Diagnosis of undifferentiated type early gastric cancers by magnification endoscopy with narrow-band imaging

Background and Aims: The diagnostic use of magnification endoscopy with narrow‐band imaging (ME‐NBI) to assess histopathologically undifferentiated‐type early gastric cancers (UD‐type EGCs) is not well elucidated. The purpose of this study was to examine the comparative relationship between ME‐NBI images and histopathological findings in UD‐type EGCs. Methods: We analyzed 78 consecutive cases of UD‐type EGCs ≤ 20 mm in diameter that underwent ME‐NBI ≤ 2 weeks prior to resection. The ME‐NBI images were compared with histopathological findings following either endoscopic submucosal dissection (ESD) or surgery. Applying the comparative results, we prospectively evaluated the success of identifying the lateral extent of UD‐type EGCs resected by ESD in additional consecutive cases. Results: Lesions with preserved but irregular surface microstructures (S‐type based on ME‐NBI) showed mucosal atrophy and corresponded histologically to the non‐whole‐layer type of intramucosal cancer (24/24, 100%). Lesions with an irregular microvasculature type (V‐type, for example, corkscrew pattern) or mixed type upon ME‐NBI corresponded histopathologically to the non‐whole‐layer type of intramucosal cancer (15/54, 27.8%), the whole‐layer type of intramucosal cancer (27/54, 50.0%) or submucosal (sm) invasion cancer (12/54, 22.2%). Applying these comparative results, we used ME‐NBI to successfully predict the lateral extent of cancer, which corresponded to the histopathological lateral extent in all 18 additional consecutive UD‐type EGCs resected by ESD. Conclusions: ME‐NBI images of UD‐type EGCs were very closely related to the histopathological findings. Thus, ME‐NBI can be useful in the pretreatment assessment of the histopathological patterns of cancer development and the lateral extent of such lesions.     

Relevance of substantia nigra hyperechogenicity and reduced odor identification in idiopathic REM sleep behavior disorder

BackgroundSubstantia nigra (SN) hyperechogenicity determined by transcranial sonography (TCS) and olfactory dysfunction are common findings in Parkinson disease (PD), which may reveal a prodromal synucleinopathy in idiopathic REM sleep behavior disorder (iRBD).MethodsTCS and the Odor Stick Identification Test for Japanese (OSIT-J) were performed in 34 consecutive patients with iRBD (67.9 ± 6.1 years), 17 consecutive patients with PD (66.4 ± 6.7 years), and 21 control group subjects (64.4 ± 5.8 years).ResultsThere was a significantly increased area of echogenicity in the SN in the iRBD group (0.20 ± 0.13 cm²) and PD group (0.22 ± 0.11 cm²) compared with the control group (0.06 ± 0.06 cm²). We found pathological SN hyperechogenicity (?0.20 cm²) in 41.2% of the iRBD group, 52.6% of the PD group, and 9.5% of the control group. Further, there were abnormal findings of both pathological SN hyperechogenicity (?0.20 cm²) and functional anosmia or hyposmia in 4 (11.8%) or 9 (26.5%) of the iRBD group subjects, respectively, and 7 (57.9%) or 2 (11.8%) of the PD group subjects, respectively.ConclusionPathological SN hyperechogenic abnormality and functional anosmia in iRBD may be a disease state in the transition to a neurodegenerative disease.     

Rotational and translational reproducibility of newly developed Leksell frame-based relocatable fixation system

Purpose The aim of this study was to evaluate three-dimensional movement of the cranium in a relocatable frame using positions of anatomical landmarks obtained from repeated quality-assurance (QA) computed tomography (CT) studies. Materials and methods We analyzed 17 series of QA-CT data representing five patients who underwent stereotactic radiotherapy for treatment of acoustic neurinoma. Helical-CT scans with 1-mm collimation were obtained at the time of treatment planning and during the course of treatment. The right and left short processes of the incus and the top of the crista galli were used as the three anatomical reference points. Results Fluctuations in distance among the reference points were all <1 mm. The translational displacements for these points were <2 mm, with standard deviations (SD) of <2 mm. A plane that included all three reference points was defined as the reference plane. To investigate the direction of cranial rotation for each QA-CT scan, unit normal vectors of the reference plane were obtained. Three-dimensional analyses indicated that cranial rotation was greatest along the X-axis, followed by the Y-axis, with the least rotation along the Z-axis. Conclusion The result suggested that movement of the craniocaudal axis in the sagittal plane was a major factor behind displacement of the cranium.