Thickening of the yellow ligament is clinically important as the main factor of backward compression in spinal canal stenosis and is known to be one of the main causes of lumbar spinal canal stenosis. Histologically, the ligament contains elastic fibers and a large amount of elastin that is a component of the fibers, and its metaplastic changes such as proliferation of collagen fibers and cartilaginous tissue occur with age. However, the molecular biological mechanism of such tissue changes has not been clarified in several respects. On the other hand, f ibroblast growth factor (FGF) is known to stimulate growth of cells of mesodermal origin such as fibroblasts, vascular endothelial cells and epithelial cells. At present there are at least 23 species of FGF attracting attention. In the present study, we examined FGF-1 in the yellow ligament and comparatively examined the relation of the FGF-1 expression with lateral images of simple roentgenogram and MR images. The subjects were 11 patients who underwent operations for lumbar spinal canal stenosis, degenerative lumbar sliding and lumbar disk herniation. Sixteen extracted yellow ligament specimens were examined. At the time of operation, the patients were 24-79 years old or 65.7 years old on average and consisted of 6 males and 5 females. During extended fenestration or discectomy performed on lumbar spinal canal stenosis, degenerative lumbar sliding and lumbar disk herniation, specimens of yellow ligament tissue were collected and examined. After collection, each specimen was embedded in O.T.C compound and fixed by freezing. Thereafter, 4μ m-thick sections were routinely prepared and stained with H-E and Alcian blue. In addition, immunostaining of FGF-1 was performed, and each tissue section was classified based on the number of FGF-1-positive cells. Images of the yellow ligament were classified according to the degree of osteophyte formation on simple roentgenogram lateral images, thickness of the yellow ligament and degree of stenosis of the spinal canal on MRI; furthermore, the relation to FGF-1 was examined. A high FGF-1 expression rate was found in the vertebral arch side where degeneration of yellow ligament was severe. The rate of FGF-1 expression rose with increasing thickness of the ligament on MR images. No clear relation to the degree of spinal canal stenosis or the degree of osteophyte formation was observed. In brief, FGF-1 was involved in degeneration of yellow ligament and showed a high correlation with changes in MR images.

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The purpose of the study was to investigate prospectively the incidence of cystoid macular edema (following CME) after cataract surgery including intraocular lens implants. The 35 subjects (50 eyes) were from 40 to 80 years of age. Patients with systemic disease such as diabetes mellitus and ocular disease were excluded. In addition, axial length and operation time were unified to reduce influence to CME as much as possible. Fluorescein leakage from the macular was evaluated according to Miyake's classification using fluorescein angiography (following FA) three months after cataract surgery. There were no postoperative complications ; a total of 50 eyes were subjects of evaluation. The incidence of angiographic CME was 22% in this study. It was higher than clinical CME. It is more precise and important to invest prospectively controlled cases.

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HIFU can occlude blood flow to induce hemostasis during bleeding from arteries as a treatment for anterior-venous malformation and to reduce the size of tumors by preventing blood flow from feeding arteries. We postulated that injecting ultrasound contrast agents might decrease the HIFU intensity required for arterial occlusion in addition, microbubbles because microbubbles are destroyed under ultrasound sonication ; might exert a cavitation effect on the endothelium, which would damage blood vessels. This study investigates the effect of contrast agents on changes in blood flow and arterial morphology induced by HIFU. We constructed a prototype transducer which provides both color flow image and HIFU sonication. HIFU was applied through the skin for 5 seconds to nine focal spots which were aligned at intervals of 0.5 mm across the veccel on each hindpaw of Sprague-Dawley (SD) rats. Peak HIFU intensities were 530, 1080, 1550 and 2750 W/cm² . Five rats were injected with 60 mg of Levovist^®, and 5 received 0.5 ml of saline (control) . Blood flow was occluded by exposure to HIFU at intensities of 530, 870, 1, 550 and 2, 750 W/cm² in 0 % (0/5), 60% (3/5), 100% (5/5) and 100% (5/5) of the rats given Levovist^®, respectively. Blood flow was occluded in 0 % (0/5), 0 % (0/5), 0 % (0/5) and 80% (4/5) of the control rats at each respective HIFU intensity. Staining with hematoxylin-eosin (HE) revealed obvious vacuolar degeneration in the tunica media and endothelium cells that had detached from the vessel walls of the rats given Levovist^®. These results imply that the cavitation induced by contrast agents under HIFU exposure exerts significant effects on the vessel endothelium. Therefore, injected contrast agents might reduce the intensity of HIFU required to occlude targeted arteries.

