Habitual dependence on modern imaging modalities: the new golem

Modern imaging techniques have been taking over our medical life, but none denies the progress that has followed introduction of modern imaging modalities. For the generation of younger physicians who entered the profession after the introduction of these techniques, use of US, CT, MRI and the like is natural and often applied. But the patient is not computerized and medicine is far from being a pure science. 3 cases of common surgical problems are presented in which excessive use of diagnostic modalities resulted in unnecessary operations, thus leading to unnecessary morbidity. In these days of soaring medical expenses, many unnecessary imaging and laboratory studies are done for reasons of "defensive" medicine. It is important to fortify the position of clinical diagnosis, but making clinical decisions without requiring expensive and sometimes misleading imaging studies significantly reduces costs. Admittedly, courage and firm professional backbone are required to face a lawyer or a judge and say: "This CT or US study would not have changed my clinical decision; it would have made no positive contribution to it, and might even have mislead me." This paper comes to remind physicians of the importance of clinical diagnosis and the need to develop and rely on primary medical skills. Machines and laboratory tests are aids to diagnosis, they do not make the diagnosis.     

FTIR Microscopic Studies on Normal, Polyp, and Malignant Human Colonic Tissues

Fourier-Transform Infrared Spectroscopy (FTIR) employs a unique approach tooptical diagnosis of tissue pathology based on the characteristic molecularvibrational spectra of the tissue. The biomolecular changes in the cellularand sub-cellular levels developing in abnormal tissue, including a majorityof cancer forms, manifest themselves in different optical signatures, whichcan be detected in infrared microspectroscopy. This report has two parts. Inthe first part, we report studies on normal, premalignant (polyp) andmalignant human colonic tissues from three patients with different stages ofmalignancy. Our method is based on microscopic infrared study (FTIR-microscopy)of thin tissue specimens and a direct comparison with traditional histopathologicalanalysis, which serves as a gold reference. The limited dataavailable showed normal colonic tissue has a stronger absorption thanpolypoid tumor and cancerous types over a wide region in a total of 100measurements. Detailed analysis showed that there is a significant decreasein total carbohydrate, phosphate and possibly creatine contents for polyp andcancerous tissue types in comparison to the controls. The same trend is maintainedin seven other patients studied. The second part consists of an analysis showingthe influence of various independent factors such as age, sex and grade of malignancy. Ourpreliminary results suggest that among the above three factors, age and gradeof malignancy have significant effect on the metabolites level, but sex has onlyminor effect on the measured spectra. Initial results on Linear DiscriminantAnalysis (LDA) showed good classification between normal and malignant cellsof human colonic tissues.     

Antibiotic induced meningitis

The inositol lipid system (polyphosphoinositides and inositol phosphates) represents an important component of the cell signal transduction. Electroconvulsive shock (ECS) is known to activate cell signaling and lead to the release of second messengers. We tested the effects of daily ECS on the inositol lipid system and the generation of second messengers in vivo, by prelabeling the components of the system with [3H]myo inositol. The response to ECS was greater 30 sec after the sixth ECS, as compared to that obtained 30 sec after the first one. Also, rats killed 24h after the fifth ECS exhibited an increased PI labeling, as compared to rats handled for 6 days without receiving ECS. These results show that daily seizures (ECS-evoked) deeply modify the neuronal response to the stimulus, thus providing new information on the biochemical events involved in cell signal transduction during seizures.     

Dietary unsaturated fatty acids influence preovulatory follicle characteristics in dairy cows

