Assessment of skin test with varicella-zoster virus antigen for predicting the risk of herpes zoster.

The Shozu Herpes Zoster (SHEZ) Study was designed to clarify the incidence of and predictive and immunological factors for herpes zoster in a defined community-based Japanese population. As part of this series, a total of 5683 residents aged ≥50 years received a varicella-zoster virus (VZV) skin test with VZV antigen, and 48 h later, the erythema and oedema were assessed by measuring the longest diameter. The diameters of both the erythema and oedema decreased with the increasing age of the subject. Sixty-three subjects contracted herpes zoster within a year after receiving the VZV skin test. Analysis of the herpes zoster incidence rate vs. the skin test reaction revealed that the shorter the diameter of erythema or oedema, the greater the likelihood of herpes zoster. These results demonstrated that the VZV skin test is an excellent surrogate marker for predicting the risk of herpes zoster.

Morphological assessment of the luminal surface of olfactory epithelium in mice deficient in tissue plasminogen activator following bulbectomy.

OBJECTIVE: This study aimed to investigate the function of tissue plasminogen activator in the olfactory epithelium of mice following neural injury. METHOD: Transmission electron microscopy was used to study the changes in the morphology of the olfactory epithelium 1-7 days after surgical ablation of the olfactory bulb (bulbectomy). RESULTS: Prior to bulbectomy, a uniformly fine material was observed within some regions of the olfactory epithelium of mice deficient in tissue plasminogen activator. At 2-3 days after bulbectomy, there were degenerative changes in the olfactory epithelium. At 5-7 days after bulbectomy, we noted drastic differences in olfactory epithelium morphology between mice deficient in tissue plasminogen activator and wild-type mice (comparisons were made using findings from a previous study). The microvilli seemed to be normal and olfactory vesicles and receptor neuron dendrites were largely intact in the olfactory epithelium of mice deficient in tissue plasminogen activator. CONCLUSION: The tissue plasminogen activator plasmin system may inhibit the regeneration of the olfactory epithelium in the early stages following neural injury.

Assessment of possible effects for testosterone replacement therapy in men with symptomatic late-onset hypogonadism.

We herein report clinical assessments of efficacy and side effects of T replacement therapy (TRT) in men with late-onset hypogonadism (LOH). The study included 56 patients who were diagnosed with LOH and treated with TRT for at least 6 months at our institution. Age, ageing male symptom (AMS) scale, and androgen decline in the ageing male (ADAM) questionnaires were examined. Fasting blood samples were analysed for sex hormones, total cholesterol (TC), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, triglycerides (TG), aspartate aminotransferase (AST), alanine aminotransferase (ALT), γ-glutamyl transpeptidase (γ-GTP), red blood cell count (RBC), haemoglobin (Hb), haematocrit (Ht), and prostate-specific antigen (PSA). Total and psychological symptoms scores were measured by the AMS scale and the ADAM questionnaire score, demonstrating that the sum of positive responses to the questions were significantly improved after TRT (P < 0.05). TC, HDL, and LDL cholesterol, TG, AST, ALT, γ-GTP, RBC, Hb, Ht, and PSA were not significantly different between before and after TRT. Although TRT for men with LOH may cause favorable changes in psychological conditions, it may not have effects on lipid metabolism, liver function, RBC, and PSA level.

An internet-based wearable watch-over system for elderly and disabled utilizing EMG and accelerometer.

An effective way for preventing injuries and diseases among the elderly is to monitor their daily lives. In this regard, we propose the use of a "Hyper Hospital Network", which is an information support system for elderly people and patients. In the current study, we developed a wearable system for monitoring electromyography (EMG) and acceleration using the Hyper Hospital Network plan. The current system is an upgraded version of our previous system for gait analysis (Yoshida et al. [13], Telemedicine and e-Health 13 703-714), and lets us monitor decreases in exercise and the presence of a hemiplegic gait more accurately. To clarify the capabilities and reliability of the system, we performed three experimental evaluations: one to verify the performance of the wearable system, a second to detect a hemiplegic gait, and a third to monitor EMG and accelerations simultaneously. Our system successfully detected a lack of exercise by monitoring the iEMG in healthy volunteers. Moreover, by using EMG and acceleration signals simultaneously, the reliability of the Hampering Index (HI) for detecting hemiplegia walking was improved significantly. The present study provides useful knowledge for the development of a wearable computer designed to monitor the physical conditions of older persons and patients.

Determining the treatment strategy for colorectal neoplastic lesions: endoscopic assessment or the non-lifting sign for diagnosing invasion depth?

