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A female patient in her 50s who underwent chemotherapy for left primary breast cancer presented with cancerous pleurisy and disseminated intravascular coagulation. Esophagogastroduodenoscopy and liver biopsy revealed gastric and liver cancer. Distinguishing between primary and metastatic cancer by pathological findings is difficult using hematoxylin and eosin staining. We diagnosed and treated simultaneous primary breast cancer (ER-positive) and gastric cancer with liver metastasis (ER-negative), based on differences in estrogen receptor expression. The patient lived for 10 months with chemotherapy. After death, an autopsy was performed because the endoscopic results were atypical for primary gastric cancer, and additional immunohistochemical studies indicated gastric metastasis of breast cancer.

We report two male patients who had a sensory seizure, which evolved into a focal impaired awareness tonic seizure, and after that, focal to bilateral tonic-clonic seizure. The first case, a 20-year-old man had been treated with steroids for anti-myelin oligodendrocyte glycoprotein (MOG) antibody-positive optic neuritis. His seizure started with abnormal sensation in the little finger of the left hand, which spread to the left upper and then to the left lower limb. The seizure then evolved into tonic seizures of the upper and lower limbs and he finally lost awareness. The second case, a 19-year-old man experienced floating dizziness while walking, followed by numbness and a pain-like electrical shock in the right upper limb. The right arm somatosensory seizure evolved into a right upper and lower limb tonic seizure, which spread to the bilateral limbs, and finally he lost awareness. Symptoms of both patients improved after the treatment with steroids. Both patients shared a similar high-intensity FLAIR lesion in the posterior midcingulate cortex. Both patients were diagnosed with MOG antibody-positive cerebral cortical encephalitis because of a positive titer of anti-MOG antibody in the serum. Several reports showed involvement of the cingulate gyrus in MOG antibody-positive cerebral cortical encephalitis, but only a few reported seizure semiology in detail. The semiology reported here is consistent with that of cingulate epilepsy or the findings of electrical stimulation of the cingulate cortex, namely, somatosensory (electric shock or heat sensation), motor (tonic posture), and vestibular symptoms (dizziness). Cingulate seizures should be suspected when patients show somatosensory seizures or focal tonic seizures. MOG antibody-positive cerebral cortical encephalitis should be considered as one of the differential diagnoses when the young patient shows the unique symptoms of an acute symptomatic cingulate seizure.

In cerebral blood flow tests using N-Isopropyl-p-[123I] Iodoamphetamine "I-IMP, quantitative results of greater accuracy than possible using the autoradiography (ARG) method can be obtained with attenuation and scatter correction and image reconstruction by filtered back projection (FBP). However, the cutoff frequency of the preprocessing Butterworth filter affects the quantitative value; hence, we sought an optimal cutoff frequency, derived from the correlation between the FBP method and Xenon-enhanced computed tomography (XeCT)/cerebral blood flow (CBF). In this study, we reconstructed images using ordered subsets expectation maximization (OSEM), a method of successive approximation which has recently come into wide use, and also three-dimensional (3D)-OSEM, a method by which the resolution can be corrected with the addition of collimator broad correction, to examine the effects on the regional cerebral blood flow (rCBF) quantitative value of changing the cutoff frequency, and to determine whether successive approximation is applicable to cerebral blood flow quantification. Our results showed that quantification of greater accuracy was obtained with reconstruction employing the 3D-OSEM method and using a cutoff frequency set near 0.75-0.85 cycles/cm, which is higher than the frequency used in image reconstruction by the ordinary FBP method.

Autoradiography (ARG) has been used for quantitative analysis of the cerebral blood flow using 123 I-IMP, and the regional cerebral blood flow (rCBF) can be assessed more accurately with scatter and attenuation correction. Currently, the filtered back projection (FBP) method is generally used for image reconstruction. However, we anticipate obtaining more accurate rCBF by the ordered subsets expectation maximization method with collimator broad correction three dimensional ordered subsets expectation maximization (3D-OSEM). In the present study, we optimized the processing conditions to quantify rCBF using the 3D-OSEM method and compared them with the FBP method. Regarding the method, we determined the subsets and iteration, compared rCBF values using a profile curve, and compared them with the rCBF values obtained by the XeCT (Xenon-enhanced computed tomography)/CBF method. We found that in the 3D-OSEM method using 90 direction collection and 1.72 mm/pixel, the most accurate image was obtained around subset 9 and iteration 10. In addition, as compared to the profile curve and the XeCT/CBF method, the thalamus rCBF was high in the 3D-OSEM method with a good correlation with that of the XeCT/CBF. Accordingly, we concluded that the 3D-OSEM method can improve the decrease in rCBF due to blurring of the distance between the source (i.e., a structure located in the central part of the brain such as the thalamus and the collimator).

Contaminated hospital linen has caused some cases of Bacillus cereus bacteremia in Japan. We analyzed the disinfection efficacy of industrial washing of hospital towels and sheets by counting the number of B. cereus on linen before and after washing. That before washing averaged 7.6 cells/cm2 on unwashed sheets, decreasing to 1.2 cells/cm2 after washing. That on unwashed towels, however, averaged 10(6) cells/cm2 before washing and 1096 cells/cm2 after washing, which was very high and suggested the possibility of causing nosocomial infection.

