シンリョウヨウ ホウシャセン ニヨル カンジャ ヒバク

All medical exposures should be justified (more benefit than risk). This requires not only knowledge of medicine but also of the radiation risks. The magnitude of risk from radiation is dose-related with higher amounts of radiation being associated with higher risks. The aim of managing radiation exposure is to minimise the putative risk without sacrificing, or unduly limiting, the obvious benefits in the prevention, diagnosis and also in effective cure of diseases (optimization). Various diagnostic radiology procedures cover a wide dose range based upon the procedure. There may be a wide variation in the dose given for the same procedure on a specific individual when performed at different facilities. This variation may be up to a factor of ten and is often due to differences in the technical factors for the procedure. Interventional Radiology is increasingly used by practitioners in many specialties to reduce morbidity and mortality. However, there is a growing literature on serious skin injuries to patients from IVR procedures. The frequency of CT examinations is also increasing rapidly. The absorbed dose to tissues from CT can often approach or exceed the levels known to increase the probability of cancer as shown in epidemiological studies. Especially both the fetus and children are thought to be more radiosensitive than adults. Diagnostic radiology is extremely unlikely to result in doses that cause malformations or a decrease in intellectual function. The main issue following in-utero or childhood exposure at typical diagnostic levels (<50 mGy) is cancer induction. Now diagnostic reference levels can be used to help manage the radiation dose to patients so that the dose is commensurate with the clinical purpose. Appropriate equipment and training are needed to minimize this risk. Patient counseling should be undertaken routinely, and follow up when appropriate

Medical Image Diagnosis of Lung Cancer by Deep Feedback GMDH-Type Neural Network

The deep feedback Group Method of Data Handling (GMDH)-type neural network is applied to the medical image diagnosis of lung cancer. The deep feedback GMDH-type neural network can identified very complex nonlinear systems using heuristic self-organization method which is a type of evolutionary computation. The deep neural network architectures are organized so as to minimize the prediction error criterion defined as Akaike’s Information Criterion (AIC) or Prediction Sum of Squares (PSS). In this algorithm, the principal component-regression analysis is used for the learning calculation of the neural network. It is shown that the deep feedback GMDH-type neural network algorithm is useful for the medical image diagnosis of lung cancer because deep neural network architectures are automatically organized using only input and output data

Medical Image Analysis of Brain X-ray CT Images By Deep GMDH-Type Neural Network

The deep Group Method of Data Handling (GMDH)-type neural network is applied to the medical image analysis of brain X-ray CT image. In this algorithm, the deep neural network architectures which have many hidden layers and fit the complexity of the nonlinear systems, are automatically organized using the heuristic self-organization method so as to minimize the prediction error criterion defined as Akaike’s Information Criterion (AIC) or Prediction Sum of Squares (PSS). The learning algorithm is the principal component-regression analysis and the accurate and stable predicted values are obtained. The recognition results show that the deep GMDH-type neural network algorithm is useful for the medical image analysis of brain X-ray CT images

Effects of Preoperative Use of an Immune-Enhancing Diet on Postoperative Complications and Long-Term Outcome: A Randomized Clinical Trial in Colorectal Cancer Surgery in Japanese Patients

Background: Despite recent advances in surgical techniques and perioperative management, postoperative infectious complications remain a problem in surgical patients. We performed a prospective randomized clinical trial to examine the effects of preoperative Immune Enhancing Diets (IEDs) on postoperative complications in Japanese patients who underwent curative colorectal cancer surgery. This study was also designed to evaluate the optimal dose of preoperative IEDs for the patients without malnutrition. Finally, we analyzed recurrence free survival (RFS) and disease-specific survival (DSS) after surgery in patients who did and did not receive IEDspreoperatively.Material and Methods: This was a prospective, randomized clinical trial conducted at the Department of Surgery, National Defense Medical College, from October 2002 to October 2005. The 88 patients undergoing colorectal surgery were enrolled and were randomly divided into 3 groups. The high- (High, N=26) and low- (Low, N=31) dose groups received normal food and, respectively, 750ml/day or 250ml/ day of IEDs for 5 days before the operation. The primary endpoint was the rates of surgical site infection (SSI) and non- infectious complications. We also evaluated the RFS and DSS rate, respectively. Results: The patients were followed for 77±10 months (9-133 months) after surgery. Incisional SSI rates in the IEDs (High and Low) groups were significantly lower than in the Control group. (0%*, 0%* and 17%) (*P<0.01 vs. Control) The incidences of the infections not involving the surgical site (non-SSI) and the lengths of hospital stay were similar among the three groups. No significant differences were observed in RFS or DSS.Conclusion: In Japanese patients undergoing colorectal cancer surgery, preoperative IEDs significantly reduced the rate of incisional SSI as compared with the control group. Very interestingly, in Japanese patients, preoperative 250ml/day IED intake may be adequate for colorectal cancer patients without malnutrition. However, with regard to the long term outcome, beneficial effects of preoperative IEDs are not evident

Anderson's disease/chylomicron retention disease in a Japanese patient with uniparental disomy 7 and a normal SAR1B gene protein coding sequence

