伴月骨周围不稳定的舟骨骨折

目的：探讨日本名古屋地区伴月骨周围不稳定舟骨骨折的发生率、相关因素、诊断和治疗。方法：对11例经腕关节镜检查确认系伴月骨周围韧带损伤的病例进行了回顾性研究，分析其临床特点、治疗方法和疗效。结果：舟骨骨折中，合并舟月或月三角韧带损伤的发生率为20．4％，其韧带损伤与左腕受伤显著相关，63．6％合并近排腕骨背伸不稳定（dorsal intercalated segment instability,DISI), 仅有1例可见明显的舟月分离。通过对应治疗，其疗效与单纯舟骨骨折相比无明显差别。结论：伴月骨周围不稳定的舟骨骨折并不罕见，腕关节镜检查可提高其检出率，积极治疗可取得较好的疗效。     

Improvements in PET Image Quality in Time of Flight (TOF) Simultaneous PET/MRI

Purpose

An integrated positron emission tomography (PET)/magnetic resonance imaging (MRI) scanner with time of flight (TOF) technology is now available for clinical use. The aim of this study is to evaluate the potential of TOF PET in PET/MRI to reduce artifacts in PET images when compared to non-TOF PET/MRI, TOF PET/X-ray computed tomography (CT), and non-TOF PET/CT.

Procedures

All patients underwent a single 2-deoxy-2-[¹⁸F]fluoro-d-glucose ([¹⁸F]FDG) injection, followed first by PET/CT, and subsequently by PET/MRI. PET/CT exams were requested as standard-of-care for oncological indications. Using the PET acquisitions datasets, 4 series of images (TOF PET/CT, non-TOF PET/CT, TOF PET/MRI, and non-TOF PET/MRI) were reconstructed. These image series were visually evaluated for: (1) dental metal artifacts, (2) breathing artifacts, and (3) pelvic artifacts due to scatter correction errors from high bladder [¹⁸F]FDG concentration. PET image quality was assessed by a 3-point scale (1—clinically significant artifact, 2—non clinically significant artifact, and 3—no artifact).

Results

Twenty-five patients (mean?±?SD age: 56?±?13 years old; female: 10, male: 15) were enrolled. TOF PET/MRI, non-TOF PET/MRI, TOF PET/CT, and non-TOF PET/CT scores 2.8, 2.5, 2.4, and 2.3, respectively for the presence of dental artifacts, 2.8, 2.5, 2.2, and 1.9, respectively, for the presence of breathing artifacts, and 2.7, 1.7, 2.0, and 1.3, respectively, for the presence of pelvic artifacts TOF PET/MRI images showed the highest image quality scores among the 4 datasets of PET images.

Conclusion

The superior timing resolution and resulting TOF capability of the new PET/MRI scanner improved PET image quality in this cohort by reducing artifacts compared to non-TOF PET/MRI, TOF PET/CT, and non-TOF PET/CT.

     

In vitro and in vivo antifungal activities of TAK-456, a novel oral triazole with a broad antifungal spectrum

TAK-456 is a novel oral triazole compound with potent and broad-spectrum in vitro antifungal activity and strong in vivo efficacy against Candida albicans and Aspergillus fumigatus. TAK-456 inhibited sterol synthesis of C. albicans and A. fumigatus by 50% at 3 to 11 ng/ml. TAK-456 showed strong in vitro activity against clinical isolates of Candida spp., Aspergillus spp., and Cryptococcus neoformans, except for Candida glabrata. The MICs at which 90% of the isolates tested were inhibited byTAK-456, fluconazole, itraconazole, voriconazole, and amphotericin B were 0.25, 4, 0.5, 0.13, and 0.5 microg/ml, respectively, for clinical isolates of C. albicans and 1, >64, 0.5, 0.5, and 0.5 microg/ml, respectively, for clinical isolates of A. fumigatus. Therapeutic activities of TAK-456 and reference triazoles against systemic lethal infections caused by C. albicans and A. fumigatus in mice were investigated by orally administering drugs once daily for 5 days, and efficacies of the compounds were evaluated by the prolongation of survival. In normal mice, TAK-456 and fluconazole were effective against infection caused by fluconazole-susceptible C. albicans at a dose of 1 mg/kg. In transiently neutropenic mice, therapeutic activity of TAK-456 at 1 mg/kg of body weight against infection with the same strain was stronger than those at 1 mg/kg of fluconazole. TAK-456 was effective against infections with two strains of fluconazole-resistant C. albicans at a dose of 10 mg/kg. TAK-456 also expressed activities similar to or higher than those of itraconazole against the infections caused by two strains of A. fumigatus in neutropenic mice at a dose of 10 mg/kg. These results suggest that TAK-456 is a promising candidate for development for the treatment of candidiasis and aspergillosis in humans.     

Performance profile of a FDG-PET cancer screening program for detecting gastric cancer: results from a nationwide Japanese survey

Purpose

It has been reported that gastric cancer is the sixth most common cancer found during the ¹⁸F-fluorodeoxyglucose-positron emission tomography (FDG-PET) cancer screening program, which is defined as cancer screening of asymptomatic subjects using FDG-PET(/CT) (in combination with other screening tests or not). The aim of this study was to analyze the detection rate and the effectiveness of the FDG-PET cancer screening program at detecting gastric cancer between 2006 and 2009 in Japan.

