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Background Chest radiography (CR) is employed as the evaluation of pneumoconiosis; however, we sometimes encounter cases in which computed tomography (CT) is more effective in detecting subtle pathological changes or cases in which CR yields false-positive results. Purpose To compare CR to CT in the diagnosis of early-stage pneumoconiosis. Material and Methods CR and CT were performed for 132 workers with an occupational history of mining. We excluded 23 cases of arc-welder’s lung. Five readers who were experienced chest radiologists or pulmonologists independently graded the pulmonary small opacities on CR of the remaining 109 cases. We then excluded 37 cases in which the CT data were not sufficient for grading. CT images of the remaining 72 cases were graded by the five readers. We also assessed the degree of pulmonary emphysema in those cases. Results The grade of profusion on CR (CR score) of all five readers was identical in only 5 of 109 cases (4.6%). The CR score coincided with that on CT in 40 of 72 cases (56%). The CT score was higher than that on CR in 13 cases (18%). On the other hand, the CT score was lower than that on CR in 19 cases (26%). The incidence of pulmonary emphysema was significantly higher in patients whose CR score was higher than their CT score. Conclusion CT is more sensitive than CR in the evaluation of early-stage pneumoconiosis. In cases with emphysema, the CR score tends to be higher in comparison to that on CT.

This article was migrated. The article was not marked as recommended. Background: There has been an increasing number of articles that have studied the topic of medical professionalism. The aims of this study were to develop a scale of medical professionalism. Methods: The concepts of medical professionalism as defined by associations and groups of physicians, nurses and physiotherapists were investigated. The surveys using self-administered questionnaires were conducted on students and junior residents. An exploratory factor analysis, calculation of the coefficient alpha, and correlation coefficients with other scales were performed. Results:A factor analysis resulted in the extraction of 30 items in 7 factors as items of the Level 1 scale for pre-clinical level students. The correlation coefficients between the scores for the 7 factors and KiSS-18 were in the range of 0.23 - 0.76. The coefficient alpha of all 30 items was 0.90. A factor analysis resulted in the extraction of 31 items in 8 factors from the Level 2 scale for students at the time of graduation. The correlation coefficient between the scores for the 8 factor and "Reflective skills" of the P-MEX was 0.31 - 0.59. The coefficient alpha for all 30 items was 0.93. Conclusion: Construct validity, criterion-related validity and reliability were generally confirmed for the two scales.

漢方治療をおこなって著効を得た脂漏性皮膚炎の5症例を経験した。うち3例は1ないし2年前から，顔面に皮疹がみられ，ステロイド剤やケトコナゾール外用剤による治療をうけていたが効果なく，十味敗毒湯により数カ月でほぼ完治した。他の2例はそれぞれ10年と25年前から被髪頭部に皮疹が続いていたが，荊芥連翹湯，麻杏よく甘湯，抑肝散加陳皮半夏の合方で，それぞれ2カ月後と8カ月後に著しく改善した。

Adenoid cystic carcinoma arising from the peripheral lung is rare. Here, we describe adenoid cystic carcinoma that developed in the peripherally in S(9) of the right lower lobe of an 84-year-old woman. Cell blocks prepared from the bronchial wash specimens exhibited the cribriform formation. An immunohistochemical examination of the surgically resected tumor revealed positive thyroid transcription factor-1 and c-kit staining. Exons 9 and 11 of c-kit in tumor cells were not mutated. We compared the clinical features of this patient with those of 10 others described in the English-language literature.

