patients were included in this study. We divided the patients into Ph-positive and Ph-negative groups., Results: Eighteen of the 55 patients (32.7%) were found to have the Ph chromosome. At initial diagnosis, the Ph-positive patients had higher circulating leukocyte counts, lower platelet counts and had a greater tendency to bleed, than the Ph-negative group. The complete remission rates were 83.3% and 83.8% for the Ph-positive and the Ph-negative groups, respectively. Four of the Ph-positive, and 13 of the Ph-negative, patients underwent allogenic bone marrow transplantation. The median follow-up for the surviving patients was 39.3 months. The three-year survival rates were 10.4% and 51.8% for the Ph-positive and the Ph-negative groups, respectively. The median disease-free survival was 7.7 months for the Ph-positive group, but did not reach the median value in the Ph-negative group. Among the Ph-positive patients, age was the only factor that had an impact on the disease outcome., Conclusion: In adult B-lineage ALL, the Ph-positive patients had similar complete remission rates to other patients; however, the remission was of shorter duration, with a higher relapse rate in the Ph-positive patients. More effective treatments are needed to improve the survival of the Ph-positive patients.

Four new zinc diphosphonate compounds with formulas [NH(3)(CH(2))(2)NH(3)]Zn(hedpH(2))(2).2H(2)O, 1, [NH(3)(CH(2))(n)()NH(3)]Zn(2)(hedpH)(2).2H(2)O, (n = 4, 2; n = 5, 3; n = 6, 4) (hedp = 1-hydroxyethylidenediphosphonate) have been synthesized under hydrothermal conditions at 110 degrees C and in the presence of alkylenediamines NH(2)(CH(2))(n)()NH(2) (n = 2, 4, 5, 6). Crystallographic data for 1: monoclinic, space group C2/c, a = 24.7422(15), b = 5.2889(2), c = 16.0338(2) A, beta = 117.903(1) degrees, V = 1856.17(18) A(3), Z = 4; 2: monoclinic, space group P2(1)/n, a = 5.4970(3), b = 12.1041(6), c = 16.2814(12) A, beta = 98.619(5) degrees, V = 1071.07(11) A(3), Z = 2; 3: monoclinic, space group P2(1)/n, a = 5.5251(2), b = 12.5968(3), c = 16.1705(5) A, beta = 99.182(1) degrees, V = 1111.02(6) A(3), Z = 2; 4: triclinic, space group P-1, a = 5.4785(2), b = 14.1940(5), c = 16.0682(6) A, alpha = 81.982(2) degrees, beta = 89.435(2) degrees, gamma = 79.679(2) degrees, V = 1217.11(8) A(3), Z = 2. In compound 1, two of the phosphonate oxygens are protonated. The metal ions are bridged by the hedpH(2)(2-) groups through three of the remaining four phosphonate oxygens, forming a one-dimensional infinite chain. The protonated ethylenediamines locate between the chains in the lattice. In compounds 2-4, only one phosphonate oxygen is protonated. Compounds 2 and 3 have a similar three-dimensional open-network structure composed of [Zn(2)(hedpH)(2)](n) double chains with strong hydrogen bonding interactions between them, thus generating channels along the [100] direction. The protonated diamines and water molecules reside in the channels. Compound 4 contains two types of [Zn(2)(hedpH)(2)](n) double chains which are held together by strong hydrogen bonds, forming a two-dimensional network. The interlayer spaces are occupied by the [NH(3)(CH(2))(6)NH(3)](2+) cations and water molecules. The significant difference between structures 2-4 is also featured by the coordination geometries of the zinc atoms. The geometries of those in 2 can be described as distorted octahedral, and those in 3 as distorted square pyramidal. In 4, two independent zinc atoms are found, each with a distorted octahedral and a tetrahedral geometry, respectively.

