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Objective The objective of this report was to describe an unusual case of emerging primary hyperparathyroidism (PHPT) accompanied by recovery of parathyroid blood flow 3 months after spontaneous parathyroid hemorrhage. Methods Neck images and laboratory tests including serum calcium and parathyroid hormone (PTH) were performed to evaluate parathyroid hemorrhage. Pathologic findings after parathyroidectomy are also presented. Results A 58-year-old woman developed acute onset of neck pain and swelling with ecchymosis. Computed tomography showed a right paratracheal hematoma-like lesion behind the thyroid. Ultrasound (US) of the neck revealed a round, hypoechoic nodule measuring 27 × 25 × 18 mm in the right lower thyroid pole without vascular flow. Blood tests showed a corrected calcium of 9.3 mg/dL (normal, 8.7 to 10.3 mg/dL), and intact PTH of 68 pg/mL (normal, 10 to 65 pg/mL). Intact PTH measurement in fine-needle aspirate of the lesion was 339 pg/mL, confirming parathyroid origin. Repeat US after 3 months showed a remarkable decrease in lesion size with significant blood flow. Blood biochemistry showed a corrected calcium of 10.9 mg/dL, and an intact PTH of 237 pg/mL. She eventually underwent parathyroidectomy, and pathologic examination revealed parathyroid adenoma with a tiny thrombus. Conclusion Spontaneous remission of PHPT after parathyroid hemorrhage has been known to occur sporadically, a phenomenon referred to as autoparathyroidectomy. Although spontaneous remission with permanent improvement of PHPT may be observed, PHPT can recur in the relative short term after parathyroid hemorrhage, and so follow-up blood biochemistry surveillance is necessary. Also, evaluating parathyroid blood flow using color Doppler US might be useful in verifying the recurrence of PHPT. Abbreviations PHPT primary hyperparathyroidism PTH parathyroid hormone US ultrasound

Multiple generations of amphibole may form in the lower crust due to magmatism and metamorphism during the development of oceanic core complexes. We investigated the occurrence and chemical compositions of amphibole in gabbro mylonites from the medial area of the Godzilla Megamullion along the Parece Vela Rift in the Philippine Sea. The samples contain brown and green amphiboles with a variety of different textures that may have different origins. The brown amphibole occurs mainly as blebs in clinopyroxene porphyroclasts (Bleb amphibole), the rims around clinopyroxene porphyroclasts (Coronitic amphibole), and as porphyroclasts and fine-grained amphibole within the matrix (Matrix amphibole). The trace element and Cl contents of the bleb and green amphiboles indicate magmatic and metamoprhic origins, respectively. The bleb amphibole is interpreted to have crystallized from a hydrous silicate melt derived from an oxide gabbro-forming melt prior to retrograde metamorphism. In contrast, the compositions of the coronitic amphibole and matrix amphibole vary between those of typical magmatic and metamorphic amphiboles, suggesting that the amphibole-forming reactions were continuously retrogressive. Retrograde metamorphism is generally interpreted to have involved seawater-derived fluids, but the trace element contents of the coronitic and matrix amphiboles do not differ significantly from those of the original minerals (i.e., clinopyroxene and plagioclase). One sample of gabbro mylonite (KH07–02-D18–1) contains amphiboles with high concentrations of light rare earth elements, indicating a large influx of externally derived LREE-enriched fluids. These fluids are interpreted to have formed from an interaction between hydrous silicate melt with LREE-enriched composition and seawater-derived fluid. Our results suggest that multiple phases of melt–fluid infiltration occurred during the development of the detachment fault at the Godzilla Megamullion.

Resume Objectif Nous avons evalue les resultats de la tomographie par emission de positons couplee a la tomodensitometrie (TEP-TDM), utilisant comme traceur le fluorodesoxyglucose marquee au fluor 18 (18F) (FDG), dans les spondylarthropathies seronegatives (Spa), la pseudopolyarthrite rhizomelique (PPR) et la polyarthrite rhumatoide (PR). Methodes Nous avons etudie 53 patients hospitalises dans notre hopital entre 2006 et 2011 : 21 atteints de Spa, 16 atteints de PPR et 16 atteints de PR. L’activite inflammatoire de la maladie a ete evaluee en determinant l’accumulation du FDG a l’aide des scores standardized uptake values (SUVmax) et FDG, aux sites d’interet suivants : tuberosites ischiatiques, grands trochanters, apophyses epineuses, corps vertebraux, articulations sacro-iliaques. Resultats Le scores SUVmax des tuberosites ischiatiques etaient plus eleves dans la PPR par rapport aux Spa et a la PR. Les scores SUVmax des grands trochanters et des apophyses epineuses etaient significativement plus eleves dans la PPR que dans la PR (p Conclusions La detection par TEP-TDM d’anomalies inflammatoires siegeant aux tuberosites ischiatiques, aux grands trochanters et aux apophyses epineuses pourrait etre discriminante entre la PPR et la PR, mais pas entre les Spa et la PPR. Les anomalies mises en evidence par la TEP-TDM permettent de distinguer les Spa des PR et des PPR et sont utiles au diagnostic precoce des sacroiliites.

