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The objective was to prepare guidelines to perform the current optimum treatment by organizing effective and efficient treatments of hemangiomas and vascular malformations, confirming the safety, and systematizing treatment, employing evidence-based medicine (EBM) techniques and aimed at improvement of the outcomes. Clinical questions (CQs) were decided based on the important clinical issues. For document retrieval, key words for literature searches were set for each CQ and literature published from 1980 to the end of September 2014 was searched in Pubmed, Cochrane Library, and Japana Centra Revuo Medicina (JCRM). The strengths of evidence and recommendations acquired by systematic reviews were determined following the Medical Information Network Distribution System (MINDS) technique. A total of 33 CQs were used to compile recommendations and the subjects included efficacy of resection, sclerotherapy/embolization, drug therapy, laser therapy, radiotherapy, and other conservative treatment, differences in appropriate treatment due to the location of lesions and among symptoms, appropriate timing of treatment and tests, and pathological diagnosis deciding the diagnosis. Thus, the Japanese Clinical Practice Guidelines for Vascular Anomalies 2017 have been prepared as the evidence-based guidelines for the management of vascular anomalies.

Background Colorectal neuroendocrine carcinoma (NEC) is a rare tumor that demonstrates aggressive growth pattern with ingrowth into the tract, metastasis to the other organs, and invasion to the surrounding organs; these clinical characteristics result in poor prognosis. Surgical resection appears as an effective approach; however, because it is difficult to accurately diagnose NEC during the early stage and owing to its aggressive growth pattern, development of a reliable standard chemotherapy regimen and management strategies are essential. Case summary Here, we report the case of patient with NEC showing an aggressive growth pattern that resulted in the rupture of the tumor to the outside the colon after stenting of the internal colonic stenosis. In addition, the tumor invaded into the duodenum, thereby causing duodenal stenosis that required an additional stent in the duodenum. This aggressive growth pattern is one of the main features of the NEC that is different from adenocarcinoma. To clarify the clinical characteristics, we reviewed 60 recently reported cases, including data on tumor location, size, treatment, and prognosis. Conclusion We consider that the information presented here is of great significance for the diagnosis, treatment, and management of symptoms of the patients with NEC.

Introduction Lymphatic anomalies (LAs) refer to a group of diseases involving systemic dysplasia of lymphatic vessels. These lesions are classified as cystic lymphatic malformation (macrocystic, microcystic or mixed), generalized lymphatic anomaly, and Gorham–Stout disease. LAs occur mainly in childhood, and present with various symptoms including chronic airway problems, recurrent infection, and organ disorders. Individuals with LAs often experience progressively worsening symptoms with a deteriorating quality of life. Although limited treatment options are available, their efficacy has not been validated in prospective clinical trials, and are usually based on case reports. Thus, there are no validated standards of care for these patients because of the lack of prospective clinical trials. Methods This open-label, single-arm, multicenter, prospective study will assess the efficacy and safety of a mammalian target of the rapamycin inhibitor sirolimus in the treatment of intractable LAs. Participants will receive oral sirolimus once a day for 52 weeks. The dose is adjusted so that the nadir concentration remains within 5–15 ng/ml. The primary endpoint is the response rate of radiological volumetric change of the target lesion confirmed by central review at 52 weeks after treatment. The secondary endpoints are the response rates at 12 and 24 weeks, respiratory function, pleural effusion, ascites, blood coagulation parameters, bleeding, pain, quality of life, activities of daily living, adverse events, side effects, laboratory examinations, vital signs, and pharmacokinetic data. Results This is among the first multicenter studies to evaluate sirolimus treatment for intractable LAs, and few studies to date have focused on the standard assessment of the efficacy for LAs treatment. Our protocol uses novel, uncomplicated methods for radiological assessment, with reference to the results of our previous retrospective survey and historical control data from the literature. Conclusions We propose a multicenter study to investigate the efficacy and safety of sirolimus for intractable LAs (SILA study; trial registration UMIN000028905). Our results will provide pivotal data to support the approval of sirolimus for the treatment of intractable LAs., Highlights • This is among the first multicenter studies to evaluate sirolimus for intractable LAs. • The study design is useful for evaluating sirolimus treatment in LAs. • Our study protocol uses novel, uncomplicated methods of radiological assessment.