Dietary unsaturated fatty acids (UFAs) have been implicated in several reproductive processes in dairy cows through a variety of mechanisms. This study examined the effects of periparturient supplementation of rumen bypass fats low or high in proportion of UFAs (oleic and linoleic) on preovulatory follicle characteristics. Forty-two 256-day pregnant dairy cows were divided into three groups and were fed a control diet (n=14) or supplemented with fats either low (LUFA; n=14) or high (HUFA; n=14) in UFAs. At 14-15 days following behavior estrus, the cows received a prostaglandin F(2)(alpha) injection and 48 h later >7 mm follicles were aspirated. Progesterone (P(4)), androstenedione (A(4)), and estradiol (E(2)) were determined in the follicular fluid. Out of 75 follicles, 37 follicles that were aspirated between 55 and 70 days post partum were regarded as E(2)-active follicles (E(2)/P(4) ratio >1) and subjected for further analysis. The diameter of preovulatory follicles was greater in cows fed HUFA than in those fed control or LUFA. The concentrations and content of A(4) and E(2) in follicles and E(2)/P(4) ratio were higher in the HUFA group than in the other two groups. The P450 aromatase mRNA expression in granulosa cells that were collected from the aspirated preovulatory follicles was also higher in the HUFA cows than in the other groups. A significant correlation was observed between E(2) concentrations in preovulatory follicles and E(2) concentrations in plasma at aspiration. In conclusion, dietary UFA increased the size of and elevated steroid hormones in preovulatory follicles, which may be beneficial to consequent ovarian function.     

Intracellular phosphates in inclusion body myositis--a 31P magnetic resonance spectroscopy study

Muscle phosphorus magnetic resonance spectroscopy was used to study oxidative metabolism at rest and during recovery from exercise in 7 patients with sporadic inclusion body myositis (s-IBM), compared with normal controls (n=8) and mitochondrial myopathies (n=20). At rest, 6/7 patients had elevated inorganic phosphates. Recovery parameters were not different from controls, in contrast with mitochondrial myopathies, who showed abnormal rest and recovery. The normal recovery suggests that mitochondrial oxidative capacity is not impaired in s-IBM.     

Muscle high-energy phosphates in central nervous system disorders. The phosphorus MRS experience

Phosphorus magnetic resonance spectroscopy (MRS) was used to study muscle phosphates metabolism in several brain disorders. Those with primary mitochondrial encephalomyopathies showed the typical pattern of impaired oxidative metabolism at rest and during recovery after exercise. In migraine, Parkinson's disease and alternating hemiplegia muscle MRS observations lend support to a possible mitochondrial dysfunction. Similar observations in multiple sclerosis are probably the result of secondary deconditioning. In post polio syndrome and in some of the hereditary ataxias, elevated intracellular inorganic phosphates may be the result of another, yet unknown, metabolic impairment. Thus, muscle phosphate metabolism may be altered in various central nervous system (CNS) disorders by different metabolic impairments. All these possibilities should be taken into account when evaluating MRS results in brain diseases.     

The efficacy of a test and ESS program

Statistical results of all the 1621 failure analyses, which cover a four‐year effort, are presented. The failure analyses were part of an elaborate test and ESS process of a high‐reliability system. Of the failure analyses, 97.5% identified the root cause. The classification of the failures by 11 root cause classes, including the test and ESS process itself is provided. The distribution of failure root causes detected during the various phases of the process is shown. Each test phase was analyzed according to the share of failures found and the fraction of failures that occurred during that phase. Applying a linear formula that summarizes the relative efficacy of each test phase compares the performances of the various phases. The term efficacy is used to describe the ability of a test phase to reveal failures without generating new problems. Copyright © 2002 John Wiley & Sons, Ltd.     

Distinction of cervical cancer biopsies by use of infrared microspectroscopy and probabilistic neural networks

Fourier-transform infrared spectroscopy has shown alterations of spectral characteristics of cells and tissues as a result of carcinogenesis. The research reported here focuses on the diagnosis of cancer in formalin-fixed biopsied tissue for which immunochemistry is not possible and when PAP-smear results are to be confirmed. The data from two groups of patients (a control group and a group of patients diagnosed with cervical cancer) were analyzed. It was found that the glucose/phosphate ratio decreases (by 23-49%) and the RNA/DNA ratio increases (by 38-150%) in carcinogenic compared with normal tissue. Fourier-transform microspectroscopy was used to examine these tissues. This type of study in larger populations may help to set standards or classes with which to use treated biopsied tissue to predict the possibility of cancer. Probabilistic neural networks and statistical tests as parts of these biopsies predict the possibility of cancer with a high degree of accuracy (> 95%).