We assessed fluorine-18 ((18)F)-labelled fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) findings in patients with seronegative spondyloarthritis (SpA), polymyalgia rheumatica (PMR), and rheumatoid arthritis (RA).We studied 53 patients with SpA (n=21), PMR (n=16), or RA (n=16) admitted to our hospital between 2006 and 2011. Disease activity in the ischial tuberosities, greater trochanters, spinous processes, vertebral bodies, and sacroiliac joints (SIJ) were evaluated by determining FDG accumulation using maximum standardized uptake values (SUV(max)) and FDG scores.SUV(max) for ischial tuberosities was significantly higher in PMR than SpA or RA. SUV(max) for greater trochanters and spinous processes was significantly higher in PMR than RA (P0.001) and significantly higher in SpA than in PMR or RA for SIJ (P=0.01). No significant difference in vertebral scores was observed among groups (P=0.488). FDG scores yielded similar results. X-ray findings were consistent with PET/CT findings in 3/15 (20%) patients with sacroiliitis, whereas magnetic resonance imaging findings were consistent with PET/CT findings in 4/7 (57.1%) patients.PET/CT detection of inflammation in the ischial tuberosities, greater trochanters, and spinous processes discriminated between PMR and RA, but not between SpA and PMR. PET/CT findings can distinguish SpA from RA and PMR and are useful for the early diagnosis of sacroiliitis.

Bound state of water in poly(vinyl alcohol) (PVA) hydrogel produced by repeated freezing and melting method was investigated by thermal analysis and Raman spectroscopy. Water frozen in PVA hydrogel showed the lowering of the melting temperature depending on PVA concentration. This water can be treated as a supercooled water, of which the melting enthalpy is different from that of normal water frozen at 0 °C. Accurate melting enthalpies of supercooled water estimated by the difference of thermal capacity of supercooled water and ice allowed us to determine the weight content of supercooled bound water. The weight content of supercooled water decreased with increasing PVA concentration, and alternatively that of non-freezable water increased. The maximum content of non-freezable water was 31.4 wt% for the 50 wt% PVA gel. The pore size filled with water was successfully estimated by thermodynamical equation. The diameter is 30.2 nm for 10 wt% gel, which is comparable to that derived from other experimental methods. Raman spectroscopy was used to investigate the hydrogen bond of water. With increasing concentration, the rate of water without hydrogen bond increased. This might be interpreted by the increment of surface area of water as the pore size is reduced. This also supports that the PVA hydrogel takes the pore model filled with water.

Twelve coals were subjected to leaching procedure with an aqueous solution containing an acid or a chelating agent, such as EDTA. The susceptibility of each metal in coal for the leaching was roughly divided into three classes: largely leached (Ca, Mg, and Mn), moderately leached (Cu, Fe, Pb, and Zn), and a little leached (Al, Co, Cr, and Ni). This tendency was common in the leaching by HNO3 as well as in the leaching by EDTA. The leaching of each metal reached a pseudo-equilibrium value within 10–30 min. The metal leaching was decreased when the concentration of HNO3 or EDTA was lowered. However, even a low concentration of EDTA (0.1 mM) had an appreciable ability of metal leaching. For several metals (Ca, Cu, Fe, Mn, and Mg), there were fairly good correlations between the leaching amount and the content in coal.