Postoperative chylothorax in infants prolongs hospital stay and possibly causes developmental delay because of its conservative treatment including inanition. Several medical and surgical treatments may be applied, but none constitute the absolute solution. Treatment with lipiodol during lymphangiography for postoperative chylothorax has been reported to be highly effective and less invasive in adults. On the other hand, few cases have been reported in infants. We demonstrate successful blockage of chyle leakage with lipiodol injection through the inguinal lymph node in a 2-year-old infant. The patient had undergone on-pump coarctectomy and chylothorax developed soon after surgery. Several medical treatments were partially effective, but the chest tube could not be removed because sequential aspiration was required to maintain a normal respiratory status. With the patient under general anesthesia, lipiodol injection combined with indocyanine green (ICG) lymphography was performed. Lymphography combined with ICG significantly contributed not only to intraoperative detection of the inguinal lymph nodes but also to postoperative early detection of lymphedema caused by this procedure. This procedure required a simple maneuver and is probably applicable to other cases of traumatic chylothorax, such as after surgeries on the esophagus, trachea, or other components of the posterior mediastinum.

Lymphatic malformation (LM), also known as lymphangioma, is a rare condition that can occur anywhere in the body in adults and children. LM, especially micro-cystic type, consists of multiple clustering skin/subcutaneous cysts that may involve deeper functional tissue. Although LM is generally benign, it may cause serious location-dependent problems. Periorbital LM, for example, often causes facial disfigurement and visual impairment. Especially, micro-cystic type of lymphatic malformation (mLM), is a challenging condition to treat. Currently available therapies for mLM have limited effectiveness and carry a high risk of complications. Thus, it is necessary to develop a novel treatment for mLM that is less invasive and highly effective. There has been a question of the exact location and direction of lymphatic flow into, within, and out of LM. There were some reports investigating the intra-cystic flow of LM; however, only a few focused on the afferent and efferent lymphatic flow of LM. With our detailed study using lymphography, we were able to determine the lymphatic flow pattern in periorbital LM, which was large enough to perform lymphatic venous anastomosis (LVA). LVA is a surgically-placed bypass between afferent collecting lymphatic vessels and veins, which in our study resulted in decreasing both the influx and the total volume of lymph in the LM. To our knowledge, this is the first study of Indocyanine green (ICG) lymphography on mLM, and LVA for its treatment. Here we present our case of periorbital mLM with LVA and discuss its less invasive surgical strategy.

Local flaps are widely used in soft tissue reconstruction because they result in good colour and texture match. They can be quickly placed without donor site morbidity. However, it is not always easy to preoperatively design a feasible procedure, predict the final scar line or image the tension that may occur on and around the flap, especially for inexperienced surgeons. Because the elasticity of the skin varies with anatomical location and among individuals, unpredictable intraoperative design changes are sometimes required. Therefore, a preoperative back-up plan would be helpful. We evaluated the possibilities and advantages of an intraoperative switch from a hatchet flap (HF) to a reading man flap (RMF) procedure. Using a previously reported computer simulation with the finite element method (FEM) analysis, we developed an intraoperative local flap transformation (iLoFT) model.