Objective: To investigate the therapeutic benefit of cyclosporin A (CSA) switching to hydroxychloroquine (HCQ) in patients with rheumatoid arthritis (RA)., Methods: Thirty four patients with RA who displayed residual inflammation and disability despite partial responses to prior maximal tolerated doses of methotrexate, were included. All were treated with a staged approach using CSA for 24 weeks to induce clinical improvement, followed by HCQ for 16 weeks to maintain the improvement. Seven ACR core set measures were evaluated every four to eight weeks., Results: During a 40 week open trial, 27/34 patients completed the study. CSA treatment significantly reduced the tender joints score, swollen joints score, visual analogue pain scale, patient's or doctor's global assessment, patient's self assessed disability, and C reactive protein. Compared with the time of entry into the trial, patients who switched from CSA to HCQ still possessed significantly lower levels of most variables, determined at 28, 32, and 40 weeks. According to the ACR 20% improvement definition, 15/27 (56%) patients had improved at 24 weeks after CSA treatment, and 14/27 (52%) remained improved at 16 weeks after the change to HCQ. Frequent side effects, such as hypertrichosis, gastrointestinal trouble, and hypertension, were noted during CSA treatment, but most of these disappeared after switching to HCQ. The mean levels of blood pressure and serum creatinine were significantly increased during CSA treatment, but returned to normal after changing to HCQ., Conclusions: The data suggest that CSA switching to HCQ treatment may be an effective strategy for patients with RA partially responding to methotrexate, particularly those with toxicity due to CSA.

Three new copper(II) diphosphonates, (NH(4))(2)Cu(3)(hedp)(2)(H(2)O)(4) (1), [NH(3)(CH(2))(4)NH(3)]Cu(3)(hedp)(2).2H(2)O (2), and [NH(2)(C(2)H(4))(2)NH(2)]Cu(3)(hedp)(2) (3), where hedp = 1-hydroxyethylidenediphosphonate, have been synthesized and characterized by single-crystal structural analysis. Crystal data: 1, monoclinic, P2(1)/n, a = 6.2137(13) Å, b = 14.747(2) Å, c = 11.1802(12) Å, beta = 105.83(2) degrees, Z = 2; 2, triclinic, P&onemacr;, a = 7.4840(12) Å, b = 8.032(3) Å, c = 10.007(2) Å, alpha = 111.68(2) degrees, beta = 96.188(14) degrees, gamma = 96.97(2) degrees, Z = 1; 3, triclinic, P&onemacr;, a = 7.0155(6) Å, b = 8.0904(9) Å, c = 9.2644(11) Å, alpha = 112.611(13) degrees, beta = 90.819(8) degrees, gamma = 92.824(7) degrees, Z = 1. The compound 1 is composed of infinite chains with a ladder-type motif. The compounds 2 and 3 adopt a two-dimensional layer structure which contains four- and eight-membered rings assembled from vertex-sharing {CuO(4)} units and {CPO(3)} tetrahedra. The magnetic properties of 3 have been investigated.

Glypicans are a family of heparan sulfate proteoglycans that are linked to the cell surface through a glycosyl-phosphatidylinositol anchor. One member of this family, glypican-3 (Gpc3), is mutated in patients with the Simpson-Golabi-Behmel syndrome (SGBS). These patients display pre- and postnatal overgrowth, and a varying range of dysmorphisms. The clinical features of SGBS are very similar to the more extensively studied Beckwith-Wiedemann syndrome (BWS). Since BWS has been associated with biallelic expression of insulin-like growth factor II (IGF-II), it has been proposed that GPC3 is a negative regulator of IGF-II. However, there is still no biochemical evidence indicating that GPC3 plays such a role.Here, we report that GPC3-deficient mice exhibit several of the clinical features observed in SGBS patients, including developmental overgrowth, perinatal death, cystic and dyplastic kidneys, and abnormal lung development. A proportion of the mutant mice also display mandibular hypoplasia and an imperforate vagina. In the particular case of the kidney, we demonstrate that there is an early and persistent developmental abnormality of the ureteric bud/collecting system due to increased proliferation of cells in this tissue element. The degree of developmental overgrowth of the GPC3-deficient mice is similar to that of mice deficient in IGF receptor type 2 (IGF2R), a well characterized negative regulator of IGF-II. Unlike the IGF2R-deficient mice, however, the levels of IGF-II in GPC3 knockouts are similar to those of the normal littermates.

Purpose: Our goal was to evaluate the diagnostic value of MRI in plica syndrome., Method: MR images of a patient group (n = 55) with arthroscopically confirmed pathologic mediopatellar plicae were retrospectively analyzed and compared with those of a control group (n = 100). We obtained axial multiplanar gradient-recalled (MPGR), axial T1-weighted, and sagittal T2-weighted MR images. MR images were assessed for the width and length of all medial plicae., Results: In the diagnosis of plica syndrome, sensitivity and specificity were 73 and 78% on axial MPGR images, 71 and 83% on sagittal T2-weighted images, and 95 and 72% on combination of both images, respectively. The incidence of pathologic medial plica increased with a criterion of extension beyond the medial end of the patella on axial MPGR images., Conclusion: MRI is a useful screening method in the diagnosis of plica syndrome.

