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Matching the diameter of the deep inferior epigastric artery (DIEA) and perforating branch (PB) of the internal thoracic artery (ITA) is important for arterial anastomosis during breast reconstruction using the DIEA flap. An anatomic investigation of these arteries was performed using multidetector row computed tomography (MDCT).Contrast-enhanced MDCT data of 50 women (aged 18-90 years) covering the neck to the groin were analyzed. The diameter of the PBs of the ITA at their origins from the first to the sixth intercostal space and of the DIEA 20 mm from the bifurcation of the external iliac artery were measured.The mean diameters of the right and left DIEAs were 1.53 ± 0.263 mm and 1.53 ± 0.306 mm, respectively. The diameter of the PBs in the second and third intercoastal spaces was the same as the diameter of the DIEA, bilaterally.It is suggested that anastomosis of the DIEA with PBs of the ITA in the second and third intercoastal spaces is optimal for DIEA flap grafting. Our results could contribute to making vascular anastomosis easier, thereby reducing the burden on both surgeons and patients.

Background The effectiveness of facial massage is often explained by the resulting increases in the blood and lymphatic flow. However, it is difficult to explain the lifting effect on the cheeks. The aim of this study was to analyze facial mobility to further current understanding of the effectiveness of facial massage. Materials and methods Two kinds of analytical methods were designed using a cadaveric head as well as advanced computed tomography (CT). The cadaveric face was divided into three sections, and three different colors of ink were injected into each section. It was kept in a supine position for 24 hours, and the ink distribution was observed. Upright and supine CT examinations were performed on six healthy adult volunteers. The images of both were superimposed by a three-dimensional image analysis system, and changes in facial contours were analyzed. Results The three colors of ink spread craniocaudally and were distributed differently from the gravitational vector. When both CT images were superimposed, two distinct lines were formed, which represented overlapping of the facial contours due to the two different CT images. These lines were found to correspond to the border of each color of the ink. Conclusion Focusing on the mobility of the face, the soft tissue of the face had vertical mobility, and it was speculated that this mobility is involved in the effectiveness of facial massage. Our results could provide useful information for cosmetic treatment and contribute to the collection of scientific knowledge for anti-aging medicine.

Background The superficial musculoaponeurotic system (SMAS) is an important structure to understand for face-lift surgeries. However, the detailed distribution and imaging findings of the SMAS have not been established yet. Objectives The aim of this study was to establish the accurate distribution and computed tomography (CT) imaging findings of the SMAS based on cadaveric studies. Methods This study was designed in a 3-step procedure. First, 7 cadaver faces were utilized to understand the distribution and histology of the SMAS. Second, the SMAS findings from the cadaveric studies were compared with the CT images. Third, CT images were enrolled for the SMAS interpretation. Results In 7 cadaveric studies, the SMAS was observed as a subcutaneous fibro-membranous structure extending from the galea aponeurotica to the platysma muscle and laterally connected to the parotid fascia. On the medial side, it also connects with major and minor zygomatic muscles. The SMAS consisted of muscular fibers, collagen fibers, and elastic fibers histologically. Eighteen CT images (all females; age range, 21-82 years) showed the thin linear structures corresponding to the fibro-membranous structures in the cadaveric studies. CT density of the SMAS was similar with that of the muscle, and the SMAS was recognizable in all 18 subjects. Conclusions The SMAS is a definite anatomical structure that can be demonstrated as a thin membranous structure on CT. This clinical application could be applicable to the development the cosmetic surgical procedures.

Background There are few reports on the relationship between facial expression formation and mass of the muscle responsible for facial expression. We analyzed the facial expression using facial action coding system (FACS) and examined the muscle mass and characteristics of the facial expression muscles using multi-detector row computed tomography (MDCT) and magnetic resonance imaging (MRI). Moreover, the relation between these was statistically evaluated. Materials and methods Ten healthy women in their 40s (43.4 ± 3.0 years, 40-49) were enrolled. The expressive faces were analyzed by facial expression analysis software based on the FACS. The muscle mass and characteristics of the facial expression muscles were investigated using MDCT/MRI. The correlation between an integrated expression intensity value (IEIV) for FACS of the widest possible grin and muscle mass was analyzed. The mean values between the two categorized groups (G-1 and G-2) based on fat infiltration into the muscle were compared. Results A positive correlation is found between the IEIV and the muscle mass. The IEIV of G-1 is significantly larger than the corresponding value of G-2. Hence, the results indicated that the subjects with high IEIV and expressive face had thicker facial expression muscles and little fat infiltration into the muscles. Conclusion Our objective imaging diagnostic study using FACS, MDCT, and MRI corroborated the anti-aging medical science about the facial expression muscles related to youthful facial appearance. The results of this research could contribute to the elucidation of the mechanisms involved in the facial aging process and to the development of cosmetology.