The complete removal of port-wine stains has remained challenging. Based on the principle of treating port-wine stains with a dye laser, intravenous injection of artificial red cells (hemoglobin vesicles) immediately before laser treatment might improve the clinical outcome of the therapy. The hemoglobin vesicle injection increases the hemoglobin concentration in microvessels. Photons of dye laser are absorbed by the mixture of red blood cells and this newly added hemoglobin, potentially producing more heat and photocoagulation and, ultimately, necrosis of the endothelial cells effectively.To confirm the performance of hemoglobin vesicles as a photosensitizer, the authors compared the absorbance of hemoglobin vesicles and human blood against 595-nm wavelength and the temperature increases that occur following dye laser irradiation. Furthermore, the authors investigated the microvessel transformation induced by the hemoglobin vesicle intravenous injection. Finally, the authors investigated the effect of the hemoglobin vesicle on the vascular destruction of dye laser irradiation with chicken wattle.Results show that hemoglobin vesicles have the same absorbance as that of human blood. They produce the same level of heat as human blood after laser irradiation. The hemoglobin vesicle intravenous injection caused dilatation of microvessels in animal models. The dye laser with hemoglobin vesicle can destroy the vessel wall effectively in animal models.Hemoglobin vesicles can function as photosensitizers to destroy the vessel wall. A possible mechanism of pulsed dye laser-resistant port-wine stains is that overly small vessels do not contain sufficient red blood cells. They are therefore poor absorbers/heaters for these lasers. Hemoglobin vesicle combination therapy will improve clinical outcomes of dye laser treatment against such lesions only.

Unilateral stress fracture of the femoral neck following total knee arthroplasty (TKA) is a rare complication; only 21 cases are described in English literature so far. Bilateral stress fractures of the femoral neck occurring simultaneously following a bilateral TKA have been seen in only 2 cases till now. We report a patient suffering from rheumatoid arthritis of both knees, who was treated with bilateral TKA. She developed spontaneous fractures of the femoral neck on both sides 12 months following the TKA. She was treated with bilateral total hip arthroplasty (THA). Stress fracture of the femoral neck should be suspected in patients complaining of hip pain who have undergone TKA.

Supplemental Digital Content is available in the text., Background: Superficial circumflex iliac artery (SCIA) perforator flap is one of the demanding flaps. However, little is known about SCIA anatomy, which is crucial for successful SCIA perforator flap elevation, in children. We assessed the efficacy of our incision design to detect the superficial branch of the SCIA in vivo. Methods: Eleven consecutive pediatric patients who required harvesting (eg, skin grafts or vascularized lymph node transfer) were assessed. All possible congenital vascular malformation cases were excluded. To reduce potential bias, all groin procedures were performed on the contralateral side of malformations. After inguinal area mapping, 1.5-cm skin incision was made. From the window opened by the skin incision, tiny perforation to the skin surface was detected for further dissection. Following the tiny branch, the main trunk of the superficial circumflex vascular bundle was dissected. The whole vascular bundle, artery, and major vein from the bundle were dissected and their sizes were measured. Results: Of the 11 patients, 4 were boys; the age range was 5 months to 14 years (mean age: 3.2 years). Vessel bundle size was 0.7–1.5 (mean: 1.1 mm). In all cases, the bundle was detected within 5 min (1–5, mean: 2.5 min). No vascular damage was observed, and all arteries pulsated well, without requiring additional skin incision. The superficial branch of the SCIA was mainly detected right below the initial skin incision. Conclusions: Our skin incision design can effectively detect the SCIA in pediatric patients and may be used in adult patients.

Background: Lymphatic malformation is a congenital lymphatic disorder. Although a few lymphangiographic and lymphoscintigraphic studies of lymphatic malformation exist, its lymphatic flow has not been fully assessed, and a classification system has not yet been established. However, indocyanine green lymphography has been developed to safely provide a fine assessment of lymph flow in the treatment of lymphedema. In addition, indocyanine green lymphography has been shown to be helpful in detecting the lymphatic malformation inflow for the treatment of refractory microcystic type lymphatic malformation using the venous anastomosis technique. Therefore, the authors aimed to reveal the in vivo lymph flow around the lymphatic malformation using indocyanine green lymphography, and to design a classification system according to the observed patterns. Methods: Indocyanine green lymphography was performed in 20 sequential pediatric patients with lymphatic malformation (aged 11 months to 10 years). Most of the cases were intractable, with microcystic or mixed-type lymphatic malformation. Results: All patients successfully completed lymphography with clear observations. The flow patterns were classified into four types: type 1 had a strong detectable inflow; type 2 had multiple small observable inflows; type 3 had a superficial lymph flow over the lesion; and type 4 had a flow around the lymphatic malformation, without any connections to the lesion. Conclusion: The proposed classification system may aid in the further development of surgical treatments for lymphatic malformation.

