An infant case of macroprolactinemia with transient idiopathic central precocious puberty

Macroprolactinemia was recognized more than a decade ago as a cause of hyperprolactinemia and the prevalence of macroprolactinemia is thought to be 10%-26% of patients with hyperprolactinemia. However, there are few published reports about macroprolactinemia in childhood. We report a 7-year-and-1-month-old girl with hyperprolactinemia due to macroprolactinemia with the complication of transient idiopathic central precocious puberty (ICPP). At the age of 6 years and 9 months, she was diagnosed with ICPP at another clinic, on the basis of isolated mammary development and increased height velocity with slightly advanced bone age. At that time, the unexpected finding of high PRL level was also observed. Four months later, she was referred to our clinic for persistently high PRL level. At this time, other endocrinological data showed prepubertal stage and we demonstrated macroprolactinemia and the presence of anti-PRL autoantibody. After other causes of hyperprolactinemia such as prolactinoma and stress were ruled out, we finally diagnosed her with hyperprolactinemia due to macroprolactinemia. Because most patients with macroprolactinemia are symptom-free despite hyperprolactinemia and drug therapy would not be indicated, macroprolactinemia should be suspected even in children to avoid unnecessary examinations and treatments.     

Adenocarcinoma arising in a mediastinal enteric cyst

A 39 year-old male was admitted to our hospital because of relapsing episodes of pneumonia. His chest roentgenogram showed a consolidated shadow and cavity formation in the left lower lobe. During a left lower lobectomy an enteric cyst in the posterior mediastinum involving lung was found. This cyst in the lung contained normal gastric parietal cells and pancreatic tissue, and was surrounded by adenocarcinoma characteristic of gastric cancer. This is a rare case in which an adenocarcinoma arise from an enteric cyst in the mediastinum.     

Cervical lymph node metastases: diagnosis at sonoelastography--initial experience

PURPOSE: To prospectively estimate the accuracy of sonoelastography in the differentiation of benign and metastatic cervical lymph nodes (LNs) in patients suspected of having thyroid or hypopharyngeal cancer, with histologic nodal findings as the reference standard. MATERIALS AND METHODS: The study protocol was approved by the hospital review board; each patient gave written informed consent. One hundred forty-one peripheral neck LNs (60 metastatic, 81 metastasis free) in 43 consecutive patients (22 men, 21 women; mean age, 58 years +/- 13 [standard deviation]) were examined. Patients referred for surgical treatment of suspected thyroid or hypopharyngeal cancer were examined with gray-scale ultrasonography (US), power Doppler US, and sonoelastography. At gray-scale and power Doppler US, the following LN characteristics were evaluated: short-axis diameter, short-to-long-axis diameter ratio, echogenicity, calcifications, and vascularity. A four-point rating scale was used to evaluate the US elastograms for LN visibility, relative brightness, margin regularity, and margin definition. In addition, strains of LN and surrounding neck muscles were measured on elastograms, and the muscle-to-LN strain ratio--that is, the strain index-was calculated. The diagnostic potential of the examined criteria for metastatic involvement was evaluated with univariate analysis and multivariate generalized estimating equation (GEE) regression. P < .05 indicated statistical significance. RESULTS: A strain index greater than 1.5 had high utility in metastatic LN classification, with 98% specificity, 85% sensitivity, and 92% overall accuracy. These results were significantly better than those obtained by using the best gray-scale criterion--that is, a short-to-long-axis diameter ratio greater than 0.5-which had 81% specificity, 75% sensitivity, and 79% overall accuracy. CONCLUSION: Sonoelastography had high accuracy (92%) in the differentiation of benign and metastatic cervical LNs in patients suspected of having thyroid or hypopharyngeal cancer.     

Follow-up study of condylar bony changes using helical computed tomography in patients with temporomandibular disorder

OBJECTIVES: We investigated condylar bone changes in 1032 joints from 516 subjects in order to clarify the incidence and type of bone changes in the temporomandibular joint (TMJ), and alteration of the change during follow-up, in patients with temporomandibular disorders (TMD). METHODS: We classified condylar bone change into five types on multiplanar reformatted (MPR) images of helical CT: N, no bone change; F, flattening; E, erosion with or without roughening; D, deformity; S, deformity accompanied by erosion with or without roughening. In 51 of 516 subjects, follow-up CT examination was performed and transition of condylar bone change was observed. RESULTS: Condylar bone change was seen in 617 (63.7%) of 1032 joints and in 70 (68.6%) of 102 follow-up joints. The number of joints of Types D and S increased at follow-up, but those of Types N, F and E decreased. CONCLUSION: In this study, the main direction of transition of condylar bone change in joints with TMD was absorptive bone change to absorptive with sclerotic (proliferative) bone change and further to sclerotic (proliferative) bone change. Our classification of condylar bone change was thought to be convenient for the evaluation of bone change in TMD.     

Method of segmenting inferior horns of lateral ventricles using active contour models

Recent research has suggested that the measurement of regional atrophy in the structure of the medial temporal lobe is a promising way to discriminate Alzheimer-type dementia patients from healthy control subjects. There are some reports that the inferior horns of the lateral ventricles are expanded by atrophying the structure of the medial temporal lobe. We developed a technique to automatically detect the region of the inferior horns of the lateral ventricles by gray-level thresholding and morphological processing. However, there were some incorrect regions in this method. Accordingly, we proposed a technique for which active contour models (ACM) were used. Our ACM incorporates the improved edge-based image and the external constraint to improve convergence and to reduce its dependence on initial estimation. In this study, we present the details of an algorithm that traces the contours of the inferior horns of the lateral ventricles and its performance relative to manual methods. The average degree of correspondence between the extract region and manual trace was measured in 30 inferior horns of 15 subjects. The average degree of correspondence of the proposed method was about 4% higher than that of the conventional method. These results suggest that the proposed method is more accurate than the conventional method.     

Influences of prolonged apnea and oxygen inhalation on pulmonary hemodynamics during breath holding: quantitative assessment by velocity-encoded MR imaging with SENSE technique

PURPOSE: The purpose of our study was to assess the influence of prolonged apnea and administration of oxygen on pulmonary hemodynamics during breath holding (BH) by using velocity-encoded MR imaging combined with the SENSE technique (velocity MRI). MATERIALS AND METHODS: Ten healthy male volunteers underwent velocity MRI during BH with and without O(2) inhalation. All velocity MRI data sets were obtained continuously with the 2D cine phase-contrast method during a single BH period. The data were then divided into three BH time phases as follows: first, second and third. To evaluate the influence of prolonged apnea on hemodynamics, stroke volume (SV) and maximal change in flow rate during ejection (MCFR) of second and third phases were statistically compared with those of first phase by using the ANOVA followed by Turkey's HSD multiple comparison test. To assess the influence of O(2) on hemodynamics, SV and MCFR with or without O(2) were compared by the paired t-test. To assess the measuring agreement of hemodynamic indices during prolonged breath holding, Bland-Altman's analysis was performed. RESULTS: Prolonged apnea had no significant influence on SV and MCFR regardless of administration of O(2) (p>0.05). Mean MCFR for all phases was significantly lower with administration of O(2) than without (p<0.05). The limits of agreement for MCFR with O(2) were smaller than without. CONCLUSION: O(2) inhalation modulated maximal change in flow rate during ejection, and did not influence stroke volume during breath holding. Influence of O(2) inhalation should be considered for MR measurements of pulmonary hemodynamics during breath holding.