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To evaluate low-dose non-enhanced CT (ldCT) and full-dose contrast-enhanced CT (ceCT) in integrated 18F-fluorodeoxyglucose (FDG)-PET/CT studies for restaging of ovarian cancer.One hundred and twenty women who had undergone treatment for ovarian cancer underwent a conventional PET/CT scans with ldCT, and then ceCT. Two observers interpreted and decided in consensus on the PET/ldCT and PET/ceCT images by a 3-point scale (N: negative, E: equivocal, P: positive) per patient and lesion site. Final diagnoses were obtained by histopathological examinations, or clinical follow-up for at least 6 months.Patient-based analysis showed that the sensitivity, specificity, and accuracy of PET/ceCT was 86.9% (40/46), 95.9% (71/74), and 92.5% (111/120), respectively, whereas those of PET/ldCT were 78.3% (36/46), 95.0% (70/74), and 88.3% (106/120), respectively. All sensitivity, specificity, and accuracy significantly differed between two methods (McNemar test, p0.0005, p=0.023, and p0.0001, respectively). The scales of detecting 104 recurrent lesion sites were N:14, E:6, P:84 for PET/ceCT, and N:15, E:17, P:72 for PET/ldCT, respectively. Eleven equivocal and one negative regions by PET/ldCT were correctly interpreted as positive by PET/ceCT.PET/ceCT is a more accurate imaging modality with higher confidence for assessing ovarian cancer recurrence than PET/ldCT.

A 80-year-old female was referred to our hospital for hematomesis. An abdominal CT revealed a heterogeneous giant tumor of about 11 cm, rich in vascularity, extending from the gastric fundus, beyond the upper side of the spleen, to the left thoracic diaphragm. Gastroscopy showed a 5 cm submucosal tumor with a visible vessel at the gastric fundus. After biopsy was performed, she was diagnosed with a c-kit-positive gastrointestinal stromal tumor (GIST)of the stomach. Following endoscopic hemostasis for gastric bleeding, imatinib mesilate was administered. The tumor reduced markedly, and vascularity in the tumor was diminished, the visible vessels of the tumor disappeared. For curative resection, total gastrectomy with a distal pancreato -splenectomy and a left diaphgram resection is necessary, but surgery was high-risk for this patient because she was advanced in age. She is now achieving a good partial response without surgery.

An 89 year old female with a history of myocardial infarction, chronic heart failure, hypertension, and atrial fibrillation was transferred to our institution with circulatory insufficiency. The patient had been undergone treatment for in-stent restenosis of the middle left ascending artery 1 week back. Her systolic blood pressure was 70 mm Hg with evident cyanosis over the whole body surface. Arterial blood gas analysis revealed severe metabolic acidosis and the patient exhibited severe hypovolemia. Initiation of dopamine therapy and transfusion ameliorated the circulatory failure. Three days after admission, she discharged massive bloody stools without absence of abdominal pain; colonoscopy revealed segmental pattern of mucosa necrosis in the sigmoid colon. Enhanced abdominal computed tomography revealed neither thrombus nor embolus in the mesenteric artery. Blood flow to the sigmoid colon was evident, prompting a diagnosis of non-occlusive mesenteric ischemia. Although emergency surgery was recommended, the patient declined and died of panperitonitis following conservative therapy. In addition to circulatory insufficiency caused by heart failure in this case, the intestinal ischemia also resulted from hypovolemia, diuretics and digitalis therapy, and arteriosclerosis.

A 62-year-old male with a history of type 2 diabetes mellitus and alcoholic liver disease presented with dysphagia, heartburn, and appetite loss. He had lost 10 kg weight within 1 month. The patient gave a history of excessive alcohol intake and a smoking habit of 60 cigarettes per day for 40 years. Upper gastroenteroscopy revealed a wartlike, whitish, protruding mass with circumferential stricture at a point 35 cm from the incisor down to the cardia. Although esophageal cancer was suspected, repeated biopsies of the mass revealed no malignant findings. Concurrent esophageal candidiasis was treated with an antifungal drug. Increased esophageal stricture made food intake impossible; therefore, total parenteral nutrition was initiated. Endoscopic mucosal resection revealed highly keratinized, well-differentiated squamous cell carcinoma with invasion into the submucosa. A diagnosis of verrucous squamous carcinoma was confirmed. Subtotal esophageal resection and esophagostomy was performed with video assistance. Postoperative pathological findings were compatible with the diagnosis of verrucous squamous carcinoma, which is known to be a slow-growing tumor that rarely metastasizes to lymph nodes or distant organs. However, verrucous squamous carcinoma is rarely diagnosed by endoscopic biopsy. Moreover, endoscopic mucosal resection or surgery should be considered in cases when endoscopic examination fails to confirm the diagnosis of carcinoma and if the lesion presents some characteristics of verrucous squamous carcinoma.

A 67-year-old male was admitted to our institution for occult blood positivity and to test for anemia. Upper and lower gastroenteroscopy revealed no abnormal findings. A thickened intestinal wall was detected in the upper jejunum by contrast-enhanced abdominal computed tomography, and a small intestinal tumor was suspected. Capsule endoscopy revealed a lesion protruding two-thirds of its circumference into the upper jejunal wall, which showed a stricture. Single-balloon endoscopy confirmed a jejunal tumor. A specimen biopsied during single-balloon endoscopy revealed a well-differentiated tubular adenocarcinoma. Therefore, the patient was treated surgically. The intraoperative findings revealed a jejunal tumor approximately 5 cm distal from the Treiz ligament, and the jejunum, including the tumor with a 5 cm margin, was partially resected. The resected tumor was 60×40×30 mm in size. Pathological examination revealed a well-differentiated tubular adenocarcinoma with invasion of the serosa and no vessel or lymphatic invasion. With the advent of capsule endoscopy and balloon endoscopy, it has become possible to visualize small intestinal mucosa and detect disease in the small intestine. We present the case of a male patient with a jejunal carcinoma that was successfully detected by capsule endoscopy and balloon endoscopy.

