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A woman in her 70s presented to our hospital with complaints of cough and dyspnea. Computed tomography(CT) images showed a large amount of left pleural effusion, pleural tumors, and mediastinal lymphadenopathy. Left thoracic drainage was performed, and high-grade fetal lung adenocarcinoma was suspected upon pleural effusion-cell block immunostaining. Pathological evaluation of the CT-guided biopsy specimen provided a diagnosis of carcinoma with high-grade fetal lung adenocarcinoma. Although the tumor progressed rapidly, chemotherapy with atezolizumab/bevacizumab/carboplatin/ paclitaxel was highly effective. However, subsequent maintenance therapy with atezolizumab/bevacizumab led to disease progression.

Surgical pulmonary embolectomy is indicated for acute massive pulmonary thromboembolism complicated by floating thrombi in the right heart system. Postoperative residual thrombi are associated with persistent pulmonary hypertension and subsequent right heart failure, resulting in poor surgical outcome. A 67-year-old man was admitted to our institution owing to dyspnea on exertion. Transthoracic echocardiography revealed a floating right atrial mass and right ventricular overload. In addition, enhanced computed tomography (CT) showed a right atrial mass as well as bilateral massive pulmonary embolism. We performed an urgent pulmonary embolectomy using a bronchoscope as an adjunctive angioscope to completely remove the peripheral thrombi and to prevent serious complications, such as endobronchial hemorrhage due to pulmonary arterial injury. A clear, bloodless view of peripheral pulmonary arteries was obtained using short intermittent circulatory arrest technique. Postoperative course was uneventful, and he was discharged ambulatory 20 days after the surgery without any symptoms.

A 54-year-old woman had a history of precordial pain since February 20XX and had undergone a clinical examination at a nearby medical clinic in April 20XX. Because a plain chest radiograph revealed a mass shadow, the patient was referred to us for medical evaluation. Chest computerized tomography(CT)revealed a mass measuring 12 cm in size along its major axis diameter in the anterior mediastinal region, along with the enlargement of the anterior mediastinal, parasternal, hilar, and supradiaphragmatic lymph nodes, suggesting a thymic tumor. Histopathological examination of a needle biopsy specimen revealed a carcinoid. Thus, the patient was diagnosed with a primary thymic carcinoid. The patient was treated by partial excision of the mediastinal tumor owing to the presence of pericardial dissemination. Because of the histopathologic diagnosis of atypical carcinoid, the patient was additionally administered everolimus therapy in May. A repeat CT in July revealed shrinkage of the mass, but a subsequent CT in November revealed slight enlargement of the tumor. Because the somatostatin receptor(SSTR-2)tested positive, concomitant octreotide acetate injection was initiated in December. Follow-up CT examinations revealed stabilization of the disease at first. However, the gradual enlargement of the tumor was noted thereafter. This case constitutes one of the few reports of the treatment of primary thymic carcinoid with everolimus and octreotide.

Purpose: We developed a novel digital phantom-creation tool that will help formulate the standard shooting method for a three-phase dynamic liver study. Here, we present data demonstrating the usefulness of this tool in the assessment of low-contrast detectability and visibility., Methods: We performed a visual evaluation by adding a spherical digital phantom with a diameter of 8 mm and a computed tomography (CT) value difference of 10 Hounsfield unit (HU) to images taken using filtered back projection and seven types of adaptive iterative dose reduction 3D (Weak, Mild, eMild, Standard, eStandard, Strong, and eStrong). We also examined the partial-volume effect by drawing a profile curve using a digital phantom with a CT value difference of 30 HU and a diameter of 5 mm. Furthermore, a digital phantom with two kinds of filters (smoothing and Gaussian) was added to the image of the home-made simulated tumor phantom to visual valuate its visibility in the phantom's low-contrast module and the digital phantom., Results: Detection sensitivity was significantly decreased in Standard, eStandard, Strong, and eStrong, and the area under the curve also decreased in a similar fashion. We confirmed that the partial-volume effect was due to the different maximum CT values in the profile curve at 4 and 5 mm thickness. The visibility of the low-contrast module and digital phantom was most consistent when using the Gaussian filter., Conclusion: This tool can be used for low-contrast detection ability evaluation.

Acquired middle ear cholesteatoma is considered to be formed by retraction of the tympanic membrane. There are rare cases in which the tympanic membrane epidermis extends into the medial surface of the tympanic membrane from the margin of its perforation, namely so-called secondary cholesteatoma. We studied the cases of secondary cholesteatoma clinically. These cases were found in 13 of 419 ears (3.1%) with acquired middle ear cholesteatoma operated on in our hospital from March 2001 to October 2010. The average age of all the cases was 51.5 years old, with a range of 11-65 years. We adopted the canal wall down tympanoplasty procedure with canal reconstruction in all cases. The postoperative hearing improvement rate was 84.6%. There were no cases of recurrence of the cholesteatoma.