Facial massage is empirically known to be associated with morphological changes, such as improvements in facial sagging. However, quantified objective evaluations of massage-induced changes have not been performed to date. This preliminary pilot study aimed to verify the effectiveness of facial massages by using breakthrough computed tomographic technology.Five healthy adult volunteers (three women and two men; age, 29-37 years) were enrolled, and computed tomography (CT) examinations using a 320 detectors-spiral CT system known as 320-multidetector-row CT (MDCT) were performed before and after facial massages. Each participant performed a self-massage twice daily for 2 weeks. Massage-induced changes in the cheeks and the superficial musculoaponeurotic system (SMAS) were analyzed by two radiologists on a workstation with a high-accuracy imaging analysis system.After facial massage, the malar top became thinner by -0.8% ± 0.45% and shifted cranially and horizontally over a distance of 3.9 ± 1.94 mm. The SMAS-height, defined as the highest vertical distance of the SMAS, increased by 2.6% ± 2.6%. The change rate in cheek thickness and SMAS-height showed a significant correlation (r = -0.63; P 0.05). These changes were attributed to the lifting and tightening effects of facial massage.We conducted a detailed analysis of the effects of facial massages by using the breakthrough CT technology. Our results provide useful information for beauty treatments and could contribute to the collection of objective scientific evidence for facial massages.

We developed software for three-dimensional (3D) facial approximation from the skull based on computed tomography (CT) scans of the head obtained from 59 Japanese adult volunteers (40 males, 19 females). CT scanning was performed while participants raised their head in an upright position while in a prone body posture. The positional relationships between the skull and head surface shape were analyzed by creating anatomically homologous shape models. Before modeling, skull shapes were simplified by concealing hollow structures of the skull using in-house software. Surficial tissue thickness (STT), represented by the distances between corresponding vertices of the simplified skull and head surface, was calculated for each individual, and averaged for each sex. Although the approximate head shapes of known individuals showed a relatively good resemblance in both the shape of the whole head and facial parts, some errors were identified, particularly in areas with thick surficial tissue. The results revealed sexual dimorphism of STT, with males exhibiting thinner surficial tissue at the cheek, and thicker tissue at the glabella, nose, mouth, and chin. Moreover, we created referential models for craniofacial superimposition from average models of the skull and head surface shape for each sex.

The orbicularis oculi muscle, an important mimetic muscle, was investigated to ascertain its anatomical relation to facial aging-especially its orbital part (Oo). Previous studies of the distinct muscle bundles frequently found inferior to the Oo have provided various definitions, including that of the malaris muscle. This study aimed to examine these muscle bundles and clarify their function in facial aging. Twelve heads of Japanese cadavers (average age: 82.5 years old) were dissected to observe the muscles, focusing in particular on those in the periorbital region. Six specimens were further dissected from the inner surfaces to examine the patterns of facial nerve branches under the operating microscope. Histological examinations of two head halves were carried out to investigate the relationship between the muscle bundles and the intraorbital structures. Muscle bundles consisting of lateral, medial, and U-shaped suspending bundles were observed in the region inferior to the Oo. Lateral and suspending bundles were found in all specimens, while the medial bundles were noted in only 9 of 22 specimens. Some branches of the facial nerve penetrated through the lateral, medial, and suspending bundles. The relationship between the suspending bundles and the protruding orbital fat was assessed. The muscle bundles found in this study were regarded as the malaris muscle-a transitional muscle between the superficial and deep facial layers. The suspending bundle may play a role in sustaining the intraorbital structures.