Effects of 16 weeks of niceritrol therapy (750 mg/d for the first 8 weeks and 1500 mg/d for the remaining 8 weeks) on serum levels of lipids, apolipoproteins, and Lp(a) were examined in diabetic patients with and without overt proteinuria. Pre-niceritrol Lp(a) levels exceeded 30 mg/dL and were comparable in both groups of patients. Pretreatment levels of lipids and apolipoproteins also were similar in both groups. Nonproteinuric patients exhibited an 18% decrease in Lp(a) and a 22% reduction in triglycerides as well as increases in high-density lipoprotein cholesterol and apolipoprotein AI. In contrast, patients with overt proteinuria showed no significant changes in serum lipids, apolipoproteins, or Lp(a) in response to niceritrol therapy. These findings suggest that the presence of overt proteinuria may affect Lp(a) metabolism in diabetic patients.

We report a case of benign symmetric Lipomatosis with hypothyroidism. Functional abnormalities and distribution of lipomas in benign symmetric lipomatosis suggest that the lipomas in this disorder may represent brown adipose tissue. In conditions where mRNAs of uncoupling protein, which is believed to be unique for brown adipose tissue mitochondria, were detected in one μg of poly (A+) rat brown fat RNA, no signal at all was found in the lipomatous tissue, suggesting that the masses of benign symmetric lipomatosis are not functional brown adipose tissue.

The purpose of our study was to compare the capability of the 320-detector row CT (area-detector CT: ADCT) using the step-and-shoot scan protocol for small abdominal vasculature assessment with that of the 16-detector row CT using the helical scan protocol. Contrast-enhanced abdominal CT for preoperative assessment was administered to 25 patients, 18 of whom, suspected of having lung cancer, underwent ADCT using the step-and-shoot scan protocol, while the remaining 7, suspected of having renal cell carcinoma, underwent 16-MDCT using the helical scan protocol. Two experienced abdominal radiologists independently assessed renal interlobar and arcuate as well as mesenteric marginal (Griffith point) arteries by means of a 5-point visual scoring systems. Kappa analysis was used for evaluation of interobserver agreement. To compare the visualization capability of the two systems, the scores for each of the arteries were compared by using the Mann-Whitney U-test. Overall interobserver agreements for both systems were almost perfect (κ0.78). Visualization scores for renal interlobar and arcuate, (p0.0001) and mesenteric marginal (Griffith point) arteries (p0.05) were significantly higher for ADCT than for 16-detector row CT. ADCT using the step-and-shoot scan protocol for small abdominal vasculature assessment can be considered superior to 16-detector row CT using the helical scan protocol.

A 65-year-old female was admitted to our hospital with abdominal distension. Abdominal CT and MRI revealed massive ascites and an omental cake, but the ovaries were of normal size. After an omentum biopsy was performed during open abdominal surgery, she was diagnosed as peritoneal serous papillary adenocarcinoma. After 6 courses of chemotherapy with paclitaxel and carboplatin, the massive ascites totally disappeared, and a second look operation could be performed. She is still alive with no sign of recurrence.

Objective Hypothyroidism is a common complication in patients receiving tyrosine kinase inhibitors. We evaluated the relationship between thyroid size evident on CT and thyroid function in patients with advanced renal cell carcinoma (RCC) receiving tyrosine kinase inhibitors. Materials and methods Forty-two patients with metastatic RCC receiving tyrosine kinase inhibitors (sorafenib n = 25; sunitinib n = 17) and, followed-up for ≥12 months were eligible. Patients who had ever shown an elevated thyroid-stimulating hormone (TSH) level of >10 mU/l were defined as having “hypothyroidism”. CT scans were performed before, and 3, 6, 9, and 12 months after the start of treatment. The area of the thyroid in the maximum section at each examination was measured and compared with that before treatment. Using repeated-measures ANOVA, differences in thyroid size were compared over time between patients with and without “hypothyroidism”, in relation to the type of drug employed. Results Twenty-one patients (sorafenib 9, sunitinib 12) developed “hypothyroidism” 95 ± 88 days (range 12–315 days) after the start of treatment. In such patients, the thyroid was reduced in size to 89 ± 16% after 3 months, 81 ± 21% after 6 months, 71 ± 21% after 9 months and 68 ± 21% after 12 months, whereas the patients without “hypothyroidism” maintained a thyroid size of 90 ± 12% even after 12 months (p = 0.0030). Among the patients with “hypothyroidism”, those treated with sunitinib tended to show greater thyroid size reduction than those with sorafenib (59 ± 23% vs. 79 ± 13%, after 12 months). Conclusion Tyrosine kinase inhibitors cause an apparent thyroid size reduction in patients with “hypothyroidism”.

To determine whether contrast-enhanced PET/CT is more accurate than either non-enhanced PET/CT or enhanced CT alone for nodal staging of uterine cancer.Forty patients with endometrial cancer and cervical cancer underwent conventional PET/CT scan with low-dose CT (ldCT), followed by full-dose CT with IV contrast (ceCT) before radical hysterectomy with pelvic and, when applicable, para-aortic lymphadenectomy. Three data sets of PET/ldCT, PET/ceCT, and enhanced CT images were interpreted separately by two readers. For region-specific comparisons, para-aortic and pelvic lymph nodes were divided into the bilateral para-aortic, common iliac, external iliac, internal iliac, and obturator areas. Based on histopathological findings as the gold standard, we compared the diagnostic accuracy between the three methods using McNemar test with Bonferroni's adjustment.Of the 40 patients, 21 underwent pelvic lymphadenectomy only. Region-based analysis showed that the sensitivity, specificity, and accuracy of PET/ceCT were 61.4% (27/44), 98.1% (308/314), and 93.6% (335/358), respectively, whereas those of PET/ldCT were 52.3% (23/44), 96.8% (304/314), and 91.3% (327/358), respectively, and those of enhanced CT were 40.9% (18/44), 97.8% (307/314), and 90.8% (325/358), respectively. Although PET/ceCT had the best sensitivity among the three imaging modalities, a significant difference was observed only between PET/ceCT and enhanced CT (p = 0.0027). Although PET/ceCT had better sensitivity and accuracy than PET/ldCT, the differences between the two imaging methods did not reach statistical significance (p = 0.046 and p = 0.047, respectively).PET/ceCT is slightly but not significantly superior to PET/ldCT for nodal staging of uterine cancer. Nodal metastasis cannot be excluded even if PET/ceCT gives negative findings.

