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Purpose: The purpose of this study was to evaluate the effects of phantom factor on the verification of measured doses using cheese phantoms in tomotherapy., Methods: Two plans for dose verification (plan classes and plan class phantom sets with a virtual organ at the risk set) were evaluated. The calculated and measured doses were compared with and without the phantom factor using cheese phantoms. Additionally, the phantom factor was evaluated for two conditions (TomoHelical/TomoDirect) in clinical cases (breast and prostate)., Results: When applying a phantom factor of 1.007, the deviation between the calculated and measured doses increased in Plan-Class and TomoDirect, decreased in TomoHelical, and increased in both clinical cases., Conclusion: When conducting dose verification, the effects of one phantom factor on measurement conditions may differ depending on when phantom factors were obtained (irradiation technique and irradiation field). It is therefore necessary to consider changes in measured doses due to changes in phantom scattering.

Malignant spinal cord compression(MSCC)is defined as a compression of the spinal cord or cauda equina with neuropathy caused by tumor spreading to the vertebral body. The common symptoms of MSCC are back pain, neck pain, muscle weakness, sensory reduction, bladder and rectal disturbance. The risk of MSCC is relatively high in patients with lung cancer, breast cancer, and prostate cancer. MSCC is one of the oncologic emergencies that requires prompt diagnosis and treatment to preserve and improve neurological function. Evaluation by magnetic resonance imaging(MRI)and computed tomography( CT)are useful for the diagnosis. The prognosis of these patients is often poor at the time of diagnosis of MSCC, thus it is important for deciding the treatment strategy to consider the prognosis and background of the patient in addition to the objective findings including the degree of MSCC and spinal instability. Treatment options consist of medical, surgical, and radiation therapy. We need a multidisciplinary approach because the pathology of MSCC involves multiple departments, such as medical oncology, orthopedics, and radiology. Supportive care including rehabilitation and preventing skeletal related events are also important. The cancer board, in which each physician and multidisciplinary health care professionals regularly have a discussion and review the cases, is required.

In recent years, the role ofimmune checkpoint inhibitors(ICIs)has become crucial in cancer therapy. However, ICIs are known to trigger a wide variety of autoimmune side effects, termed immune-related adverse events(irAEs), which can influence multiple organs. Hypophysitis induced by ICIs, which is defined as the inflammation of the pituitary gland and is the cause ofhypopituitarism, is one ofthe important toxicities, because it can be life-threatening event when it is not diagnosed or managed properly. Therefore, ICIs-induced hypophysitis should be recognized as one ofthe oncologic emergencies. Symptoms, laboratory data, hormone level measurement, and pituitary magnetic resonance imaging are necessary for diagnosis. It should be taken into consideration that types of agents in ICIs have an effect on patterns of symptoms, onset timing, and hormone deficiencies. Replacement of appropriate hormones according to severity is fundamental strategy. Patient education especially about sick day rules is vital, because adrenal insufficiency secondary to adrenocorticotropic hormone deficiency usually remains permanently. There is no established predictive biomarker for irAEs yet. Thus, for an early awareness of the symptoms ofirAEs and a proper management in clinical practice, interprofessional collaboration among oncologists, endocrinologists, nurses, pharmacists, and other health care workers must be essential.

A 21-year-old woman presented with a chief complaint of generalized tonic-clonic seizures occurring once a month at night since the age of 14. The patient was treated with clonazepam plus levetiracetam, but seizure frequency was not reduced. After the detailed re-examination of her history of illness, it was revealed that she has been suffering from transient and recurrent choreoathetoid attacks triggered by sudden voluntary movements since she was a junior high school student, and it recently increased in frequency. Neither she nor her family recognize that it was significant to describe to the doctors. She was diagnosed as a complex of paroxysmal kinesigenic choreoathetosis (PKC) and its related conditions. Direct sequencing of proline-rich transmembrane protein 2 (PRRT2) revealed the most frequently described gene mutation, (NM_145239.2:c.649dupC), among PRRT2-related paroxysmal disorders. PKC and seizures were readily controlled with small dose of carbamazepine. Given the broad spectrum of PRRT2-related paroxysmal disorders, assessment of potential clinical complication of paroxysmal disorders including PKC might therefore be critical.

