Kanji Kojima

CT appearance of interstitial pulmonary emphysema.

Interstitial pulmonary emphysema (IPE) is the initial manifestation of ventilator-induced barotrauma. We report two patients in whom computed tomography was useful in showing IPE.

Ciliated foregut cyst of the gallbladder: report of a case.

We report the rare case of a gallbladder cyst arising from the foregut remnants. A 36-year-old woman was referred to our hospital after screening ultrasonography (US) detected a tumor in the gallbladder. On admission, she was well and her blood analyses were all normal. US showed a cystic mass with internal high-echoic lesions, and computed tomography (CT) demonstrated a protruding tumor with slight enhancement in the gallbladder. Angiography provided no additional information; however, sequential CT-arteriography (CTA) clearly demonstrated that this tumor was a cystic lesion. Surgical exploration was performed, first because of the difficulty in establishing a definite diagnosis, and also because the patient wanted the tumor removed. The resected specimen contained a unilocular cystic tumor that looked like a submucosal tumor. Histologically, the wall of the cyst was lined by ciliated stratified columnar epithelium with interspersed goblet cells and underlying smooth muscle fibers. The mass was finally diagnosed as a congenital ciliated foregut cyst of the gallbladder. Cysts of the gallbladder are uncommon and the majority are acquired. To our knowledge, this represents only the fourth report of a ciliated foregut cyst of the gallbladder in the literature. Although rare, an awareness of this entity could allow a preoperative diagnosis to be made, whereby surgical exploration may be avoided. CT-A is a very useful diagnostic tool, especially when the nature of the tumor presents a difficult differential diagnosis.

Clinical values for an index predicting postoperative residual liver function by pre-operative liver-scintigraphy in patients with liver disease

Hepatic resection is essential in treating hepatocellular carcinoma. However, before an operation, it is difficult to predict the functional reserve in the remnant following massive resection. We devised an original method by which effective liver volume was measured by liver scintigraphy. In order to predict the residual liver function before hepatic resection in a preoperative radiocolloid study, we obtained a predictive index by combining the K values with effective liver volumes which seemed to have the estimated residual liver function. Twenty-one patients with liver or biliary tract disease were selected at random for the present study. We divided them into 3 groups in accordance with prognosis after hepatic resection. There were statistically significant difference between the deceased group who died from hepatic failure and the group who died from causes other than hepatic failure ; and between the deceased group who died from hepatic failure and the living group in the preictive index (p< 0.01). Our data suggest that if the predictive index is above 0.45, the probability of hepatic failure after hepatic resection is low. We concluded that our predictive index is useful to use in preoperative prediction of post-hepatectomic residual liver function.

Improved method of preparation of inflated-fixed lung for radiologic-pathologic correlation

The technique of inflation and fixation of the lung with polyethylene glycol is useful for specimen radiography and radiologic-pathologic correlation, but it is limited by poor histologic staining of the fixed tissue. To improve staining we used formalin to distend and fix the lung before standard fixation with a polyethylene glycol mixture. In this preliminary study, canine and infant lungs, and lungs from three cases of lung cancer were examined. The modified technique provided high-quality staining and satisfactory specimen radiography in all cases except one of the lung cancers; in this case excessive shrinkage occurred and degraded radiographic quality. We conclude that the new method of preparation permits both specimen radiography and high quality staining of the fixed tissue.

Lacrimal gland accumulation of 67Ga-citrate in patients with Sjögren's syndrome.

The extent of 67Ga accumulation in the two lacrimal glands in patients with keratoconjunctivitis sicca (KCS) of Sjögrens syndrome was studied. Of the two main groups one consisted of 69 subjects without ophthalmic complaints (control group), the other consisted of 26 patients with KCS of Sjögrens syndrome. Of the 26 patients with KCS, 7 had been diagnosed as probable KCS (probable sub-group) and the other 19 had been diagnosed definite KCS (definite sub-group). About 3 mCi (111 MBq) 67Ga-citrate was injected IV into each subject and this was followed by scintigraphy at 24, 48, and 72 h after the injection of 67Ga. A positive finding in the lacrimal gland was noted in 64 of 69 subjects (92.7%) in the control group and in 7 of 7 patients (92.7%) in the control group and in 7 of 7 patients (100%) with probable KCS. Three of 19 patients with definite KCS (15.7%) showed positive findings under scintigraphy. When the scintigraphic finding in the lacrimal gland is not positive in patients with suspected KCS of Sjögrens syndrome, they can then be diagnosed with little risk as definite KCS cases. Shirmers test was performed on subjects in the probable and definite groups. There was statistical significance between the positive and equivocal or negative scintigraphic finding and Schirmers values. These results suggest a correlation between gallium accumulation in the lacrimal gland and the tear production.

A kinetic study on secretion and elimination of endogenous thyrotropin in the thyrotropin-releasing hormone test

Serum thyrotropin (TSH) concentrations in normal young men were measured by a highsensitivity immunoradiometric assay before and after intravenous administration of 500μg of TSH-releasing hormone (TRH). A kinetic model was applied to evaluate the secretion rate both before (V0) and after (V0+V* at maximum rate) the administration of TRH, the elimination constant (K), the latent time (L) between TRH administration and start of the stimulated secretion, and the total amount of TSH (T) released in response to TRH. Vo, V* and T varied widely from individual to individual, but correlated well with TSH before TRH administration (r=0.93, 0.80 and 0.87, respectively). A few minutes (1.89± 1.30 min) after the administration of TRH, the secretion of TSH (0.025±0.016μU/min ml) was stimulated, and the total release over about 1 h was 12.5±5.6,μU/ml. Serum TSH was maximum at 31.5±5.7 min. The half-time of disappearance of TSH was 42±9 min. These data confirm that the stimulated secretion continues for more than 30 min, and that the pituitary releases 43.2±22.9 mU of TSH (assuming the distribution volume of TSH is 5.8% of body weight) in response to TRH, an amount which correlates closely (r=0.91) with TSH before TRH administration.