本研究の目的は大腿四頭筋訓練器を用いて膝関節伸展屈曲運動を行った場合の負荷量が運動速度及び個人により異なるかどうかを明らかにすることである。大腿四頭筋訓練器を膝関節運動中の負荷量と角度変化がKin-Comに取り込めるように改良したものを測定に使用し、健常女子学生20名に対して4種類の速度で膝関節の伸展屈曲運動をそれぞれ13回ずつ行わせた。結果、各速度における負荷量の値はp

The purpose of this study was to assess retrospectively the characteristics of FDG uptake in elastofibroma dorsi using integrated PET/CT.From 10,261 oncology FDG-PET/CT scans performed over a 2-year period, findings suggestive of elastofiboma dorsi were observed in 46 FDG-PET/CT scans of 34 patients. As 20 patients had bilateral lesions and 14 had unilateral lesions, a total of 75 elastofibroma dorsi lesions on images were identified in this study. For visual analysis of intensity of FDG uptake , a four-point grading system was used: grade 0 for no uptake, grade 1 for less uptake than the liver, grade 2 for uptake comparable to the liver, and grade 3 for intense uptake greater than the liver. For quantitative analysis, the standardized uptake value (SUV) was calculated. The relationships between SUV and age, blood glucose level, lesion size, and related symptoms were also assessed.Among the 75 lesions, 4 had an uptake grade of 0, 41 had grade 1, 25 had grade 2, and 5 had grade 3. The mean SUV (±SD) of the 75 lesions was 2.0 ± 0.63 (range 0-5.1). The Pearson correlation coefficient test indicated a weak positive correlation between SUV and lesion size and no correlation between SUV and either age or blood glucose level. The SUVs of patients with symptoms due to the disease and patients without symptoms were almost the same.Mild and moderate uptake of FDG is frequently observed in elastofibroma dorsi, which should not be misinterpreted as abnormal accumulation observed in malignant lesions.

We report a case of multicystic adenomyosis, which is an exceedingly rare benign tumor. The patient complained of an irregular menstrual cycle and abnormal genital bleeding that gradually increased in amount and frequency. The patient finally became severely anemic, and a hysterectomy was therefore performed. T2-weighted magnetic resonance imaging (MRI) indicated hyperplasia of the endometrium, with a myometrial lesion, where a high signal intensity multicystic mass was observed. The preoperative diagnosis was complicated by confusing MRI results. Postoperative macroscopic examination revealed a villous endometrium and a myometrium thickened with multiple small cysts containing serous transparent fluid. The final diagnosis, based on the hysterectomy specimen, was adenomyosis coexisting with simple endometrial hyperplasia. The MRI and positron emission tomography images are presented.

To compare the capability of 320-detector row CT (area-detector CT: ADCT) with step-and-shoot scan protocol for small abdominal vasculature assessment with that of 64-detector row CT with helical scan protocol.Total of 60 patients underwent contrast-enhanced abdominal CT for preoperative assessment. Of all, 30 suspected to have lung cancer underwent ADCT using step-and-shoot scan protocol. The other 30 suspected to have renal cell carcinoma underwent 64-MDCT using helical scan protocol. Two experienced radiologists independently assessed inferior epigastric, hepatic subsegmental (in the segment 8), mesenteric marginal (Griffith point) and inferior phrenic arteries by using 5-point visual scoring systems. Kappa analysis was used for evaluation of interobserver agreement. To compare the visualization capability of the two systems, the Mann-Whitney U-test was used to compare the scores for each of the arteries.Overall interobserver agreements for both systems were almost perfect (κ0.80). Visualization scores for inferior epigastric and mesenteric arteries were significantly higher for ADCT than for 64-detector row CT (p0.05). No significant difference was found for hepatic subsegmental and inferior phrenic arteries.Small abdominal vasculature assessment by ADCT with step-and-shoot scan protocol is potentially equal to or better than that by 64-detector row CT with helical scan protocol.

Purpose: Early cardiopulmonary (CPR) is the second link in the chain of survival, but the execution of CPR causes fatigue.1 However, it is possible that rescuers are already tired at the time of starting CPR.2 This can be the case of a lifeguard. Nowadays, different automatic compression device have appeared in the market.3 This mechanisms are able to realize quality chest compressions. The aim of this study was to analyze the use of an automatic compression device on the quality of chest compressions after a water rescue. Materials and methods: Twenty lifeguards form the sample of this study. They had to carry out two tests. The first test consisted in fiveminutes of CPR (rested). Then, the samplewas divided into two groups. In the second test, they realized a water rescue (50m running – 75m swimming – 75m dragging manikin) and five minutes of CPR. One group realized CPR after water rescue with an automatic compression device, the Lund University of Cardiac Arrest System (LUCAS). The data CPR were recorded with the manikin Laerdal Resusci Anne Wireless SkillReporter. Results:We found differences in the percentage of correct chest compressions. Lifeguards reached 71.1% of correct compressions in rested conditions. After water rescue, the percentage decreases to 62.4% (p

To investigate post-transplant lymphoproliferative disorder (PTLD) following renal transplantation at our institution.Medical records of 631 patients who underwent renal transplantation at Osaka University Hospital between March 1965 and December 2008 were reviewed.PTLD following renal transplantation was detected in 10 patients (five men, five women; mean age at transplantation, 38.5 years). Mean duration from renal transplantation to the onset of PTLD was 7.1 years (range, 5 months to 18 years, 9 months). Mean duration of observation was 3.9 years from the onset of PTLD. Immunosuppressant therapy comprised multidrug combination therapy, including cyclosporine in six patients and tacrolimus in four patients. In addition to a reduction in the immunosuppressant dose, which was performed in all patients, PTLD was treated with surgery in seven patients, radiotherapy in two patients, rituximab in five patients, and cytotoxic chemotherapy in four patients. A complete remission in eight patients and progressive disease in two were observed. At last follow up, seven patients were alive and five patients had functioning grafts.The incidence of PTLD following renal transplantation at our institution is 1.6% with onset occurring more than 5 years after transplantation in five patients. Consequently, with long-term renal graft survival now feasible, attention must be paid to detecting late-onset PTLD.