Klippel-Trenaunay syndrome (KTS) is a congenital vascular anomaly in children, which requires treatment but challenging. The characteristics of KTS include disproportionality of the affected limbs, usually with enlargement due to lymphatic malformation (LM) [1]. Sometimes the condition is accompanied by pain that is difficult to treat. Compression therapy is one option for reducing the swelling; however, this has limitations [2]. We previously reported that lymphatic venous anastomosis (LVA) may be a safe and effective procedure for reducing the size of micro cystic type LM by decreasing the intra cystic lymph [3]. We treated a case of KTS in a 9-year-old boy who had improvement of lower abdominal swelling and penile pain after a single LVA. The method involved is to make a bypass, from the afferent lymph-collecting vessel to subcutaneous veins. However, to apply LVA to LM, it is sometimes problematic to detect the afferent flow in combined vascular malformations, such as KTS. Therefore, we performed VA making a bypass directly from LM, instead. We classify two types of LVA methods for LM: afferent lymph vessel LMVA (A-LMVA), and sidewall LMVA (S-LMVA). S-LMVA has more merits than the previously reported A-LMVA.

The efficacy and safety of therapeutic lipiodol lymphangiography have been reported by several studies. However, to our knowledge, no study has reported the use of this procedure in very-low-birth-weight infants. We present a case of an extremely-low-birth-weight infant girl who developed chylothorax on day 34 that was refractory to medical treatment. We performed therapeutic lipiodol lymphangiography on day 59 when her body weight was 800 g. Six days after the procedure, her pleural effusion suddenly decreased, and the chest tube was removed on day 67. No complications occurred.

Although a superficial circumflex iliac artery perforator (SCIP) flap has recently been widely used owing to its various advantages, reports on its use in the pediatric population are limited. A case of a supermicrosurgical reconstruction of a soft tissue defect of the ankle associated with the congenital deficiency of the tibia using a free sensate SCIP flap in a 1-year-old child has been presented. The correction of the valgus deformity of the ankle resulted in a soft tissue defect, which required flap coverage. The lateral cutaneous branch of the intercostal nerve of the flap was coapted with the deep peroneal nerve for sensory recovery. Postoperative course was uneventful and the flap completely survived. The patient was able to ambulate independently at 7 months after surgery. To the best of our knowledge, this is the youngest case of a SCIP flap transfer in literature. This case showed that young age is not a contraindication for SCIP flap transfer. It is believed that the SCIP flap procedure may be a useful option for free flap reconstruction in children.

Background:. Super-microsurgery has widely spread due to the improvement of high magnification microscopes. The cost of multiple microscopes is high. Furthermore, the microscope heads are too large to fit in multiple surgical fields for pediatric patients. We adapted a 2-dimensional magnification system for performing lymphatic venous anastomosis on pediatric lymphedema cases. Methods:. We attached a close-up lens filter to the suspended camera (CHZ-1,360-PTR camera, Carina system, Tokyo, Japan) in the operative field. This was done to achieve 26× magnification using a small camera head, making it possible to perform super-micro anastomoses. Anastomoses time, scar length, and lymph vessel diameters were measured, and the outcomes were statistically analyzed and compared with the contralateral side. Results:. Four pediatric lymphedema patients underwent the aforementioned technique, using the multisite microscopic approach. All anastomoses were completed within 20 minutes. The results were not significantly different from the conventional microscopic lymphatic venous anastomosis. Conclusion:. This system is advantageous because (1) it has less costly initial investments; (2) it requires a small camera head, which provides available space for the multisite microscopic approach even for pediatric patients; and (3) it allows for a wider surgical working space.