OBJECTIVE The aim of this study was to compare the diagnostic precision of bone scintigraphy with BONENAVI version 1 and BONENAVI version 2 in bone metastasis of primary breast cancer. METHODS The subjects were 56 consecutive patients (all women, mean age 59 ± 12.7 years) who underwent bone scintigraphy with Tc-MDP and were diagnosed with bone metastasis of primary breast cancer from January 2012 to November 2014. Bone scintigraphy was performed with BONENAVI version 1 and BONENAVI version 2 to calculate artificial neural network (ANN), bone scan index (BSI), and hot-spot values, with ANN ≥ 0.5 considered to reflect bone metastasis for the calculation of sensitivity. Mean ANN, BSI, hot-spot values, and sensitivity were compared between BONENAVI version 1 and BONENAVI version 2, with P < 0.05 considered a significant difference. RESULTS With BONENAVI version 1, mean ANN was 0.73 ± 0.29, BSI was 1.47 ± 1.85, the hot-spot value was 12.4 ± 12.5, and sensitivity was 76.8% (43/56). With BONENAVI version 2, the mean ANN was 0.86 ± 0.19, BSI was 1.53 ± 2.09, hot-spot value was 12.9 ± 15.6, and sensitivity was 94.6% (53/56). BONENAVI version 2 yielded significantly better ANN and sensitivity than BONENAVI version 1 (both P < 0.01). CONCLUSION BONENAVI version 2 has improved sensitivity for detecting bone metastasis of primary breast cancer compared to BONENAVI version 1.

BACKGROUND The superficial musculoaponeurotic system (SMAS) is an anatomical structure involved in the facial ageing process. We aimed to evaluate the SMAS laxity using multi-detector row computed tomography (MDCT) as a diagnostic tool, and to analyse the relationship between SMAS laxity and age. METHODS Fifty-seven female subjects (aged 21-57 years) were enrolled in the study. The subjects were divided into two age groups: one below the mean age (Group Y, 30 subjects) and one over it (Group O, 27 subjects). The Posture Change (PC)-induced SMAS Laxity Index was measured using reconstructed CT images, and the relationship between the PC-induced SMAS Laxity Index and age was analysed. RESULTS The PC-induced SMAS Laxity Index was significantly larger in Group O than in Group Y. As well, a strong and significant positive correlation was detected between the PC-induced SMAS Laxity Index and age (r = 0.72; P

Bone scan index (BSI) has been used to quantify the spread of bone metastasis and be a prognostic indicator in prostate cancer with bone metastases. However, the utility of BSI in breast cancer patients with bone metastasis has not been yet established. We retrospectively reviewed 57 female breast cancer patients with osteoblastic/lytic combined type bone metastases and treated with zoledronic acid after bone metastasis was identified. Serial bone scintigrams were taken at the time of bone metastasis detection and during the 6- and 12-month follow-ups. The scintigrams were analyzed by BONE NAVITM version 1 and the BSI value was calculated. Additionally, serum cancer antigen 15-3 (CA15-3) and carcinoembryonic antigen (CEA) were measured. The patients were divided in 2 distinct groups—group A representing all follow-up BSI values ≤ initial BSI values and group B representing all follow-up BSI values ≥ initial BSI values. The interval changes of CA15-3 and CEA were divided in the same fashion. Kaplan-Meier method and log-rank test revealed that the overall survival rate was significantly greater in group A than those of group B after 6 months (p = 0.011) and 12 months (p = 0.016). Univariate analysis revealed that the overall survival rate was significantly greater in group A than those of group B, after a 6 month period (Hazard Ratio [HR] 5.841; 95% confidence interval [CI] 1.248 - 27.34; p = 0.025) and 12 month period (HR: 4.22; 95% CI 1.17615.15; p = 0.027). Multivariate analysis demonstrated that BSI changes after 6 and 12 months trended toward significance regarding parameters affecting survival rate (age and CA15-3) with a HR = 12.760 (95%CI 1.8110 - 89.850) at 6 months with a p = 0.010 and a HR = 5.0640 (95%CI 1.0590 - 24.220) at 12 months with a p = 0.042. BSI changes after 6 and 12 months appear to be a prognostic factor in breast cancer patients with bone metastasis treated with zoledronic acid.