Study design Familial cases of "idiopathic" scoliosis associated with neurologic abnormalities are reported with a review of the literature. Objective To investigate the prevalence of neurologic abnormalities such as syringomyelia, Chiari 1 malformation, and tonsillar ectopia in patients with genetically determined "idiopathic" scoliosis. Summary of background data Idiopathic scoliosis is widely considered to be a genetic disorder of unknown etiology. Magnetic resonance imaging (MRI) studies have shown that several cases of "idiopathic" scoliosis show neurologic abnormalities including syringomyelia and Chiari 1 malformation. Recently, several familial cases of either syringomyelia or Chiari malformation were reported, and it is suspected that genetic factors may influence the development of the craniovertebral malformation. It was hypothesized that some cases of "idiopathic" scoliosis include a craniovertebral malformation that is genetically determined. Methods This study, using clinical examinations and MRI, investigated 71 patients with scoliosis and a family history of "idiopathic" scoliosis in third-degree relatives for the presence of neurologic abnormalities. If neurologic abnormalities were confirmed with MRI, the relatives affected with scoliosis were also examined. Results Nine (13%) patients showed neurologic abnormalities on MRI. Magnetic resonance imaging showed syringomyelia with Chiari 1 malformation in four patients, Chiari 1 malformation in three patients, and tonsillar ectopia in two patients. Among the relatives of these patients, 4 of 15 individuals affected with scoliosis also showed neurologic abnormalities on MRI. Conclusions It is suggested that familial neurologic abnormalities may have a wide range of expression, and that some patients with "idiopathic" scoliosis present with genetically determined craniovertebral malformations such as syringomyelia, Chiari 1 malformation, and tonsillar ectopia.

Study Design. Analysis of the estrogen receptor gene of girls with idiopathic scoliosis. Objectives. To determine whether estrogen receptor gene polymorphisms correlate with curve severity of adolescent idiopathic scoliosis. of Background Data. Studies suggest that idiopathic scollosis is a familial condition and that curve progression is related to genetically determined factors, such as skeletal and sexual growth. Methods. A total of 304 girls with idiopathic scoliosis were followed until growth maturation. Height, arm span, menarcheal age, and age at growth maturation were recorded, and curve severity was measured using Cobb's method. The estrogen receptor gene, which contains polymorphic Pvull and Xbal sites, was amplified from lymphocyte deoxyribonucleic acid by polymerase chain reaction. Results. The mean maximum Cobb measurements for patients with genotypes XX and Xx were greater than for those with genotype xx (P = 0.002). The risk of curve progression, defined as progression of >5° from initial evaluation, was higher with genotype Xx than with xx (P = 0.03). Patients with genotypes XX and Xx had a significantly higher risk for operative treatment than those with genotype xx (21,4%, 24.7% vs. 7.6%, P < 0.001). Growth examination around the time of the growth spurt revealed that the Xbal site polymorphism was also related to the age of growth maturation. The frequency of patients with growth maturation at ≥16 years was higher for genotypes XX and Xx than for genotype xx (33.3%, 29.9% vs. 16.8%, P = 0.013). Conclusion. Our results suggest that the Xbal site polymorphism is associated with curve severity. DNA analysis may predict curve progression.

Fourteen patients with untreated hypercholesterolemia were given simvastatin 5 mg/d for 12 weeks. Cholesteryl ester transfer protein (CETP) activity and lecithin-cholesterol acyltransferase (LCAT) activity were determined every 4 weeks during treatment. Total cholesterol (TC) decreased from 279.1 ± 55.1 mg/dL before treatment to 224.6 ± 30.7 mg/dL after 12 weeks, and high-density lipoprotein cholesterol (HDL-C) rose from 56.2 ± 13 mg/dL to 61.2 ± 15.2 mg/dL. These changes were statistically significant. CETP activity decreased significantly from 26.8 ± 6.4% before treatment to 23.6 ± 6.3% after 12 weeks, and LCAT activity at 37 °C increased significantly from 43.3 ± 33.5 nmol/mL per hour to 68.4 ± 32.6 nmol/mL per hour. The changes in TC correlated with those in CETP activity at each time point (r = .674), but not with those in LCAT activity. The HDL-C level was negatively correlated with CETP activity at each time point (r = .655) but not with LCAT activity. These findings show that CETP activity may play a more important role than LCAT activity in simvastatin-induced HDL-C elevation and suggest that simvastatin increases HDL-C by reducing CETP activity secondary to low-density lipoprotein cholesterol reduction.