Neural networks have been successfully applied to various pattern classification problems in terms of their learning ability, high discrimination power, and excellent generalization ability. However, for the case of classifying large-set and complex patterns, the greater part of conventional neural networks suffer from several difficulties such as the determination of the structure and size of the network, the computational complexity, and so on. In this paper, to cope with these difficulties, we propose a structurally adaptive intelligent neural tree (SAINT). The basic idea is to partition hierarchically input pattern space using a tree-structured network which is composed of subnetworks with topology-preserving mapping ability. The main advantage of SAINT is that it attempts to find automatically a network structure and size suitable for the classification of large-set and complex patterns through structure adaptation. Experimental results reveal that SAINT is very effective for the classification of large-set real world handwritten characters with high variations, as well as multilingual, multifont, and multisize large-set characters.

OCI-5 encodes the rat homologue of glypican-3, a membrane-bound heparan sulfate proteoglycan that is mutated in the Simpson-Golabi-Behmel overgrowth syndrome. OCI-5 and glypican-3 are 95% identical. It has been recently suggested that glypican-3 interacts with insulin-like growth factor-2 (IGF-2) and that this interaction regulates IGF-2 activity. We report here that we have transfected OCI-5 into two different cell lines, and we have not been able to detect an interaction between the OCI-5 proteoglycan produced by the transfected cells and IGF-2. On the other hand, we have found that OCI-5 interacts with FGF-2, as has already been shown for glypican-1. This interaction is mediated by the heparan sulfate chains of OCI-5 because it can be inhibited by heparin or by heparitinase.

This paper focuses on methods of analysis of areas under receiver operating characteristic (ROC) curves. Analysis of ROC areas should incorporate the correlation structure of repeated measurements taken on the same set of cases and the paucity of measurements per treatment resulting from an effective summarization of cases into a few area measures of diagnostic accuracy. The repeated nature of ROC data has been taken into consideration in the analysis methods previously suggested by Swets and Pickett (1982, Evaluation of Diagnostic Systems: Methods from Signal Detection Theory), Hanley and McNeil (1983, Radiology 148, 839-843), and DeLong, DeLong, and Clarke-Pearson (1988, Biometrics 44, 837-845). DeLong et al.'s procedure is extended to a Wald test for general situations of diagnostic testing. The method of analyzing jackknife pseudovalues by treating them as data is extremely useful when the number of area measures to be tested is quite small. The Wald test based on covariances of multivariate multisample U-statistics is compared with two approaches of analyzing pseudovalues, the univariate mixed-model analysis of variance (ANOVA) for repeated measurements and the three-way factorial ANOVA. Monte Carlo simulations demonstrate that the three tests give good approximation to the nominal size at the 5% levels for large sample sizes, but the paired t-test using ROC areas as data lacks the power of the other three tests and Hanley and McNeil's method is inappropriate for testing diagnostic accuracies. The Wald statistic performs better than the ANOVAs of pseudovalues. Jackknifing schemes of multiple deletion where different structures of normal and diseased distributions are accounted for appear to perform slightly better than simple multiple-deletion schemes but no appreciable power difference is apparent, and deletion of too many cases at a time may sacrifice power. These methods have important applications in diagnostic testing in ROC studies of radiology and of medicine in general.

We report a case of eosinophilic cholangitis, with US, CT, and cholangiographic findings. The lesion showed marked wall thickening of cystic and common bile ducts on US and CT together with mild diffuse narrowing of the common duct on cholangiography.

We propose a new type of recurrent neural-network architecture, in which each output unit is connected to itself and is also fully connected to other output units and all hidden units. The proposed recurrent neural network differs from Jordan's and Elman's recurrent neural networks with respect to function and architecture, because it has been originally extended from being a mere multilayer feedforward neural network, to improve discrimination and generalization powers. We also prove the convergence properties of the learning algorithm in the proposed recurrent neural network, and analyze the performance of the proposed recurrent neural network by performing recognition experiments with the totally unconstrained handwritten numeric database of Concordia University, Montreal, Canada. Experimental results have confirmed that the proposed recurrent neural network improves discrimination and generalization powers in the recognition of visual patterns.