The aim of this study was to compare thoracic duct (TD) configuration depicted by magnetic resonance imaging (MRI) with TD configuration described in the anatomical literature.MRI Scans were acquired with a three-dimensional T2-weighted turbo spin echo (TSE) MRI with a two-dimensional prospective acquisition correction (PACE) technique in 63 patients. We found with MRI that TD displacement occurred more on the left side than that reported in the anatomical literature, and this tendency was more marked in elderly patients. In patients with marked leftward TD displacement, the TD configuration on MRI was compared to the descending aortic configuration on chest radiography. The degree of correspondence between the MRI findings and the anatomical literature was assessed by a χ(2) goodness-of-fit test, and P0.05 indicated a significant difference. The degree of similarity was determined between TD configuration and aortic configuration by Kendall's coefficient of concordance (W).On MRI scans the TD was often located to the left of the mid-vertebral line compared to the location reported in the anatomical literature (P0.001). Nine patients had marked leftward TD displacement, a configuration similar to that of the descending aorta (W = 1); however, no association with age was established.The TD configuration depicted by MRI differed from that described in the anatomical literature.

The various nonionic iodinated contrast media used in contrast computed tomography (CT) studies differ in terms of their composition, characteristics, and iodine concentration (mgI/ml), as well as the volume injected (ml). Compared with ionic iodinated contrast media, nonionic iodinated contrast media are low-osmolar agents, with different agents having different osmotic pressures. Using a custom-made phantom incorporating a semipermeable membrane, the osmotic flow rate (HU/s) could easily be measured based on the observed increase in CT numbers, and the relationship between the osmotic pressure and the osmotic flow rate could be obtained (r(2)=0.84). In addition, taking the effects of patient size into consideration, the levels of contrast enhancement in the abdominal aorta (AA) and inferior vena cava (IVC) were compared among four types of CT contrast medium. The results showed differences in contrast enhancement in the IVC during the equilibrium phase depending on the type of contrast medium used. It was found that the factors responsible for the differences observed in enhancement in the IVC were the osmotic flow rate and the volume of the blood flow pathways in the circulatory system. It is therefore considered that the reproducibility of contrast enhancement is likely to be reduced in the examination of parenchymal organs, in which scanning must be performed during the equilibrium phase, even if the amount of iodine injected per unit body weight (mgI/kg) is maintained at a specified level.

The tracheobronchial structures were evaluated by multidetector-row computed tomography (MDCT), which provided imaging information for one-lung anesthesia during thoracic surgery. The subjects consisted of 100 patients. Three-dimensional (3D) images of the tracheobronchial structures and the bronchial tubes were created. Individual differences were found in the tracheobronchial structures in 100 patients. The length and the diameter of the right main bronchus were measured with 3D images and were not related to the patient’s physical appearance, such as body height. Problematic intubation cases included a short right main bronchus

Destructive spondyloarthropathy (DSA) is the most serious spinal complication of dialysis-related amyloidosis in patients on long-term hemodialysis (HD), but we could not find any information about DSA in patients on peritoneal dialysis (PD) for over 10 years. We retrospectively evaluated factors contributing to DSA in HD and PD patients. Sixty-seven patients on dialysis for 10 to 19 years were compared between a PD group (n = 23) or a HD group (n = 44). In the PD group, nine patients (39%) developed DSA. The mean age of DSA patients was significantly higher than that of non-DSA patients (66.2 ± 10.0 vs. 51.0 ± 12.8 years, P = 0.03). The frequency of cervical spine DSA did not show any difference between the PD and HD groups, but the frequency of lumbar spine DSA showed a significant difference (22% vs. 5%, P = 0.04). The serum beta-2 microglobulin (B2MG) level was significantly higher in PD patients than in HD patients (38.4 mg/L vs. 27.4 mg/L, P = 0.0025). Mechanical stress such as elevation of the intra-abdominal pressure due to infusion of PD fluid (1500 mL to 2000 mL) for over 10 years might contribute to lumbar DSA in patients on long-term PD.

