Influence of inclined wall self-shading strategy on office building heat gain and energy performance in hot humid climate of Malaysia.

External shading geometry on buildings has been found to contribute substantially to reducing energy consumption for cooling. This study examines the effect of inclined wall self-shading strategy on heat gain in an office building. Field measurement of environmental variables such as ambient temperature, relative humidity, dew point, and wet bulb temperature was carried out in a case study inclined wall self-shading office building located in Putrajaya, Malaysia. The results of the validation of ApacheSim simulation software tool against the measured environmental variables indicated significant reliability having Pearson correlations ranging from 0.56 to 0.90. In establishing the relationship between different inclined wall strategies to the amount of heat gain, modification of the inclined wall self-shading projection (SSP) was modelled and experimented using ApacheSim simulation. Findings from the analysis revealed a relationship between heat gains into a building space and self-shading projection (SSP), as heat gains tend to reduce with increased SSP. From the findings, the optimum inclination angle of self-shading for effective heat gain reduction is based on a 45% self-shading projection. The application of inclined wall self-shading strategy in buildings would, therefore, bring about a reduction in heat gain, which invariably reduces energy consumption for cooling.

Clinical relevance of quantified fundus autofluorescence in diabetic macular oedema.

PURPOSE: To quantify the signal intensity of fundus autofluorescence (FAF) and evaluate its association with visual function and optical coherence tomography (OCT) findings in diabetic macular oedema (DMO). METHODS: We reviewed 103 eyes of 78 patients with DMO and 30 eyes of 22 patients without DMO. FAF images were acquired using Heidelberg Retina Angiograph 2, and the signal levels of FAF in the individual subfields of the Early Treatment Diabetic Retinopathy Study grid were measured. We evaluated the association between quantified FAF and the logMAR VA and OCT findings. RESULTS: One hundred and three eyes with DMO had lower FAF signal intensity levels in the parafoveal subfields compared with 30 eyes without DMO. The autofluorescence intensity in the parafoveal subfields was associated negatively with logMAR VA and the retinal thickness in the corresponding subfields. The autofluorescence levels in the parafoveal subfield, except the nasal subfield, were lower in eyes with autofluorescent cystoid spaces in the corresponding subfield than in those without autofluorescent cystoid spaces. The autofluorescence level in the central subfield was related to foveal cystoid spaces but not logMAR VA or retinal thickness in the corresponding area. CONCLUSIONS: Quantified FAF in the parafovea has diagnostic significance and is clinically relevant in DMO.

Non-Hodgkin's lymphoma of the ocular adnexa.

This study investigates the relationship between the clinical features of lymphoma in the ocular adnexal region and the revised European and American lymphoma (REAL) classification. Specimens from 41 patients with ocular adnexal lymphoproliferative disease were reassessed pathologically using the REAL classification. Thirty-two patients with primary non-Hodgkin's lymphomas (NHL) were included in the study, almost all of them having been treated with radiotherapy with or without chemotherapy. Seven of the 32 patients with NHL showed distant recurrence after treatment: 3 out of 26 with extranodal marginal zone B-cell lymphoma, and 4 with other types of NHL. Although the three patients with recurrent marginal zone B-cell lymphomas all survived, other patients with recurrent lymphomas died of disease. The REAL classification provides a good indication of tumor control probability and survival of patients with ocular adnexal NHL. Radiation therapy is an effective treatment modality for extranodal marginal zone B-cell lymphoma of the ocular adnexa.

Long descending lymphatic pathway from the pancreaticoduodenal region to the para-aortic nodes: its laterality and topographical relationship with the celiac plexus.

In 6 of 15 postmortem-treated cadaveric specimens, we found macroscopically thick lymphatic collecting vessels that originated from not only the nodes along the common hepatic artery (No. 8 nodes) but also from the pancreaticoduodenal region, and which drained directly into the para-aortic nodes immediately below the left renal vein (No. 16b1-inter or -latero nodes). The collecting vessels, if they originated from the ventral (dorsal) visceral side, passed to the left (right) of the superior mesenteric and celiac arteries. Moreover, the right-side vessels (5 specimens) were classified into superficial and deep courses to the celiac plexus, whereas they were superficial in the left side (2 specimens). One of the deep (right) courses continued to the thoracic duct without any intercalated nodes. In addition, another deep route drained into the para-aortic node immediately above the left renal vein (No. 16a2-inter node). We consider that these collecting vessels form "direct descending pathways" from the relatively peripheral lymphatics in the upper abdomen toward the thoracic duct origin. The pathway seems to be a collateral, or even major drainage route, and it appears responsible for skipped metastasis of primary cancer. Since the classical, limited entity of the intestinal lymph trunk does not coincide with our pathway, it should be reconsidered. The proposed entity of the direct, long descending pathway will influence the selection and modification of lymphadenectomy methods in cancer surgery in the pancreaticoduodenal region.