BACKGROUND AND STUDY AIMS: Assessment of the invasion depth of colorectal neoplasia is important in deciding between endoscopic and surgical resection treatment methods. Prior to attempting endoscopic resection, the lesion is lifted by submucosal injection, and a positive "non-lifting sign" is usually considered to indicate deeper submucosal infiltration. The purpose of this prospective multicenter study was to assess the predictive value of the non-lifting sign for differentiating between adenoma and early cancer (up to discrete submucosal infiltration [sm1]) and cancer with deeper infiltration (sm2). PATIENTS AND METHODS: During an 11-month period, a total of 271 colorectal neoplastic lesions in 239 patients were included in the study. Apart from the location, size, and macroscopic type of the lesion, the presence or absence of the non-lifting sign was recorded and compared with the endoscopic assessment of invasion depth. RESULTS: The non-lifting sign had a sensitivity of 61.5 %, a specificity of 98.4 %, a positive predictive value of 80.0 %, a negative predictive value of 96.0 %, and an accuracy of 94.8 %. Endoscopic diagnosis of deeper infiltration had a sensitivity of 84.6 %, a specificity of 98.8 %, a positive predictive value of 88.0 %, a negative predictive value of 98.4 %, and an accuracy of 97.4 %. Statistically significant differences were found in terms of sensitivity and accuracy. CONCLUSION: Because of its lower sensitivity and accuracy, the non-lifting sign will not replace endoscopic assessment. If a lesion does not lift, this can make resection technically difficult, but does not reliably predict deeper cancerous invasion.

Quantitative assessment of the total myocardial uptake ratio of 123I-BMIPP by using the Ishii-MacIntyre method is useful for predicting cardiac complications in patients with mitochondrial encephalomyopathy or myotonic dystrophy.

We evaluated the usefulness of the total myocardial uptake ratio (TMUR) of 15-(p-[123I]iodophenyl)-3(R,S)-methyl-pentadecanoic acid (123I-BMIPP) for predicting cardiac complications in patients with mitochondrial encephalomyopathy or myotonic dystrophy. Six patients with mitochondrial encephalomyopathy, four with myotonic dystrophy, and 10 control subjects were studied. Quantitative assessment of 123I-BMIPP dynamic myocardial imaging was performed, and the TMUR of 123I-BMIPP was calculated according to the Ishii-MacIntyre method. Then, the TMUR was compared in the 10 patients and 10 healthy controls, and all patients were followed for 56.1+/-22.1 months to evaluate cardiac complications. TMUR in patients (2.69+/-0.64) was significantly (P =0.01) lower than that in controls (3.28+/-0.25). Three patients in whom the TMUR value was above 3.00 had no cardiac complications. On the other hand, all patients in whom TMUR was below 3.00 had some kind of cardiac complication during the follow-up period. Two patients showed progressive conduction abnormality and underwent pacemaker implantation, one patient had sick sinus syndrome and underwent pacemaker implantation, another patient showed non-sustained ventricular tachycardia and paroxysmal atrial fibrillation, and four of seven patients, including one with a pacemaker, showed an increased cardiothoracic ratio value over 50%. In conclusion, measurement of the TMUR by the Ishii-MacIntyre method is useful for evaluating the development of cardiac complications in patients with mitochondrial encephalomyopathy or myotonic dystrophy.

The value of ultrasound-guided fine-needle aspiration cytology for thyroid nodules: an assessment of its diagnostic potential and pitfalls.

This study was conducted to assess the diagnostic potential and pitfalls of performing fine-needle aspiration cytology (FNAC) for thyroid nodules. We retrospectively analyzed 1,012 aspirated samples obtained from 806 thyroid nodules by the ultrasound (US)-guided method. Of these 806 nodules, 226 (31%) had been surgically treated, 152 (67%) of which were histologically diagnosed as malignant. The rate of sufficient aspirate was 82%, being lower in nodules with a diameter of less than 5mm (73%, P = 0.10); either calcified (77%, P = 0.043) or benign (72%, P = 0.0002). The accuracy of FNAC was 75%, the rate of indeterminate diagnosis was 16%, the false negative rate was 13%, and the positive malignancy rate was 99%. The rate of indeterminate diagnosis was higher in adenomatous goiter, follicular carcinoma, and malignant lymphoma, at P = 0.015, P = 0.0008, and P = 0.035, respectively. The accuracy was lower in follicular carcinoma and malignant lymphoma (both at P = 0.013). Sufficient aspirate was finally obtained from 701 (87%) of the 806 nodules by repeated aspiration. Of 152 malignant nodules, 28 (18%) were diagnosed after two or more aspirations, and the accuracy was improved to 81% by repeating the procedure. These findings indicated that repeated aspiration may be a simple and effective method of improving the diagnostic potential of FNAC.