Most commercial intact parathyroid hormone (intact PTH) assays cross-react with non-(1-84) PTH (likely 7-84 PTH). Using a whole-molecule PTH (whole PTH) assay that specifically measured only 1-84 PTH, we compared the kinetics of whole PTH and intact PTH after parathyroidectomy in patients with primary hyperparathyroidism (HPT) and secondary HPT.This study comprised 74 patients with primary HPT caused by a single adenoma and 18 patients with secondary HPT who underwent parathyroidectomy. Blood samples were drawn after anesthesia, just before excision of a single adenoma in primary HPT, and just before excision of the last parathyroid gland in secondary HPT, and at 5, 10, and 15 minutes after excision. The 7-84 PTH level was calculated by subtracting the whole PTH value from the intact PTH value.There was a difference between the percentage of 7-84 PTH/intact PTH in plasma samples from patients with primary HPT and secondary HPT (28%+/-12% vs 35%+/-9%; P.05). Plasma whole PTH decreased more rapidly than intact PTH after parathyroidectomy in patients in both the primary HPT (P.0001) and secondary HPT groups (P.0001). Decline of intact PTH was slower in patients with secondary HPT than in patients with primary HPT; however, there was no significant difference in the decline of whole PTH between the 2 groups.The quick intact PTH assay is not used frequently during surgery in patients with secondary HPT; however, our results suggest that a quick whole PTH assay may be a more useful adjunct to parathyroidectomy in both secondary HPT and primary HPT.

In most of the industries, classical reliability-centered maintenance (RCM) is employed to decide the maintenance strategies using reliability data without having adequate interaction with the design and operational systems. This means that the RCM process will be conducted with no or limited access to the design and operational data/knowledge. Commonly, the developed maintenance strategies are implemented and managed within the computerized maintenance management system (CMMS), which is usually separate from the RCM automated environment. This paper presents the detailed system design and mechanism of improved RCM process as integrated with CMMS. The proposed solution is integrated with design and operational systems and consolidates some successful maintainability approaches to formulate an effective solution for optimized plant maintenance. The major components of the enhanced RCM process are identified and a prototype system is implemented as integrated with the various modules of the adopted CMMS (MAXIMOt). A case study is used to show the effectiveness of the proposed RCM-based CMMS solution in optimizing plant maintenance over the traditional approaches. r 2003 Elsevier Ltd. All rights reserved.

Several procedures have been proposed for surgical treatment of the thyroid nodule; they have not gained wide acceptance, however, because of the expertise required, the relatively long operation times, the wide dissection needed to create a working space, and the extra cost of specialized instruments, especially when port sites are created in the remote area. These barriers have led some surgeons to perform video-assisted thyroidectomy via the neck. We describe the indications for, procedures related to, and results of both total endoscopic thyroidectomy and video-assisted thyroidectomy via the neck. Excellent cosmetic results were obtained by both procedures; however, video-assisted procedures required less time and a smaller dissection area.

Objective: Hyperventilation during phonation is one of the causes of fatigue in-patients with vocal disorders. Methods: The transcutaneous (tc) PCO 2 during phonation in 8 normal subjects and 12 patients with unilateral vocal cord paralysis was measured. Cases were further divided into two groups by the degree of the tcPCO 2 decrease during phonation. Patients with a tcPCO 2 decrease less than 3.4 mmHg during phonation were classified as group 1 (G1). Patients with a tcPCO 2 decrease larger than or equal to 3.4 mmHg during phonation were classified into group 2 (G2). Results: The average changes in tcPCO 2 in the G1 cases was not significantly different from that in normal subjects. The decrease in tcPCO 2 during phonation in the six G2 cases was 10.7±6.2 mmHg, and was significantly different from that in normal subjects ( P t -test). The decrease of tcPCO 2 during phonation in both G1 and G2 cases improved significantly after surgical treatment. Easy fatigability during phonation in two G1 cases and five G2 cases improved. Conclusions: The decrease in tcPCO 2 during phonation in cases of unilateral vocal cord paralysis is well correlated with easy fatigability. It is clinically useful to classify cases into two groups using the criteria of a less than 3.4 mmHg or larger than or equal to 3.4 mmHg decrease in tcPCO 2 . These results also suggest that hyperventilation is one major cause for easy fatigability during phonation in cases with unilateral vocal cord paralysis. TcPCO 2 changes during phonation are useful in evaluating hyperventilation and the effect of treatment.

Background: Endoscopic thyroidectomy has not gained wide acceptance because of the expertise required, the long operation time, the wide dissection, and the extra cost of specialized instruments. We developed a video-assisted hemithyroidectomy procedure that requires only one small incision at the upper neck. Methods: Hemithyroidectomy was performed through a 25 to 30 mm transverse incision made in the upper lateral neck for the treatment of benign thyroid nodule. No gas or external lift dissection was needed. Results: The mean age of 39 patients was 33.8 years. The tumor size ranged from 1.9 to 5.5 cm (mean 3.1 cm). All patients underwent total lobectomy without conversion to traditional cervicotomy. The mean operation time was 56 minutes (range 36 to 90). Follicular adenoma was the final pathologic diagnosis in 25 patients and adenomatous goiter in 14. Transient recurrent laryngeal nerve palsy was seen in 1 patient. Conclusions: Our technique is safe, minimally invasive, less time consuming, and cosmetically excellent.