Comprehensive MR imaging of acute gynecologic diseases.

Rapid advances in techniques of magnetic resonance (MR) imaging have enabled diagnosis of acute gynecologic conditions, which are characterized by sudden onset of lower abdominal pain, fever, genital bleeding, intraperitoneal bleeding, or symptoms of shock. The chemical-selective fat-suppression technique not only helps establish the characteristics of lesions that contain fat components but also increases the conspicuity of inflammatory lesions. When a T2-weighted image is obtained with a very long effective echo time (>250 msec), even a small amount of ascites can be easily identified and the contrast between urine and complex fluid becomes more conspicuous. T2*-weighted images are useful for identification of hemorrhagic lesions by demonstrating deoxyhemoglobin and hemosiderin. Contrast material-enhanced dynamic subtraction MR imaging performed with a three-dimensional fast field-echo sequence and a rapid bolus injection of gadopentetate dimeglumine allows evaluation of lesion vascularity and the anatomic relationship between pelvic vessels and a lesion and allows identification of the bleeding point by demonstrating extravasation of contrast material. To optimize the MR imaging examination, attention should be given to the parameters of each pulse sequence and proper combination of the sequences.

Scrotal disorders: evaluation of testicular enhancement patterns at dynamic contrast-enhanced subtraction MR imaging.

PURPOSE: To evaluate testicular enhancement patterns in various scrotal disorders at dynamic contrast medium-enhanced subtraction magnetic resonance (MR) imaging. MATERIALS AND METHODS: Forty-two patients with scrotal symptoms (22 testicular diseases, 20 extratesticular scrotal disorders) underwent three-dimensional (3D) fast field-echo or fast spin-echo dynamic subtraction MR imaging after injection of paramagnetic contrast medium. The relative percentages of peak height and mean slope of the testes on the affected side were compared with those on the unaffected side by using time-signal intensity curves. RESULTS: Extratesticular scrotal disorders (time-signal intensity curve mean peak height, 93.1%; mean slope, 89.8%) showed gradual and progressive increase in homogeneous testicular contrast enhancement in all normal testes. Relative percentages of peak height and mean slope of testicular torsion (mean peak height, 17.3%; mean slope, 10.6%), infarction (mean peak height, 30.4%; mean slope, 19.8%), traumatic hemorrhagic necrosis (mean peak height, -3.5%; mean slope, -12.0%), and epidermoid cyst (mean peak height, -6.6%; mean slope, -14.2%) were significantly lower than those of extratesticular scrotal disorders. Acute mumps orchitis (mean peak height, 135.1%; mean slope, 307.5%) and malignant testicular tumor (mean peak height, 178.7%; mean slope, 467.6%) showed higher relative percentages of peak height and mean slope. CONCLUSION: Dynamic contrast-enhanced subtraction MR imaging can provide information about testicular perfusion on the basis of contrast enhancement and can be used to differentiate testicular diseases from scrotal disorders.

Pseudo-obstruction of the extrahepatic bile duct due to artifact from arterial pulsatile compression: a diagnostic pitfall of MR cholangiopancreatography.

PURPOSE: To evaluate the frequency of artifact from arterial pulsatile compression as the cause of pseudo-obstruction of the extrahepatic bile duct at magnetic resonance (MR) cholangiopancreatography (MRCP) and specify the causative vessels. MATERIALS AND METHODS: In 234 patients (102 men, 132 women; age range, 25-80 years), MRCP images obtained by using a single-shot turbo spin-echo sequence were reviewed to assess pseudo-obstruction of the extrahepatic bile duct caused by vascular compression. Dual-phase spiral computed tomography, contrast material-enhanced three-dimensional MR angiography, and/or digital subtraction angiography also were performed to determine the vessel that caused the pseudo-obstruction. RESULTS: Thirty-six pseudo-obstructions due to vascular compression were found in 33 (14%) patients. The common hepatic duct (27 [75%] sites) was the most common pseudo-obstruction site, followed by the left hepatic duct (four [11%] sites), proximal common bile duct (three [8%] sites), and right hepatic duct (two [6%] sites). The causative vessels were identified as the right hepatic artery at 24 (67%) sites; gastroduodenal artery, two (6%) sites; cystic artery, two (6%) sites; proper hepatic artery, one (3%) site; and an unspecified branch of the common hepatic artery, seven (19%) sites. CONCLUSION: At MRCP, pseudo-obstruction of the extrahepatic bile duct can be caused by pulsatile vascular compression of the hepatic and gastroduodenal arteries, and it should not be misdiagnosed as a bile duct tumor or biliary stone.