Sinus node recovery time assessment by the overdrive suppression test employing an intravenous injection of disopyramide phosphate.

Although sinus node recovery time (SNRT) assessment by the overdrive suppression test (ODST) is important in detecting sick sinus syndrome (SSS), its sensitivity is still inadequate. We have evaluated the effect of intravenous injection (i.v.) of disopyramide phosphate (DP) in ODST. The subjects were 30 SSS patients (64.9 +/- 10.0 years old). If SNRT was <2,000 ms or the corrected SNRT (CSNRT) was < 1,000 ms, ODST was repeated after DP i.v. (2 mg. kg(-1), < or = 100 mg in total). Eleven normal subjects (59.3 +/- 9.0 years old) were also studied. Although SNRT was <2,000 ms or the CSNRT was < 1,000 ms in 13 of the 30 SSS patients (43%), SNRT was prolonged from 1,510 +/- 300ms to 3,400 +/- 1,160 ms (P<0.01), and CSNRT from 510 +/- 190 to 2,470 +/- 1,470 ms (P<0.01) after DP i.v. in these patients. Thus, SNRT was > or = 2,000 ms and the CSNRT was > or = 1,000 ms in 27 of 30 SSS patients (90%) after DP i.v. Using a combination of overdrive suppression and intravenous injection of disopyramide phosphate, the corrected sinus node recovery time was diagnostic (>525 ms) in 29 of the 30 patients (97%). In contrast, SNRT and CSNRT were shortened in the normal subjects during ODST after DP i.v. (P<0.01). The plasma concentration of DP estimated in nine patients was 4.1 +/- 1.0 microg.ml(-1). No serious side effect occurred. ODST employing DP i.v. is safe and seems to be highly effective in diagnosing SSS.

Assessment of disease severity in parkinsonism with fluorine-18-fluorodeoxyglucose and PET.

UNLABELLED: Fluorine-18-fluorodeoxyglucose (FDG) and PET have been used to identify an abnormal regional metabolic covariance pattern in Parkinson's disease (PD). To examine the potential use of this covariance pattern as a metabolic imaging marker for PD, we describe the Topographic Profile Rating (TPR), which is a method for calculating subject scores for this pattern in individual PD patients. We then assess the relationship between these metabolic measures and objective independent disease severity ratings. METHODS: Two independent groups of PD patients were studied with FDG-PET. Group A consisted of 23 patients (mean age 60.2 +/- 12.2; mean Hoehn and Yahr stages 2.4 +/- 1.3) and Group B had 14 patients (mean age 49.0 +/- 12.1; mean Hoehn and Yahr stage 3.2 +/- 1.2). The regional cerebral metabolic rates for glucose (rCMRGlc) in all patients in each group were measured. TPR was used to calculate subject scores for the disease-related covariance pattern on a patient-by-patient basis. RESULTS: In both PD patient groups, subject scores correlated with Hoehn and Yahr disease severity ratings (Group A: r = 0.59, p < 0.004; Group B: 0.57, p < 0.04), quantitative ratings for bradykinesia (Group A: r = 0.63, p < 0.002; Group B: r = 0.61, p < 0.03), rigidity (Group A: r = 0.59, p < 0.004; Group B: r = 0.59, p < 0.04), but not with tremor. CONCLUSION: These findings indicate that regional metabolic covariance patterns are robust imaging markers of disease severity. FDG-PET may be useful clinically in assessing parkinsonian disability and disease progression.

DNA adduct formation and assessment of aberrant crypt foci in vivo in the rat colon mucosa after treatment with N-methyl-N-nitrosourea.

N-Nitroso-compound DNA adduct formation in vivo and occurrence of aberrant crypt foci (ACF) were studied in the rat colon mucosa after a single, local treatment with a carcinogen, N-methyl-N-nitrosourea (MNU), using a simple surgical approach. A segment of F344 rat colon was ligated to make a pouch and injected with MNU solution. For the study of DNA adduct formation, the solution contained 50 microCi of [3H]MNU. The results demonstrated that similar ranges of carcinogen dose, i.e. 0.15 x 10(-2) - 1.5 x 10(-2) M MNU, could induce both DNA adduct formation and appearance of ACF in the rat colon with both parameters showing a nearly linear dose dependence. HPLC analysis revealed the DNA adducts to include both 7-methylguanine (7-mGua) and O6-methylguanine (O6-mGua) with the 7-mGua/O6-mGua ratio being 8.2-11.3:1 in the system used. Assessment of ACF development from 4 to 16 weeks after MNU treatment at a dose of 7.5 x 10(-2) M showed the numbers to increase up to the 8th week, followed by a decrease at weeks 12 and 16, when 40% of the ACF counted at the peak time point were still present. The percentage of large ACF (> or = 4 crypts/ACF) significantly increased with time. These results indicate a clear relation between DNA adducts and preneoplastic lesions, i.e. ACF. In conclusion, DNA adduct formation and ACF can be efficiently and simply detected in vivo by using the method described in the present paper.