Background:. A lymphangioma, also called a lymphatic malformation, is a congenital condition that frequently occurs in young children. It is classified into 3 groups depending on the size of the cysts (macrocystic, microcystic, and mixed). Spontaneous regression occurs in some cases; however, the characteristics of patients who show regression have not been studied previously. Furthermore, the types and the timing of the initial treatment are still controversial. Therefore, we statistically analyzed the occurrence of short-term spontaneous regression, patient age at original occurrence, cyst types, cyst sizes, and cyst locations in patients diagnosed with peripheral localized lymphangiomas in a single children center over 34 years. Methods:. We retrospectively collected the data of 153 patients and reviewed the medical charts. Results:. Spontaneous regression occurred only in macrocystic or mixed type; regression was most frequent in patients who, at the time of onset, were more than 2 years old. Conclusions:. We concluded that elderly patients with macrocystic or mixed type lymphangioma may have to wait for treatment for over 3 months from the initial onset. Conversely, microcystic type could not be expected to show regression in a short period, and prompt initiation of the treatments may be required. The difference of the regression or not may depend on the characteristics of the lymph flow.

Background Cleft lip and palate repair requires a deep and small surgical field and is usually performed by surgeons wearing surgical loupes. Surgeons with loupes can obtain a wider surgical view, although headlights are required for the deepest procedures. Surgical microscopes offer comfort and a clear and magnification-adjustable surgical site that can be shared with the whole team, including observers, and easily recorded to further the education of junior surgeons. Magnification adjustments are convenient for precise procedures such as muscle dissection of the soft palate. Methods We performed a comparative investigation of 18 cleft operations that utilized either surgical loupes or microscopy. Paper-based questionnaires were completed by staff nurses to evaluate what went well and what could be improved in each procedure. The operating time, complication rate, and scores of the questionnaire responses were statistically analyzed. Results The operating time when microscopy was used was not significantly longer than when surgical loupes were utilized. The surgical field was clearly shared with surgical assistants, nurses, anesthesiologists, and students via microscope-linked monitors. Passing surgical equipment was easier when sharing the surgical view, and preoperative microscope preparation did not interfere with the duties of the staff nurses. Conclusions Surgical microscopy was demonstrated to be useful during cleft operations.

Frontonasal dysplasia (FND) is a congenital malformation of the central portion of the face, including the eyes, nose, and forehead. Owing to its rarity and wide spectrum of phenotypes, the optimal timing and technique of surgery remain controversial. Here, we report a case of a patient with FND, who presented with respiratory distress. The deformed nostrils were so small that the patient could not normally breathe through the nose immediately after birth. Rhinoplasty using a costochondral graft was performed at 16 months of age. After surgery, the nostrils enlarged and the appearance of the nose improved. Although congenital nasal deformity is frequently corrected during adolescence, surgery at an early stage can be considered when important issues are noted, such as inability to breathe through the nose.