Background Polarized secretion of lamellar granules (LGs) delivers various lipids, proteases, and protease inhibitors into the stratum corneum (SC) of the epithelium. Disruption of LGs is associated with severe cutaneous diseases, but the mechanism of their polarized secretion is not known. On the other hand, recent study shows epidermal tight junctions (TJs) localize in stratum granulosum (SG), and TJs are involved in polarized molecule secretion. Thus, we hypothesized epidermal TJs relate to polarized LGs secretion. Objective To assess the possibility that epidermal TJs are involved in polarized LGs secretion. Methods In order to examine LGs secretion, we used fluorescent ceramide (BODIPY® FL C5-ceramide) and a natural LG cargo, lympho-epithelial Kazal-type-related inhibitor (LEKTI), in cultured normal human epidermal keratinocytes and a reconstructed human epidermis. We investigated their alteration using the medium-chain fatty acid sodium caprate (C10), TJs inhibitor. In addition, LG distribution was observed by electron microscopy. Results C10 significantly inhibited secretion of both fluorescent ceramide and LEKTI in cultured normal human epidermal keratinocytes and a reconstructed human epidermis. C10 also disturbed the polarized localization of fluorescent ceramide and LEKTI in the reconstructed epidermis. Electron microscopy revealed that a large number of LGs remained in corneocytes in the C10-treated epidermis, rather than being secreted. Conclusion Our data indicate that C10 perturbs the polarized secretion of LGs. Our study therefore suggests that epidermal TJs are possibly involved in polarized LG secretion and provides new insights into potential of treatments for skin diseases caused by abnormal LG secretion.

Castleman’s disease is a highly heterogeneous clinical-pathological entity that belongs to the lymphoproliferative disorders and is associated with pulmonary arterial hypertension (PAH) in some patients. It is linked to excessive immune stimulation by interleukin-6 (IL-6), which is also involved in the pathogenesis of PAH. A 31-year-old woman with Castleman’s disease demonstrated PAH characterized by severe right heart failure. Since she was resistant to various conventional therapies including steroids, prostacyclins, bosentan, and sildenafil, tocilizumab (anti-IL-6 receptor antibody) therapy was started. Her clinical course was followed for 6 months, with significant improvement without any adverse effect. This is the first reported case of use of tocilizumab in addition to steroids and conventional PAH therapy in a patient with PAH associated with Castleman’s disease.

To evaluate the ability of dibenzothiophene N-substituted sulfilimines as photochemical nitrene sources, their photolyses in the presence of several trapping reagents, such as sulfides, olefins, and phosphorus compounds, were performed. In the reactions, the corresponding imino-transfer compounds, namely sulfilimines, aziridines, and iminophosphoranes, were formed in good yields, indicating dibenzothiophene N-tosyl and N-acylsulfilimines have a potent nature as nitrogen sources.

Study Objective: To evaluate the thermal ablative effects of magnetic resonance-(MR) guided focused ultrasound surgery (MRgFUS) on adenomyosis and to assess improvement in clinical parameters. Design: Twenty patients with adenomyosis were treated with MRgFUS. Extensive adenomyosis (6 cases) was treated with 2 applications. Uterine volume was evaluated by MR imaging before and immediately after MRgFUS. Ablation of adenomyosis and the architecture of nonperfused areas were evaluated immediately after MRgFUS. Improvement in patient symptoms was assessed through the symptom severity score questionnaire (Canadian Task Force classification II-3). Setting: Department of gynecology at a Japanese general hospital. Patients: Premenopausal women at least 18 years of age with symptomatic adenomyosis. Interventions: Thermal ablation by MRgFUS. Measurements and Main Results: We classified the nonperfused lesions on contrast-enhanced MR images immediately after MRgFUS into 3 types: lesions with round margins (type R), serrated margins (type S), and honeycomb architecture (type H). Type R was the most common (16/20 patients). Most adenomyosis lesions could be sufficiently ablated close to the serosal surface or to the endometrium by MRgFUS. The mean uterine volume 6 months after therapy was decreased by 12.7%. Symp- tom severity score improved significantly during 6 months of follow-up. No serious complications were observed. Conclusion:These earlyresults indicate the safeandeffective ablation ofadenomyosis tissue byMRgFUS.The procedurealso resulted in the improvementin clinical symptomsduringthe 6monthsoffollow-up. Journal ofMinimally InvasiveGynecology (2008) -, --- 2008 AAGL All rights reserved.

[C-11] choline positron emission tomography ([C-11] choline PET) has been expected to be one of the new PET modalities similar to [F-18] fuluorodeoxyglucose positron emission tomography (FDG-PET), which has spread worldwide as a gold standard of PET oncologic imaging. However, there has been no report on [C-11] choline PET used for detection of colorectal cancer, which is one of major targets of oncologic FDG-PET. We initiated the research to investigate the detectability of [C-11] choline PET for various tumors including colorectal cancer. This is the first report of a patient who underwent surgical resection for advanced colon cancer depicted by [C-11] choline positron emission tomography/computed tomography.

Objective The aim of the present study was to evaluate the value of magnetic resonance (MR) screening for detection of hepatic metastasis in patients with locally controlled choroidal melanoma. Methods MR examinations were performed after an initial diagnosis of choroidal melanoma in 159 patients (mean age 56 years: range, 10-86 years). The MR follow-up interval was 5.2 +/- 1.7 years (range, 1.2-6.6 years). A total of 363 MR studies were reviewed by two radiologists for predominant signal intensity characteristics. Hepatic metastasis was verified by histological examination: tumor resection and CT-guided needle biopsy specimens and/or on the basis of an obvious progression in number and/or size of the lesions on the follow-up MR examination. Results The majority of patients underwent MR examinations from one to three times (n = 126, 79%). During a mean follow-up period of 5.7 years, a focal abnormality in the liver was found in 20 patients (13%). Of these, 15 patients (9%) were diagnosed as having hepatic metastasis. The number of the metastatic lesions with a short T1 and short T2 pattern were one (n = 1, 9%), two (n = 2, 18%), three (n = 1, 9%) and multiple (n = 7, 63%). The focal abnormalities of MR examinations in five other patients consisted of vascular artifacts (n = 3, 15%) and cysts with hemorrhage (n = 2, 10%). Conclusions The screening of MR examinations detected hepatic metastasis in 15 of 159 patients (9%) with locally controlled choroidal melanoma.

