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[Studies of peripheral nerve conduction velocities in vibrating tool operators].

Vibrating tools such as chain-saws, rock-drills, grinders and tie-tampers have been widely used in many kinds of industries in Japan, causing vibration syndrome among the operators. As is well-known, the syndrome includes disorders of the peripheral circulation in the hands, e.g. Raynaud's phenomenon, and of the peripheral and central nervous systems. As the result of preventive countermeasures to the syndrome during the last decade, the picture of the syndrome has been partly changing especially for the patients among the state forestry workers; for example, the prevalence of the peripheral nerve disorders has been relatively increasing compared with that of Raynaud's phenomenon. Peripheral nerve disorders such as numbness, paresthesia and hypesthesia in the upper limbs tend to be usually cumulative and irreversible. The disorders are very important problem of vibration syndrome from the standpoint of treatment and prevention, though there are only a few reports of the study on the disorders using electrophysiological methods. In order to make objectively clear the peripheral nerve disorders, 236 male vibrating tool operators (= Group V) were examined. The following nerve conduction velocities were measured: (1) Maximal motor nerve conduction velocities (MCV) of the median and ulnar nerves in the forearm. (2) Sensory nerve conduction velocities (SCV) of the median and ulnar nerves in the forearm and palm. (3) Residual latency (RL) of the median and ulnar nerves. Besides, working conditions and complaints relevant to vibration syndrome were examined by using questionnaires. MCVs, SCVs and RLs that were outside of mean +/- 2 S.D. of the control group (= Group C), consisting of 30 healthy men, were evaluated as abnormal. The obtained results led to the following conclusions: (1) All MCVs, SCVs and RLs of Group V were significantly less than those of the control group. In Group V, prevalence of the abnormality in each of forearm SCVs was higher than that in each of MCVs of the corresponding nerves. (2) The difference between the median and ulnar SCV in the palm and the respective SCV in the forearm of each subject was significantly greater for Group V than Group C. (Palm-forearm difference) (3) The difference between the forearm and palmar SCV of the ulnar nerve and the respective velocities of the median nerve was statistically greater for Group V than for Group C. (Ulnar-median difference) (4) Ulnar SCV in the palm of Group V was significantly related to the total operating hours of vibrating tools. (5) There was no significant relation between all the nerve conduction velocities and the white finger attack. But a significant relation was noticed between the prevalence of the abnormal values of ulnar SCV in the palm and the peripheral circulatory function score computed from the data of nail press test and cold immersion test.

Adult

Image feature analysis and computer-aided diagnosis in digital radiography. 3. Automated detection of nodules in peripheral lung fields.

We are investigating the characteristic features of lung nodules and the surrounding normal anatomic background in order to develop an algorithm of computer vision for use as an aid in the detection of nodules in digital chest radiographs. Our technique involves an attempt to eliminate the background anatomic structures in the lung fields by means of a difference image approach. Then, feature-extraction techniques, such as tests for circularity, size, and their variation with threshold level, are applied so that suspected nodules can be isolated. Preliminary results of this automated detection scheme yielded high true-positive rates and low false-positive rates in the peripheral lung regions of the chest. This detection scheme, which can assist the final diagnosis by the clinician, has the potential to improve the early detection of lung carcinomas.

Diagnostic Errors

[Experiences with computer-assisted x-ray diagnosis of pulmonary coin lesions (author's transl)].

Favourable results of the computer-aided diagnosis of peripheral bronchial carcinoma lead to a simplified scheme for calculation fo diagnosis, basing upon X-ray symptoms. This scheme was tested in the Zentralinstitut für Krebsforschung (ZIK) in 102 pateints and in the Forschungsinstitut für Lungenkrankheiten und Tuberkulose (FLT) in 101 patients. These patients had coin lesions of the lung with unknown diagnoses. The histological diagnoses later proved were compared with the calculated diagnoses. In ZIK there were correct diagnosis in 92.16% (in 96.53% of the carcinomas, in 44.4% of the tuberculomas and in all benign tumors), while in FLT 85.53% of the coin lesions were correctly classified (89.13% of carcinomas, 79.31% of the tuberculomas and all benign tumors). The comparison with the clinical-histological diagnoses showed a clear improvement of the accuracy by the calculated diagnoses. The method can be recommended for the basic diagnosis especially of peripheral bronchial carcinoma. It implies a reduction of the diagnostic delay, but it can not substitute the histologic investigation of the lesions.