<p>Abstract</p> <p>Background</p> <p>Anderson's Disease (AD)/Chylomicron Retention Disease (CMRD) is a rare hereditary hypocholesterolemic disorder characterized by a malabsorption syndrome with steatorrhea, failure to thrive and the absence of chylomicrons and apolipoprotein B48 post-prandially. All patients studied to date exhibit a mutation in the <it>SAR1B </it>gene, which codes for an essential component of the vesicular coat protein complex II (COPII) necessary for endoplasmic reticulum to Golgi transport. We describe here a patient with AD/CMRD, a normal <it>SAR1B </it>gene protein coding sequence and maternal uniparental disomy of chromosome 7 (matUPD7).</p> <p>Methods and Results</p> <p>The patient, one of two siblings of a Japanese family, had diarrhea and steatorrhea beginning at five months of age. There was a white duodenal mucosa upon endoscopy. Light and electron microscopy showed that the intestinal villi were normal but that they had lipid laden enterocytes containing accumulations of lipid droplets in the cytoplasm and lipoprotein-size particles in membrane bound structures. Although there were decreased amounts in plasma of total- and low-density lipoprotein cholesterol, apolipoproteins AI and B and vitamin E levels, the triglycerides were normal, typical of AD/CMRD. The presence of low density lipoproteins and apolipoprotein B in the plasma, although in decreased amounts, ruled out abetalipoproteinemia. The parents were asymptomatic with normal plasma cholesterol levels suggesting a recessive disorder and ruling out familial hypobetalipoproteinemia. Sequencing of genomic DNA showed that the 8 exons of the <it>SAR1B </it>gene were normal. Whole genome SNP analysis and karyotyping revealed matUPD7 with a normal karyotype. In contrast to other cases of AD/CMRD which have shown catch-up growth following vitamin supplementation and a fat restricted diet, our patient exhibits continued growth delay and other aspects of the matUPD7 and Silver-Russell Syndrome phenotypes.</p> <p>Conclusions</p> <p>This patient with AD/CMRD has a normal <it>SAR1B </it>gene protein coding sequence which suggests that factors other than the SAR1B protein may be crucial for chylomicron secretion. Further, this patient exhibits matUPD7 with regions of homozygosity which might be useful for elucidating the molecular basis of the defect(s) in this individual. The results provide novel insights into the relation between phenotype and genotype in these diseases and for the mechanisms of secretion in the intestine.</p

Three-dimensional imaging of thoracic diseases with multidetector row CT

The benefits of multi-detector row CT (MDCT) relative to single-detector row helical CT are considerable. Multi-detector row CT allows shorter acquisition times, greater coverage, and superior image resolution. These factors substantially increase the diagnostic accuracy of the examination. Three-dimensional (3D) volume data from MDCT provides various unique applications on thoracic diseases. These includes isotropic viewings, use of multi planar reformation (MPR), maximum and minimum intensity projections (MIP and min IP), and volume rendering performed from external and internal perspectives allowing the user to “fly around” and “fly through” the structures. Recent advances in 3D volume rendering put real-time, interactive virtual reality guidance of the procedures such as bronchoscopy and surgery into practice

Radiographic comparison between male and female patients with lumbar spondylolysis

We studied the lumbar spines of 117 adults (39 women and 78 men) with spondylolysis unrelated to low back pain using multidetector computed tomography (CT). Of the 117 subjects with spondylolysis, including five with multiple-level spondylolysis, there were 124 vertebrae with spondylolysis. In adult lumbar spines with unilateral spondylolysis, there was no significant difference between the incidence of spondylolisthesis in female and male subjects. However, in those with bilateral spondylolysis, there was a significantly higher incidence of spondylolisthesis in female subjects (90.9%) than in males (66.2%). Furthermore, females with bilateral spondylolysis had significant more slippage than males. Lumbar index and lumbar lordosis were not significantly different between male and female subjects, and did not significantly correlate with slippage. In conclusion, to treat acute spondylolysis in adolescents, it is important to obtain bony union at least unilaterally, especially in female subjects, to prevent further slippage

Synchronous neuroendocrine tumors in both the pancreas and ileum: A case report

AbstractIntroductionAlthough it is well-known that in multiple endocrine neoplasia type 1 (MEN 1) disease, multiple endocrine lesions frequently occur, synchronous or metachronous neuroendocrine tumors (NETs) in non-MEN 1 patients are extremely rare.Presentation of caseAn asymptomatic 72-year-old woman with an ileal NET was referred to our hospital. Abdominal computed tomography revealed another circular tumor within the pancreatic head. She was classified as a non-MEN 1 patient. An operative procedure was performed with a preoperative diagnosis of synchronous NET, which was confirmed by pathological examination.DiscussionBoth morphologic and immunophenotypic findings were different between in the ileum and pancreas. Therefore, it was reasonable to consider that both tumors were primary tumors. The synchronous occurrence of these tumors is unusual, and it may be considered as a chance occurrence.ConclusionWe here report the first case of synchronous pancreatic NET and ileal NET in a non-MEN 1 patient

Simple noise reduction for DWI

Our purpose in this study was to reduce the noise in order to improve the SNR of Dw images with high b-value by using two correction schemes. This study was performed with use of phantoms made from water and sucrose at different concentrations, which were 10, 30, and 50 weight percent (wt%). In noise reduction for Dw imaging of the phantoms, we compared two correction schemes that are based on the Rician distribution and the Gaussian distribution. The highest error values for each concentration with use of the Rician distribution scheme were 7.3 % for 10 wt%, 2.4 % for 30 wt%, and 0.1 % for 50 wt%. The highest error values for each concentration with use of the Gaussian distribution scheme were 20.3 % for 10 wt%, 11.6 % for 30 wt%, and 3.4 % for 50 wt%. In Dw imaging, the noise reduction makes it possible to apply the correction scheme of Rician distribution