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Fractalkine (FKN, CX3CL1) is a membrane-bound chemokine with a domain which can induce both adhesion and migration of leukocytes and is involved in the recruitment of cells into tissues undergoing inflammatory responses. Since FKN is expressed in many tissues but at particularly high levels in the brain, we hypothesized that FKN and its specific receptor CX3CR1 may be implicated in the pathogenesis of systemic lupus erythematosus (SLE), especially of SLE with neuropsychiatric involvement (NPSLE) . The aim of this study is to determine soluble FKN (sFKN) levels in SLE and to assess their relationship with disease activity and damage. Soluble FKN levels in serum and cerebrospinal fluid (CSF) were measured by ELISA. The expression of FKN and CX3CR1 was quantified using real-time PCR. The surface expression of CX3CR 1 on peripheral blood mononuclear cells (PBMCs) was determined flow cytometrically. Disease activity and organ damage were assessed using the SLE Disease Activity Index (SLEDAI) and Systemic Lupus International Collaborating Clinics / American College of Rheumatology Damage Index (SLICC/ACR DI), respectively. Serum sFKN levels were significantly higher in SLE patients than in rheumatoid arthritis (RA) patients or healthy con trols, and there were significant correlations between serum sFKN levels and SLEDAI, SLICC/ ACR DI, anti-ds DNA and anti-Sm antibody titers, immune complex levels (IC-C1q) and serum complement levels (CH50) . The expression of CX3CR 1 was significantly greater in PBMCs from patients with active SLE than in those from RA patients or healthy controls. Levels of sFKN were also significantly higher in CSF from newly-diagnosed, untreated NPSLE patients than in SLE patients without neuropsychiatric involvement ; treatment significantly reduced both CSF and serum sFKN levels in NPSLE patients. FKN and CX3CR1 play key roles in the pathogenesis of SLE including neuropsychiatric involvement. Soluble FKN is also a serologic marker of disease activity and organ damage in SLE patients, and its measurement in CSF may be useful for diagnosis and follow-up of NPSLE patients.

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Seventy-two Graves' disease patients with normal thyroid function or latent hyperthyroidism on the basis of antithyroid drug (ATD) use in the first trimester of pregnancy were adopted as subjects in this study. The subjects were divided into either a ATD-continuity group of patients who took at least one tablet a day at the time of delivery (n=32), or a ATD-discontinuity group (n=40) . We attempted to predict discontinuation of oral therapy at the time of delivery on the basis of the TRAb titer and ATD dose alone but it was impossible. Though we also performed a bivariate analysis using TSH receptor antibody (TRAb) titer and ATD dose, clear discrimination was also impossible. We therefore performed a nominal logistic analysis using two factors : y = 3.507-0.080 × TRAb-0.329 × ATD dose The value of y was used in the prediction formula below, and the higher value was adopted as the prediction result. Probability (ATD discontinuity) =1/ {1 + Exp (y) } Probability (ATD continuity) = Exp (y) × 1 / {1 + Exp (y) } Calculation of the correct diagnosis rate for the outcome of 50 new pregnancy and delivery patients using this formula yielded 90%. This formula made possible prediction of the subjects condition at the time of delivery making this formula very useful in clinical practice.

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The clinical usefulness of MDCT (multidetector-row-CT) is determined by its ability to obtain thinner slices through a wider portion of the body. Thus, MDCT provides improvement of time resolution and high quality reconstruction images. In particular, clinical application for the heart and coronary arteries is difficult by CT, excluding EBCT (electron beam CT), because of its poor time resolution. However, MDCT has improved the time resolution of CT and is used for cardiac and coronary disease evaluation. Reports regarding delineation of cardiac diseases with MDCT have recently increased and many successful cases have been reported. We developed a cardiac phantom for ECG gated MDCT to better understand the function of MDCT. The phantom closely simulates motion of the left ventricle while providing a valuable tool to evaluate coronary stenosis and calcification making this newly developed cardiac phantom for ECG gated MDCT useful for functional evaluation of cardiac MDCT.

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We report two rare cases of ganglionic mass originating from the transverse ligament of the hip joint. MRIs of both cases showed low intensity in T1 and high intensity in T2 at the medial-caudal site of the femoral head. Corresponding hip arthroscopy of the medial-caudal site of the femoral head revealed a soft tissue mass covered with synovial tissue at the transverse ligament. Punction was performed through arthroscopy and the diagnosis for ganglion was done by aspiration of typical glassy, clear fluid. In the literature there are no cases reported of ganglion originating from the transverse ligament of the hip joint. Hip arthroscopy is valuable for diagnosis and treatment of intra-articular diseases. In these two cases, in particular, hip arthroscopy revealed the exact site of the ganglion, and precise aspiration and resection with forceps was performed resulting in a minimum invasive operation.

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