Display colour scale effects on diagnostic performance and reader agreement in cardiac CT and prostate apparent diffusion coefficient assessment.

AIM: To investigate the effect of colour scale choice on diagnostic performance in the interpretation of medical images. MATERIALS AND METHODS: Twelve clinicians interpreted 210 myocardial computed tomography (CT) perfusion (CTP) examinations, and nine clinicians interpreted 165 magnetic resonance imaging (MRI) apparent diffusion coefficient (ADC) prostate images. In three separate sessions, each participant read the same image set using greyscale, hot-iron, and rainbow scales, respectively. Participants scored their level of confidence for tumour presence in the ADC study, and for ischaemia in the CTP study, from 0 to 100. The area under the receiver operating characteristic (ROC) curve (AUC) was used as the performance metric. For cases that scored >50, CTP readers' agreement on the ischaemic transmural extent was analysed, and ADC map readers' selected values and coordinates for the lowest ADC within the detected tumour were compared across different colour scales. RESULTS: For CTP detection, the AUC was up to 0.10 higher with greyscale, 0.67±0.02 (standard error), compared to rainbow, 0.56±0.02, and detection with hot-iron was in between (0.61±0.03). For ischaemic transmural lesion categorisation, observed inter-reader agreement was highest with greyscale for category 25-50%. There is a small tendency for rainbow and greyscale to outperform hot-iron in the detection of prostate tumours. The selected lowest ADC value and pixel localisation was similar with all colour scales. CONCLUSIONS: The present findings suggest that colour visualisation has a measurable effect on CTP and ADC performance. Further investigation is necessary to determine the magnitude of the effect in diagnostic tasks.

Changes in Cytokine levels related to the Immunopathogenesis of Helicobacter pylori disease. Immunological and histological effects of triple treatment (omeprazol, azytromycin, and amoxycillin)

Las enfermedades gastroduodenales causadas por H. pylori son consecuencia de una inapropiada respuesta inmunitaria del huésped. Los objetivos del presente estudio han sido evaluar: 1) niveles séricos de citocinas en pacientes infectados o no con H. pylori y la relación de los primeros con la inmunopatogénesis de las lesiones en la mucosa gástrica y duodenal causada por este agente; 2) cambios en los niveles de citocinas posteriores al tratamiento y relacionados con algunas alteraciones histológicas.Se estudiaron 40 pacientes ambulatorios (edad media 68.7 años; 59-80 años),de ambos sexos, con diagnóstico clínico y endoscópico de úlcera gástrica,úlcera duodenal y gastritis erosiva y/o lesiones duodenales. Se diagnosticó H. pylori en muestras de tejido gástricas y duodenales por el Test de la Ureasa rápido, exámenes histológicos y cultivo de tejido. La sensibilidad antibiótica se determinó por la Técnica Elipsométrica, para evaluar la concentración inhibitoria mínima (CIM) en g.ml–1 de azytromycina y amoxycilina. Se evaluaron los niveles séricos de IL-2, IL-4, IL-10, IFN-γ y TGF-β antes y después del tratamiento. Los pacientes con diagnóstico confirmado de infección por H. pylori fueron tratados con omeprazol, amoxycilinay azitromycina. Aquellos no infectados con H. pylori sólo recibieron omeprazol.Se detectó una diferencia significativa en los niveles de todas las citocinas entre los pacientes H. pylori (+) y H. pylori (-) (p<0.01). Se determinaronniveles significativamente menores de IL-2 (p<0.05) e IFN-γ ymayores de IL-4, IL-10 y TGFβ en pacientes H.pylori (+) comparados conlos de pacientes H. pylori (-)(p<0.01). También las diferencias fueron significativas entre las determinaciones pre y post tratamiento de los pacientes H.pylori (+) (p<0.01). La eficacia del tratamiento empleado se evidenció tanto por los valores de las citocinas evaluadas así como en la reversión las alteraciones histológicos observadas antes de la terapia (AU)

