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The purpose of this study was to analyze the native T 1 value of myocardium and the relationship between myocardial native T 1 value and gender, age and myocardial areas in Japanese. The subject of this study was 145 Japanese healthy subjects who underwent cardiac magnetic resonance imaging (MRI) at medical examination. MRI scanner was Ingenia 1.5T (Philips Healthcare, Best, The Netherlands). T 1 mapping was acquired with modified look-locker inversion recovery method using IR pulse. The native T 1 value of all subjects was 983.5±34.8 ms, and we were able to acquire the reference value of the native T 1 value at our hospital. The native T 1 value was significantly higher in females than in males. There was variation in native T 1 value among the myocardial areas, and the native T 1 value was significantly higher in the septum than in the lateral region. In the future, collaborative research in multicenter is necessary to obtain the reference value of Japanese.

A 14-year-old girl was referred to us with severe migraine-like headaches associated with vomiting and right homonymous hemianopsia. On admission, MRI examination showed high signals in the left occipital cortex and subcortex on T2-weighted images, without reduction of apparent diffusion coefficient suggestive of cerebral infarction. Her EEG demonstrated periodic sharp waves in the left posterior region, and laboratory tests revealed she had increased levels of lactic and pyruvic acid both in blood plasma and CSF. Gene analysis confirmed mitochondrial DNA A3243G mutation. Based on this data, we diagnosed her as having mitochondrial myopathy, encephalopathy, lactic acidosis and a stroke-like episode (MELAS). L-arginine infusion was unsuccessful for her severe headaches, which remained prolonged. She received a low dose (0.05 mg/kg/h) midazolam infusion, resulting in immediate improvement and the disappearance of headaches and abnormal EEG findings. By the age of 18, she had been readmitted eight times for stroke-like episodes accompanied by headaches. While L-arginine infusions alleviated her headaches when administered on day 1 of her episodes, they were not effective when started on or after day 2. Her L-arginine-resistant headaches were relieved by midazolam. Although the pathogenesis of headaches in MELAS is still unknown, neuronal hyperexcitability and trigeminovascular activation are considered important. Midazolam may play a role in suppressing neuronal hyperexcitability and trigeminovascular activation. Treatment with midazolam is advisable for headaches in patients with MELAS, in the event that L-arginine therapy is unsuccessful.

Skin inflammation is one of several allergic symptoms that are regulated by several mediator molecules. One of these molecules, calcitonin gene-related peptide (CGRP) affects several immune cells including T cells, B cells, dendiritic cells and mast cells. CGRP binds to CGRP receptors composed of receptor activity-modifying protein 1 (RAMP1) and calcitonin receptor-like receptor (CLR) to modulate various functions such as pain transmission and vasodilation. Studies showing that CGRP physiologically regulates skin inflammation using a CGRP antagonist, capsaicin-induced depletion model, RAMP1-deficient mice and mouse contact hypersensitivity (CHS) model have been reported. Interestingly, while CGRP has inhibitory effects on Th1-mediated CHS, it was demonstrated that CGRP enhances Th2-mediated CHS response. Moreover, these skin inflammations were affected by elevated CGRP concentrations through an abnormal condition of the nervous system induced by exposure to psychological stress or neonatal chemical stimulation. In this review, we present the importance of CGRP in the regulation of skin inflammation under the several nervous conditions and provide a new insight into understanding various types of skin inflammation and skin diseases.

We evaluated the usefulness of 99mTc-methoxy-isobutyl-isonitrile (MIBI) dual phase scintigraphy for detecting hyperfunctioning parathyroid adenoma. We retrospectively reviewed 18 hyperparathyroid patients who received MIBI prior to neck exploration and compared the radiological findings of MIBI with ultrasonography (US) and magnetic resonance imaging (MRI). Fifteen patients were studied with MRI, and 17 patients were examined with US. All patients were found to have a solitary parathyroid adenoma histopathologically. MIBI correctly revealed the location of 17 adenomas among 18 confirmed tumors. In our series, there was one false-positive case that was found to have thyroid adenoma. The diagnostic sensitivity of MIBI MRI and US was 94.4%, 80% and 52.5%, respectively. The positive predictive value (PPV) was 94.4% for MIBI, 81.8% for MRI and 92.3% for US. We conclude that MIBI is useful and accurate for the preoperative localization of adenoma in primary hyperparathyroidism.