Adult

Far-field potentials in muscle.

Far-field potentials have been predicted by computer simulations as well as demonstrated in both animals and humans with respect to the peripheral and central nervous systems. Computer simulations have also predicted far-field potentials originating at the termination of muscle tissue. This investigation demonstrates the occurrence of 2 far-field potentials in the human biceps muscle resulting from action potential termination at the musculotendonous junctions. A monophasic potential is produced at both the muscle's origin and insertion, and the polarity is entirely dependent upon the recording montage. Sequential stimulation of the biceps muscle at 2.5-cm increments resulted in the 2 far-field potentials and their respective latencies changing proportional to the distance between the stimulus site and the 2 musculotendonous junctions. Various stimulation and recording montages are used to investigate the properties of these far-field potentials. The leading/trailing dipole model is utilized to explain the production and polarity of far-field potentials generated by muscle tissue.

Action Potentials

Transient abdominal granulomas in children.

Space-occupying liver lesions in febrile patients are usually caused by tumor or infection and other causes are seldom encountered. In five patients age 20 months to 12 years who were evaluated for fever of unknown origin, imaging studies revealed hepatic nodules consisting of transient, sterile granulomas for which no cause could be determined. Stellate architecture histologically supported clinical evidence of subacute bacterial infection. Imaging modalities included: 99Tc-sulfur colloid (n = 2) and 67Ga (n = 2) scintigraphy; ultrasound (n = 5); computed tomography (n = 4); and magnetic resonance imaging (n = 2). Peripheral low density, as revealed by computed tomography in one and hyperintense halos on magnetic resonance imaging of another patient are both considered predictive for neoplastic disease but were associated with granulomas. The differential diagnosis of macroscopic liver lesions seen on imaging studies in febrile children should include the possibility of transient, idiopathic granulomas.

Child

[Characteristics of central and peripheral hemodynamics in infants with hemolytic disease of newborn].

Overall 82 full-term neonates (52 children with hemolytic disease and 30 healthy neonates) were examined. The general circulation was investigated over time (on days 1, 3.5-7 of life). Use was made of echocardiography and monitor studies of arterial pressure and heart rate; lability of arterial pressure and general peripheral vascular resistance were computed. As a result of the studies and correlations, it has been revealed that neonates with hemolytic disease manifest appreciable disorders of the cardiovascular system, correlating with the disease gravity. Earlier times of the closure of fetal communications were established as were the hyperkinetic type of +cardiac hemodynamics, arterial hypotension accompanied by arterial pressure instability and a decrease of the general peripheral vascular resistance which should be taken into consideration in choosing therapeutic measures.

Cardiovascular System

On the biologically active structures of cholecystokinin, little gastrin, and enkephalin in the gastrointestinal system.

The biologically active conformations of a series of four peptides [four cholecystokinin (CCK)-related peptides and enkephalin] in their interactions with gastrointestinal receptors have been deduced using conformational computational analysis. The two peptides that interact exclusively with peripheral-type CCK receptors are the heptapeptide COOH-terminal fragment from CCK (CCK-7) and the analogous sequence from cerulein (CER-7) in which threonine replaces the methionine proximal to the NH2 terminus. The two peptides that interact exclusively with the gastrin receptor in the stomach are the active COOH-terminal fragment of little gastrin and the COOH-terminal tetrapeptide sequence common to all of these peptides, CCK-4. We find that preferred conformations for the peripherally active peptides CCK-7 and CER-7 are principally beta-bends, whereas little gastrin and CCK-4 are fundamentally helical. In the class of lowest energy structures for both CCK-7 and CER-7, the aromatic rings of the tyrosine and phenylalanine lie close to one another whereas the tryptophan indole ring points in the opposite direction. This structure is superimposable on the structures of a set of rigid indolyl benzodiazepine derivatives that interact with complete specificity and high affinity with peripheral CCK receptors further suggesting that the computed beta-bends are the biologically active conformation. The biologically active conformation for CCK-4 and the little gastrin hexapeptide has also been deduced. By excluding conformations common to CCK-7 and CCK-4, which do not bond to each other's receptors, and then by selecting conformations in common to CCK-4 and the gastrin-related hexapeptide, which do bind to each other's receptors, we deduce that the biologically active conformation at the gastrin receptor is partly helical and one in which the indole of tryptophan and the aromatic ring of phenylalanine are close to one another while the methionine and aspartic acid side chains point in the opposite direction. These major differences in preferred structures between the common CCK-7/CER-7 peptides and the common CCK-4/little gastrin peptides explain the mutually exclusive activities of these two sets of peptides. We have observed that [Met]enkephalin strongly antagonizes the action of the naturally occurring peripherally active CCK-8 (CCK-7 with an NH2-terminal aspartic acid residue added). The computed lowest energy structures for this opiate peptide closely resemble key features of the computed CCK-7/CER-7 structure, further supporting the proposed structure.