We report a case of malignant epiglottic natural killer (NK)/T cell lymphoma. A 33-year-old man seen 1-month period for throat pain was found in endoscopic larynx examination to have inflammation with plaques and redness epiglottic. The 4 month period, right epiglottic inflammation showed progressive necrosis. The diagnosis of malignant lymphoma was confirmed by 3 biopsies. Laryngomicrosurgery specimens histologicalily showed moderate leukocytic infiltration mainly of atypical lymphocytes. Neoplastic cells were UHCL1+, CD3+, L26-, CD79a, and EBER-ISHW. Despite 4 units of DeVIC chemotherapy and regional irradiation, the man died of metastatis 1 year and 9 months after initial treatment. Among malignant laryngeal tumors, malignant epiglottic NK/T cell lymphoma is extremely rare, with only one case reported in the literature.

A food developed at the Hiroshima Prefectural Food Technology Research Center, Hiroshima, Japan, has proved to be a boon in videofluorography. The food features decreased hardness with retained their shape due to being impregnated with macerating enzymes under reduced pressure after vegetables are defrosted. Samples were removed immediately from the enzyme solution after freeze infusion. All foods tested raging from carrots to chicken contasted well in videofluorography in an evaluation of swallowing in 107 subjects with dysphagia, results for carrots compared well with those for 33% iopamidol, jelly, and yogurt. Only a subjects showed silent aspiration with carrots, compared to 19 with 33% iopamidol. Among 70 subjects showing no residual jelly and/or yogurt, just 12-8 severe and 4 moderate-showed residual carrots in the pharyngeal space. In contrast, among 67 subjects showing no residual carrots in the pharyngeal spase, 9 moderate subjects showing no residual jelly and/or yogurt. We concluded foods such as carrots treated as stated following jelly and/or yogurt as new nutrition sources for subjects with dysphagia.

We report a case of focal spared area of segment VIII in fatty liver. The patient was a 73-year-old man. Abdominal ultrasonography showed focal hypo-echogenicity with an irregular margin in segment VIII. Abdominal computed tomography and enhanced computed tomography showed a high-density mass in segment VIII of the right lobe. MRI examination revealed that the mass in S8 was high-intense on the T1 out of phase image and iso-intense on the T1 in phase image. The lesion was not observed on T2 weight images. He had a sigmoid colon cancer and was performed a sigmoidectomy and partial resection of the liver. A microscopic examination of the liver specimen revealed normal hepatic parenchymal cells, while the surrounding liver had a fat deposition.

A 60-year-old women presenting with an abnormal shadow on a chest X-ray film was admitted to our hospital in June 2004. Her CT scan of the chest showed a cavitary mass shadow in the left upper lobe. FDG-PET was performed to examine whether this shadow was the lung cancer or not, and incidentally it showed an additional accumulation of FDG in the ileocecal resion. The colonoscopy was then carried out. Luminal narrowing with circumferential ulcer in the ileocecal resion could be observed, and pathological findings of the biopsy specimen revealed epithelioid cell granulomas. Partial lobectomy of the left upper lung was also performed, and the histological examination revealed typical pulmonary tuberculosis. Since the antituberculosis therapy was effective to the ileocecal lesion, we assert that the ileocecal lesion was intestinal tuberculosis.

In Aug, 2002 (heisei 14), a 74-year-old male inpatient had been complaining of fever and diarrhea. A feces culture test was done and a few colonies were discovered and were suspected to be Salmonella O7 and were later confirmed to be as such. A further investigation and interviewing of patients was undertaken. As a result we suspected an internal infection, and did feces culture tests with 7 out of 15 inpatients who had recently had a stomachache or diarrhea and were able to be tested, and 2 discharged patients. Salmonella O7 was detected by direct fulguration in 4 of them and by enrichment in 2, for a total of 6 out of 9 patients. We considered the source to be food poisoning originating in hospital meals and in adherence to the Food Hygiene Law, turned to the proper authorities, which was the Nagaoka Board of Health, for administrative guidance. To search for the cause of this infection, environmental inspections of the patients' rooms and hospital kitchen were undertaken. Further interviews with the patients were also done but they cleared neither the infection source nor the infection route. Even without a genic test, the biotypes were all the same as 53525040. This was discovered by an Autoscan 4 (DADE BEHRING) and the result gave a strong suspicion of an internal infection. The Nagaoka Board of Health was of the opinion that there was a low possibility of the hospital meals being a source of the infection. The reasons were because the diarrhea did not present at the same time among all the patients, there were a distinct few cases of diarrhea among the hospital meal fed patients, and there were no contamination factors found by their investigation of the staff or the system for preparing the meals. Three patients were given an antimicrobic and the measures for training and educating the staff, maintaining a clean environment and fighting infection were re-examined. The case was brought to its conclusion after about 40 days.