Gastroduodenal diseases caused by Helicobacter pylori are a consequence of an inappropriate host's immune response This study aims to evaluate: 1) cytokine serum levels in H. pylori infected patients and its relationship with the immunopathogenesis of the gastric and duodenalmucosa lesions caused by this agent; 2) the immunological changes that could be detected after treatment and linked to some histological alterations Forty ambulatory patients (mean age 68.7 years; 59-80 years), both sexes with clinical and endoscopical diagnosis of gastric ulcer, duodenalulcer or erosive gastric and/or duodenal lesions, were studied. H. pyloriwas diagnosed in gastric and duodenal tissue samples by urease rapidtest, histological examination and tissue culture. Antibiotic sensitivitytests by the ellipsometric technique was performed to determine the minimalinhibitory concentration (MIC) in g.ml–1 of azytromycin, and amoxycillin.The serum levels of IL-2, IL-4, IL-10, IFN-γ and TGF-β were assessed before and after treatment. Patients with confirmed diagnosis of H.pylori infection were treated with omeprazol, amoxycillin and azitromycin.H. pylori non infected patients only received omeprazol. A significant difference was detected in cytokine levels between H. pylori (+) (n=24)and H. pylori (-) (n=16) patients (p<0.01) In H. pylori (+) patients IL-2(p<0.05) and IFNγ levels were lower and IL-4, IL-10 and TGF-β were higher when compared with H. pylori (-) subjects (p<0.01). Pre and post treatment assessments were also significantly different (p<0.01). The employed treatment efficiency was expressed not only on cytokine values but also on the reversion of the histological c (AU)

Changes in Cytokine levels related to the Immunopathogenesis of Helicobacter pylori disease. Immunological and histological effects of triple treatment (omeprazol, azytromycin, and amoxycillin)

Las enfermedades gastroduodenales causadas por H. pylori son consecuenciade una inapropiada respuesta inmunitaria del huésped. Los objetivosdel presente estudio han sido evaluar: 1) niveles séricos de citocinasen pacientes infectados o no con H. pylori y la relación de los primeroscon la inmunopatogénesis de las lesiones en la mucosa gástrica y duodenalcausada por este agente; 2) cambios en los niveles de citocinas posterioresal tratamiento y relacionados con algunas alteraciones histológicas.Se estudiaron 40 pacientes ambulatorios (edad media 68.7 años; 59-80 años),de ambos sexos, con diagnóstico clínico y endoscópico de úlcera gástrica,úlcera duodenal y gastritis erosiva y/o lesiones duodenales. Se diagnosticóH. pylori en muestras de tejido gástricas y duodenales por el Test de laUreasa rápido, exámenes histológicos y cultivo de tejido. La sensibilidadantibiótica se determinó por la Técnica Elipsométrica, para evaluar la concentracióninhibitoria mínima (CIM) en g.ml–1 de azytromycina y amoxycilina.Se evaluaron los niveles séricos de IL-2, IL-4, IL-10, IFN-γ y TGF-βantes y después del tratamiento. Los pacientes con diagnóstico confirmadode infección por H. pylori fueron tratados con omeprazol, amoxycilinay azitromycina. Aquellos no infectados con H. pylori sólo recibieron omeprazol.Se detectó una diferencia significativa en los niveles de todas lascitocinas entre los pacientes H. pylori (+) y H. pylori (-) (p<0.01). Se determinaronniveles significativamente menores de IL-2 (p<0.05) e IFN-γ ymayores de IL-4, IL-10 y TGFβ en pacientes H.pylori (+) comparados conlos de pacientes H. pylori (-)(p<0.01). También las diferencias fueron significativasentre las determinaciones pre y post tratamiento de los pacientesH.pylori (+) (p<0.01). La eficacia del tratamiento empleado se evidenciótanto por los valores de las citocinas evaluadas así como en la reversión lasalteraciones histológicos observadas antes de la terapia