Estimation of stature from the skeletal reconstruction of an immature Neandertal from Dederiyeh cave, Syria.

Skeletal reconstruction of a child Neandertal unearthed at Dederiyeh Cave, Syria in 1993, is undertaken and the acquired stature discussed. Although the skeletal remains were well preserved, the reconstruction required several assumptions to be made because of the immature status of the specimen. The assumptions were mainly concerned with distances between bones in the inter-vertebral spaces and in the joints of the hip, knee, and ankle. These were estimated from X-ray films of modern children and data from previous studies. Stature was directly measured on the reconstruction, and found to be 79.2 cm. After corrections for soft tissue thickness and shrinkage of the casts, the stature became 81.7 cm. This estimate is consistent with estimates based on regression equations of long bone lengths, especially from those of the lower extremity. In comparison with longitudinal data for white American boys, the assessment of stature for Dederiyeh varied according to the estimated age. For a younger estimated age, the stature falls in the lower half of the white American range of variation, but with an older estimated age, it falls below the lower limit of the range of variation. Other immature Neandertals including two European specimens, Roc de Marsal and La Ferrassie 6, fall below the lower limit of the 5th to 95th percentile range based on the estimated statures from their long bone lengths. More comprehensive age assessment covering both fossil and modern humans is required before accurate conclusions in relation to Neandertal growth can be drawn.

Dynamic subtraction contrast-enhanced MR angiography: technique, clinical applications, and pitfalls.

Rapid advances in techniques of contrast material-enhanced magnetic resonance (MR) angiography have enabled evaluation of the entire aorta and the main arteries. Dynamic subtraction MR angiography consists of first-pass imaging of long segments of arteries by using a three-dimensional fast field echo sequence with multiple rapid bolus injections of a small dose of gadopentetate dimeglumine. Subtraction enables clear demonstration of the enhanced vascular lumen by eliminating background signal. Improved temporal resolution and repeated sequences after gadopentetate dimeglumine administration allow demonstration of arteries and veins separately. Double subtraction postprocessing can be used to eliminate arterial enhancement in demonstration of the portal and systemic veins. Additional postprocessing can be used to demonstrate arteries in a single image in patients with aortic dissection or a prolonged circulation time. To optimize the examination, the pulse sequence, injection dose, injection rate, timing of the start of data acquisition, imaging time, breath holding, section thickness, and coil selection should be considered. This technique is flexible enough to be applied in a variety of clinical settings, including atherosclerotic occlusive disease, aneurysm of aortoiliac arteries, bypass graft, Takayasu arteritis, aortic dissection, antiphospholipid antibody syndrome, renal artery disease, pelvic vascular disease, and the portomesenteric venous system.

Contrast-enhanced three-dimensional MR portography.

Three-dimensional (3D) magnetic resonance (MR) portography with contrast material enhancement is a fast means of evaluating the portal venous system that has some advantages over currently used modalities, such as digital subtraction angiography, helical computed tomography, ultrasonography, and nonenhanced MR angiography with time-of-flight and phase-contrast techniques. With contrast-enhanced 3D MR portography, a first-pass study of the mesenteric vasculature is performed after rapid bolus injection of gadopentetate dimeglumine; a 3D fast field echo sequence is used, which can demonstrate the intrahepatic and extrahepatic portal venous system clearly. Repeated sequences after administration of gadopentetate dimeglumine allow separate demonstration of the splanchnic arteries and portomesenteric veins. The images are reconstructed by means of maximum-intensity projection postprocessing, and a subtraction technique can be used to eliminate arterial enhancement and demonstrate portosystemic shunts. The coronal source images simultaneously demonstrate parenchymal lesions of the liver, pancreas, biliary tract, and spleen. This technique is clinically indicated in portosystemic shunt, portal vein thrombosis, hepatocellular carcinoma, pancreatobiliary tumor, hepatic vein obstruction, differentiation of splanchnic arterial from portal venous disease, and gastrointestinal hemorrhage. Its limitations include allergic reactions to contrast media, inappropriate positioning of the 3D acquisition slab, respiratory motion artifacts, and pseudodissection.