Serum (1→3) beta-D-glucan (BG) measurement is a useful test for systemic mycoses, and often used. On the other hand, various factors, including administration of intravenous immunoglobulins (IVIG) may cause false-positives. In the present study, we measured BG concentration of seven IVIG preparations with three lots respectively. BG levels varied with individual IVIG preparations (<3.0 - >300 pg/mL), and contamination from manufacturing processes was suspected. With serum BG concentration of clinical specimens obtained in Niigata University Medical & Dental Hospital, the difference between before and after administration of IVIG were calculated. The false-positive rate of BG due to IVIG administration was 9.8 %, and the positive predective value was reduced to 37.5%. Above all, administration of IVIG can complicate the BG test's interpretation, and caution is required.

Objective: We evaluated the effectiveness of synthetic adrenocorticotropic hormone (ACTH) therapy without tapering in treating patients with West syndrome., Methods: Forty-four patients with cryptogenic (n = 7) or symptomatic (n = 37) West syndrome were treated with synthetic ACTH therapy between 2003 and 2012. The synthetic ACTH dosage was 0.0125 mg/kg/day administered daily for 2 weeks and then stopped without a tapering period. The initial effectiveness, long-term seizure outcome, and adverse effects were examined., Results: During synthetic ACTH therapy, epileptic spasms disappeared in 37 of 44 patients (84.1%) and hypsarrhythmia on electroencephalography disappeared in 42 of 44 patients (95.5%). The average number of synthetic ACTH injections needed to achieve spasm control in these 37 patients was 5.8. Long-term seizure outcomes were assessed in 31 patients followed up for longer than half a year after synthetic ACTH therapy. Nine (29.0%) of these patients experienced recurrence of epileptic spasms, with a mean interval to recurrence of 2.4 months. Overall, 12 patients (38.7%) experienced various types of seizures other than spasms with a mean interval to recurrence of 8.0 months. Although adverse effects such as hypertension, infection, and mild brain shrinkage were noted in 13 patients (29.5%), no severe adverse effects were observed., Conclusions: These results are comparable to those of other reports on the initial effectiveness and long-term seizure control following synthetic ACTH therapy, and suggest that administration without tapering is reasonable to treat patients with West syndrome.

Rehabilitation is becoming an important field of care at pain clinics designed to alleviate pain. Exercise and physical therapies are widely used in rehabilitation, and exercise therapy in particular is considered a treatment that should be actively incorporated. Intervention must continue to be provided after ascertaining whether exercise therapy is within the scope of pain clinicians themselves, or whether it should be offered in collaboration with physical therapists. This can be achieved by deepening knowledge of exercise therapy and investigating how it should be offered depending on the disease. Focus should be placed on abnormal posture and exercise, as well as secondary pain. Visualizing movement and building up associated sensorimotor experiences are also considered important. To achieve this, cooperation between physiatrists and physical therapists, they must deepen and exchange understanding and knowledge with each other.

An 80-year-old man presented with abdominal fullness and vomiting. Laboratory data revealed severe anemia, an inflammatory response, and elevated white blood cell counts. Abdominal computed tomography indicated ileus caused by a jejunal tumor measuring 8cm in diameter. Although small-bowel endoscopy enabled visualization of the tumor, adequate biopsy specimens could not be obtained for accurate diagnosis. The patient's condition rapidly deteriorated, because of which surgical treatment could not be initiated. The patient died approximately 3 weeks after admission. High serum granulocyte colony-stimulating factor (G-CSF) levels were detected at autopsy. Immunohistochemical staining of the autopsy specimen indicated positive G-CSF levels in the jejunal tumor. On the basis of these findings, a final diagnosis of undifferentiated carcinoma of the jejunum producing G-CSF was made.

