Nagano National Hospital

The aim of this study was to analyze the reason for variation of image quality in the upper abdomen CT with the use of CT-AEC. The CT investigated was 3D modulation in the 16MDCT and LSCT phantom was used to simulate the patient. When there was a phase difference, an image noise increase of around 15% at the maximum was accepted. It is concluded that the major reason for variation in image quality is respiratory motion and the importance of respiration control must be recognized.

Osteoporosis-pseudoglioma syndrome (OPS; OMIM 259770) is an autosomal-recessive genetic disorder characterized by severe osteoporosis and visual disturbance from childhood. Biallelic mutations in the low-density lipoprotein receptor-related protein 5 gene (LRP5) have been frequently detected, while a subset of patients had only one or no detectable mutation. We report on the clinical and molecular findings of four unrelated Japanese patients with the syndrome. The four patients had typical skeletal and ocular phenotypes of OPS, namely severe juvenile osteoporosis and early-onset visual disturbance, with or without mental retardation. We undertook standard PCR-based sequencing for LRP5 and found four missense mutations (p.L145F, p.T244M, p.P382L, and p.T552M), one nonsense mutation (p.R1534X), and one splice site mutation (c.1584+1G>A) among four OPS patients. Although three patients had two heterozygous mutations, one had only one heterozygous splice site mutation. In this patient, RT-PCR from lymphocytic RNA demonstrated splice error resulting in 63-bp insertion between exons 7 and 8. Furthermore, the patient was found to have only mutated RT-PCR fragment, implying that a seemingly normal allele did not express LRP5 mRNA. We then conducted custom- designed oligonucleotide tiling microarray analyses targeted to a 600-kb genome region harboring LRP5 and discovered a 7.2-kb microdeletion encompassing exons 22 and 23 of LRP5. We found various types of LRP5 mutations, including an exon-level deletion that is undetectable by standard PCR-based mutation screening. Oligonucleotide tiling microarray seems to be a powerful tool in identifying cryptic structural mutations.

We conducted and reported the first (1982; 55,388 subjects), and second (1992; 45,674 subjects), epidemiological surveys conducted on bronchial asthma in elementary students across 11 prefectures in western Japan. The 2 surveys were conducted in the same regions using the same methodology employing a modified Japanese version of the American Thoracic Society-Division of Lung Diseases (ATS-DLD) Epidemiology Questionnaire. We conducted the third survey in 2002, and compared the findings to those of previous studies. In the third survey, 37,036 students attending the same schools as in previous surveys (in 11 prefectures) were given the questionnaire. A total of 35,582 responses (96.1%) were collected. An ATS-DLD Epidemiology Questionnaire was also used in this study, and the findings were compared to those of previous studies. 1. The prevalence of bronchial asthma (BA) in boys, girls, and all students was 3.8%, 2.5%, and 3.2%, respectively, for the first survey; 5.6%, 3.5%, and 4.6% for the second survey; and 8.1%, 4.9%, and 6.5% for the third survey. 2. A decline in the BA prevalence in older subjects which could be seen in the first survey was absent in the second and third surveys. There were no regional differences in the third survey. 3. The boys-to-girls ratio in the first, second, and third surveys was 1.5, 1.6, and 1.6, respectively. 4. BA was more prevalent among subjects with a past history of respiratory disease in infancy and those with a family history of allergic disease. 5. The prevalence of asthma symptoms and wheezing in the first, second, and third surveys was 7.1%, 9.8%, and 11.8%, respectively. 6. A comparison of the prevalence of other allergic diseases between the second and third surveys revealed a decrease in atopic dermatitis and an increase in allergic rhinitis, allergic conjunctivitis, and cedar pollinosis. BA prevalence in the third survey increased 2.1 and 1.4 times respectively compared to the first survey and second survey, indicating an upward trend in all regions and age groups surveyed.

Misplacement of nasogastric feeding tubes into the respiratory tract often results in tremendous complications such as pneumonia, empyema and pleural effusion. The National Health Service issued advice to prevent these errors in 2005, describing that verification of pH 5.5 or lower of the aspirate fluid or X-ray confirmation is a prerequisite condition for feeding. However, the usefulness and feasibility of this advice has not been well evaluated. Our experience to implement this advice revealed the problem that in about 30% of the instances before feeding, such verification is infeasible. Therefore, we suggest the following recommendations by reviewing the literature and caregivers' opinions. 1. Placement of newly inserted tubes should always be confirmed by X-ray before use for feeding or medication. 2. At re-insertion of the tube, verification of pH 5.5 or lower of the aspirate fluid or X-ray confirmation should essentially be performed before medication or feeding. 3. Before every feeding, checking the external length of the tube from the nostril and observing the inside of the mouth should be done to determine if the tube is partially removed or not. If there is no suspicion of tube removal, feeding can be started.

Recently, hip pads have been developed to prevent the femur fracture by falling for aged persons. It is necessary for hip pads that the material and the structure select and design to realize the higher performance of impact absorption. In this work, an experimental system was made to test the impact absorbing properties of hip pad with cellular cushion and commercial hip pad. Using an artificial femur with composite materials that consist of cortical and cancellous region, impact load was applied to greater trochanter of the femoral model. Impact absorbing performance was evaluated by the impulsive force, collision time and impact strain. As a result, significant differences were not showed about absorbing performance in hip pad with cellular cushion except 12mm thickness.

脾嚢胞は画像診断の進歩に伴い,さほど稀な疾患ではなくなりつつある.今回われわれは5年間の経時的変化を追ったCAI9-9産生巨大脾嚢胞の1例を経験したので報告する. 症例は44歳,女性,左季肋部痛を主訴に来院した.初診時の腹部CT上で直径10cm大の脾嚢胞を認めた.嚢胞は年々増大したが手術を拒否していたため,そのまま経過観察していた.嚢胞容積はCT volumetoryにてほぼ直線的な増加を示し,5年後には嚢胞は最大径28cmと巨大なものになった.血清CEAは0.6ng/mlと正常であったがCA19-9は1,759U/mlと高値を示していた.持続的な腹痛も伴うようになったため脾摘出術施行となった. 嚢胞内容液は約6,000ml,嚢胞内CEAは125.9ng/ml, CA19-9は1.7×105U/mlと高値を示した.組織学的には真性嚢胞と診断され,免疫染色ではCEA, CA19-9とも嚢胞内上皮に陽性所見を認めた.摘出後の血中CA19-9は正常に復した.

The Japan Sooiety of Meohanioal Engineers 508 3 CT