Diagnostic pitfalls of MR cholangiopancreatography in the evaluation of the biliary tract and gallbladder.

Magnetic resonance (MR) cholangiopancreatography is a noninvasive imaging technique that has proved accurate in the diagnosis of biliary obstruction. However, various diagnostic pitfalls have been reported with MR cholangiopancreatography that were not encountered previously at conventional biliary imaging. These pitfalls may simulate or mask various pathologic conditions of the extrahepatic bile duct or main pancreatic duct and may be caused by a variety of factors. Because of its postprocessing nature, maximum-intensity-projection reconstruction may mask a small gallstone if the stone is surrounded by hyperintense bile and may cause false ductal disconnection or duplication when a breath hold is not performed perfectly. Extraductal factors (e.g., metallic surgical clips, intravascular metallic coils, gas in the stomach or duodenum) can cause signal loss in the adjacent part of the extrahepatic bile duct, which may in turn lead to a false-positive diagnosis of ductal narrowing or obstruction. Normal vascular structures including the right hepatic and gastroduodenal arteries can cause pseudo-obstruction of the extrahepatic bile duct by pulsatile compression. Intraductal factors (e.g., gas, hemorrhage, debris, iodinated contrast material) reduce the signal intensity of the bile, which may result in pseudo-obstruction, false filling defects, or a nonvisualized gallbladder or bile duct. Knowledge of the existence and high prevalence of these diagnostic pitfalls should help prevent misinterpretation of MR cholangiopancreatograms.

[Clinical usefulness of fat suppression technique for MR cholangiopancreatography (MRCP)].

In order to obtain high quality of MRCP image, it is important to reduce the background signal intensity and increase the contrast of the pancreatobiliary ducts relative to surrounding fat tissue. The combination of long effective-TE and fat suppression technique including the short-TI inversion recovery and chemical-selective fat suppression enables to suppress the background signal intensity enough to obtain high quality MR cholangiopancreatogram. However, susceptibility artifacts from the metal, gastroduodenal gas, and vascular pulsation can be augmented by using the chemical-selective fat suppression technique, which may result in signal loss of the pancreatobiliary ducts. This potential diagnostic pitfalls can be avoided by interpreting the coronal source images obtained with long effective-TE and without fat suppression technique.

Place of the Hokkaido Ainu (northern Japan) among circumpolar and other peoples of the world. A comparison of the frequency variations of discrete cranial traits.

Fifteen discrete cranial variations were studied in Ainu and a number of populations from around the world. The major findings, extracted by B-squared distance analysis and Fisher's exact probability test, are as follows: A) The five key traits which distinguish Ainu from the predominant eastern Asians are (1) medial palatine canal, (2) hypoglossal canal bridging, (3) supraorbital foramen, (4) transverse zygomatic suture vestige, and (5) mylohyoid bridging. The frequency of the first trait is comparable to those of Africans, especially Subsaharan Africans, the second and fifth conform to those of the New World peoples, the third is similar to Australians and Subsaharan Africans, and the fourth is the only one aligning the Ainu to Northeast Asians. B) The frequencies of a few wormian bones in Ainu are significantly different from those of many Southeast Asians. The frequencies favour rough clinality from the south to as far north as the arctic area of Northeast Asia in the regions of western Oceania and eastern Asia. The present study confirms that Ainu and Jomon are certainly members of populations originated in Asia but possibly outliers of more predominant Asian populations.

Os zygomaticum bipartitum: frequency distribution in major human populations.

The frequency of the Os zygomaticum bipartitum was examined in major human populations around the world. Eastern Asians have a higher frequency of the bipartite zygomatic bone than any other geographical groups. The arctic peoples, Amerindians and the Oceanians, who all may have derived from eastern Asian population stocks, have a considerably low frequency of this trait. The frequency distribution from East/Southeast Asia to Africa and Europe through South/Central/West Asia suggests some clinality for the bipartite zygomatic bone. The second peak in the frequency is seen in Subsaharan Africa. The clinal variation with no identifiable regulation by subsistence patterns and environmental factors suggested a genetic background for the occurrence of the Os zygomaticum bipartitum.

High-resolution MR cholangiopancreatography.