Pyogenic ventriculitis is an uncommon and potentially fatal central nervous system infection. Delayed treatment due to non specific clinical symptoms may lead to an unfavorable outcome. Brain magnetic resonance imaging (MRI) plays an important role in the diagnosis of pyogenic ventriculitis. We describe two patients with pyogenic ventriculitis presenting with a pathognomonic MRI finding. The first patient, a 77-year-old female, developed high fever and consciousness disturbance. MR images revealed hyperintense lesions with a fluid-fluid level in the bilateral lateral ventricles on diffusion-weighted images (DWIs) and hypointense lesions on T2-weighted images (T2WIs). MR images also revealed findings of left otitis media. The second patient, a 63-year-old male, who had a past history of multiple myeloma and had received chemotherapy, developed high fever and left hemiparesis. MR images revealed a hyperintense lesion with a fluid-fluid level in the right lateral ventricle on DWIs and a hypointense lesion on T2WIs, multiple ring-enhancing lesions on gadolinium enhanced T1-weighted images, and pontine infarction on DWIs. Chest computed tomography revealed an infiltrative shadow in the lower lobe of the left lung. On the basis of MRI findings, both patients were diagnosed as having pyogenic ventriculitis and were administered high-dose meropenem intravenously. The second patient was also administered sulfamethoxazole-trimethoprim orally. Intraventricular abnormalities disappeared and the patients achieved complete remission after the antibacterial treatment. Intraventricular hyperintense lesions on DWIs and hypointense ones on T2WIs with a fluid-fluid level is a pathognomonic finding of pyogenic ventriculitis and has not been previously reported in other diseases. Recognition of the characteristic MRI features and initiation of high-dose and appropriate antibiotics in an early stage may lead to a favorable outcome of the disease.

Intracranial subdural hematoma (SDH) occurred in a 58-year-old female after laparoscopy-assisted distal gastrectomy under general and thoracic epidural anesthesia. On postoperative day 2, she complained of headache in sitting position, but there were no remarkable neurological defect and nausea. On postoperative day 5, her headache subsided and she could walk by herself. But on postoperative day 10, she felt heavy-headed again, and complained sensory abnormality of her right leg. Magnetic resonance imaging of the head showed small acute subdural hematoma in bilateral parietal regions with no mass effect. She was managed conservatively with bed rest and intravenous fluids. Her condition improved and was discharged on postoperative day 17 without subsequent complications. SDH after epidural anesthesia is rare, but diagnosis in early stage has a decisive influence on its prognosis. It is crucial to exclude the possibility of SDH and observe closely if the patient complains of severe headache or another unexplained symptom only with postdural puncture headache.

In a case of patient who transfers from hospital-stay to homecare, a pre-discharge conference will be held on behalf of the patient, family and regional staff along with our hospital support guideline system. We would make sure at the conference whether a continued care provided to the patient will seamlessly be offered before and after the discharge. The transfer care arrangement was normally taken place while a patient was still at the hospital. We analyzed the interview evaluation done by the patient, family, and regional staff: three cases with a successfully transferred to the regional home were chosen because they attended the pre-discharge conference more than twice while they were at hospital. All cases had received an arranged care continuously. It seems that the arranged caring was appropriate for the patient and family.

A 5-year-old girl presented with flushing and sweating on the left arm with coldness on the left palm that had persisted for approximately 24 hours. She had a fever and chicken pox-like exanthemas on her skin. She had no weakness, sensory disturbance or other autonomic dysfunction, such as orthostatic hypotension. Physical, neurological, blood and cerebrospinal fluid findings, including those of a viral study, were normal. A spinal MRI revealed no abnormal signals. Motor nerve conduction velocity, compound muscle action potential and sensory nerve conduction velocity in both medial nerves were normal, although compound sensory nerve action potential was low in the left medial nerve. F waves were absent in both medial nerves. The amplitude of the sympathetic skin response was low in the left palm. The cold-induced vasodilatation test showed bilateral sympathetic nerve dysfunction, especially on the left side. The coefficient of variation of RR intervals was low. Aciclovir was administered until chicken pox was ruled out. Subsequently, her symptoms improved. However, a sympathetic skin response and cold-induced vasodilatation findings 9 months later revealed sympathetic nerve dysfunction. These findings suggested autonomic neuropathy with local sympathetic dysfunction and a mild sensory nerve disturbance.

