Digital radiography of the chest

Digital radiography is an appropriate method for both bedside and in-department chest radiographs. Its major advantage in bedside chest radiography is its control of the displayed optical density of these radiographs. With dynamic range control processing, it improves the visibility of tubes and lines superimposed on the mediastinal tissues. When used for in-department chest radiography, it may offer slight advantages in the evaluation of disease in the mediastinum, but in general is equivalent to film-screen chest radiography. The main reasons for using digital chest radiography for in-department chest radiographs relate mainly to its use as a data entry point method of projection radiography for high-quality teleradiology or for its use in a picture archiving and communication system. Apart from these advantages, there is no reason to change from conventional to digital chest radiographs. Digital radiographs are, with certain systems, printed at smaller than life size. Because of this, there is a necessary period of learning as radiologists adjust to the new image size. The most important change in radiologists' work pattern appears to be the need to sit closer to the film. Findings of disease are smaller, but, with experience, just as easy to see.     

Image processing in digital radiography

Image processing is a critical part of obtaining high-quality digital radiographs. Fortunately, the user of these systems does not need to understand image processing in detail, because the manufacturers provide good starting values. Because radiologists may have different preferences in image appearance, it is helpful to know that many aspects of image appearance can be changed by image processing, and a new preferred setting can be loaded into the computer and saved so that it can become the new standard processing method.Image processing allows one to change the overall optical density of an image and to change its contrast. Spatial frequency processing allows an image to be sharpened, improving its appearance. It also allows noise to be blurred so that it is less visible. Care is necessary to avoid the introduction of artifacts or the hiding of mediastinal tubes.     

Storage phosphor digital mammography

Digital mammography using storage phosphor CR is still in the investigational stage. It is the only digital mammography system that has been tested in preliminary clinical trials with promising early results. Further clinical studies are needed to assess the impact of the limited spatial resolution of storage phosphor technology on its application as a digital screening mammography system. Further studies also are needed to determine the optimum image processing parameters needed in digital mammography.     

Benign intracranial hypertension and recombinant growth hormone therapy in Australia and New Zealand

Benign intracranial hypertension (BIH) is reported in three children from Australia and one from New Zealand, who were being treated with recombinant human growth hormone (rhGH). Three males and one female, aged between 10.5 and 14.2 y, developed intracranial hypertension within 2 weeks to 3 months of starting treatment. A national database, OZGROW, has been prospectively collecting data on all 3332 children treated with rhGH in Australia and New Zealand from January 1986 to 1996. The incidence of BIH in children treated with growth hormone (GH) is small, 1.2 per 1000 cases overall, but appears to be greater with biochemical GHD (<10IUml ^-1), i.e. 6.5/1000 (3 in 465 cases), relative risk 18.4, 95% confidence interval 1.9-176.1, than in all other children on the database. The incidence in patients with Turner's syndrome was 2.3/1000 (1 in 428 cases). No cases in patients with partial GHD (10–20 IUml ^-1) or chronic renal failure were identified. Possible causative mechanisms are discussed. The authors'practice is now to start GH replacement at less than the usual recommended dose of 14IUm-² week^-1 in those children considered to be at high risk of developing BIH. Ophthalmological evaluation is recommended for children before and during the first few months following commencement of rhGH therapy and is mandatory in the event of peripheral or facial oedema, persistent headaches, vomiting or visual symptoms. The absence of papilledema does not exclude the diagnosis.     

Immunological effects of tumor vaccines: II. T cell responses directed against cellular antigens in the viral oncolysates

Peripheral blood mononuclear cells (PBMC) from patients with epithelial adenocarcinoma of the ovary treated in vivo with tumor vaccines administered as viral oncolysates (VO) exhibited significant proliferative responses in vitro to VO as well as to cellular oncolysates (CO). These responses were dependent on the concentration of VO or CO. VO consisted of lysates from the same ovarian tumor cell lines 2774 and CaOV3 infected in vitro with the avirulent strain of influenza virus A/PR8/34. CO were lysates from the same ovarian tumor cell lines without virus. Depletion experiments with the OKT3 monoclonal antibody plus complement demonstrated that these proliferative responses are T cell specific and under the control of the HLA-D region. Furthermore, these T cell responses are directed against both tumor tumor cellular components and tumor HLA class I molecules. These responses can be detected as early as two weeks after the first intraperitoneal injection of VO and reach a maximum 12-16 weeks after the first application of VO for treatment. PBMC from ovarian patients that received in vivo VO exhibited insignificant proliferative responses to CO prepared from human fibroblasts or tumor cell lines of hematopoietic origin. In contrast, they exhibited significant proliferative responses to CO prepared from a human cervix tumor cell line. These results demonstrate systemic T cell activation by antigens in the tumor vaccines in patients with epithelial ovarian carcinoma after in vivo intraperitoneal administration of VO.