Background:. Less-invasive surgeries, such as lymphaticovenular anastomosis (LVA), are the widely accepted intervention for lymphedema. This study aimed to assess the outcomes of flow-oriented LVA modification on lymphatic malformation (LM). Methods:. We included 19 patients diagnosed with LM mixed type or microcystic type, who came to our clinic from June 2015 to December 2017. Under general anesthesia, all patients were administered an indocyanine green lymphography injection subcutaneously. In the case of a strong inflow, the patient underwent afferent lymph vessel of LM to venous anastomosis (LMVA). Otherwise, the side wall of LMVA was performed to the cysts. Outcomes were classified into the following groups based on the size changes: treatment effect (TE) 4 = >80% reduction rate; TE 3 = 50%–80% reduction rate; TE 2 = 20%–50% reduction rate; and TE 1 = 0%–20% reduction rate. Results:. All cases underwent surgery, with no case having an increased size. The results were as follows: TE 4 = 4 (21%) patients; TE 3 = 6 (32%) patients; TE 2 = 5 (26%) patients; and TE 1 = 4 (21%) patients. No case required study termination due to disease progression. Minor complication occurred in 3 cases. One vesicle increased at the labial mucosa and one wound dehiscence that epithelized within 1 month. Conclusion:. LMVA could be a novel, minimally invasive lymph flow-oriented surgical method for intractable LM.

Background Kasabach-Merritt phenomenon (KMP) is a rare condition and optimal treatments have not yet been established, especially for cases that are unresponsive to first-line therapy. We retrospectively reviewed 11 KMP cases treated over the past 13 years in our institute. Observations With the exception of 1 case, steroids were administered as the first-line therapy. Eight cases required second-line or third-line therapy. The effective salvage therapies include interferon (n=1), radiotherapy (n=1), and chemotherapy (n=5). One case continues to depend upon chemotherapy. Three refractory cases were therapy dependent over 1 year of age, whereas 8 were treated effectively by 6 months of age. Conclusions Chemotherapy seems to be the most effective therapy for steroid-resistant KMP cases.

Nipple adenoma is an uncommon proliferative process of the breast and predominantly occurs in women aged 40-50. Its incidence is extremely low in men, and it has not been reported in a boy. Although nipple adenoma is rare and benign, being familiar with it is important because it clinically resembles Paget disease and histologically adenocarcinoma. We report a case of nipple adenoma in a boy.

Late postoperative cervical metastasis (LCM) greatly influences prognosis in cases such as squamous cell carcinoma of the tongue. Indications and preferred prophylactic neck dissection of the clinically negative neck (N0) in tongue carcinoma remain controversial and non standardized. We studied adequate neck dissection area, focusing on T2N0, T2N1 and T3N0 tongue carcinoma. We retrospectively analyzed surgical efficacy in 61 cases with stage I-T1N0, stage II-T2N0, stage III-T2N1 and T3N0 and stage IV-T2-3 N2b-c. All were treated initially with surgery alone. In 13 T1N0 cases, tumors were removed with a 15-20 mm surgical margin, showing LCM in 2. In 18 T2N0 cases, resected with the same surgical margin, LCM was seen in 9. In 5 T2N1 cases performed with partial tongue resection and radical neck dissection (RND), no LCM was seen. In 3 of 4 T3N0 cases, including level I resection, LCM occurred. In 9 stage IV pull-through cases and RND, LCM ocurred in 2. In 30% (9/30) of stage II LCM, 44.4% (4/9) was salvaged by RND. Five-year cumulative survival in 61 was 71.1%, 87.5% in stage I, 76.8% in stage II, 65.6% in stage III, and 55.4% in stage IV. We concluded that local resection is feasible (1) in T1N0 and early T2N0, (2) local and level I-III neck dissection in late T2N0 and T2N1, (3) local dissection, pull-through technique and level I-IV neck dissection in T3N0 and (4) local dissection, pull-through and level I-V neck dissection in stage IV.