Malignant disorders of the sternocostoclavicular region include a diverse group of lesions with a wide variety of histological lineages. Evaluation of tumours usually includes conventional chest radiography to detect and localise the lesions, CT or MRI to further characterise the tumour and define its extent, and investigation of anato-metabolic correlation by FDG PET/CT. Although the majority of these tumours have a non-specific appearance, in some patients, the combination of clinical and imaging findings may suggest the diagnosis. Despite their non-specific appearances, imaging is important for the staging, grading, therapeutic planning and follow-up of malignant disorders of the sternocostoclavicular region.

Primary bone tumours of the sternocostoclavicular region include a diverse group of lesions of osseous and cartilaginous origin. Radiological assessment is an essential component of the management of these tumours. Evaluation usually includes conventional chest radiography to detect and localise the lesion, cross-sectional imaging (CT or MRI) to further characterise and define tumour extent, and anatometabolic correlations with FDG PET/CT. Several of the primary bone tumours of the sternocostoclavicular region have characteristic features that allow confident identification. However, many tumours have non-specific imaging features and biopsy is frequently required for diagnosis. Despite this, imaging remains important to patient management and is frequently used to facilitate biopsy, assess postprocedural complications, monitor tumours that are not excised and assess significant prognostic imaging characteristics.

Background: Rotator cuff tears can cause serious pain and dysfunction in the shoulder joint among adults. Previous reports have indicated the importance of the lesion area in the rotator cuff to shoulder dysfunction, but few have reported its effects on glenohumeral joint stability or muscle force. Purpose: The purpose of this study was to clarify the effects of rotator cuff tears on glenohumeral joint stability and muscle force using a musculoskeletal simulation. Methods: Three young adults participated in this study. Joint reaction force in the glenohumeral jointwas used to estimate joint stability. Arm elevation in the frontal and sagittal plane were measured by a motion capture system. A threemarker cluster attached to the acromion was used to obtain the scapular motion. We analyzed the arm elevation below 120 degree due to skin motion artifact. The AnyBody shoulder model was used to calculate the shoulder joint reaction force andmuscle force frommotion capture data, whichwere estimated in the intact model and four simulated cuff tear models

Quantitative polymerase chain reaction (PCR) with patient-specific, allele-specific oligonucleotide (ASO) primers for individual immunoglobulin H VDJ region (ASO-PCR) amplification was performed using several sources of clinical material, including mRNA from peripheral blood cells (PBMNCs), whole bone marrow cells (BMMNCs), and the CD20 + CD38 − B-cell population in bone marrow, as well as cell-free DNA from the sera of patients with multiple myeloma (MM). We designed the ASO primers and produced sufficient PCR fragments to evaluate tumor burden in 20 of 30 bone marrow samples at diagnosis. Polymerase chain reaction amplification efficiency depended on primer sequences because the production of ASO-PCR fragments did not correlate with serum M-protein levels. However, the ASO-PCR levels in BMMNCs showed statistically significant correlations with those in PBMNCs and CD20 + CD38 − B-cells. The good association between the BMMNC and PBMNC data indicated that PBMNCs could be a suitable source for monitoring minimal residual disease (MRD). In the case of cell-free DNA, ASO-PCR levels showed a unique pattern and remained high even after treatment. Because the sequence information for each ASO-PCR product was identical to the original, the cell-free DNA might also be useful for evaluating MRD. Moreover, the ASO-PCR products were clearly detected in 17 of 22 mRNA samples from CD20 + CD38 − populations, suggesting that MM clones might exist in relatively earlier stages of B cells than in plasma cells. Thus, ASO-PCR analysis using various clinical materials is useful for detecting MRD in MM patients as well as for clarifying MM pathogenesis.

Allogeneic immune responses during hematopoietic reconstitution play central roles in beneficial and adverse effects after allogeneic bone marrow transplantation (allo-BMT).Appropriate regulation of the immune responses might improve the outcome of allo-BMT. However, a useful marker for monitoring allogeneic immune responses remains to be established. We enrolled 22 consecutive patients who underwent myeloablative allo-BMT between March 2002 and March 2006 and examined the relationship between CD27 expression on peripheral blood T-lymphocytes, a possible marker for naive/effector pheno-types, and clinical events, especially acute graft-versus-host disease (aGVHD). In 8 patients with aGVHD of grades II to IV, the CD27+/CD27- ratios of CD4+ (but not CD8+) T-lymphocytes were significantly higher after allo-BMT, even at day 21, than the ratios in patients with aGVHD of grade 0 or I and remained high after day 21. In contrast, the ratios were low after day 21 following allo-BMT in 14 patients with aGVHD of grade 0 or I. Moreover, the clinical analysis suggested a relationship between the ratio and aGVHD grade. Thus, we showed that the CD27+/CD27- ratio in CD4+ T-lymphocytes may have value in predicting the development of severe aGVHD and may correlate with clinical symptoms of aGVHD.

Mucoepidermoid carcinomas in the bronchial tree are extremely rare tumors. Such tumors are classified into low-grade and high-grade on the basis of histological criteria. Fluorine-18-fluorodeoxyglucose positron emission tomography (F-18 FDG PET) is a useful technique for the evaluation of pulmonary lesions; however, to our knowledge, F-18 FDG PET findings in mucoepidermoid carcinoma of the bronchus have been described in only a few cases. Identifiable focal F-18 FDG uptake has been reported in high-grade mucoepidermoid carcinoma, but it is unclear whether F-18 FDG accumulates in low-grade mucoepidermoid carcinoma. Here, we present the case of a 37-year-old woman, with pathologically proven low-grade mucoepidermoid carcinoma, who underwent high-resolution computed tomography (CT) and F-18 FDG PET/CT before treatment.

We report a case of Mazabraud syndrome with monostotic fibrous dysplasia and a solitary intramuscular myxoma with abnormal F-18 fluorodeoxyglucose (FDG) uptake. Mazabraud syndrome is characterized by intramuscular myxoma and fibrous dysplasia. The key to accurate diagnosis of Mazabraud syndrome lies in awareness of the association between a myxoma and fibrous dysplasia. In this case, the intramuscular myxoma was immunohistochemically strongly positive for GLUT-1. FDG positron emission tomography showed the abnormal accumulation in the intramuscular myxoma and fibrous dysplasia of Mazabraud syndrome.