[Discarding medical images and its evaluation].

Following a survey of our filing system, the period of storage of medical images was generally limited to ten years, a system which was put into execution in 1990. Film jackets older than ten years are discarded every year, except for those registered for permanent storage. Fourteen thousand jackets (6.5% of total) have been registered for permanent storage. A follow-up survey has been performed to evaluate this system. The survey focused mainly on the frequency of re-issue of film jackets, and the rate of access to jackets. Discarded jackets now number about 50,000, a reduction of 20%. A total of 405 jackets were re-issued in a year due to the re-examination of patients whose jackets had been discarded. The annual number of re-called jackets from the repository outside our hospital was about 2,200 (about 500 of them were for research work), which corresponded to 1.5% of the patients re-examined in the radiology department. The new filing system has been well integrated into the hospital daily routine. Information cost was calculated as a function of access rate to the stored information, and the concept of "cost-of-information" was proposed as a measure of cost analysis of an information system.

Noninvasive assessment of cardiac performance of intravenous benzodiazepines by systolic time intervals.

The effects of anesthetic induction by diazepam, flunitrazepam and midazolam on cardiac performance were evaluated in 33 ASA class I surgical patients (average age was 36 years). The patients were divided according to the 3 drug groups, and the effects of each drug assessed utilizing measurements of systolic time intervals. An increase in heart rate and decrease in blood pressure was observed following flunitrazepam and midazolam induction. There was no changes in PEPI (pre-ejection period index) and LVETI (left ventricular ejection time index) by benzodiazepines induction. The PEP/LVET ratio was increased by diazepam while the DPTI (diastolic pressure time index)/TTI (tension time index) was reduced by flunitrazepam and midazolam. However, these changes in PEP/LVET and DPTI/TTI were within normal limits. These data indicate that in healthy humans the induction dose of either diazepam, flunitrazepam or midazolam does not extremely influence either PEP/LVET for cardiac performance or DPTI/TTI for cardiac oxygen balance. The results also suggest that the simultaneous use of PEP/LVET and DPTI/TTI is more informative than any single variable for the evaluation of cardiac effects of anesthetics.

[Assessment of cisplatin in concurrent use with radiotherapy in esophageal carcinoma--joint research among nationwide multi-facilities, primary results. Research Committee for Radiation and Cisplatin Treatment of Esophageal Carcinoma].

The effect of cisplatin in concurrent use with radiotherapy for esophageal carcinoma has been assessed as a theme of joint research among nationwide 40 facilities for 18 months from October, 1985, to March, 1987. As the subjects, non-operative cases, recurrent cases and metastatic cases diagnosed as esophageal carcinoma were enrolled. Regimens in 4 kinds were used for treatment and CDDP was used concurrently with radiotherapy in all the regimens. The results of classifying and totalizing the effects in 73 cases, of whom the local effects were analyzed, turned out to be: CR-25 cases, CR rate being 34.2% and PR-33 cases, the effective rate being 79.5%. As a result of aggregating the effects by major axis of X-ray image, CR and effective rates were found as 60 and 90% in the cases with the axes less than 5 cm; 36 and 79% in the cases with axes more than 5 cm and less than 10 cm; and 19 and 76% in the cases with the axes more than 10 cm, all respectively.

[Relationship between left atrial diameter and cardiac function in myocardial infarction--assessment of left ventricular end-diastolic pressure by the left atrial index].