Progressive scoliosis in young children has been treated with "spinal instrumentation without fusion" to avoid interference with spinal growth. Patients have to undergo a series of operations to have instruments exchanged for maintaining the correction. We have developed a newly designed remote-controlled growing-rod spinal instrumentation system proposed for the treatment of progressive scoliosis in young children. It can be used to stretch and correct the spinal deformities repeatedly and non-surgically, by means of a remote controller, after the first instrumentation operation. The purpose of this study is to describe the possible clinical application of this system for the treatment of progressive scoliosis in young children. To this end, we used the system in five beagle dogs with induced scoliotic deformities. The maximum distraction force of the instrument was 194 N. Correction of 1 cm was performed non-surgically in awake animals 3 weeks after the instrumentation operation, and then correction of 1 cm was carried out again 6, 9, and 12 weeks after the operation. The average initial Cobb's angle of the induced scoliotic deformities was 25 degrees; this was corrected to 20 degrees, 15 degrees, 8 degrees, and 3 degrees, after the distractions at 3, 6, 9, and 12 weeks, respectively, postoperatively. All corrections were performed non-surgically without apparent complications. By repetitive distractions with the use of our new system, we may be able to reduce the number of operations required in young scoliotic children.

We investigated 21 pairs of twins for zygosity and idiopathic scoliosis. DNA fingerprinting confirmed that 13 pairs were monozygotic and eight were dizygotic. There was concordance for idiopathic scoliosis in 92.3% of monozygotic and 62.5% of dizygotic twins. Of the 12 pairs of monozygotic twins concordant for idiopathic scoliosis, six showed discordant curve patterns but eight had differences in Cobb angle of less than 10°. Seven of the ten pairs of monozygotic twins had similar back shapes. Our findings suggest that there is a genetic factor in the aetiology of idiopathic scoliosis; they also indicate that there is a genetic factor in both the severity of the curve and the general shape of the back.

Chylous joint effusion is a rare condition in which synovial fluids containing large amounts of lipids take on a milky appearance as a result. We report on a 19-year-old male patient with posttraumatic chylous knee effusion. Several days after striking his knee against the ground because of a traffic accident, his left knee showed obvious swelling. Aspiration of his knee was performed, yielding 70ml of purulent-appearing fluid. To distinguish this condition from purulent or tuberculosis arthritis, arthroscopic biopsy and debridement were performed. Arthroscopic examination visualized distinctive yellow-white soft lesions covering much of the joint capsule, resembling a cobweb. Tissue cultures for bacteria were negative. Pathologically, we identified clusters of xanthoma cells with fibrin exudation due to disruption of the synovium and intra-articular fat pad necrosis. Centrifuging the aspiration fluid yielded a thick creamy lipid layer as the supernatant. A fresh drop preparation showed that the specimen contained innumerable fat globules, which stained red with oil red O stain. The patient was able to walk without difficulty or further swelling of his knee at the end of the second postoperative week. Posttraumatic chylous effusion is self-limited. Purulent arthritis or tuberculosis arthritis, however, should still be the presumptive diagnosis in such cases. Arthroscopic irrigation and debridement should be considered for these traumatic cases to confirm diagnosis and to speed up recovery.

Background Amino acids (AAs) are emerging as a new class of effective molecules in the etiology of obesity and diabetes mellitus. However, most investigations have focused on subjects with obesity and/or impaired glucose regulation; the possible involvement of AAs in the initial phase of glucose dysregulation remains poorly understood. Furthermore, little attention has been given to possible associations between the pattern/degree of fat deposition and the plasma AA profile. Our objective was therefore to determine the relationships between plasma AA concentrations and the type/degree of obesity and glucose regulation in Japanese adults with normal glucose tolerance. Methods Eighty-three subjects with normal glucose tolerance were classified as obese or nonobese and as visceral obesity or nonvisceral obesity. Correlations between the plasma levels of 23 AAs and somatometric measurements, visceral fat area (VFA), subcutaneous fat area (SFA), and 75-g oral glucose tolerance test results were analyzed. Results Obesity or visceral obesity was associated with higher levels of branched-chain AAs (isoleucine, leucine, and valine), lysine, tryptophan, cystine, and glutamate but lower levels of asparagine, citrulline, glutamine, glycine, and serine (p