The accuracy of antifungal susceptibility testing is important for the clinical management of patients with serious infections due to fungus. Our primary objective was to analyze the results of antifungal susceptibility testing of Candida species performed at Niigata University Medical and Dental Hospital and usage of antifungal agents. Antifungal susceptibility testing was performed by the CLSI M27-A2 method. Yeast-like fungi were isolated from 6% of 6,730 samples. All isolates were Candida species, i.e., C. albicans (50%), C. parapsilosis (28%), C. guilliermondii (9%), C. krusei (5%), C. glabrata (4%), and C. tropicalis (4%). The results of the minimum inhibitory concentration that inhibits 90% of the strain tested (MIC90) were 1 microg/mL for fluconazole, 0.5 microg/mL for miconazole, 0.06 microg/mL for itoraconazole, < or = 0.03 microg/mL for micafungin, respectively. The results of non-albicans species were 32 microg/mL for fluconazole, 8 microg/mL for miconazole, 0.5 microg/mL for itoraconazole, 1 microg/mL for micafungin, respectively. All Candida species were susceptible to the available antifungal agents, except C. krusei that was resistant to fluconazole. Thus, antifungal susceptibility varies greatly according to fungal species. The accuracy of identification of the fungus and antifungal susceptibility would contribute to the proper management of patients with serious fungal infections.

Elevated contact stress on the articular joints has been hypothesized to contribute to articular cartilage wear and joint pain. However, given the limitations of using contact stress and areas from human cadaver specimens to estimate articular joint stress, there is need for an in vivo method to obtain such data. Magnetic resonance imaging (MRI) has been shown to be a valid method of quantifying the human joint contact area, indicating the potential for in vivo assessment. The purpose of this study was to describe a method of quantifying the tibiofemoral joint contact area using MRI. The validity of this technique was established in porcine cadaver specimens by comparing the contact area obtained from MRI with the contact area obtained using pressure-sensitive film (PSF). In particular, we assessed the actual condition of contact by using the ratio of signal intensity of MR images of cartilage surfaces. Two fresh porcine cadaver knees were used. A custom loading apparatus was designed to apply a compressive load to the tibiofemoral joint. We measured the contact area by using MRI and PSF methods. When the ratio of signal intensity of the cartilage surface was 0.9, the error of the contact area between the MR image and PSF was about 6%. These results suggest that this MRI method may be a valuable tool in quantifying joint contact area in vivo.

We recently evaluated a patient with ADEM after a mycoplasma infection who initially presented with psychiatric symptoms, including hyperkinesis, irritability, and emotional outbursts. Psychiatric symptoms in ADEM are rare and usually suggest some underlying psychiatric or psychogenic disorder. This case illustrates that in children who initially present with psychiatric symptoms, even in the absence of typical neurologic symptoms associated with encephalitis such as disturbance of consciousness or seizures, ADEM should be considered in the differential diagnosis. Recent history of infections or vaccinations should also be considered.

Objective: Acute exacerbations adversely affect the quality of life and prognosis of patients with chronic obstructive lung disease (COPD). Prevention of future exacerbations is extremely important, especially for elderly patients. In this study, we evaluated the efficacy of influenza vaccine for acute exacerbation of COPD in elderly patients., Methods: A prospective cohort study was conducted among 289 patients over 65 years of age with COPD (FEV1/FCV<0.70) during the 2001-2002 influenza season. Background data, outpatient visits for wheezing and hospitalizations were compared between the vaccinated group (n = 189) and the unvaccinated group (n = 100)., Results: The number of patients who visited hospital for wheezing was 11 of 189 (5.8%) in the vaccinated group and 23 of 100 (23%) in the unvaccinated group (RRR: relative risk reduction 74.7%, 95% CI: confidence interval 0.51-0.87). The number of hospitalizations for pneumonia was 8 of 189 (4.2%) in the vaccinated group and 14 of 100 (14%) in the unvaccinated group (RRR 69.8%, 95% CI: 0.32-0.87). The costs of hospitalization were lower in the vaccinated group with direct savings of 91,525 yen per patient., Conclusions: For elderly COPD patients, influenza vaccine decreases acute exacerbation due to pneumonia and bronchoconstriction, and also may minimize the costs of hospitalization.