Gastroduodenal diseases caused by Helicobacter pylori are a consequenceof an inappropriate host's immune response This study aims toevaluate: 1) cytokine serum levels in H. pylori infected patients and itsrelationship with the immunopathogenesis of the gastric and duodenalmucosa lesions caused by this agent; 2) the immunological changes thatcould be detected after treatment and linked to some histological alterationsForty ambulatory patients (mean age 68.7 years; 59-80 years), bothsexes with clinical and endoscopical diagnosis of gastric ulcer, duodenalulcer or erosive gastric and/or duodenal lesions, were studied. H. pyloriwas diagnosed in gastric and duodenal tissue samples by urease rapidtest, histological examination and tissue culture. Antibiotic sensitivitytests by the ellipsometric technique was performed to determine the minimalinhibitory concentration (MIC) in g.ml–1 of azytromycin, and amoxycillin.The serum levels of IL-2, IL-4, IL-10, IFN-γ and TGF-β were assessedbefore and after treatment. Patients with confirmed diagnosis of H.pylori infection were treated with omeprazol, amoxycillin and azitromycin.H. pylori non infected patients only received omeprazol. A significantdifference was detected in cytokine levels between H. pylori (+) (n=24)and H. pylori (-) (n=16) patients (p<0.01) In H. pylori (+) patients IL-2(p<0.05) and IFNγ levels were lower and IL-4, IL-10 and TGF-β were higherwhen compared with H. pylori (-) subjects (p<0.01). Pre and post treatmentassessments were also significantly different (p<0.01). The employedtreatment efficiency was expressed not only on cytokine values butalso on the reversion of the histological changes

Method for measuring veiling glare in high-performance display devices.

An experimental method for measuring the veiling glare characteristics of display devices is presented. The measured veiling glare ratio (G) is taken to be the luminance in the surrounding bright field divided by the luminance in a dark circle. The method is based on a collimated conic probe that minimizes signal contamination from bright surroundings allowing for measurements of low luminance in a circular dark spot of a test pattern. A correction factor computed with test patterns having opaque spots is introduced. The factor is expressed as a bivariate function of the dark-spot radius and the distance between the probe and the emissive surface. We studied the uncertainty introduced by the method by measuring veiling glare test patterns printed on radiographic film for which the transmission of the dark spots was determined experimentally. Performance characterization measurements show that signal contamination is less than 10(-4) of the bright field surrounding a dark circle. Our results show that G of a few hundred can be measured with an uncertainty of a few percent, and ratios of approximately 10(3) can be reported within 10%. Finally, we demonstrate the method by measuring G for a high-performance monochrome cathode-ray tube display.

High-fidelity electronic display of digital radiographs.

A fully digital radiography system requires high-fidelity electronic display devices that preserve diagnostic quality. Current cathode-ray tube monitors do not meet desired performance criteria for displaying radiographs and have excessive size, weight, and power consumption. Recent developments in flat-panel display technology (in particular active-matrix liquid crystal displays, field-emission displays, and organic light-emitting displays) suggest that high-fidelity, lightweight displays will be available in the near future. Large-size active-matrix liquid crystal display devices have been demonstrated. High brightness can be easily achieved with bright back illumination. Further developments in optical design for monochrome displays should provide high fidelity and improve the angular dependence of the emitted light. Field-emission display devices have attractive emission distribution and potential for low veiling glare. This technology needs to be extended to a large area, and problems with cathode aging and nonuniformity have to be contemplated. Organic light-emitting displays represent a simple and potentially inexpensive display technology with the ability to achieve high image quality. However, extensive research and development is required to achieve large-area manufacturing methods.

Image quality degradation by light scattering in display devices.