Cyst infection and cyst hemorrhage are frequent and serious complications of autosomal dominant polycystic kidney disease (ADPKD), often being difficult to diagnose and treat. The first objective of this study is to clarify the clinical features of ADPKD patients with cyst hemorrhage or infection. The second objective is to establish diagnostic criteria for ADPKD patients with cyst infection or cyst hemorrhage.Patients with definite cyst infection or hemorrhage were enrolled from among the ADPKD patients referred to us between January 2004 and October 2011. We investigated their symptoms, laboratory data, and the computed tomography (CT)/magnetic resonance imaging (MRI) features of infected cysts (before and after onset), normal cysts, and cysts with hemorrhage.There were 24 patients with cyst infection (36 infected cysts) and 12 patients with acute cyst hemorrhage (13 bleeding cysts). White blood cell (WBC) count10,000/μl, serum C-reactive protein (CRP)15.0 mg/dl, and body temperature38 °C strongly suggested cyst infection. All of the cysts with hemorrhage contained a high-density mass-like area or showed overall high density on CT, and all patients with cyst hemorrhage had abdominal pain or gross hematuria. On the other hand, infected cysts showed an increase of intensity on MRI [diffusion-weighted imaging (DWI)], while a fluid-fluid level, wall thickening, and gas were also evidence of infection. Abdominal pain and/or sequential changes on MRI after onset of symptoms were useful for localizing infected cysts.Acute cyst hemorrhage and infection can be identified from symptoms, laboratory data, and CT/MRI findings.

Summary Objectives Primary lymphoedema is said to be caused by lymph duct malformations, lymphatic hypoplasia or lymphatic agenesis, but no definite treatment has been established. In this study, we used magnetic resonance thoracic ductography (MRTD) to assess the morphology of the thoracic duct in patients with primary lymphoedema. Methods The study was conducted on nine patients with primary lymphoedema who were hospitalised at the Department of Plastic and Reconstructive Surgery (University of Tokyo Hospital) from September 2007 through April 2011. Results The patients consisted of five men and four women, aged 20–54 years (mean age: 31.1 years). Five of them were in early-onset group and the rest were in late-onset group. In the 6 months prior to the onset of oedema, three of the four patients in the late-onset group had episodes of trauma near the areas which would later be affected by lymphoedema. MRTD showed no clear image of the thoracic duct in four of five patients in the early-onset group. Conclusions MRTD assessment of patients diagnosed as ‘primary lymphoedema' indicates that the pathogenetic mechanisms seen in late-onset patients are completely different from those found in early-onset patients, and may be classified as ‘traumatic lymphoedema.'

A 65-year-old woman visited the emergency department due to severe right lower quadrant pain of sudden onset after intense coughing due to bronchitis. She had been receiving haemodialysis for glomerulonephritis for 25 years. Physical examination revealed severe and rebound tenderness on the right lower quadrant area. Complete blood count revealed a white cell count of 4700/μl, haemoglobin level 9.0 g/dl, platelets 14.8×104/μl, C reactive protein 0.3 mg/dl, prothrombin time 12 s and partial thromboplastin …

Parathyroid glands arise from the third and fourth pharyngeal pouches. Parathyroid lesions sometimes develop ectopically. The aim of this article is to illustrate the knowledge of pharyngeal apparatus development to assist with diagnostic localization of ectopic parathyroid lesions. We retrospectively reviewed charts of 23 patients who received a diagnosis of ectopic parathyroid lesions. The ectopic lesions were widely distributed; cranially lesions were located on the carotid bifurcation, caudally in the right paraaortic region, ventrally on the surface of the sternohyoid muscle, and dorsally in the paraesophageal region. In most cases, parathyroid tissues were associated with structures related to the third or fourth pharyngeal pouches that traveled to regions where the ectopic lesions ultimately developed. In a few cases, lesions were not associated with these pouches and might have developed from parathyroid tissue that migrated due to an anomalous pathway of parathyroid travel. When patients present without entopic lesions, the presence of ectopic lesions should be evaluated based on an understanding of the developmental mechanisms of parathyroid glands and the frequency with which ectopic lesions have been found in specific locations. Systematic diagnosis can minimize the frequency with which ectopic lesions are missed during clinical care and maximize their accurate localization.

Here we describe a 65-year-old Japanese man with chronic renal failure (CRF) and a large, dense, calcified abdominal mass. The patient had a history of proteinuria, which was diagnosed as focal glomerulosclerosis. This diagnosis was confirmed by renal biopsy in 2002, with worsening renal function by July 2005 when a large area of calcification was detected on abdominal radiography, which further increased in size on follow-up radiography in December 2006. The calcified mass was surgically resected and histopathologically diagnosed as myxoid-type liposarcoma composed of dedifferentiated, myxoid, and well-differentiated components with areas of osseous metaplasia. Soft tissue calcifications and ossifications are often benign, but malignant tumors should be considered when the calcified mass is retroperitoneal, occurs in a patient with no history of chronic infection, and is not located near a large joint or associated with administration of calcium carbonate or a vitamin D derivative.