In October 2004, a 73-year-old man underwent loop ileostomy because of unresectable peritoneal disseminated sigmoid colon cancer with liver metastasis. The oral chemotherapy by S-1 was administered(80 mg/day for 4 weeks followed by a 2-week rest period). A half year later, the primary lesion was remarkably diminished on barium enema, and peritoneal dissemination and liver metastasis disappeared on CT. Because he was unwilling to have an ileostomy, we decided to resect the primary lesion and close the ileal stoma in May 2005. There was no obvious peritoneal dissemination, and operation was successful. He died without intestinal stoma one year after second operation. This therapy can be orally administered at home, and is considered to be useful from the viewpoint of QOL as well. S-1 is expected to be an effective agent for the treatment of colon cancer.

Purpose: We recently reported treatment of asthmatic patients with a combination of FP-DPI 800 microg/day and BDP-HFA 400 microg/day. This regimen induced significant improvement in subjective symptoms and pulmonary function tests. This led us to study the additive effect of BDP-HFA 400 microg/day for seven unstable severe persistent bronchial asthma patients., Results: PEF improved, daily (circadian) variation was minimized and FVC and FEV1.0 testing showed slight improvement. V25/height also revealed significant improvement. The more peripheral the airways are, the greater improvement was observed. The annual emergency admission rate of 4.6 times per patient decreased to 2.1 times after the addition of BDP-HFA 400 microg/day. All the three cases dependent on oral steroid medication could be removed from the drug and 6 out of 7 cases were able to lower the dose of anti-asthmatic drugs., Conclusions: The effectiveness of inhaled corticosteroids (ICS) differs based on the site reached in the bronchi and depending on the inhalation devices used. Addition of a second ICS has the potential to further alleviate symptoms of unstable asthmatics on conventional therapy with ICS and other drugs.

Aim: Community-acquired pneumonia (CAP) remains a common and serious illness. CAP can be a major cause of morbidity and mortality in elderly patients. This study aims to investigate the precision of disease severity staging scales such as Pneumonia Outcomes Research Team (PORT) Severity Index (PSI) and A-DROP (Age, Dehydration, Respiratory failure, Orientation disturbance, shock blood Pressure) in elderly patients with CAP. For this study, 111 elderly CAP patients admitted to our hospital during a two-year period were recruited and stratified using these scales., Methods: We reviewed the precision of the above-mentioned scales in the 111 patients aged 65 years or above, and investigated the disease severity classifications, initial treatment, and clinical course of these patients., Results: The mean age of the patients was 82 (+/-7.6) years. Among these patients, 15% were aged between 65 and 75 years, 50% were older with their ages ranging from 75 to 84 years, and 35% were extremely old with their ages over 85 years. The mortality rates for the patients with the A-DROP score of 0, 1, 2, 3, 4, and 5 were 0%, 0%, 2.2%, 17.2%, 20.0%, and 40.0%, respectively, and those for the patients with PSI class I, II, III, IV, and V were 0%, 0%, 0%, 0%, and 36.0%, respectively., Conclusions: PSI is a useful method for estimating the prognosis in elderly CAP patients. On the other hand, the A-DROP score may be inadequate in terms of judging the disease severity in these patients. With regard to the severity of pneumonia in elderly patients, we should consider not only the A-DROP score but also the underlying diseases such as malignancy, cardiac failure, cerebrovascular disease, liver disease, or renal disease.