Veiling glare and ambient light reflection can significantly degrade the quality of an image on a display device. Veiling glare is primarily associated with the diffuse spread of image signal caused by multiple light scattering in the emissive structure of the device. The glare ratio associated with a test image with a 1-cm-diameter black spot is reported as 555 for film, 89 for a monochrome monitor, and 25 for a color monitor. Diffuse light reflection results from ambient light entering the display surface and returning at random emission angles. The diffuse reflection coefficient (luminance/illuminance, 1/sr) is reported as 0.026 for film, 0.058 for a monochrome monitor, and 0.025 for a color monitor with an antireflective surface coating. Both processes increase the luminance in black regions and cause contrast reduction. Specular reflections interfere with detail in the displayed scene. The specular reflection coefficient (luminance/luminance) is reported as 0.011 for film, 0.041 for a monochrome monitor, and 0.021 for a color monitor with an antireflective coating.

[Use of a new steroid (Org OD 14) in the climacteric syndrome]. / Uso de un nuevo esteroide (Org OD 14) en el síndrome climatérico.

A double-blind study was carried out in 60 women with climacteric symptoms: 30 women were given Org OD 14 (2.5 mg) and 30 were given a placebo to be taken daily for six weeks. The effects of the medication on the climacteric symptoms, the subjective sensations, the plasma FSH levels and endometrial histology were studied. In the treated group compared with the control group the relief or improvement of the following climacteric symptoms were recorded: perspiration, palpitations, irritability and backache. A favourable effect on the subjective sensations was noted in both groups, although no significant difference for the group which received Org OD 14 was found. At the end of the treatment with Org OD 14, the FSH levels were found to be greatly reduced in comparison with the basal values; this, however, was not the case with the placebo group. With regard to endometrial histology, no sign of hyperplasia was found in any of the patients. No relevant side effects or symptoms of estrogenic or androgenic stimulation were recorded. For the climacteric patient needing estrogen therapy, it can be concluded that Org OD 14 is an effective and innocuous medication in the doses used.

Bromocriptine in the treatment of hyperolactinemic amenorrhea.

Thirty women with secondary amenorrhea and hyperprolactinemia were studied; galactorrhea was present in 25 of them, and 18 were infertile. Serum prolactin (PRL) levels were high in all cases, between 26 and 120 ng/ml. All women were treated with bromocriptine in increasing doses from 2.5 to 5.0 or 7.5 mg daily, according to the response obtained, for 4 months. In 27 patients a PRL determination was performed during treatment; values returned to normal (up to 20 ng/ml) in 23 women and remained high in 4. Galactorrhea disappeared in 21 of 25 women. Ovulatory menses were re-established in 17 patients (56.6%). Seven women became pregnant (38.8%), one of them after bromocriptine and clomiphene were given simultaneously in the same cycle. According to our results and a literature review the following conclusions may be drawn: (1) bromocriptine is a useful therapeutic tool for re-establishing menstruation and inducing ovulation in patients with the hyperprolactinemic-amenorrhea syndrome; (2) the association of bromocriptine and clomiphene could be the next step in the treatment of patients who fail to ovulate with bromocriptine alone.

Plasma levels of norepinephrine during the periovulatory period in normal women. Further studies.

Eleven normally cycling women in whom laparotomy was indicated for benign gynecologic pathology were studied. Surgery was performed on day 0 (expected day of ovulation). Blood samples were drawn daily from day -8 to day -4, and every 8 hours from day -3 to day +2; estradiol (E2), progesterone (P), norepinephrine (NE), and LH were determined by RIA. Ovulation was certified by ovarian visualization and biopsy during laparotomy. In nine ovulatory patients mean E2 peak was found 48 hours before LH peak. Mean NE levels showed minimal variations until 48 hours before LH peak; 8 hours after E2 peak mean NE values increased significantly, fell 8 hours later, and rose immediately again, reaching maximal levels 24 hours after E2 peak. These values remained high until 16 hours before the LH peak and decreased gradually, thereafter reaching basal levels 32 hours after LH peak. Two anovulatory patients showed an atypical pattern of ovarian steroids and LH secretion and NE showed large variations without any correlation with estradiol or LH levels. This study confirms previous findings in women and experimental work in animals regarding the existence of a noradrenergic trigger mechanism to the LH ovulatory discharge.