Several types of recurrence may be detected by radiologic assessment after treatment in patients with prostate cancer. However, early detection of distant metastasis using positron emission tomography has so far never been published. We report two patients who underwent hormone therapy or surgical resection for prostate cancer. They developed distant metastases which were detected on whole body [C-11] choline positron emission tomography/computed tomography with significant elevation of serum PSA level. In one patient, recurrent tumor of the supraclavicular node (6 mm) diminished in size after subsequent hormone therapy. Surgical resection of recurrent tumor of the lung (12 mm) was performed in the other patient, the pathology of which confirmed the metastatic adenocarcinoma derived from the prostate. The recurrent tumor can be correctly detected by dual-phase whole body [C-11] choline positron emission tomography/computed tomography.

We report a case of leiomyosarcoma of the renal vein, which is a rare tumor with no more than 30 cases found in the published English language literature. This case demonstrates encasement of the renal artery by the tumor mass, a previously unreported manifestation. The present study could be useful in considering this rare tumor in the differential diagnosis of renal hilar tumors.

Objective Adiponectin, a fat cell–derived protein, has been attracting considerable attention because of its antidiabetic and antiatherogenic activities. The aim of the present study is to identify molecules physiologically associating with adiponectin and to understand how the protein displays diverse biological activities. Materials and Methods We used an expression cloning method combined with enzyme-linked immunosorbent assay to clone adiponectin-binding proteins from the MS-5 complementary DNA library. Results We successfully isolated two chemokines, stromal cell–derived factor-1 (SDF-1) and CCF18, and verified that adiponectin bound to them via its globular head. Adiponectin bound with various chemokines in vitro, such as macrophage-inflammatory protein-1α (MIP-1α), RANTES, and monocyte chemoattractant protein-1 (MCP-1), suggesting that the protein had a feature commonly to bind to the chemokine family. The middle part of chemokines, dispensable for interacting with their receptors, was found to be important for the adiponectin binding. Although the interaction of adiponectin to SDF-1 affected neither the SDF-1–CXCR4 binding nor the SDF-1 signaling in Jurkat cells, adiponectin and heparin mutually interfered in their association to SDF-1 and MCP-1 in vitro, implying that their association might influence the distribution of adiponectin and SDF-1 in inflammatory sites. Indeed, both adiponectin and SDF-1 was positively immunostained in vascular walls in guts from acute graft-vs-host disease patients. In addition, peripheral blood of adiponectin-deficient mice contained more hematopoietic progenitors than that of wild-type mice. Conclusion Adiponectin may be involved in regulation of inflammation via binding to specific chemokines. Additionally, the interaction possibly enables adiponectin to gather and play its role in inflammatory sites.

As a result of future advancements in image engineering and computer technology, digital radiographic systems and MDCT systems will continue to evolve, and it can be predicted that new diagnostic methods that utilize the advantages of digitalization in the radiological diagnosis of gastric carcinoma will also be developed. MDCT gastrography has little potential at present as a diagnostic method for the primary lesions of gastric carcinoma. However, with further advances in MDCT, higher-speed examinations, improved image quality, and optimization of exposure dose, it appears certain that MDCT gastrography will gradually replace radiography, endoscopy, and ultrasound endoscopy.

The purpose of this study was to characterize the thin-section computed tomography (CT) findings of primary and secondary pulmonary malignant melanoma and to correlate them with the histopathologic features.Patients were identified from a pathologic registration system database through a query for patients with diagnosed primary or secondary pulmonary melanoma who had undergone surgical resection. A total of 19 pulmonary malignant melanomas, including one primary and 18 secondary involvements, from 10 patients were enrolled into this study. The patients consisted of 3 men and 6 women, with a mean age of 55 years (range, 28 to 71 years). Thin-section CT findings evaluated by consensus between two radiologists were compared with the histopathologic specimens.Tumor size ranged from 4 to 62 mm (mean, 19 mm) on thin-section CT images. Four characteristic patterns including solitary or multiple solid nodule, endobronchial lesion, cavitary nodule, and nodule with ground-glass attenuation were disclosed by correlation between thin-section CT and pathologic findings. The most common thin-section CT finding was a solid nodule with a well-defined, smooth margin (n=14). Endobronchial lesions were seen in one primary and one secondary involvement (n=2). Less common CT findings were cavitary nodule (n=1) and nodule with ground-glass attenuation (n=1).Primary and secondary pulmonary malignant melanomas show various patterns of involvement on thin-section CT.

Pulmonary lymphangioleiomyomatosis (LAM) is a rare disease of unknown etiology that occurs almost exclusively in women of reproductive age. High-resolution computed tomography (HRCT) reveals the striking feature of diffuse cystic changes throughout the lung parenchyma. The correct diagnosis may be delayed by several years after the onset of symptoms because of the rarity of the disease and the need for chest CT scans to identify the lung involvement. We describe a case of pulmonary LAM in a male patient associated with tuberous sclerosis complex (TSC), in whom the early stage of disease could be depicted by chest HRCT scans.

Maffucci's syndrome is a rare sporadic congenital disorder associated with multiple enchondromas and soft tissue hemangiomas. These bone and soft tissue tumors have the potential of malignant transformation to various histologic types: chondrosarcoma, osteosarcoma, fibrosarcoma, and angiosarcoma. We report a rare case of Maffucci's syndrome with soft tissue angiosarcoma of the leg to illustrate MRI findings with pathologic correlations.

4Department of Radiology, Kobe University Graduate School of Medicine, Chuo-ku, Kobe 650-0017 Hyogo, Japan. typical polypoid adenomyoma (APA) is a rare polypoid tumor of the uterus composed of atypical endometrial glands surrounded by smooth muscle [1]. It generally occurs in women of reproductive age who have abnormal genital bleeding. Although it is considered to be benign, adenocarcinoma is occasionally found in resected specimens [2]. MRI findings have been reported in a few cases of APA [3]. However, to the best of our knowledge, the 18F-FDG PET appearance of APA has not been reported. Here we describe a case of APA identified on 18F-FDG PET combined with MRI in which malignancy could not be ruled out.