Objectives: Immune suppression (IS) therapy has provided another opportunity of cure or improvement in the aplastic anemia patients who cannot receive bone marrow transplantation due to many causes. There are a few reports regarding the factors that affect response, survival and prognosis after IS therapy, including antilymphocyte globulin (ALG) in aplastic anemia. Therefore, we analysed our experience to determine the prognostic factors., Methods: Statistically analysed were 172 patients, from April 1982 to July 1992, who were diagnosed as severe aplastic anemia and treated with IS therapy, including ALG, at Catholic University Medical College, St. Mary's Hospital., Results: Among 172 severe aplastic anemia (SAA) patients who entered the study from April 1982 to July 1992, 144 patients were analysed for response and 122 patient for survival. 58.4% (84/144) responded after the first course of IS therapy. Among those who did not respond on the first course an additional 44% (11/25) responded after the second course of IS therapy. Prognostic factors that might affect the response to the treatment and survival were analysed. In a univariate analysis of patients with no previous history of treatment before is therapy, and a shorter interval between diagnosis and treatment, higher hemoglobin levels before IS therapy, and higher granulocyte counts and combined use use of cyclosporin A(CSA) were positively associated with response (p < 0.05). The combined use of CSA during IS therapy, younger age, lower monthly requirement of platelets transfusion before IS therapy, higher leukocyte counts, higher percent of polymorphonuclear leukocytes, lower percent of lymphocyte, higher bone marrow cellularity and response were positively associated with survival (p < 0.05). In a multivariate analysis, shorter interval between diagnosis and treatment, no combined use of hemopoietic stimulants, such as androgen, and lesser total amount of transfusion were positively associated with Response (p < 0.05). Higher leukocyte counts before IS therapy and the combined use of CSA during IS therapy were significantly associated with longer survival (p < 0.05). Patients with complete or partial response had excellent prognosis (96.7%-100% of 5 year survival rates). In contrast, patients with no response after IS therapy had 45.1% of 5 year survival rates., Conclusions: With these results from the retrospective study of IS therapy, we find many valuable factors that have an influence on response or survival. IS therapy improves the survival of responded patients with SAA, and we confirmed that IS therapy is an important therapeutic tool for the SAA patients who are not feasible candidates for bone marrow transplantation.

Objective: The purpose of this study was to compare fat-suppressed T1-weighted with conventional MR images for the diagnosis of endometriosis, focusing on the detectability of peritoneal implants, and to evaluate the usefulness of MR imaging in predicting the severity of disease., Subjects and Methods: We analyzed the MR images of 31 patients with clinically suspected endometriosis. Laparoscopy confirmed no evidence of disease in two and endometriosis in 29. Conventional T1- and T2-weighted images and supplementary axial fat-suppressed images were obtained in all patients. In both groups, detection of endometriotic lesions with MR imaging was compared with detection at laparoscopy. Only the findings on fat-suppressed images were used to evaluate the usefulness of MR imaging in predicting the severity of disease. Early stages of disease included stages I and II; advanced stages of disease included stages III and IV., Results: Diagnostic accuracy was higher with fat-suppressed imaging (77%) than with conventional imaging (55%) (p = .06). The overall sensitivity in detecting peritoneal implants was significantly higher with fat-suppressed imaging (61%) than with conventional imaging (27%) (p < .01). The disease was likely to be at an early stage when MR images showed peritoneal implants that were 5 mm or less in maximum diameter. The disease was likely to be at an advanced stage when MR images showed an endometrial cyst that was larger than 1.5 cm., Conclusion: Our results show that fat-suppressed MR imaging is more accurate in the diagnosis of pelvic endometriosis and is better for predicting the severity of disease than conventional MR imaging is.

Rationale and Objectives: The authors assessed the effect of noise on the detectability of rib fractures by residents., Methods: Eight radiology residents read chest posterior-anterior radiographs of 92 subjects with rib fracture(s) and 28 normal subjects to detect rib fracture(s) according to a five-point scale of confidence, under quiet and "noisy" conditions. Each individual's attitude toward noise was measured by a multiple-choice questionnaire., Results: The readers were divided into two groups depending on the questionnaire result: group A readers were accustomed to a quiet environment, and group B readers were accustomed to noisy environments or were unaffected by noise. Group A's performance, measured by the area (Az) under the receiver operating characteristic (ROC) curve, was better in quiet conditions when compared with their performance in noisy conditions; however, the opposite tendency was observed for group B. There was a significant individual difference of performance in response to noise., Conclusion: Effect of noise on the detection of rib fractures depends on an individual's attitude toward sound and noise.