In the present study, 37 patients with advanced laryngeal carcinoma (stage III and IV) were analyzed, who had been treated at St. Marianna University, School of Medicine between 1996 and 2007, based on the modified TNM classification by the international union against cancer (UICC, 6th edition, 2003). Before the modification of the TNM classification, total laryngectomy (TL) was our strategy of treatment for T3 and T4 patients. Those patients who refused TL received radiotherapy (low-dose concurrent chemoradiotherapy or radiotherapy alone). Five out of 16 cases in T3 who were classified under the 6th edition belonged to T2 under the previous edition, which made the treatment of T3 more difficult. The 5-year cause-specific survival rate of all cases was 63.9%, 81.3% in stage III, 46.8% in stage IV, 90.9% in the glottic type and 50% in the supraglottic type. A particularly significant difference was seen between these latter two types (p

The projections of the nucleus of the optic tract (NOT) were studied in cats using three kinds of retrograde tracers (horseradish peroxidase wheat germ agglutinin (WGA-HRP), dextran fluorescein (DF) and dextran tetramethylrhodamine (DTR)). First, in the cases that WGA-HRP were injected into the rostral part of medial vestibular nucleus (VN), a significant number of retrograde-labeled neurons, which concentrated between 600 and 800 μm from the rostral part of the NOT, were observed in the NOT ipsilateral to the injection sites. Second, no double-labeled neurons were found following injections of DF in the medial VN and DTR in the nucleus prepositus hypoglossi (NPH) at the same time. In this experiment, it was made clear that two different kinds of neurons in the NOT projected to the medial VN and the NPH, respectively.

The vestibulo-ocular reflex (VOR) serves to keep images relatively stable on the retina. To maintain appropriate performance and minimize image slip throughout life, VOR is subjected to long-term adaptive regulation by visual input. It has been reported that adaptive changes in VOR gain (eye velocity/head velocity) are evoked either by fitting subjects with magnifying, miniaturizing, or reversing spectacles during normal behavior, or by moving a large visual field in or out of phase relative to the subject's head movement. The changes in VOR gain are frequency selective. Here, we examine the extent of VOR gain flexibility by causing VORs of similar direction to undergo different behavioral gain changes. Nine healthy adults participated in the study, ranging in age from 24 to 38 years (mean: 26 years) and with no history of neurotological symptoms. All subjects were clinically normal according to a screening battery that included combined neurologic and otologic physical examinations. Horizontal and vertical eye positions were recorded by bitemporal DC-coupled electro-oculography (EOG). The subject sat in a rotating chair. The axis of rotation of the body was always earth-vertical, with the interaural axis crossing the axis of rotation of the chair. The head was pointed 20 degrees downwards in all experiments and stabilized in this position using a chin rest. The chair was surrounded by a half-cylindrical optokinetic screen (78 cm in diameter) placed in front of the subject, onto which random dot patterns were projected. Goggles were used to ensure that the subject was in complete darkness during both pre- and postadaptation periods. The chair was rotated sinusoidally at maximum amplitude of 30 degrees or 60 degrees : for 30 degrees the stimulation was at 0.1, 0.2, 0.3, and 0.4 Hz; for 60 degrees it was at 0.1, 0.2, and 0.3 Hz. VOR adaptation was obtained by inducing a retinal slip velocity by short-term alteration of the visual input of the large field; this change was produced by a combination of sinusoidal head rotation and the random dot patterns. In each adaptation session, the sinusoidal head rotation was either at 0.1 or 0.3 Hz and the amplitude was 30 degrees. The random dot pattern was synchronized with sinusoidal head rotation in the same direction (x0 experiment) to make the retinal slip zero, and in the opposite direction to make the retinal slip twofold (x2 experiment). Therefore, a total of four adaptation protocols were tested. The subjects were asked to fixate on a single dot with the eyes straight-ahead in the x0 experiment, and follow it within random dot patterns in the x2 experiment. Each adaptation session lasted for 30 min. Two adaptation experiments were performed on each subject once per day. The averages of VOR gain and phase lag were calculated using Fourier analysis. Seven of the subjects who participated in the x2 adaptation experiment at 0.3 Hz and 30 degrees amplitude showed a steady increase of VOR gain within a couple of trials. One of the remaining two subjects showed a decrease in VOR gain in all the three trials, and the other subject showed a VOR gain increase in three trials and decrease in two trials. In the x2 adaptation experiment at 0.3 Hz and 30 degrees amplitude (peak velocity: 28 degrees /s), the percentage gain change ((post-pre)/pre) was 133% at the same stimulation and 100% at 0.4 Hz (peak velocity: 37 degrees /s). The gain change was 65% at 0.1 Hz and 60 degrees amplitude (peak velocity: 18 degrees /s), and 64% at 0.2 Hz and 60 degrees amplitude (peak velocity: 37 degrees /s). In the x1 adaptation experiment (30 degrees at 0.3 Hz), the percentage gain change was -62% under the same conditions, -50% at 0.1 Hz and 60 degrees amplitude, and -30% at 0.2 Hz and 60 degrees amplitude. No change of VOR gain was observed at other frequencies, and the subject was not adapted at 0.1 Hz and 30 degrees amplitude. The larger VOR gain increase in the x2 adaptation experiment for the faster head angular acceleration leads to the conclusion that the VOR gain mechanism can set vuite similar in terms of the head acceleration.