Amino Acid Sequence

Computer-aided image analysis for the differentiation of mononuclear cells in peripheral blood smears from leukemic patients.

Different leukemias originating from the lymphatic system and from the myeloid tissue of the bone marrow were selected to develop and test algorithms to cytophotometrically define leukemic cells. Two of these cases were of low-grade, one of intermediate-grade and one of high-grade malignancy. The malignant cell types of each leukemic form could be identified and characterized by assessing the chromatin texture of the nucleus in the leukemic cells. With this method, normal peripheral white blood cells could be differentiated from leukemic ones. The results correlate directly with established hematologic parameters as they are described in the literature. The investigation demonstrated the usefulness of computer methods in the differentiation of closely related cell structures.

Blood Cells

Clinical significance of hematic cyst of the orbit.

Hematic cyst is a rarely encountered orbital lesion consisting of encapsulated blood or blood breakdown products. The abnormality may be recognized by identifying the cystic structure by B-scan ultrasonography or computed tomography. Cysts located peripherally in the orbit tend to have histologic features suggesting hematoma formation. More centrally located orbital cysts are sometimes associated with vascular abnormalities. In other cases, the etiology is obscure, as in the case presented here. The visual prognosis is usually good, and associated systemic abnormalities are lacking.

Adult

Peripheral nerve function in sepsis and multiple organ failure.

Forty-three patients who had sepsis and multiple organ failure (critical illness) were studied prospectively to determine the incidence and severity of peripheral nerve function and to correlate such function with a number of variables. Electrophysiologic studies indicated a primary axonal degeneration of motor and sensory fibers in 30 (70 percent). Fifteen (30 percent) had the clinical signs of difficulty in weaning from assisted ventilation, weakness of limb muscles, and reduced or absent deep tendon reflexes. Full recovery from the polyneuropathy occurred among the 23 (53 percent) who survived, except three who had a very severe polyneuropathy. A peripheral nerve function index, computed from electrophysiologic measurements, showed statistically significant (p less than 0.01) negative correlations with the time in the critical care unit, and the serum glucose value; the serum albumin level showed a positive correlation. Multiple regression analyses indicated all three factors accounted for 47 percent (r2 = 0.4678) of all potential variables. In a separate analysis, the nerve function index correlated with the amplitude of the diaphragm compound muscle action potential (p less than 0.01). The results were consistent with the polyneuropathy being due to the same mechanisms that are currently postulated to cause dysfunction in this syndrome of other organ systems (including the neuromuscular respiratory system).

Bacterial Infections

Changes in systemic vascular resistance detected by the arterial resistometer: preliminary report of a new method tested during percutaneous transluminal coronary angioplasty.