In order to check the presence of spinal deformity in the early stage, orthopedists have traditionally performed on children a painless examination called a forward- bending test in school screening. In forward-bending test, mainly medical doctor checks to see if one shoulder is lower than the other. But this test is neither reproductive nor objective. Moreover, the inspection takes much time when applied to medical examination in schools. To overcome these difficulties, a moire method has been proposed which takes moire topographic images of human subject backs and checks symmetry/asymmetry of the moire patterns in a twodimensional way on visual screening. In this paper, we propose a new technique for automatic detection of spinal deformity from moire topographic images. In the first stage, once the original moire image is fed into computer, the middle line of the subject’s back is extracted on the moire image by employing the approximate symmetry analysis. Regions of interest are then automatically selected on the moire image from its upper part to the lower part. Numerical representation of the degree of asymmetry is therefore useful in evaluating the deformity. Displacement of local centroids and difference of gray value are calculated between the left-hand side and the right-hand side regions of the moire images with respect to the extracted middle line. Extracted 4 feature vectors (mean value and standard deviation from the each displacement) from the left-hand side and right-hand side rectangle areas are applied to train the Neural Network (NN), Support Vector Machines (SVMs). In the final stage, normal and abnormal cases are classified by NN and SVM. An experiment was performed employing 1,200 real moire images based on NN and SVMs, and classification rates of 90.3% and 85.3% was achieved respectively.

Spinal deformity is one of serious diseases, mainly suffered by teenagers during their growth stage. To detect the spinal deformity in early stage, orthopedists have traditionally performed a painless examination called a forward bending test or moire topographic image test in mass screening of school. It is, however, inspection base on the forward bending method takes much time and moire images, and visual examination also require a large amount of moire images because they are collected from elementary as well as junior high schools. This causes exhaustion of doctors and therefore leads to misjudgment. Therefore realization of automatic spinal deformity detection based on the moire images has long been desired among orthopedists. In this paper, we propose a method for automatic detection of spinal deformity from moire topographic images by using a new asymmetric feature which is obtained by using statistical features between left- and right hand side shoulder and waist lines. We classified an unknown moire image employing linear discriminant function. The proposed technique is applied to 1200 real moire topographic images. By the employment of the two asymmetric features, 66 % of unknown moire images were successfully classified in the performed experiment. Some experimental results are shown along with discussions.

Study design A prospective trial of preoperative MRI study in patients with "idiopathic" scoliosis. Objectives To investigate the prevalence of neural axis malformations and the clinical relevance of MRI in the evaluation of patients with idiopathic scoliosis undergoing surgical intervention. Summary of background data With the development of MRI, neural axis abnormalities such as syringomyelia or Chiari malformations are increasingly being found in patients with "idiopathic" scoliosis. The risk of neurologic complications during correction of scoliosis without prior decompression surgery for syringomyelia has been documented; however, there have been no prospective studies for identifying the risk of neurologic complications as a result of scoliosis surgery in patients with asymptomatic neural axis malformations. Methods A total of 250 patients who were classified as having "idiopathic" scoliosis at first presentation and admitted for spinal surgery were evaluated. All patients were examined for neural axis abnormalities using MRI. The presence of neurologic symptoms and abnormal neurologic signs was also examined before and after surgical intervention. Neurologic complications during scoliosis surgery were reviewed in patients with neural axis abnormalities. Results There were 44 (18%) patients (13 males and 31 females) who had neural axis abnormalities on MRI, including syringomyelia with Chiari malformations in 22 patients, syringomyelia with tonsillar ectopia in 2, Chiari malformations in 13, tonsillar ectopia in 6, and low conus medullaris in 1. On clinical examination, 44 (18%) patients had abnormal neurologic signs and 26 (7%) patients complained of headache or back pain. There were significant differences between patients with and without neural axis abnormalities regarding the age at first visit, gender, curve pattern, sagittal profile of thoracic spine, presence of neurologic deficit, and complaint of pain. Only 12 of 44 patients needed neurosurgical treatment for foramen magnum decompression before correction of scoliosis. Neurologic status temporarily worsened in 3 patients, including 2 patients with neurosurgical treatment and 1 patient without neurosurgical treatment; however, there were no permanent neurologic complications as a result of scoliosis surgery. All patients without neurologic deficits or complaints of pain did not receive neurosurgical treatment, while they had no permanent neurologic complications. Conclusions Foramen magnum decompression for neural axis malformations could prevent permanent neurologic complications during scoliosis surgery. There is little risk of neurologic complications in patients with "idiopathic" scoliosis whose neurologic status is normal, even if these patients have a neural axis malformation on MRI.