Pituitary and ovarian response to acute stimulation with LH-RH in normal and anovulatory women.

The LH FSH estradiol and progesterone responses to acute stimulation with LH-RH were studied in 12 normal women with ovulatory cycles (4 in the initial follicular phase, 4 in the mid-follicular phase and 4 in the late follicular phase) and in two castrated women, two under hormonal contraception, two with ovarian amenorrhea, twelve with central amenorrhea of no detectable origin (6 with normal and 6 with low basal gonadotrophins), eleven anovulatory patients with pseudomenstruation, two with anorexia nervosa, and two with pituitary amenorrhea. Each woman received a rapid i.v. injection of 100 microgram synthetic LH-RH at 9:00 a.m. Serum levels of LH, FSH, estradiol and progesterone were determined by radioimmunoassay in samples collected before and 60, 120, 240 and 480 minutes after injection. The findings were : 1) A significant rise in estradiol and progesterone levels, in addition to LH and FSH elevation, in normal women; 2) A lack of ovarian steroid response in the castrated women and in ovarian amenorrheas, which suggests that the source of steroid response to stimulation is not extragonadal; 3) Significant differences in the responses of the four hormones to LH-RH in the women with central amenorrhea in comparison with the normal group with great variability of results; the steroid response in the presence of a positive LH response might correlate with the severity and/or prognosis of the disorder, a point deserving further study; 4) In anovulatory women with pseudomenstruation, LH responses for the most part normal, and particularly, progesterone responses.

PIP: Simultaneous pituitary and ovarian responses to acute stimulation (100 mcg iv injection) with luteinizing hormone-releasing hormone (LH-RH) in normal women at different times of the menstrual cycle were determined and the results were compared with those obtained in women with anuvulation from different causes. There were 12 normal women, 2 women who had had surgical oophorectomy, 2 who were taking combined hormonal contraceptives, 1 with amenorrhea following pelvic irradiation, 1 with gonadal dysgenesis, and 2 with anorexia nervosa. There were also 12 patients with secondary amenorrhea without detectable pathology. All patients received an iv injection of 100 mcg of synthetic LH-RH. In the normal patients basal LH levels were significantly (p .05) higher on Days 13-14 of the cycle than on Days 4-5. In all 3 phases of the cycle, LH reached peak poststimulation levels within 60 minutes after LH-RH injection. Castrate women showed basal LH levels and LH response profiles similar to normals. There were no estadiol or progesterone responses in this group. Women using hormonal contraception showed low basal levels of both gonadotropins with poststimulation LH response but no follicle stimulating hormone response. Estradiol response in this group was slightly lower and more sustained than in normal women. In patients with ovarian amenorrhea, responses were similar to those in castrated women. In patients with anorexia nervosa findings were normal.

Plasma levels of norepinephrine (NE) during the periovulatory period and after LH-RH stimulation in women.

In three normally cycling women studied daily from day 10 to 17 of the menstrual cycle, the levels of circulating norepinephrine showed a sharp rise preceding or concomitantly with the ovulatory LH surge. In two patients the norepinephrine peak took place 24 hr. previously to the LH rise and in the third one it occurred simultaneously. The simultaneous determination of ovarian hormones and norepinephrine showed no temporal correlation between this catecholamine and either estradiol or progesterone. On the other hand, after a single intravenous 100 mug dose of LH-RH, a significant rise in plasma norepinephrine, preceding the LH peak, was found in the four patients studied. The determination of norepinephrine at 3 minute intervals beginning one minute after LH-RH injection showed a significant rise in the amine levels ranging from 5 to 10 times in respect to basal values between 1 and 6 minutes after LH-RH stimulation. In these patients a second peak of norepinephrine occurred simultaneously with the maximal response of LH, which rose to peak levels after 18 minutes in one patient and after 24 minutes in the other. These findings are discussed with respect to the origin and role of increased amounts of plasma norepinephrine related to the LH surge.

