We examined a large population of patients undergoing temporomandibular joint (TMJ) surgery and provide a documentation of the average patient population, frequency of procedures, frequency of repeat procedures, and trends in open (arthrotomy) versus closed (arthroscopy) TMJ surgery. Data on 194 TMJ surgical procedures was extracted from line item claims information collected by Trigon Blue Cross/Blue Shield of Virginia. The frequency of arthroscopy increased during the study, while the incidence of arthrotomies remained relatively low. Approximately half of the hospitals statewide did not perform either procedure. There was a low frequency (3%) of repeat procedures. In the Commonwealth of Virginia, since the advent of TMJ arthroscopy, it has become the preferred surgical technique for treatment of internal derangement. There is a low incidence of repeat procedures for both types of treatment. Analysis of insurance carrier computer records is a valid technique for evaluating trends in surgical care.

The role of magnetic resonance imaging (MRI) in diagnosing the ovarian cyst was reviewed with emphasis on its diagnostic value of endometrial cyst. 94 cystic ovarian masses in 77 patients were evaluated using 0.15 Tesla MRI just before laparotomy at Okayama University Hospital from 1984 to 1987 and these images were followed up by histopathological data. From these obtained images, 6 parameters; that is (1) laterality and (2) delineation of the cyst, (3) presence or absence of septal image, and (4) homogeneity, (5) signal intensity and (6) T1 value of the cyst contents, were extracted and analyzed respectively. In 95.5% of endometrial cysts, homogenous internal pattern was observed in all 3 images (short spin echo (SE), inversion recovery (IR) and long SE) and its signal intensity was at the same level or higher than that of myometrium. On the other hand, in all cases of follicular cyst, para-ovarian cyst, corpus luteum cyst and in 95.0% of serous cystadenoma and in 90.9% of mucinous cystadenoma, cyst contents showed either lower signal intensity than the myometrium or similar to it in T1 contrast images (short SE and IR). 93.1% of dermoid cyst showed heterogenous signal intensity in all 3 images and their signal intensity levels were widely ranging. High signal intensity of cyst contents in all 3 images could be observed in 72.7% of endometrial cyst, 5.0% of serous cystadenoma with internal hemorrhage, 9.1% of mucinous cystadenoma with internal hemorrhage and 3.4% of dermoid cyst consisted of fatty tissue only. Endometrial cyst showed markedly shortened T1 value (209.6 +/- 102.7 ms) and the other hemorrhagic cyst showed comparatively short value (360-970 ms). On the other hand, T1 value of non hemorrhagic cyst was as high as the level of urine. All of endometrial cysts were clearly defined from the other pelvic structures. In result, endometrial cysts were found to exhibit the characteristic findings in MRI images such as homogenous high signal intensity of internal fluid and clear delineation of cyst contour. The diagnostic accuracy of MRI in endometrial cyst were considered 96.8% in our cases.

Our hepatic assist device is composed of a membrane plasma separator, blood and plasma pumps, hemodialyzer and controller. Using this device, the patients plasma is replaced with fresh donor plasma in a 5000 ml amount daily. This procedure of plasma exchange takes place in the intensive care unit, until the patient recovers consciousness or cerebral death is confirmed. In the initial results of this plasma exchange, 5 out of 10 patients with fulminant hepatic failure survived. Even with fatal cases, prolongation of survival time was observed. Our hepatic assist device, performing an easy and safe procedure for plasma exchange, appears to be the most promising method of providing long-term hepatic support for acute liver failure at the present time.

Left ventricular image processing methods of x-ray cineangiocardiograms and ultrasound echocardiograms are discussed. 3-D reconstruction methods of the left ventricle from ultrasound echocardiograms and magnetic resonance images are also discussed. Boundary detection of the left ventricle and the quantitative analysis of the left ventricular function and wall motion are discussed. To reconstruct 3-D shapes, we need several cross sectional shapes or silhouettes of the left ventricle. Several cross sectional echo images of apical long axis view are taken by changing the angles of rotation of the probe of echo transducer around its axis. Gated multi-phase MRI method is used to obtain each 2 cross sectional images in transverse, coronal and sagittal directions. Some results of 3-D shapes of the left ventricle and myocardium reconstructed are shown and 3-D functional images which give us regional functions of the left ventricular wall on three dimensional shape are shown.