To study the assessment of cardiac function in acute myocardial infarction (AMI), we measured left atrial diameter, left ventricular end-diastolic pressure (LVEDP), pulmonary capillary wedge pressure (PCWP), ejection fraction (EF) in 20 patients with acute myocardial infarction. Left atrial diameter was measured using echocardiography and was expressed as left atrial index (LAI, mm/m2) dividing by body surface area. LAI in AMI was 21.3 +/- 2.7 mm/m2 and significantly larger than LAI in normal subject (19.9 +/- 2.0 mm/m2) (p less than 0.05), In AMI, LVEDP was 13.3 +/- 3.4 mmHg, PCWP was 9.0 +/- 2.8 mmHg and EF was 52.3 +/- 14.8%, Relationship (r value) between LAI and LVEDP (r = 0.70, p less than 0.001, y = 0.87 x-5.4 x; LAI, y; LVEDP) was greater than PCWP and LVEDP (r = 0.60, p less than 0.01). LVEDP calculated from LAI using this method was directly measured LVEDP directly measured +/- 2.4 mmHg. In 9 patients, LAI was larger than 20.9 mm/m2, in 8 patients of them LVEDP was higher than 13 mmHg. In 11 patients LAI was smaller than 20.9 mmHg, only in 2 of them LVEDP was lower than 13 mmHg. It concluded that sensitivity was 88.9%, specificity was 81.8%, accuracy was 85.0%. Relationship between LAI and PCWP (r = 0.30), LAI and EF (r = -0.36) were not significant. We can measure LAI repeatedly in AMI non-invasively, and predict LVEDP. Thus, the measurement of LAI is useful in treatment of AMI.

Assessment and follow-up of patients with ventricular septal defect and elevated pulmonary vascular resistance.

Cardiac catheterization was undertaken in 87 patients (for a total of 89 studies) with ventricular septal defects, including 58 patients with moderate or severe elevation of pulmonary arteriolar resistance. When resting resistance was less than or equal to 7.9 U . m2, it always decreased with isoproterenol and no postoperative problems were experienced with pulmonary vascular obstructive disease. In 36 patients resting resistance measured greater than or equal to 8 U . m2. In 17 of these patients it decreased to less than 7 U . m2 with isoproterenol. Fifteen patients were operated on and postoperative problems with pulmonary vascular disease were experienced only in the single patient whose repair broke down. Surgery was undertaken in 4 of 19 patients in whom resistance did not decrease to less than 7 U . m2 with isoproterenol and advanced pulmonary vascular disease was evident in the 3 patients with follow-up observation. Correlation between measured resistance and other hemodynamic parameters was only fair. A pulmonary to systemic resistance ratio greater than or equal to 0.75 always indicated high absolute resistance but resistance ratios less than 0.75 were found quite frequently in the group with limited response to isoproterenol. These data argue that a reliable estimate of resistance, less than 7 U . m2, with a vasodilator predicts a good postoperative response regardless of measurements at rest or other hemodynamic parameters. Although observations on postoperative progress of patients with resistance greater than 7 U . m2 with a vasodilator are limited, a good postoperative course is unlikely unless resistance can be lowered to a level close to 7 U . m2.

Gated cardiac imaging using a continuously rotating CT scanner: clinical evaluation of 91 patients.

To produce electrocardiographically (ECG)-gated computed tomographic (CT) images of the heart, a post-data-acquisition ECG correlation technique was used in which data for missing angular projections are derived from the original scan data to complete 360 angular projections. Improved image quality and clinical usefulness were demonstrated compared with routine nongated CT and two-dimensional echocardiography. Gated CT was better than nongated CT in 26 of 41 positive and three of five negative cases of suspected myocardial infarction, four of 10 positive and one of 12 negative cases of suspected left atrial mass, three of 10 cases with pericardial fluid collection, and three other cases. Compared with echocardiography, CT was of additional value in eight of 10 cases of myocardial infarction, five of nine positive and one of 10 negative cases of suspected left atrial mass, four of 10 positive and one of three negative cases of suspected pericardial fluid collection, and two other cases. The equipment required for CT gating is of low cost, but the examination time is lengthy and less conveniently performed than echocardiography. However, when echocardiography is indecisive or suspected to be falsely negative, gated CT imaging of the heart is recommended.

Diagnostic value of body surface map in myocardial infarction: assessment of location, size and ejection fraction as compared with coronary cineangiography and 201Tl myocardial scintigraphy.

The diagnosis of the location and size of old myocardial infarction was made by the map and various indices obtained from the map were correlated with coronary arteriography, left ventriculography, and 201Tl myocardial scintigraphy. Diseased coronary arteries were presumed from Q30, Q40 area and/or peak voltage map and left ventricular wall motion was estimated from subtraction map. There were significant correlations between ejection fraction and sigma R in anterolateral MI (r = 0.51, p less than 0.001) and between ejection fraction and nQ30 in anterolateral (r = -0.47, p less than 0.001) and inferoposterior (r = -0.63, p less than 0.01) MI. Negative correlation was observed between myocardial uptake ratio (MUR) and nQ30 (r = -0.69, p less than 0.001) and positive correlation between MUR and sigma R (r = 0.50 p less than 0.01) in anterolateral MI. Those cases which could not be diagnosed by either ECG or 201Tl scintigraphy were correctly diagnosed by the map and it proved to have an excellent diagnostic accuracy for myocardial infarction.