A 65-year-old man was admitted to our hospital because of dyspnea on exertion. He had oculocutaneous albinism innately and his parents were consanguineous. His chest roentgenogram on admission showed reticulo-nodular infiltrates and cystic changes throughout both lung fields, and 7 cm mass in the left middle field. Cytology of bronchoalveolar lavage fluid (BALF) revealed macrophages containing ceroid. The diagnosis of HPS was made clinically and the tumor was diagnosed as poorly differentiated adenocarcinoma of the lung. He died of respiratory failure. By autopsy, additional well-differentiated adenocarcinoma was detected. Cytology of BALF was useful to confirm ceroid accumulation in the lung.

Three hundred and four girls with adolescent idiopathic scoliosis were investigated to determine if DNA polymorphisms in the vitamin D receptor (VDR), estrogen receptor (BR), and CYP17 gene were related to curve progression of idiopathic scoliosis. The results suggested that XbaJ site polymorphism in the ER gene was associated with curve progression. The Cobb's curve angle with genotype XX and Xx was statistically greater than that with genotype xx. The curve progression risk (approximately 5 degrees) was higher for genotype XX and Xx than for genotype xx. Furthermore, patients with genotype XX and Xx had a higher risk of receiving operative treatment than those with genotype xx. In conclusion, DNA analysis may predict curve progression, although other polymorphisms were not associated with curve severity.

We undertook a radiographic analysis with pre-operative computed tomographic myelography in 78 patients with idiopathic scoliosis in order to analyse rotation of the spinal cord and to investigate its clinical significance. The angle of rotation of the cord had a statistically significant relationship to both that of the apical vertebra and the size of the primary curve. The relationship between the rotation of the cord and that of the apical vertebra was divided into three types. The cord rotated in the same direction as the apical vertebra in 55 patients and rotated in the opposite direction in the remaining 23 patients. In the first group, the angle of rotation of the cord was more than that of the vertebra in six patients, but less than it in 49 patients. These results suggest that the neuraxis in idiopathic scoliosis may be under tension in the axial dimension.

In the treatment of diffuse panbronchiolitis, azithromycin (AZM), a new macrolide antibiotic with 15-membered lactone ring, was studied for its efficacy and safety. AZM, 250 mg, was intermittently administered to a total of 60 patients twice a weeks, for 3 months as a rule, and its efficacy was clinically evaluated in 52 patients and the safety in 55. The rate of efficacy was 84.6% (44/52). Clinical findings 12 weeks after the start of administration showed a decrease in sputum volume in 30 of 46 patients and amelioration of dyspnea on exertion in 23 of 46 patients, and no worsening of symptoms was observed in the patients. Vital capacity (4/22), FEV1.0 (6/21), cold agglutination reaction (22/28), and CRP (16/36) were also improved. The rate of eradication of organisms isolated from the sputum except for indigenous organisms was 39.5% (15/38); 4 of the 22 strains of Pseudomonas aeruginosa were eradicated. Adverse reactions were observed in 4 of the 55 patients (7.3%), 1 patient each with rash, itching, diarrhea, and a gastric symptom (heavy feeling in the stomach). 4 of the 54 patients (7.4%) exhibited abnormal changes in clinical laboratory test values values. These were an increase in eosinophil count in 2, elevation of GOT in 1, and elevation of Al-P in 1. These adverse reactions and abnormal changes in laboratory tests were mild or moderate. Therefore, long-term intermittent administration of AZM, twice a week, is expected to have the same effect in the treatment of diffuse panbronchiolitis as long-term small-dose administration of 14-membered macrolides such as erythromycin and clarithromycin, whose effects have already been established.