We reported two cases of intracranial skull base chondroma and discussed the differential diagnosis and the treatment strategies. The first case was a 39-year-old male who presented with left exophtalmos, visual loss and oculomotor disturbance. MRI showed a huge tumor occupying the bilateral cavernous sinus. Partial removal of the tumor was performed through the left orbitozygomatic subtemporal approach. The second case was a 54-year-old male who presented with left hemiparesis. MRI showed a brain stem infarction with a huge tumor located at the right middle fossa. Partial removal was performed through the right orbitozygomatic subtemporal approach. In these two cases, the histopathological diagnosis of the tumors was benign chondroma and the size of residual tumors have not changed for one year without any additional therapy. Although preoperative definite diagnosis for skull base chondromas is difficult, strategies for diagnosis and treatment without any complication are essential. In our cases, chondromas showed low uptake in PET images, which might be useful for differentiation between chondromas and chordomas. The current popular surgical approach for parasellar tumors is transcranial such as the orbitozygomatic subtemporal approach. In surgical removal of skull base chondromas, it is advisable to try to confirm the diagnosis preoperatively with characteristic image findings and to consider the best approach in each case to decompress the involved nerves without any complications.

The pain remaining after a needle stick is categorized as neuropathic pain. CRPS (Complex Regional Pain Syndrome) is a typical disease in this category. Neuropathic pain is extremely intractable when it becomes chronic pain, inducing psychological and physical pain in patients over a long period of time. Neuropathic pain is a complex system caused by various factors, and its mechanism remains unclear. For prevention, medical practioners should carefully select centesis, and apply necessary measures corresponding to the situation. There is no established treatment for neuropathic pain. We usually treat the disease with nerve block and drug therapy. Nerve block is useful for pain relief. We typically use a sympathetic nerve block (SGB; stellate ganglion block, IRSB; intravenous regional sympathetic block et. al.) as the initial treatment. In the stage of chronic pain, it is very important to improve patients' ADL (activity of daily living) and QOL (quality of life). If neuropathic pain is suspected, it is crucial to treat at an early stage. Therefore, it should be emphasized that when pain persists after a needle stick, the patient should immediately consult a pain clinician or an orthopedist.

Complex regional pain syndrome type I (CRPS-I) requires the presence of regional pain and sensory changes associated with findings such as abnormal skin color, temperature change, sudomotor activity, or edema, following a noxious event. Complex regional pain syndrome type I induced by phenobarbital (PB) is not well known, although several reports have strengthened the association between PB and CRPS-I. I reviewed the charts of 99 patients treated with PB to assess the incidence, clinical characteristics, investigations, dosage and plasma concentration of PB, and risk factors in the development of CRPS-I. Six patients developed CRPS-I. Pain was severe and allodynia, swelling, discoloration, sweating were present in all patients. This syndrome manifested bilaterally in some patients. Affected patients included 5 men and 1 woman between the ages of 52 and 78 (average 64.2 years). A radiograph showed demineralization in one patient. Thermography showed temperature differences between affected and unaffected limbs, although in a few patients the differences were little because of bilateral affected limbs. 99Technetium methlyene diphosphonate bone scan showed increased periarticular changes in most of the patients. The patients developed CRPS-I at 9.7 weeks (average) after PB was begun. The average time was 7.5 months between CPRS-I and PB reduction. Neither sympathetic ganglion blockade nor physical therapy was effective. Treatment of CRPS-I consists of PB reduction and prednisone and/or Neurotropin. In all patients clinical symptoms and signs such as pain and edema, and range of motion of their shoulders were improved after PB discontinuation. One patient was followed longitudinally, documenting improvement following discontinuation, reexacerbation with PB rechallenge, and remission once more when PB were discontinued. The higher incidence should depend on the coexistence of separate risk factors such as age and PB dosage. Recognition of CRPS-I induced PB, early diagnosis, and withdrawal of PB are important for symptomatic relief and improvement of QOL.