Induction of ovulation in long-standing secondary amenorrhea with clomiphene citrate and repeated injections of LH-RH. Preliminary report.

PIP: Induction of ovulation in long-standing secondary amenorrhea with clomiphene citrate and repeated injections of luteinizing hormone-releasing hormone (LH-RH) in 13 women with long-standing secondary amneorrhea was assessed. All of the patients had failed to respond to treatment with clomiphene citrate plus human chorionic gonadotropin (HCG). The patients received 500-750 mg clomiphene citrate per cycle, followed by repeated injections of LH-RH (50 mcg every 90 minutes up to a total dose of 200 mcg) when the Cervical Reaction Scale reached a score of 9 or more. LH-RH treatment was initiated within 7-9 days following the completion of clomiphene therapy. LH levels showed a marked and progressive increase following each injection of LH-RH in 6 patients. The response of follicle stimulating hormone was similar, but became manifest in a shorter period of time. 7 normoestrogenic and 1 hypoestrogenic patient ovulated in response to therapy. Those patients who did not ovulate had lower LH responses than those who did. It is suggested that this therapeutic regimen may be expecially useful in patients with normoestrogenic amenorrhea.^ieng

Luteinizing hormone-releasing hormone in the treatment of anovultory infertility.

Fifteen infertile, anovulatory women, ages 20 to 37, were treated with synthetic luteinizing hormone-releasing hormone (LH-RH) to stimulate follicular maturation and/or ovulation. Thirteen of the patients had been treated unsuccessfully with other therapeutic regimens. To obtain follicular maturation, LH-RH was given intramuscularly in daily doses of 25 mu-g for 7 days and 50 mu-g for the next 7 days, or 100 mu-g for 3 days and 150 mu-g for the next 3 days. Both regimens were begun on the 4th day of a spontaneous or induced cycle. Follicular maturation (evaluated by the cervical mucus scale) occurred in three of seven cycles treated withe the first regimen and three of five treated with the second regimen. To induce ovulation, LH-RH was given in intravenous infusion (50 to 500 mu-g), intramuscularly (100 mu-g), or in a combination of both methods. The drug was administered after follicular maturation with LH-RH, clomiphene citrate, or human menopausal gonadotropin had been achieved; it was also given during four cycles in which spontaneous follicular maturation had occurred. Ovulation occurred in 10 of 25 treated cycles. Five pregnancies resulted, three in the first post-treatment cycle.

[Treatment of the anovulatory sterility with LH-RH (author's transl)]. / Tratmiento de la esterilidad anovulatoria con LH-RH

Thirthy one infertile women with different forms of anovulation were treated with LH-RH on various schemes of application: continuous intravenous (i.v.) infusion, intramuscular (i.m.) unique injection, continuous i.v. infusión plus i.m. unique injection, repeated i.v. injection, repeated i.m. injection and estrogens plus unique i.m. injection. On 46 cycles treated, ovulation was obtained in 18 (39.1%), 13 patients ovulated at least one cycle (41.8%) and six became pregnant (19.3%) three during the treatment and three during the first cycle post-treatment. The best results were obtained (63.2%) of ovulation) with the repeated i.v. injection scheme. Though the results obtained with LH-RH in relation to pregnancies, are lower than those obtained with other therapies of anovulation, the fact that we have been sucessful in cases on which other therapies of anovulation had been unsuccessful, the report up to now of only one case of mild ovary hyperestimulation, and the recent development of LH-RH analogs of more powerful and longer action, justifies the continuing of therpeutic assays with this hormone as to find the most effective scheme to induce ovulation.