Rationale and Objectives: The authors analyzed opinions regarding how a radiologist should answer a patient's or patient's family's questions about radiologic results., Methods: Questionnaires were obtained in a university hospital from 135 physicians of various specialties, including radiologists, and 501 nonphysicians, such as medical students, nurses, patients, families of patients, and hospital personnel. The questionnaire included three questions, each with five choices. The first question concerned a normal result, the second a minor abnormality, and the third a major abnormality. The five choices in each question consisted of two suggestive answers to patients' inquiries and three excuses for the refusal of immediate answers. Respondents were asked to choose the single most desirable and the single least desirable answer., Results: Approximately 50% of all physicians believed that a radiologist should refer the patient to his or her physician rather than to give a suggestive answer to a patient with an abnormality. Considerably fewer physicians had a similar opinion in cases involving a patient with normal results. Patients and the families of patients believed that a radiologist should give at least a suggestive answer in any circumstances where the patient is agitated to know the result. Radiologists were reluctant to convey any information regardless of the test result., Conclusions: Physicians had significantly different opinions from patients and the families of patients, and radiologists preferred to keep their traditional role of referral physician.

In order to assess the effectiveness of the thermal biofeedback training combined with the progressive muscle relaxation therapy in the treatment of patients with essential hypertension, blood pressure decline was measured on the treatment group who had the combined thermal biofeedback and progressive muscle relaxation training (N = 11), and on the control group who had only the progressive muscle relaxation training (N = 8). Baseline blood pressure was measured four times for two weeks on both groups. For the treatment group, blood pressure was measured twice before and after each of eight sessions of thermal biofeedback training for four weeks. For the control group, blood pressure was measured every two visits to a clinic for progressive muscle relaxation self-training twice before and after the self-training. A significant decline of the systolic blood pressure by 20.6 mmHg and of the diastolic blood pressure by 14.4 mmhg was observed in the treatment group. There was a tendency for both blood pressures to increase in the control group.

Rationale and Objectives: The authors assessed the influence of a prior reader's opinion on the detectability of rib fractures., Methods: Six pairs of observers read the chest PA radiographs of 92 subjects with rib fracture(s) and 28 normal subjects to detect rib fracture(s) according to a five-point rating of confidence with three methods. In method A, each reader read films as a primary reader. In method B, each reader read films after knowing his or her partner's opinion. In method C, each reader initially observed films and then made the final decision after knowing his or her partner's opinion., Results: Methods B and C were superior to method A in sensitivity. There was no difference in performance between methods B and C. Method C required a significantly longer time than the other methods., Conclusion: Detection of rib fractures is improved by seeking the opinion of other observers.

We performed a study to determine whether clinical history gives a positive or negative influence on X-ray film interpretation. One hundred and nine patient's radiograms, consisting of 55 normal and 54 abnormal cases (136 abnormalities), were interpreted twice by three pairs of residents in radiology and a pair of qualified radiologists, without clinical history first and with clinical history next. The interpreters recorded diagnosis and confidence level of normal or abnormal findings on a six-point scale. Analysis of receiver operating characteristic (ROC) curves showed that knowledge of clinical history improved diagnostic accuracy. Residents, especially beginners, should be advised to obtain clinical history whenever they read radiograms.

The treatment of injuries inflicted on hands and occasionally forearms by crushing between hot rigid surfaces (thermal crush injury) is usually complex because of the possibility of fractures, nerve and tendon injuries, as well as heat destruction of the skin which also may be macerated. A review of the treatment of 60 patients with thermal crush injuries has defined the more important aspects of treatment including the choice of materials for wound coverage (split thickness skin or tube pedicle tissue graft) and the optimal time for surgical repair of the injury.

A simple, reliable, and innocuous method is described for evaluating the penetrability of cerebrospinal shunts with the use of 99mTc O4. After introducing 25 muCi of 99mTc O4 in a volume of about 0.2 ml into Rickham's reservoir, series scintigrams in the lateral or AP direction are made with the aid of a Nuclear Chicago Pho Gamma HP Scintillation Camera. The results are in satisfactory agreement with the surgical findings. No complications have so far been observed.