We report a case of extranodal Rosai-Dorfman disease (RDD) (sinus histiocytosis with massive lymphadenopathy) presenting with a solitary active lesion of the femur.

Immune cells show quick responses to infection. Many studies concerning cellular and humoral immunity have focused on the regulation of mature lymphocyte function. However, recent studies revealed that the early stage of hematopoiesis plays an important role in the immune system. In bone marrow, hematopoietic stem/ progenitors (HSPC) are targets of pathogen products and danger signals. After the exposure to Gram-negative lipopolysaccharide, the ligand of Toll-like receptor 4, hematopoietic stem cells enter cell-cycle and differentiate into myeloid lineage cells while B lymphopoiesis almost arrests. Little has been known how early T lymphopoiesis in thymus changes. Previously, we cloned signal-transducing adaptor protein-2 (STAP-2) as a c-fms/M-CSFR interacting protein, and found STAP-2 in T lymphocytes or macrophages is crucial for immune responses. The function of STAP-2 is generally recognized under inflammatory condition, interacting with a variety of signaling or transcriptional molecules. We reported that STAP-2 binds to STAT5 for regulation of T cell proliferation, and in macrophages, STAP-2 combines with MyD88 and IκB kinase to activate NF-κB and enhances the production of IL-6 and TNFα. In this study, the effects of STAP-2 on early T progenitors were evaluated using gene-modified mice. All experimental procedures were conducted under specific pathogen-free conditions, according to protocols approved by Institutional Animal Care and Use Committees of Osaka University. We first evaluated the expression level of STAP-2 in murine thymus with quantitative PCR. STAP-2 mRNA was ubiquitously observed all through T cell development, including the CD4- CD8- double-negative (DN) stage. To test the influences on T lymphopoiesis, we generated knock-out and transgenic mice (Tg) that are modified STAP-2 gene expression. In Tg mice, STAP-2 was overexpressed under the control of the Lck proximal promoter. The promoter could drive expression of the inserted cDNA in T lineage cells from the late of DN 2 stage (CD44+ CD25+). We found that thymus was significantly enlarged in Tg mice (46.7 ± 11.15 mg in WT vs 88.1 ± 25.2 mg in Tg), while the number of T lymphocytes in periphery was comparable to wild-type mice (WT). Results from flow cytometric analysis showed STAP-2 enhanced the percentages of DN2 and DN3 (CD44- CD25+) T progenitors, and the actual numbers of DN2, DN3, DN4 (CD44- CD25-) and CD4+ CD8+ double-positive subpopulations. There were no differences between control and knock-out mice in thymus and peripheral bloods. When Lin- Sca1+ cKitHigh HSPC derived from Tg mice were cultured with Delta-like 1-transduced OP9 stromal cells (OP9-DL1) under T cell generation condition, the development of DN4 cells was accelerated (26.9 ± 6.2 % in WT vs 35.2 ± 4.1 % in Tg). Co-cultures from Lin- CD44+ CD25- cKitHigh early T cell progenitors showed the same tendency. These results indicate that STAP-2 regulates the proliferation and differentiation of T progenitors during DN3 to DN4 stage. To elucidate the signaling regulated by STAP-2, microarray experiment with DN3 T progenitors was conducted. The bioinformative approach with Ingenuity Pathway Analysis showed the canonical pathways related with IL-12 signaling, 4-1BB (CD137) signaling and helper T cell differentiation were significantly influenced. Interestingly, we found that STAP-2 affected the distribution of functional T lymphocytes. The ratio of helper CD4+ cells to suppressor CD8+cells in peripheral bloods was lower in Tg mice than that in WT. In summary, we found that STAP-2 regulates the early T lymphopoiesis in thymus. DN2 to DN4 stages of T progenitors increased in STAP-2 transgenic mice, and STAP-2 promoted the differentiation in vitro. Moreover, STAP-2 affected the cell decision in development to helper CD4+ cells or suppressor CD8+ cells. Our study indicates the up-regulation of STAP-2 under inflammatory condition might be crucial for immune response at the early stage of T lymphopoiesis. Further study would clarify the precise molecular mechanisms of the enhancement of T lymphopoiesis by STAP-2. Disclosures No relevant conflicts of interest to declare.