A 19-year-old male presented with dyspnea. Clinical examination revealed the left infant-head-sized testicular tumor, multiple lung metastases and retroperitoneal bulky lymph node metastasis with marked elevation of serum lactic dehydrogenase (LDH) and alpha-fetoprotein. Left radical orchiectomy followed by the chemotherapy with etoposide and cisplatin (EP) for 4 cycles was performed. The tumor weighed 1,700 g, and was pathologically diagnosed as mixed germ cell tumor consisting of embryonal carcinoma and yolk sac tumor. After the treatment, the tumor markers were normalized with partial response (PR) of lung metastases and complete response (CR) of retroperitoneal lymph node metastasis. Thereafter, biopsy of lung metastases through video-assisted thoracoscopic surgery (VATS) was performed, and pathologically no viable cells were detected. Five months after the treatment, he was seized with convulsion due to brain metastasis with hemorrhage. Therefore, a surgical resection of brain metastasis and 2nd line chemotherapy with etoposide, ifosfamide and cisplatin (VIP) chemotherapy for 3 cycles was performed. The patient has been free of recurrence for 21 months after the 2nd line chemotherapy.

We report a rare case of primary hyperparathyroidism with a functioning parathyroid cyst in a 45-year-old male. He was a recurrent stone former, and consulted our hospital for further examinations of hypercalcemia. Plasma levels of intact parathyroid hormone (PTH) were elevated to 130 pg/ml. Ultrasonography, computed tomography and magnetic resonance imaging revealed a parathyroid cyst on the right lobe of the thyroid gland. We performed right superior parathyroidectomy. Histological examination demonstrated a secondary pseudocyst resulting from cystic degeneration of a parathyroid adenoma. Plasma levels of intact PTH normalized after operation. To our knowledge, only 48 cases of functioning parathyroid cyst were reported in the Japanese literature. We discuss the clinical features and histological evidence of functioning parathyroid cyst.

We applied low dose external beam radiation (6 MV) to 17 eyes of 17 patients (Mean age 70.9 years, range 58 approximately 85) who had subfoveal choroidal neovascularization associated with age-related macular degeneration. None of the cases were suitable for photocoagulation according to the Macular Photocoagulation Study protocol, and no feeding vessels underlying choroidal neovascular membrane could be detected. Corrected visual acuity ranged from 0.02 to 0.6 before treatment. The patients were divided into two groups. One group of 11 eyes was treated with 10 Gy and the other group of 6 eyes with 21 Gy. Mean follow up period was 347 +/- 89 (mean +/- standard deviation) days in the 10 Gy group and 312 +/- 100 days in the 21 Gy group. We evaluated the outcome as "effective' if no progression in neovascular membrane was found by ophthalmoscopic and angiographic examination. Only 3 eyes (21%) of patients in the 10 Gy group and 2 eyes (33%) in 21 Gy group showed any effect. Although the rate of progression in choroidal neovascular membrane was significantly smaller in the 10 and 21 Gy group than in the controls, the corrected visual acuity in the treated group was not improved over that of the controls. No serious complications were seen. Only one case showed a stabilized neovascular membrane in the control group of 7 patients. Although the present results seem to be worse than those in previous reports, the efficacy of this treatment still needs to be evaluated because no beneficial strategies in the treatment of subfoveal neovascularization have been established.

Migrant workers known in Japanese as "dekasegi" refer to workers who migrate seasonally from their town of residence to areas where work is readily available. The eastern part of Toyama Prefecture is well known as a source of migrant workers who engage in jobs associated with dust exposure such as tunnel projects. Most of these workers suffered from silicosis. A total of 695 migrant workers suffering from silicosis who had underwent health screening between 1977 and 1982 were followed until the end of 1983. For cases of death, the cause and date of death were individually confirmed on the basis of death certificates. Based on these data, the person-years of risk and cause-specific mortality rates were calculated. The mean person-years of risk per person was 4.7. During this period of observation, there were 75 deaths among these silicosis patients, giving a mortality rate of 23.0 per 1,000 person-years of risk. When classified by the Japanese roentgenographic category of pneumoconiosis, the mortality rate was 10.5 for category 1, 21.3 for category 2, 38.6 for category 3 and 49.3 for category 4. The mortality rates of categories 3 and 4 were significantly higher than those of categories 1 and 2. The highest cause-specific mortality rate among silicosis patients per 1,000 person-years was 5.2 for malignant neoplasms followed by 3.7 for pulmonary tuberculosis, 3.1 for both cardiovascular diseases and pneumoconiosis, and 2.8 for pneumonia and bronchitis. High mortality rates in the 50-69 age group were found among silicosis patients belonging to categories 3 and 4. By cause of death, the mortality rates of all malignant neoplasms (especially lung cancer), pulmonary tuberculosis, and cerebrovascular diseases were relatively high in this age group. In the 70-89 age group, the mortality rate of those belonging to categories 2, 3 and 4 was high and by cause of death the mortality rates of pneumoconiosis, pulmonary tuberculosis, all malignant neoplasms (especially lung cancer), cardiovascular diseases and pneumonia and bronchitis were high. The mortality rates of silicosis patients with abnormal findings in %VC, FEV1% and AaDO2 by pulmonary function tests tended to be higher than those of silicosis patients without such abnormalities.