Intracranial circulation: pulse-sequence considerations in three- dimensional (volume) MR angiography

The technique and feasibility of magnetic resonance (MR) angiography of intracranial vessels were studied in 35 healthy volunteers. Variations in image orientation, repetition time (TR), and flip angle were evaluated to determine their effects on flow-related enhancement. Gradient modifications--including echo time (TE), motion compensation, bandwidth, and field of view--were also studied in an effort to reduce motion-induced phase shifts. Results indicated that a FISP (fast imaging with steady precession) sequence with a TR of 50 msec, TE of 15 msec, velocity compensation in the read and section-select directions, acceleration compensation in the read direction, anisotropic volume, and a 1.25-mm partition thickness produced three-dimensional angiographic MR images that were accurate and reproducible in the depiction of the major intracranial vessels. Difficulties with field of view, persistent signal void secondary to higher-order motion, and spatial resolution remain major problems requiring additional study.     

Chronic low level physical activity as a determinant of high density lipoprotein cholesterol and subfractions

Physical activity has been associated with reduced risk of coronary heart disease. A mechanism for the reduced risk may be through increased high density lipoprotein cholesterol (HDL-C) and subfractions, in particular HDL2-C. Research associated with increased physical activity investigating HLD-C have assessed the effects of intense aerobic activity. The current research evaluated the relationship between low intensity, long duration activity to HDL-C and subfractions in 35 active postal carriers. Measurements of physical activity via the Large Scale Integrated monitor and reported miles walked, and lipoproteins were assessed at 3-month intervals over a 1-year period. Reported miles walked/day (5.3) was significantly correlated with HLD2-C (r = 0.50, P = 0.003) and approached significance for HDL-C (r = 0.29, P = 0.06). The Large Scale Integrated measures were correlated with HDL-C (r = 0.44, P = 0.008) and HDL2-C (r = 0.44, P = 0.007). Controlling for either age, alcohol consumption, body mass index, or leisure time activity did not reduce the relationship between reported miles walked or Large Scale Integrated readings and HDL2-C, suggesting that the increased HDL-C was the result of long duration, low intensity physical activity.     

Digital mammography. ROC studies of the effects of pixel size and unsharp-mask filtering on the detection of subtle microcalcifications

We investigated the spatial resolution requirement and the effect of unsharp-mask filtering on the detectability of subtle microcalcifications in digital mammography. Digital images were obtained by digitizing conventional screen-film mammograms with a 0.1 X 0.1 mm2 pixel size, processed with unsharp masking, and then reconstituted on film with a Fuji image processing/simulation system (Fuji Photo Film Co., Tokyo, Japan). Twenty normal cases and 12 cases with subtle microcalcifications were included. Observer performance experiments were conducted to assess the detectability of subtle microcalcifications in the conventional, the unprocessed digital, and the unsharp-masked mammograms. The observer response data were evaluated using receiver operating characteristic (ROC) and LROC (ROC with localization) analyses. Our results indicate that digital mammograms obtained with 0.1 X 0.1 mm2 pixels provide lower detectability than the conventional screen-film mammograms. The detectability of microcalcifications in the digital mammograms is improved by unsharp-mask filtering; the processed mammograms still provide lower accuracy than the conventional mammograms, however, chiefly because of increased false-positive detection rates for the processed images at each subjective confidence level. Viewing unprocessed digital and unsharp-masked images in pairs resulted in approximately the same detectability as that obtained with the unsharp-masked images alone. However, this result may be influenced by the fact that the same limited viewing time was necessarily divided between the two images.     

Maxillary sinusitis in adults: an evaluation of placebo-controlled double-blind trials

BACKGROUND: In general practice, acute sinusitis is frequently diagnosed and treated with antibiotics. OBJECTIVE: This study aimed to determine the evidence for the effectiveness of antibiotic treatment in acute maxillary sinusitis in adults by assessing the methodological quality of placebo-controlled double-blind randomized trials. METHOD: An evaluation by four raters through a 35-item scoring-scale for internal and external validity of all placebo-controlled double-blind randomized trials on acute sinusitis found between January 1966 and July 1996. RESULTS: Eighty-five trials were excluded because they were not placebo-controlled, double-blind, randomized, or were carried out in patients with chronic sinusitis or in children. The three remaining trials were performed in different populations (one in general practice) between 1973 and 1978. Only one study claimed superiority of antibiotic treatment. Different inclusion criteria and major outcome measures were used by the authors. The reliability of major outcome events was reported poorly or not at all and in two studies outcome measures were clinically inappropriate. The studies scored 30-62% of the maximum attainable score for internal validity and 10-20% for external validity. CONCLUSION: The effectiveness of antibiotic treatment in acute maxillary sinusitis in a general practice population is not based sufficiently on evidence.      