A case of a fibroadenoma coexisting with an invasive lobular carcinoma of the breast in a 60-year-old female is presented, and its pathological features are correlated with high-resolution magnetic resonance imaging (HR-MRI) and other imaging findings. The patient presented with the chief complaint of having a palpable mass in her right breast for 3 months. Mammography revealed a lobular mass with a micro-lobulated margin, which suggested a malignant nature; however, it included coarse calcifications. Sonographic imaging and HR-MRI findings were compatible with malignant tumor. Cytology was performed, and the results indicated an invasive carcinoma. Breast-conserving surgery was performed as a curative operation. The pathological features revealed a fibroadenoma coexisting with an invasive lobular carcinoma. This case suggests that radiologists should always pay attention to the associated malignant imaging characteristics, such as the shape and border of the mass, whenever a mass demonstrates benign-like calcifications.

We present an adult patient with a massive mucinous cystadenoma of the appendix that induced intussusception. Multiplanar reconstruction images and maximum intensity projection images enabled us to assess the tumor accurately and characterize the intussusception. Thus, reconstructed computed tomographic images proved highly useful for diagnosis.

We present the case of a 58-year-old Japanese woman with a huge amyloid tumor in the genital region. Hemodialysis therapy was started for renal failure secondary to polycystic kidney disease in 1974. From 1989 to 1991, carpal tunnel decompression was performed surgically, and beta(2)-microglobulin (beta2MG)-amyloid deposition was found in the wrists. She was hospitalized at our institute for evaluation of lower-abdominal fullness and lower-extremity edema in March 2003. Magnetic resonance imaging showed a huge mass measuring 9.0 x 6.0 x 5.0 cm sandwiched between the vagina and rectum. The mass was hypointense compared with adjacent muscle on T2-weighted images. Computed tomography showed soft-tissue density accompanied by diffuse calcification. A biopsy specimen of the mass obtained by using a transvaginal approach showed material that was positive for beta2MG-amyloid immunohistologically. When patients on long-term dialysis therapy develop a genital mass with low-signal intensity on T2-weighted images by magnetic resonance imaging and diffuse calcification by computed tomography, beta2MG-amyloidoma should be considered as a differential diagnosis.

One-lung anesthesia is a method of anesthesia performed by inserting the tip of a bronchial tube into either the right main bronchus or the left main bronchus. The right bronchial tube is a special structure. Since the distance of the carina to the right upper lobe bronchus is short, a side hole is made to prevent blockading of the right upper lobe bronchus, and the cuff is attached aslant to it. When inserting a bronchial tube into the right main bronchus, care is required to prevent the occurrence of atelectasis though a gap in the bronchial tube. We evaluated the structure of a trachea and a bronchus using the multidetector-row computed tomography (MD CT), and tried to select the right bronchial tube most suitable for each structure. There are individual differences in the structure of a trachea and a bronchus. By creating a 3-dimensional image of a trachea and a bronchus, the structure could be easily grasped, and therefore selection of the most appropriate bronchial tube according to the structure was possible.

The staging diagnosis of esophageal carcinoma is important to determine therapeutic modalities and to predict prognosis. The current status of imaging diagnosis of tumor invasion to the adjacent organs and lymph node metastasis is described. The diagnostic criteria used to determine tumor invasion to the adjacent or gans by computed tomography (CT) and magnetic resonance imaging(MRI) are displacement and compression deformity of the tracheobronchial tree and obliteration of the periaortic fat plane over more than 90 degrees of the aortic circumference. Detection of the fat plane between the esophagus and the aorta supported by density profile analyzing software on CT may enable the diagnosis of invasion. Cine-MRI imaging is also useful to obtain dynamic information on the tumor and aorta. Tumor invasion to the aortic wall can be excluded when a low-intensity stripe is recognized between the tumor and the aortic wall. Although the criterion for lymph node metastasis on CT is 10 mm or more in long transverse diameter, the diagnostic accuracy is poor. The accuracy improves when imaging patterns such as heterogeneous internal structures in the enhanced lymph nodes and/or hyperenhancement in the lymph nodes in the early phase by dynamic study are added to the diagnostic criteria. However, small metastatic lymph node remain undetected and it is difficult to diagnose negative lymph node metastasis properly on CT and MRI. It is important to have full knowledge of the advantages and limitations of each imaging modality and to obtain objective information form them.