Materials and methods

A total of 153,775 asymptomatic subjects (92,255 men, 61,520 women) between 30 and 80 years old underwent the FDG-PET cancer screening program. Of these, we analyzed 790 cases with findings of possible gastric cancer in any screening test.

Results

The number of cases who were verified to have gastric cancer was 124. Among these, only 47 cases were detected by FDG-PET, which resulted in a relative sensitivity of 37.9 % and a positive predictive value of 33.6 %. The relative sensitivity of FDG-PET was much lower than those of gastric endoscopy and the serum pepsinogen test.

Conclusion

The FDG-PET screening program in Japan detected some cases of early-stage gastric cancer, but this was not achieved using FDG-PET alone but in combination with gastric endoscopy. Gastric endoscopy should be included in FDG-PET cancer screening programs to screen for gastric cancer.     

Incidental focal FDG uptake in heart is a lighthouse for considering cardiac screening

Objectives

Cardiac FDG uptake is known to show a variety of patterns under clinical fasting conditions. We hypothesized that focal FDG uptake in the heart (FUH) represents a sign of cardiac disease risk, especially in coronary artery disease (CAD).The aim of this study was to clarify the relationship between FUH and cardiac disease.

Methods

Cases showing FUH were selected based on comments in diagnostic reports or identification on retrospective review. Quantitative analysis was performed using maximum standardized uptake value (SUV_max), with regions of interest drawn over focal uptake areas in the heart as confirmed by PET/CT and in lateral side of the same slice showing focal FDG uptake.

Results

For the 20 patients (11 men, 9 women) with confirmed FUH, coronary artery stenosis or history of treatment for coronary disease was present in 11 patients (55.0 %), and 2 patients showed apical hypertrophy. Mean SUV_max of FUH did not differ significantly between patients with confirmed cardiac disease and those with no evidence of cardiac disease (P = 0.78).

Conclusions

FUH suggests a high likelihood of CAD in patients without myocardial symptoms. Cardiac screening or a check of the history of cardiac disease is thus worth considering when FUH is seen incidentally on FDG-PET/CT.     

Evaluation of organ-specific glucose metabolism by <Superscript>18</Superscript>F-FDG in insulin receptor substrate-1 (IRS-1) knockout mice as a model of insulin resistance

Objective  

Insulin resistance (IR) is a physiological condition in which the body produces insulin but does not result in a sufficient biological effect. Insulin resistance is usually asymptomatic but is associated with health problems and is a factor in the metabolic syndrome. The aim of the present study is to clarify organ-specific insulin resistance in normal daily conditions using [¹⁸F]-2-fluoro-2-deoxy-d-glucose ([¹⁸F]-FDG).     

Hydrocephalus due to diffuse villous hyperplasia of the choroid plexus

An 8-month-old female presented with hydrocephalus caused by cerebrospinal fluid (CSF) overproduction due to bilateral choroid plexus enlargement, which was clinically diagnosed as diffuse villous hyperplasia of the choroid plexus, but differentiation from bilateral choroid plexus papilloma was difficult. She initially underwent ventriculoperitoneal shunt surgery, but developed marked retention of ascites. Therefore, the peritoneal end of the shunt was removed for external drainage, but excessive CSF (1,500 ml/day) was collected. Computed tomography and magnetic resonance imaging revealed marked symmetric enhancement of the choroid plexuses in the bilateral lateral ventricles. Thallium-201 chloride single-photon emission computed tomography showed pronounced uptake on both early and delayed images, and good washout. CSF examination revealed no abnormalities such as atypical cells, and a ventriculoatrial shunt was inserted, achieving good control of the hydrocephalus.     

Factors associated with the relapse of cryptogenic and secondary organizing pneumonia

Background

Organizing pneumonia (OP) is a histopathological response pattern to lung inflammation. It is clinically classified into cryptogenic OP and secondary OP, which is associated with various clinical conditions. Rapid resolution with corticosteroids and frequent relapses are common in OP. However, few studies have investigated the factors associated with OP relapse.

腕舟骨骨折关节镜检查的结果及其意义

目的　应用腕关节镜研究腕舟骨骨折后腕关节的反应、合并软组织、软骨损伤与腕骨排列的异常。方法　分析了 5 8例次腕舟骨骨折患者的关节镜检查结果 ,镜检中重点观察了腕关节滑膜、关节软骨、掌侧韧带、骨间韧带、三角纤维软骨和骨折线等内容。结果　舟骨骨折后滑膜增生开始于伤后 2周 ,并经历了波浪式的消涨过程 ,其增生与否与骨折移位无相关性 (P >0 .0 5 ) ;关节软骨的破坏最早在伤后 5周即有表现 ,并有较大比例的患者合并韧带和三角纤维软骨损伤。结论　腕关节镜检查能更清楚地观察腕关节的病变 ,并为完善诊断和制定治疗计划提供有力的依据。