We experienced a case of intractable lower limb pain successfuly treated by spinal cord stimulation with an electrode inserted retrogradely. The patient is a 32 year-old-man suffering from intractable lower limb pain on the area innervated by the sciatic nerve from unidentified cause for about 4 years. We tried various treatments such as epidural block, S 1 nerve-root block including thermocoagulation technique, opiate. Nevertheless, his pain became worse further. Therefore, 6 years after the onset of the symptom, we tried to stimulate electrically the nerve with an electrode inserted retrogradely. This method of spinal cord stimulation produced enough pain reduction. The method of retrograde insertion of an electrode for spinal cord stimulation seems to be a good way to treat intractable pain of the area innervated by a single spinal nerve.

Purpose: To evaluate the usefulness of MR imaging for the detection of severe facial nerve damage in patients with facial nerve palsy., Materials and Methods: We retrospectively reviewed 26 consecutive patients with facial nerve palsy (13 non-responders and 13 responders). T1-weighted, T2-weighted, and postcontrast T1-weighted images were obtained in all patients. FLAIR images were also obtained in 3 non-responders., Results: The geniculate ganglion, labyrinthine segment, and tympanic segment or mastoid segment showed high signal intensity on T2-weighted images in 9 of 13 non-responders, whereas high signal intensity of the nerve was only seen in 1 of 13 responders. FLAIR imaging revealed high signal intensity lesions of the distal intrameatal segment in 2 non-responders. Contrast enhancement of the facial nerve showed a similar pattern in non-responders and responders. High signal intensity lesions on T2-weighted or FLAIR images showed enhancement on postcontrast T1-weighted images., Conclusion: These results suggest that a high signal intensity area on T2-weighted images is a marker of severe facial nerve damage. FLAIR imaging is useful for identification of T2-prolongation in the distal intrameatal segment.

Crossed cerebellar atrophy (CCA) on imaging study reflects secondary degeneration of the cerebellar hemisphere caused by neuronal disconnection with the contralateral cerebral hemisphere. We report an 11-month-old child with traumatic left acute subdural hematoma, who showed crossed cerebellar atrophy on MR images. Eighteen months after the trauma, MR images showed brain atrophy not only in the left cerebral hemisphere but also in the right cerebellar hemisphere. The cerebellar atrophy was prominent in the lateral part. This finding is consistent with CCA and may support neuronal interactions between the cerebral hemisphere and the lateral part of the contralateral cerebellar hemisphere.

Obesity frequently promotes a variety of cardiovascular diseases including atherosclerosis, hypertension, and type 2 diabetes. In a view of both the preventive and therapeutic aspects of the abovementioned diseases, most intensive clinical interventions have been primarily directed at decreasing excessive amounts of fat tissue by a change in the balance between intake and expenditure of energy; such changes are typically effected via daily exercise and diet control. Mechanical stimuli such as stretching and rubbing of fat tissues using gymnastic exercises or massage are believed to decrease obesity; however, there is no report concerning the direct effect of the mechanical stimulation on adipocytes. Here, we demonstrated that cyclic stretch inhibited adipocyte differentiation of mouse 3T3-L1 cells, which was attributable to a reduced expression of adipogenic transcription factor peroxisome proliferator-activated receptor (PPAR)gamma(2) via the activation of an extracellular signal-regulated protein kinase (ERK) pathway. The inhibitory effect of the cyclic stretching on the differentiation of 3T3-L1 cells could be restored by troglitazone, a synthetic ligand for PPARgamma. Our results provide a molecular basis for the physiological significance of the local application of mechanical stimuli to fat tissues, which is totally independent of a mechanism for systemic energy consumption.

A 57-year-old female underwent left lower lung lobectomy and was histologically diagnosed as having lymphoepithelioma-like carcinoma. One year and 2 months after surgery, pleural thickening was recognized, so she was administered 4 courses of CBDCA/PTX combined chemotherapy. Toxicity associated with the chemotherapy was very mild. Pleural thickening and effusion disappeared after treatment, so this case was judged to be a complete response. She suffered from left chest pain before chemotherapy, which later lessened. She was thus able to stop taking NSAIDs. Because primary pulmonary lymphoepithelioma-like carcinoma is a rare tumor, there is no standard chemotherapy treatment. CBDCA/PTX combined chemotherapy is effective for pulmonary lymphoepithelioma-like carcinoma and shows good tolerability and improves QOL.