The patient was a 35-year-old man with confusional state and headache. Analysis of cerebrospinal fluid (CSF) showed 1,383/mm3 cell count, the protein level of 300mg/dl and glucose level of 42 mg/dl. Cryptococcus neoformans was disclosed by India ink preparation. The cryptococcal antigen test was positive at 1:125 by latex agglutination. The diagnosis of cryptococcal meningoencephalitis was determined. Antifungal treatment with amphotericin B resulted in improvement of neurologic signs, CSF findings and cryptococcal antigen test. But two months later, brain MRI demonstrated low intensity areas on T1 weighted image and high intensity areas on T2 and proton weighted images in the cerebral cortical region. Gd-DTPA MRI showed enhanced areas in the cerebral leptomeninges. It was considered that these MRI lesions corresponded to pseudocysts and Gd-DTPA enhanced lesion indicated dilated vessels or destructed blood-brain barrier. After administration of larger doses of amphotericin B, these lesions on MRI disappeared. It is suggested that brain MRI is useful in diagnosis of cryptococcal meningoencephalitis to detect pseudocysts at the cortical region which may imply the early stage of procrastinating process.

To evaluate the relationship between regional wall motion and 99mTc-methoxy-isobutyl-isonitrile (MIBI) uptake, ECG-gated single-photon emission computed tomography (SPECT) with 99mTc-MIBI was performed in 20 patients with prior myocardial infarction. The left ventricular images at end-diastole (ED) and end-systole (ES) were divided into 39 segments, respectively. Based on circumferential profile analysis, relative uptake (%EDc, %ESc), percent count increase (% delta C), and normalized percent count increase (% delta Cn) were analyzed in each segment and compared with regional wall motion indices assessed by echocardiography and left ventriculography. ECG-gated SPECT with 99mTc-MIBI provided high contrast tomograms of the left ventricular myocardium. %EDc and %ESc showed good correlations with regional wall motion indices. % delta C and % delta Cn, however, showed lower correlations compared with %EDc and %ESc. In conclusion, high-quality left ventricular images were obtained with 99mTc-MIBI ECG-gated SPECT, but quantitative analysis based on only percent count increase (% delta C) have limitations for evaluation of regional wall motion.

CT findings in primary low spinal fluid pressure syndrome are studied on the basis of 3 cases. Case 1 was a 43-year-old male with a complicated bilateral isodense subdural hematoma (SDH). Case 2 was a 45-year-old female with a complicated bilateral high dense SDH. Case 3 was a 36-year-old female discharged without any complications after spinal fluid pressure normalized. Slight downward displacement of the brain under low spinal fluid pressure is shown as the narrowing of with a Sylvian fissures and infratentorial cisterns on CT. On the other hand in this syndrome with a complicated bilateral isodense SDH, in addition to this finding CT reveals distortion and narrowing of body of lateral ventricles, which may be the differential findings from this syndrome without complicated SDH. Under low spinal fluid pressure, bridging veins are more stretched by a downward displacement of the brain. And consequently they are easily insured and SDH is developed.

A 43-year-old man with no history of trauma or neurosurgical procedure was admitted our hospital because of orthostatic headache made worse in upright position. Spinal fluid pressure was 0 mmH2O, and CT scan revealed wide cortical sulci and ventricles. In the 26th hospital day he had severe headache and CT scan revealed bilateral subdural hematoma, then neurosurgical procedure was done. About 2 months later, he was relieved of the headache and spinal fluid pressure returned to normal. We performed lumbar isotope cisternography and isotope choroid plexography in our case when low spinal fluid pressure and normalized pressure. Isotope cisternography revealed the radioactivity counts decreased rapidly in low pressure and normal in normal pressure. On the other hand isotope choroid plexography was almost no difference between low and normal pressure. Our data suggest that primary low spinal fluid pressure syndrome is not caused by hypoproduction, but by an undetectable leak from a minute tear in a spinal root sleeve or hyperabsorption at the spinal arachnoid membrane.

It has been well established that acquired lesions of the corpus callosum such as surgical section bring about disturbances of interhemispheric transfer of visual information. In contrast, patients with callosal agenesis do not display these specific deficits. The mechanisms of this compensation have been postulated as follows; (1) bilateral development of language function, (2) exploitation of extracallosal commissure fibers such as the anterior commissure. Several studies have reported, however, minor disturbances of interhemispheric visual transfer in callosal agenesis, such as less efficient interhemispheric transfer of complex visual stimuli (Gott & Saul, 1978), slower reaction time in interhemispheric comparison of visual stimuli (Sauerwein & Lassonde, 1983), or deficits in spatial localization in the right hemi-field (Martin, 1985). In order to settle these issues, we have administered four kinds of tachistoscopic visual recognition tests on 4 patients with complete agenesis of the corpus callosum confirmed by magnetic resonance imaging (MRI). This technique enabled us to see the mid-sagittal plane of the corpus callosum and diagnose its total absence with much higher certainty and precision than previous studies employing computed tomography (CT) or pneumoencephalography. Case 1: A 41-year-old right-handed man visited us because of recurrent numbness in the four extremities. Neurological examination revealed no abnormalities. MRI has confirmed that the corpus callosum was totally lacking, and that the anterior commissure was normally visualized. Case 2: A 31-year-old right-handed man was referred to us for the treatment of partial complex seizure. Total agenesis and lipoma of the corpus callosum was diagnosed by MRI and reconstructed sagittal view of CT scan.(ABSTRACT TRUNCATED AT 250 WORDS)