A recently developed apparatus provides on-line continuous monitoring of systemic vascular resistance (SVR) by means of simple computer analysis of the peripheral arterial waveform. The fundamental equation of this method is Ri = P'/(dP/dt), where dP/dt is the peak dP/dt of the peripheral arterial waveform, P' is the pressure at time of peak dP/dt, and Ri is a resistance index that bears a direct relation to SVR. Eleven patients undergoing percutaneous transluminal coronary angioplasty (PTCA) were studied to evaluate the changes in SVR associated with myocardial ischemia (angina detection). There were 49 balloon inflations, all of which were associated with an increase in Ri (from 38.4 +/- 12 to 81.2 +/- 36 X 10(-3) sec; p less than .01) and a decrease in dP/dt (from 2076 +/- 257 to 1327 +/- 326 mm Hg/sec; p less than .01). In 42 of the balloon inflations these changes were associated with electrocardiographic ST-T changes and in 23 it was also associated with anginal pain. When angina was present, a further increase in Ri (to 97.5 +/- 43 X 10(-3) sec; p less than .01) and a decrease in dP/dt (to 1218 +/- 338 mm Hg/sec; p less than .01) was observed. It was found that myocardial ischemia is associated with an increase in the resistance index and a decrease in dP/dt and can be detected by the resistometer.

Angioplasty, Balloon

Beat-to-beat estimation of peripheral resistance and arterial compliance during pressure transients.

We have used a computer-based parameter estimation method to obtain peripheral resistance, total arterial compliance, and characteristic resistance from the measurement of aortic pressure and flow in the open-thorax cat, assuming the three-element windkessel as a model of the systemic arterial tree. The method can be applied on a beat-to-beat basis in the steady state and in transients. We have validated this method by analyzing nonsteady-state data obtained from an electrical analog with fixed values of the resistances and compliance and by showing that the values obtained by this procedure were within 5% of the fixed values of the circuit. Changes in total peripheral resistance and arterial compliance were studied before, during, and after acute heart rate changes in five open-thorax cats with blocked autonomous nervous system. As expected, the peripheral resistance, estimated during the heart rate transient [3.93 +/- 0.94 (SE) kPa X ml-1 X s] was the same as before the transient (3.53 +/- 0.83 kPa X ml-1 X s); total arterial compliances were also identical (0.28 +/- 0.04 vs. 0.27 +/- 0.03 ml/kPa). In six cats without nervous blockade we obtained similar results. Calculation of peripheral resistance during transients from the mean pressure-to-mean flow ratio, i.e., without correction for arterial compliance, suggested changes in resistance values of less than or equal to 57%, which shows that correction is necessary. The findings indicate that peripheral resistance and total arterial compliance can be estimated in vivo on a beat-to-beat basis, even during hemodynamic transients.

Animals

Subpleural pulmonary hamartoma: demonstration by computed tomography.

A case of a subpleural pulmonary hamartoma demonstrated by computed tomography is presented. The literature on subpleural pulmonary lesions demonstrated by computed tomography is reviewed. Although peripheral pulmonary hamartomas have been well documented, we believe this is the first demonstration of a subpleural location by computed tomography scanning. In the appropriate clinical setting, pulmonary hamartoma should be included in the differential diagnosis of subpleural lesions identified on computed tomography scanning of the chest.

Aged

Rat heart fatty acid-binding protein is highly homologous to the murine adipocyte 422 protein and the P2 protein of peripheral nerve myelin.

The rat heart contains an abundant cytosolic protein which binds long chain fatty acids. We have determined its primary structure by Edman degradation of peptides generated from chymotryptic, tryptic, and elastase digestions. This polypeptide (Mr = 14,992) contains 134 amino acids and has a blocked (acetylated) NH2 terminus. The sequence of rat heart fatty acid-binding protein (FABP) is remarkably similar to the murine adipocyte 422 protein and the P2 protein of peripheral nerve myelin. Computer-assisted alignment of heart FABP and 422 revealed that 82 of 132 comparable residues are identical (62%). There are 77 identities out of 131 possible matches between this protein and the human myelin P2 protein (59%). Similar comparisons demonstrate that heart FABP has significant homology to several other proteins which bind hydrophobic ligands. The rank of order of similarity to heart FABP is: 422 greater than myelin P2 greater than cellular retinoic acid-binding protein greater than cellular retinol-binding protein II greater than cellular retinol-binding protein greater than intestinal FABP greater than liver FABP. These eight sequences form a family of paralogous homologues. Heart FABP has a region of internal homology involving tandemly arrayed oligopeptides spanning residues 71-100 and 101-131. This feature is not found in the 422 and P2 sequences. The endogenous ligands bound by the 422, P2, and heart FABP sequences have not been defined. Interpretation of the biological significance of their structural similarities and differences will require information about their ligand specificities and affinities.

Amino Acid Sequence