HTLV-I carriers or patients with HTLV-I associated myelopathy (HAM) are prone to immune-mediated inflammatory disorders. We present a 44-year-old female with HAM who developed Graves' disease. She developed severe Graves' ophthalmopathy shortly after 131I therapy, concurrently with a remarkable increase in TSH-receptor antibody titer. Ophthalmopathy was aggravated in spite of prednisolone therapy and euthyroidism being maintained by thyroxine replacement. Uveitis also developed after 131I therapy and iridocyclitis finally required trabeculotomy. This case suggests that HAM patients may have a higher risk of immune-mediated Graves' ophthalmopathy after 131I therapy.(Internal Medicine 33: 564-568, 1994)

Background Baggy eyelids, formed by intraorbital fat herniation in the lower eyelids, are a sign of aging observed in the midface. This study aimed to identify the cause of baggy eyelids by evaluating the relationship between orbicularis oculi muscle thickness, orbital fat prolapse length, and age using multidetector row computed tomography (MDCT). Methods The 34 patients in the study ranged in age from 20 to 79 years. The patients were divided into three age groups: 20–29 years, 30–54 years, and 55–79 years. Orbicularis oculi muscle thickness and orbital fat prolapse length were measured using reconstructed computed tomography (CT) images. Results The orbicularis oculi muscle was found to be significantly thinner in the oldest group. Likewise, orbital fat prolapse was found to be significantly more prominent in the oldest group. A strong and significant negative correlation was found between orbicularis oculi muscle thickness and orbital fat prolapse length (r = −0.78; P

The effect of rhubarb extract on the urinary constituents was examined in rats with chronic renal failure induced by adenine. Orally administered rhubarb extract caused a significant decrease in the urinary excretion of urea. The amount of urinary Na, K, and Ca was significantly reduced in the rhubarb extract-treated rats, while urinary inorganic phosphate was significantly elevated. A polyuria-preventive effect was observed. However, there was no marked change in the amount of urinary creatinine throughout the experimental period. The mechanism of uremia-improving action of rhubarb extract is discussed on the basis of the present results and the previously reported data [Chem. Pharm. Bull., 32, 4506 (1984)].

Background The purpose of this study was to investigate the usefulness of intracystic MRI features for detection of severe cyst infection that is usually refractory to antibiotic therapy alone in patients with autosomal dominant polycystic kidney disease. Methods Seventy-six patients (88 episodes) with positive cyst cultures treated from January 2006 to December 2013 were enrolled as the cases for this case–control study, while 147 patients who continued to attend our hospital from January 2011 to December 2013 and did not have cyst infection diagnosed during that period were enrolled as the controls. Intracystic MRI findings were investigated. Results At least one of four intracystic MRI features (high signal intensity (SI) on diffusion-weighted images (DWI), fluid-fluid level, wall thickening, or gas) was found in all of the cases, but such findings were also detected in some controls. Intracystic gas was specific for cyst infection, but its sensitivity was only 1.1 %. A high intracystic SI on DWI showed a sensitivity of 86.4 %, but its specificity was lower at 33.3 %. Both the specificity and sensitivity of a fluid-fluid level or wall thickening were about 80 %. However, the specificity of these MRI features decreased as total liver and kidney volume (TLKV) increased, falling to 65.8 % in patients with organomegaly (TLKV > 8500 cm3). A cyst diameter > 5 cm was useful for detecting severely infected cysts that needed drainage, and specificity was increased by combining the other four MRI findings with a cyst diameter > 5 cm. Conclusions MRI with DWI was useful for detecting severe cyst infection in ADPKD. While the specificity of MRI alone was not high enough in patients with organomegaly, combining the four MRI features with abdominal pain, sequential MRI changes, or cyst diameter > 5 cm improved detection of severely infected cysts in these patients. Electronic supplementary material The online version of this article (doi:10.1186/s12882-016-0381-9) contains supplementary material, which is available to authorized users.