We have found that postoperative tetany occurs in patients with Graves' disease who have secondary hyperparathyroidism caused by a deficiency in calcium and vitamin D concomitant with transient hypoparathyroidism after surgery. There are seasonal variations in serum 25-hydroxyvitamin D (25[OH]D) concentrations. The purpose of this study was to investigate the effects of seasonal changes in calcium homeostasis on the incidence of postoperative tetany in patients with Graves' disease who undergo subtotal thyroidectomy.A prospective study was carried out to investigate sequential changes in serum levels of intact parathyroid hormone (iPTH), calcium and other electrolytes, 25(OH)D, and 1,25-dihydroxyvitamin D (1,25[OH]2D) in female patients with Graves' disease who underwent subtotal thyroidectomy during the summer (n = 89) and during the winter (n = 89).The serum levels of calcium, magnesium, and 25(OH)D were significantly higher, but iPTH levels and 1,25(OH)2D levels were lower in summer than in winter. The percentage of vitamin D deficiency (25(OH)D25 nmol/L) was 23% in summer and 62% in winter (P.001). iPTH was below the detection limit on the first postoperative day in 15 patients (13.8%) in summer and in 13 patients (11.4%) in winter. In summery, tetany developed in only 4 of 15 patients and in one patient whose iPTH level was below normal (incidence of tetany, 5.6%). In winter, however, tetany developed in 6 of 13 patients and in 4 patients whose iPTH level was below normal (incidence of tetany, 11.2%).Patients with Graves' disease are more susceptible to calcium and vitamin D deficiency during the winter than during the summer, resulting in the tendency toward a higher incidence of postoperative tetany in winter.

We give a very simple proof that the renormalization of the Chern-Simons coupling in the Wilsonian effective action is exhausted at one-loop. Our proof can apply to arbitrary 2+1-dimensional abelian as well as nonabelian gauge theories without a bare Chern-Simons coupling, including any non-renormalizable interactions and non-minimal couplings. Our proof reveals that small (but not large) gauge invariance is enough to ensure the absence of higher order corrections., LaTex, 8 pages, no figures. to appear in Physics Letters B

Local mixture concentration near the spark plug of a direct gasoline injection engine was observed by a fast flame ionization detector. To ensure combustion stability in DISC (Direct Injection Stratified Charge) operation using conventional lean burn intake ports, the swirl ratio and the piston configuration were optimized. Swirl is needed to retain well-vaporized and stable mixture near the spark plug, especially under light load. Also, adequate volume in the piston cavity is required for trapping curved fuel spray. Measurement with a fast flame ionization detector was very effective for understanding the mixture features on DISC operation.

BACKGROUND & AIMS: Serum 7alpha-hydroxycholesterol level reflects hepatic bile acid synthesis in humans. The aim of this study was to examine the maximal bile acid synthesis in patients with chronic liver diseases. METHODS: Cholestyramine (12 g/day) was administered for 3 days to patients with compensated liver cirrhosis (n = 7), patients with chronic hepatitis (n = 10), and control subjects (n = 9), and serum total 7alpha-hydroxycholesterol level was measured by gas-liquid chromatography-mass spectrometry. RESULTS: A preliminary study showed that cholestyramine increased the serum value to the maximum by the third day. Before cholestyramine treatment, there were no significant differences in serum 7alpha-hydroxycholesterol levels among the groups. Three days of cholestyramine treatment increased the serum levels 5.71 +/- 2.90-fold in the controls, 3.25 +/- 0.85-fold in patients with chronic hepatitis, and 1.70 +/- 0.78-fold in cirrhotic patients. Cirrhotic patients had significantly lower serum 7alpha- hydroxycholesterol levels after the treatment compared with other groups. Serum 7alpha-hydroxycholesterol levels stimulated by cholestyramine significantly correlated with serum albumin levels and indocyanine green retention rate. CONCLUSIONS: Three days of cholestyramine loading increased the bile acid synthesis to its maximal level. The cholestyramine test showed that patients with chronic hepatitis had enough hepatic reserve for bile acid synthesis; however, patients with compensated liver cirrhosis had significantly decreased capacity. (Gastroenterology 1997 Apr;112(4):1277-83)