1. High-resolution MRCP is a noninvasive imaging modality for depicting the pancreatobiliary tree. The imaging quality of high-resolution MRCP is satisfactory. MRCP can demonstrate dilation, stenosis, and intraductal filling defects of both the biliary tract and the pancreatic duct, which meets the clinical demand for pancreatobiliary imaging. 2. MRCP was successful in almost all the patients. However, the causes of MRCP failure were patient motion, irregular respiratory rhythm, severe pneumobilia, and massive ascitic fluid. 3. When only MIP reconstructed images were used for interpretation, small intraductal filling defects such as a gallstone can be missed. In combination with coronal source images, the ability to detect intraductal stones can be increased. 4. Ferrite ammonium citrate (FAC) is useful in suppressing the background signal intensity of gastrointestinal contents so that the ducts can be clearly visualized. The other technique for decreasing the background signal intensity is target MIP postprocessing, which works well for better visualization of the ducts. 5. The degree of ductal narrowing tends to be overestimated with MRCP because of MIP reconstruction artifact and lower spatial resolution of MRCP than ERCP. 6. MRCP has a diagnostic pitfall of a pseudostenosis of extrahepatic ducts, which may lead to a false-positive diagnosis of ductal narrowing. This pitfall may be caused not only by MIP postprocessing artifacts but by gas, surgical metal, and vascular compression of right hepatic artery. There is another diagnostic pitfall that it is difficult to differentiate intraductal mucin from pancreatic fluid in dilate pancreatic ducts, although ERCP identifies mucin as intraductal filling defects.

Cranial variation in prehistoric human skeletal remains from the Marianas.

Nonmetric cranial variation and facial flatness of the Pacific and circum-Pacific populations are investigated. The peoples of the Marianas, eastern Polynesia and Hawaii form a cluster and show affinities in terms of nonmetric cranial variation with the Southeast and East Asians rather than with the Jomon-Ainu, a view which is widely supported by others. Facial flatness analysis also indicates that Polynesians have different patterns of facial prominence as compared with the Jomon-Ainu. These results increase the difficulty of accepting the Jomon-Pacific cluster proposed by Brace and his coworkers. Although genetic and nonmetric cranial variation reveal relatively close relationships, the Mariana skeletons are markedly different in facial flatness and limb bone morphology from those of Polynesians.

Struma ovarii: MR findings.

PURPOSE: The purpose of this study was to determine the MR appearance of struma ovarii correlating with the pathological features. METHOD: MR findings of two patients with struma ovarii were retrospectively reviewed and compared with the pathological findings. RESULTS: Both tumors were complex masses composed of multiple cysts and solid components. The size and signal intensity of multiple cysts varied within the tumor. Hyperintense cystic areas on T1-weighted images were thought to correspond pathologically to hemorrhagic cysts and follicles containing viscous proteinaceous colloid. Solid components had as high a signal intensity as did uterine endometrium on T2-weighted images and as intermediate a signal intensity as did uterine muscle layer on T1-weighted images. After intravenous administration of gadolinium-DTPA, the solid components showed marked contrast enhancement. There was also ascitic fluid associated with adhesion and peritoneal thickening. CONCLUSION: The characteristic MR appearance of struma ovarii is thought to be a mixed mass composed of T2-hyperintense solid components with intense contrast enhancement and multiple T1-hyperintense cystic areas suggestive of hemorrhagic degeneration and viscous proteinaceous colloid.

Primary testicular non-Hodgkin's lymphoma: a clinical study and review of the literature.

Non-Hodgkin's lymphoma (NHL) of the testis is a rare disease, and treatment outcome is generally poor. In this retrospective study, we investigated treatment results for testicular NHL in an attempt to develop an effective treatment policy for this disease. The survival rate and characteristics were retrospectively analyzed in eight patients with NHL of the testis who were treated between 1969 and 1991 at Kyoto University Hospital, Department of Radiology. Four patients were at stage IEA, one at stage IIEA, and three at stage IVEA. Of the eight testicular lymphomas, six were classed as intermediate grade lymphomas and two as high-grade lymphomas according to the Working Formulation. All of the eight patients received orchiectomy. Six patients received combined chemotherapy and radiation therapy as the primary treatment for the disease. One patient each was treated with radiation therapy alone or combination chemotherapy alone. The 5-year overall and disease-free survival rate was 45 and 33%, respectively. Even though almost all of the patients had received combination chemotherapy, high incidence of relapse in the central nervous system (CNS) was observed. Prophylactic treatment against such recurrence may be necessary to improve the treatment outcome of patients with testicular NHL.