The neu-oncogene product in serum and tissue of patients with breast carcinoma

BACKGROUND:: A soluble 105 kD neu-related protein is detectable in conditionedmedium from breast cancer cells expressing the neu-oncogeneproduct and in serum of nude mice bearing tumors that overexpressneu-oncogene PATIENTS AND METHODS:: In 100 patients with primary (n - 33) relapse-free (n - 6) andmetastatic (n - 61) breast carcinoma the serum levels of thesoluble new-related protein were investigated by ELISA techniques.Median age was 57 years, range 26–89 years. RESULTS:: The neu-protein serum levels were below 40 HNU/ml (human neu-antigenunit) in 72 patients and 40 or more HNU/ml in 28 patients. In30 patients with primary breast carcinoma, tested before mastectomy,all serum- neu-protein samples were negative. However, 26 of61 metastazised patients (43%) were serum-neu-protein-positive.In disseminated disease (n – 61), serum-neu-protein-positivitywas more likely to be seen in patients with visceral metastases(18/33 – 54%), than in patients with nonvisceral metastases(8/28 – 28%). Furthermore, monitoring of the serum-neu-proteinlevels reflected clinical course. For 53 patients original paraffin-embeddedtumor material was available for studying immunohistochemicalneu-protein expression. In 39/53 (73%) patients immunohistochemicaland ELISA data showed corresponding results. In 27/30 (90%)patients, from whom sera and tissue could be obtained at thesame time at primary mastectomy, results of immunohistochemistryin primary tumor and serum ELISA were negative and mutuallyconfirmatory. However, the other three patients were positivefor immunohistochemical neu-protein expression in primary tumorbut negative for serum-neu-protein expression. CONCLUSIONS:: Our results suggest that patients with advanced breast cancerand an elevated serum-neu-protein level may have a poor clinicaloutcome. This test might be a useful tool for monitoring patientswith advanced breast carcinoma, but not those with early disease.Further prospective studies are warranted to elucidate the questionof whether this test can contribute to determining prognosisand treatment strategies. breast carcinoma, c-erb-B2, HER-2, neu, oncogene, pl85     

Digital radiography of subtle pulmonary abnormalities: an ROC study of the effect of pixel size on observer performance

Forty conventional radiographs with examples of mild interstitial infiltrates and subtle pneumothoraces and 40 normal studies of the chest were selected and digitized, with pixel sizes of 1.0, 0.5, 0.2, and 0.1 mm. Observer performance tests were carried out using receiver operating characteristic analysis. Conventional radiographs and digitized images were compared. The results indicate that, in such cases, diagnostic accuracy increases significantly as the pixel size is reduced, at least to the 0.1-mm level. We conclude that, for digital systems using screen-film or similar image receptors, use of a pixel size substantially larger than 0.1 mm may result in some loss of diagnostic accuracy.     

Data compression: effect on diagnostic accuracy in digital chest radiography

High-resolution digital images make up very large data sets that are relatively slow to transmit and expensive to store. Data compression techniques are being developed to address this problem, but significant image deterioration can occur at high compression ratios. In this study, the authors evaluated a form of adaptive block cosine transform coding, a new compression technique that allows considerable compression of digital radiographs with minimal degradation of image quality. To determine the effect of data compression on diagnostic accuracy, observer tests were performed with 60 digitized chest radiographs (2,048 x 2,048 matrix, 1,024 shades of gray) containing subtle examples of pneumothorax, interstitial infiltrate, nodules, and bone lesions. Radiographs with no compression, with 25:1 compression, and with 50:1 compression ratios were presented in randomized order to 12 radiologists. The results suggest that, with this compression scheme, compression ratios as high as 25:1 may be acceptable for primary diagnosis in chest radiology.     

Arteriovenous fistulas of the lung--their clinical aspects and radiologic images

Based on the data of 15 patients the typical radiological signs of pulmonary arteriovenous fistulas, their differential diagnostic implications, clinical signs and symptoms and management are reviewed. In addition, lung function parameters of 9 patients are presented. The critical role of pulmonary angiography and sequential dynamic CT for the diagnosis is stressed, particularly in those cases in which conventional chest radiographs and tomographies fail to show characteristics abnormalities. Since pulmonary arteriovenous fistulas tend to increase in size and cause complications, they should be subjected to intermediate treatment, even if they are of no haemodynamic relevance.