Infection of a hepatitis C virus (HCV) is confirmed by the presence of HCV antibody or HCV-RNA. Recently, a highly sensitive method to examine HCV-core antigen has been developed. In this study, to evaluate the clinical significance of HCV-core antigen determination, we examined serum HCV infection markers, HCV-core antigen, HCV-RNA (AMPLICOR) and HCV-antibody (third generation) concentrations. We determined 225 serum samples, and three patients receiving the treatment with interferon. In 102 HCV-RNA positive samples, significant correlation was observed between HCV-RNA and HCV-core antigen (r=0.734, p<0.0001). However, three out of 102 (2.9%) cases were included within the negative range of HCV-core antigen (20 fmol/l). The HCV-core antigen value in three patients receiving the treatment with interferon paralleled with the amount of HCV-RNA. The determination of HCV-core antigen by CLEIA is a useful and time-saving method, but an attention should be paid to the presence of false-negative cases.

A 20 year-old female was admitted to our department because of an abnormal shadow in chest roentgenogram on a physical check-up. The barium swallowing study revealed an oppression of the middle of the esophagus. Endoscopy, chest CT and MRI failed to distinguish submucosal tumor from mediastinal tumor. Endoscopic ultrasonography showed the mass originated from the esophagus and a diagnosis of esophageal smooth muscle tumor was obtained. The tumor was tried to resect by thoracoscopic surgery but was failed because of its shape like a tortoise shell. The tumor was resected through the right thoracotomy and the diagnosis was confirmed histopathologically.

A 40-year old woman had experienced repeated spontaneous pneumothorax on the right side at the beginning of each menstrual period for one year. The level of serum CA125 was high at 60 ng/ml. Right thoracotomy revealed the presence of multiple darkly-pigmented spots and several pinhole like perforations near the central tendon of the diaphragm. The partial resection of the diaphragm was done, endometrial tissues were detected histologically. Tha patient has been asymptomatic after operation and the level of serum CA125 is normal.

Shear-induced platelet aggregation (SIPA) in a patient with Glanzmann's thrombasthenia was examined during platelet infusion therapy. Prior to platelet infusion, SIPA measured with the modified cone-and-plate type viscometer, as well as ADP-and collagen-induced platelet aggregation measured with the conventional platelet aggregometer, were absent. The patient's SIPA after multiple infusions of platelet, in parallel with the bleeding time and the clinical hemostatic effect, improved to the normal level, while ADP-and collagen-induced platelet aggregation remained abnormal. These observations imply that SIPA is physiologically more relevant than the conventional agonist-induced platelet aggregometry in this type of the disease.

Corticosteroids have desirable antiinflammatory and immunosuppressive actions and are administered orally, parenterally and topically for the treatment of various diseases. The pharmacological spectrum of corticosteroids includes activities which may result in numerous adverse reactions. The development of more effective drugs, the development of preparations suitable for administration and the improvement of administration routes have been extensively studied with respect to a separation of therapeutic and toxic effects of corticosteroids. In the present paper, the recent trend and development of corticosteroids are reviewed.

The clinical significance and detection methods for circulating activated platelets are reviewed. It has been recently demonstrated that three kinds of platelet granules, dense granule, alpha-granule and lysosome, have specific membrane proteins; granulophysin, GMP-140 (PADGEM) and CD63 antigen, respectively, and that these specific granule-membrane proteins become exposed on the surface of the activated platelets. It is believed that detection of circulating activated platelets, using monoclonal antibodies specific to these granule-membrane, may be reliable and diagnostic value in thrombotic and prethrombotic diseases. Preliminary clinical studies using 2T60, a newly developed anti-GMP-140 monoclonal antibody, was presented.

Three dimensional (3D) images were reconstructed from axial CT slices using the personal computer. Some devices of the program made it possible to decrease the image processing time and to produce the realistic images with cubic effect. The thresholding in the conventional 3 D imaging was not practical especially in the display of the soft tissues. The employment of the volume rendering technique and MRI data will give a clue to the solution of these problems.