Introduction; The PCR with patient-specific, allele-specific oligonucleotide primers for individual IgH VDJ regions (ASO-PCR) is considered the most sensitive method to detect minimal residual disease (MRD) levels in patients with multiple myeloma (MM). In this study, we quantified the ASO-PCR products by using peripheral blood mononuclear cells (PBMNCs) as well as bone marrow mononuclear cells (BMMNCs). We also quantified the ASO-PCR products in mRNAs from CD20+38- B-cells in BM to examine whether there are clonogenic cells in relatively earlier B-cell fraction as well as cell-free DNAs from the sera to examine whether there are DNA fragments from MM cells in PB. Materials and methods; We have analyzed 30 MM cases. After an informed consent, patient-oriented PCR primers were designed from sequence information of immunoglobulin heavy chain (IgH) variable regions of myeloma cells of each patient. Results; The median age in this cohort was 64.5 years (36-83); the ratio of men to women was 16:14; and the numbers of IgG-, IgA-, and Bence Jones protein (BJP)- type patients were 18, 7, and 5, respectively. The patient-specific ASO primers could be designed in 25 cases, but not in 3 BJP-type cases or 2 IgG-type cases. We could quantify the ASO-PCR products in 20 of 30 BMMNCs samples at diagnosis. The ASO-PCR levels (IgH/β−actin levels)in BMMNCs correlated with those in PBMNCs, but not to the percent of plasma cells in BM or the values for M-protein. However, the ASO-PCR levels were decreased after the treatment and reflected tumor burden well individually. The ASO-PCR levels in PBMNCs showed a statistically significant correlation with those in BMMNCs at diagnosis (Spearman’s ρ= 0.98, P Discussion; Our findings that we could quantify the ASO-PCR products in PBMNCs, BM CD20+CD38- B-cells, cell-free DNA as well as BMMNCs strongly suggest wide sources of clinical materials to analyze. There were statistically significant correlations in values of the ASO-PCR products between BMMNCs and PBMNCs, therefore suggesting the possibility that clonogenic plasma cells or myeloma precursor cells might circulate in peripheral blood. We expect the possibility that PBMNCs will be a good source to monitor MRD. We could also detect and quantify the ASO-PCR products in cell-free DNA from the sera. To the best of our knowledge, this is the first report that IgH DNA fragments from MM cells circulate in the sera. Furthermore, we could detect and quantify the ASO-PCR products in CD20+CD38- B-cells in BM at diagnosis. These results indicated that clonogenic MM cells could exist not only in the CD20-CD38high plasma cell fraction but also in the CD20+CD38- B-cell fraction, which might include myeloma stem or initiating cells. Thus, we could consider the treatment strategies to include anti-CD20 antibodies against the clonogenic CD20+CD38- B-cell population. In conclusion, our ASO-PCR using various clinical materials is supposed to be useful for detecting MRD in the patients with MM as well as for clarifying the pathogenesis of MM. Disclosures Sata: Celgen: Research Funding; Takeda: Research Funding; Janssen: Research Funding. Shibayama:Celgen: Research Funding; Takeda: Research Funding; Janssen: Research Funding. Habuchi:Celgen: Research Funding; Takeda: Research Funding; Janssen: Research Funding. Fukushima:Celgen: Research Funding; Takeda: Research Funding; Janssen: Research Funding. Fujita:Celgen: Research Funding; Takeda: Research Funding; Janssen: Research Funding. Ezoe:Celgen: Research Funding; Takeda: Research Funding; Janssen: Research Funding. Tadokoro:Celgen: Research Funding; Takeda: Research Funding; Janssen: Research Funding. Maeda:Celgen: Research Funding; Takeda: Research Funding; Janssen: Research Funding. Mizuki:Celgen: Research Funding; Takeda: Research Funding; Janssen: Research Funding. Oritani:Celgen: Research Funding; Takeda: Research Funding; Janssen: Research Funding. Kanakura:Janssen: Research Funding; Takeda: Research Funding; Celgen: Research Funding.

A 69-year-old woman was referred to our hospital due to a liver tumor that was incidentally noted on ultrasound (US). US revealed a pedunculated mass of 5 cm in diameter, with a heterogeneous echo pattern. On arterial phase dynamic contrast-enhanced computed tomography (CT), a tiny enhancing dot in the upper aspect of the mass was seen; whereas, the main portion of the lesion appeared as hypoattenuating. The tumor was of low intensity on T1-weighted magnetic resonance (MR) images, and showed slightly heterogeneous high intensity on T2-weighted MR images. The most characteristic feature of the tumor was its exophytic appearance. On post-gadolinium hepatic arterial dominant-phase MR images, the tumor showed nodular enhancement centrally, with progressive spread of enhancement on later images. Angiography showed dilatation of the right posterior inferior branch of the hepatic artery and C-shaped opacification. Since we could not rule out malignancy for these nonspecific radiologic findings, a partial resection of the liver was carried out, resulting in a pathological diagnosis of hepatic hemangioma. This hemangioma had marked hyalinization and fibrosis, causing a heterogeneous appearance on MR images. The tumor presented an exophytic appearance, which caused some diagnostic confusion.

Purpose: To compare the performance of the phased-array coil (PAC) with that of the single-loop coil (SLC) in magnetic resonance (MR) imaging of the breast. Materials and Methods: MR imaging was performed with a 1.5T MR imager. A phantom study was performed with the right element of the two coils to obtain their signal-to-noise ratio (SNR). MR images of the breasts of 12 patients with breast lesions were obtained with the PAC and SLC, and these images were reviewed by five readers in a blind evaluation employing a scoring system for assessing overall image quality. Results: In the phantom study, the SLC exhibited a SNR 1.82 times higher than that of the PAC at the center of the coil; however, the SLC exhibited an inhomogeneous sensitivity profile and its SNR varied with the distance from the center of the coil in the horizontal and vertical directions. In most of the 12 patients, the MR images obtained with the PAC showed more noise than did those obtained with the SLC, and the PAC obtained lower scores than the SLC in the assessment of overall image quality; however, the difference was significant (p

We present two cases of sclerosing perineurioma, a rare soft tissue tumor, in the palm and the ring finger respectively, presenting as a small, painless and subcutaneous mass. This tumor has a predilection for the digits and palms of young, predominantly male adults. In the present cases the tumors showed very low signal intensity on T2-weighted magnetic resonance (MR) images. Histologically they contained abundant collagen and hyalinized stroma, which would account for areas of low signal intensity on T2-weighted MR images. Immunohistochemically, the tumor cells were positive for vimentin, epithelial membrane antigen and human erythrocyte glucose transporter 1 and negative for S-100 protein. To the best of our knowledge, the appearance of sclerosing perineurioma on MR imaging has not been previously reported in the English-language literature. Sclerosing perineurioma should be considered in the differential diagnosis of hand tumors when the tumor shows low signal intensity on T2-weighted MR images.

A 65-year-old man was referred to our hospital because of weight loss. Endoscopic examination and computed tomography (CT) revealed an advanced gastric cancer with multiple abdominal lymph node swellings. Distal partial gastrectomy was performed but lymph node resection was not done, since it was not thought to be curative. Adjuvant chemotherapy was performed for 4 courses with a regimen of ADM 20 mg/m2 day 1, CDDP 50 mg/m2 day 1, ETP 100 mg/day days 3-7, 5-FU 600 mg/m2 every other day on days 3-29. After 3 courses of ACVF therapy, the patient's serum CEA and SCC level normalized and the lymph node metastases became undetectable by CT scan. No severe side effects were observed at any time during the administration of these medications. In this case, serum SCC level was elevated even though histologic examination did not reveal squamous cell carcinoma but poorly differentiated adenocarcinoma. On immunohistochemical analysis, these tissues were stained diffusely with CEA, locally with AE1 + 3, and partially with PAS or Alcian blue. We speculate that this tumor could have developed the potency of SCC secretions without structural change into squamous metaplasia.

We report a rare case of a young woman with cystic craniopharyngioma who developed not only aseptic chemical meningitis as an initial sign but also aseptic localized peritonitis which was confirmed by the presence of ascites.