The autoregulatory mechanism, including myogenic response, so-called "Bayliss effect", is well developed in the brain circulatory area, where also, cerebral vasospasm is often encountered after subarachnoid hemorrhage. In the cerebral artery smooth muscle, protein kinases, such as Rho-associated kinase, tyrosine kinase, and protein kinase C, are activated in response to mechanical stresses, including stretch, pressure and flow. All of these kinases are also activated in due course of time after development of the vasospasm. Myogenic response is a kind of reception and subsequent reaction to mechanical stress, whereas cerebral vasospasm is primarily caused by oxyhemoglobin, i.e., oxidative stress. Thus both myogenic and vasospastic episodes imply a common stress-responding mechanism. It seems possible that various kinases activated by mechanical stress act as not only a physiological signaling but also a proatherogenic/remodeling one. The stiffness of vasospastic artery was enormously increased in particular in the late phase of vasospasm, indicating the augmented process of pathologic remodeling. Therefore, "Bayliss effect" in modern sense and cerebral vasospasm can be argued in terms of a stress-reaction of cerebral artery.

Using Amebocyte lysate of horseshoe crab to measure (1-->3)-beta-D-glucan specifically, a component of the cell wall, several kinds of diagnostic methods for deep mycosis are in practical use in Japan. However, the most important problem is that the judgment of positive or negative is method dependent. To elucidate the cause of the problem, each measurement value of the identical sample by four methods, beta-Glucan Test Maruha (MARUHA), beta-Glucan Test Wako (WAKO). FUNGITEC G Test (FUNGITEC-G) and FUNGITEC G Test MK (FUNGITEC-MK) was compared with the clinical data using 119 cases and 289 tests. Each case was divided into three groups; proven fungal infection, probable fungal infection and non-fungal infection. The negative cases for all the methods tested in the groups of proven fungal infection and probable fungal infection were allergic bronchopulmonary aspergillosis and cryptococcosis, and that for all the methods tested except FUNGITEC-MK method in the group was pulmonary aspergilloma. It seems that these cases cannot be detected correctly by only measuring (1-->3)-beta-D-glucan. On the other hand, the ratio of false positive, positive for non-fungal infection group was high in the case of FUNGITEC-MK. About 23% against the total case was positive for FUNGITEC-MK method, but negative for MARUHA, WAKO, and FUNGITEC-G methods. Although the difference of the sensitivity among four methods was not observed, the specificity, the diagnostic efficiency, and the positive predictive value of FUNGITEC-MK method were remarkably lower than those of the other methods due to false positive measurement. In conclusion, MARUHA, WAKO and FUNGITEC-G except FUNGITEC-MK is not method dependent. It is suggested that FUNGITEC-MK detects non-specific reaction resulted in false positive.

beta-Glucan Test MARUHA for high sensitive diagnosis of deep mycosis which was developed recently detects (1-->3)-beta-D-glucan, a component of the cell wall. The performance of beta-Glucan Test MARUHA is evaluated in this report. Although existing methods to detect (1-->3)-beta-D-glucan have trouble with sulfa drugs, hemolysis, and immunoglobulin G (IgG), these problems were overcome by the beta-Glucan Test MARUHA: No effect was observed for beta-Glucan Test MARUHA at lower than 200 micrograms/ml, 500 mg/dl, and 6,000 mg/dl of sulfa drugs, hemoglobin, and IgG, respectively. The effect of drugs administrated on the measurement value of beta-glucan Test MARUHA was checked at several concentrations. However, almost no effect of drugs, such as, 5 kinds of antifungals, 8 kinds of antibiotics, a kind of antibacterial, 2 kinds of infusions, and a kind of contrast media was observed at the practical concentrations.