To clarify the effects of obstructive jaundice on the liver, sequential changes of hepatic energy charge, the concentrations of adenine nucleotides and malondialdehyde, DNA synthesis rate, and histology of the liver were examined on the day before and Days 1, 2, 4, 7, and 14 after biliary obstruction in rats and compared with those of sham-operated controls. Foci of necrotic hepatocytes were present on Days 1 and 2 and mitoses of the hepatocytes were frequently observed with a peak on Day 2 in the jaundiced liver. Marked proliferation of bile ductules were subsequently observed on Days 7 and 14, resembling biliary cirrhosis. The DNA synthesis rate was significantly activated after bile duct obstruction with its peak on Day 2, more than nine times higher than the control value and returned to the control level on Day 14. Hepatic ATP concentration and energy charge gradually declined with prolonged jaundice and significantly lower levels persisted after Day 7 compared with the controls. The malondialdehyde level in the jaundiced liver gradually increased and became significantly higher on Day 14. We conclude that obstructive jaundice decreases hepatic energy charge and increases the lipoperoxide level. In the initial stage of obstructive jaundice, the hepatocytes proliferate associated with activated DNA synthesis probably to compensate hepatic damage; however, prolonged obstructive jaundice induces functional hepatic injury possibly necessitating biliary drainage.

We report a patient with primary B-cell lymphoma of the breast complicated by smoldering type adult T-cell leukaemia (ATL). A 52-year-old Japanese woman complained of a rapidly enlarging lump in her right breast. She had been diagnosed to have smoldering type ATL since the age of 49. Aspiration cytology and subsequent excisional biopsy revealed B-cell type lymphoma of the breast. A gallium-scintigram showed abnormal accumulation in the bilateral breasts. Radiology was adopted because the lesion was localized only in the breasts and associated with smoldering type ATL. The lesions disappeared after the treatment.

Temperature dependence of the Raman spectrum of liquid 411e at a pressure of 5 kg/cm2 has been measured in the temperature region from 0.65 to 3.75 K. The temperature dependence has been found to be described by the one-component model with lorentzian temperature-broadening both above and below the lambda temperature T λ . From the analysis, temperature dependence of the minimum energy and the lifetime of rotons have been determined. The roton energy shows weak temperature dependence, and the lifetime deviates from the Landau-Khalatnikov theory above 1.80 K.

In a recent publication, we reported that deoxycholic acid is 7 alpha-hydroxylated to yield glycocholate or taurocholate in vivo in the hamster (1987. Kuroki et al. Hepatology. 7: 229-234). In order to explore the possibility that amidation of free deoxycholic acid precedes the 7 alpha-hydroxylation, we assayed 7 alpha-hydroxylase activities of free and conjugated deoxycholates in vitro. 7 alpha-Hydroxylase activities of glycodeoxycholate and taurodeoxycholate were 720 +/- 132 and 640 +/- 160 pmol/mg.min-1, respectively. Activity of 7 alpha-hydroxylation of free deoxycholate was very low (60 +/- 20 pmol/mg.min-1). After treatment with phenobarbital in a dose of 100 mg/kg per day for 6 days, 7 alpha-hydroxylase activities of conjugated deoxycholates were decreased significantly (40%, P less than 0.01, n = 8), whereas that of free deoxycholate was not significantly changed. In the rat, 7 alpha-hydroxylase activities of conjugated deoxycholates were induced significantly (45% increase, P less than 0.05, n = 5) by phenobarbital treatment in sharp contrast to the hamster. There were significant correlations between the 7 alpha-hydroxylase activity of taurodeoxycholate and that of glycodeoxycholate both in the hamster and in the rat (hamsters: n = 16, r = 0.98, P less than 0.01; rats: n = 10, r = 0.82, P less than 0.01). These studies suggested that deoxycholic acid is 7 alpha-hydroxylated after amidation with glycine or taurine in vivo and that the same enzyme may well catalyze the 7 alpha-hydroxylation of glycodeoxycholate and taurodeoxycholate in the hamster.(ABSTRACT TRUNCATED AT 250 WORDS)

A simplified and accurate assay of cholesterol 7α-hydroxylase activity using 5α-cholestane-3β,7β-diol as an internal standard is described. Endogenous microsomal cholesterol was used as the substrate. Following incubation and addition of the internal standard, lipids extracted from the incubation mixture were applied to Bond-Elut silica cartridge columns. 7α-Hydroxycholesterol, 7β-hydroxycholesterol, 7-ketocholesterol and the internal standard were quantitatively recovered by eluting the column with 6 ml of benzene—ethyl acetate (2:3, v/v) after removal of cholesterol with 6 ml of benzene—ethyl acetate (9:1, v/v). After trimethylsilylation, the mass of 7α-hydroxycholesterol was determined by capillary gas chromatography with selected-ion monitoring. The method permits a faster, easier and more sensitive determination of the activity of cholesterol 7α-hydroxylase in small samples.