The incidence of inferior vestibular nerve disorders in patients suffering from unilateral vestibular neuritis and the recovery of these disorders were evaluated by monitoring the vestibular-evoked myogenic potential (VEMP). Eight patients ranged from 21 to 73 years that suffered from unilateral vestibular neuritis underwent VEMP and caloric testing. Abnormal VEMP was observed in two of the eight patients with unilateral vestibular neuritis. Two patients were diagnosed as having an inferior vestibular nerve disorder. One of these patients showed recovery of the inferior vestibular nerve function as assessed by the VEMP. Disorders of the inferior vestibular nerve function and their recovery was confirmed by our current results. The time course of recoveries of the superior and inferior vestibular nerve systems were similar in the two patients.

非言語表現を活用したヒューマンインタフェースは, 人と機械との親和性の向上に役立つと考えられる. これまでに, 非言語表現の理解構造モデルに沿った動作計測や分析方法の検討を行ってきた. 本研究では, ヒューマンインタフェースの適用場面をコンピュータタスク時に限定し, 観察実験, 分析を行うことで, 非言語表現の理解構造モデルにおける言語的動作特徴と人物の感情・意図の表現用語の類型化, およびそれらの関連性の把握などを行い, ヒューマンインタフェースへの適用の可能性を検討することを目的とした. 観察実験は3タイプのコンピュータタスクに対して行われ, 様々な動作についての特徴や感情・意図の言語表現を得て, パターン分類と判別分析を行った. 分析結果から, 部分的ながらも言語的動作特徴と人物の感情・意図の関連構造の有効性が確認され, コンピュータタスクを支援する非言語ヒューマンインタフェースへの展開可能性が示唆された.

Descending necrotizing mediastinitis (DNM) resulting from oropharyngeal abscess, is a serious and life-threatening infection. However, surgical management, by transcervical, mediastinal drainage or aggressive thoracotomic drainages remains controversial. Recently, we encountered three cases of DNM at our institution. Case 1 was a 65-year-old male with sore throat, marked neck swelling and difficulty in swallowing. CT demonstrated an abscess, extending from the right parapharyngeal and retropharyngeal space to the vascular visceral and prevertebral space, transcervical and mediastinal drainage was performed. Case 2 was a 78-year-old male who complained of neck swelling after dental treatment. CT demonstrated gases in the parapharyngeal and retropharyngeal space. Only antibiotics were given. Surgery was not performed. Case 3 was a 54-year-old male with severe sore throat, neck swelling and dyspnea. CT demonstrated several abscess, ranging from parapharyngeal and retropharyngeal space in the neck to the vascular visceral and prevertebral space at the level of the sternum. Transcervical, mediastinal and thoracotomic drainage was performed bilaterally. In cases 1 and 3, drainage and irrigation of the neck and mediastinal abscess were performed in combination with antibiotic treatment. All cases recovered. CT was very useful for determing whether to perform surgery, including transcervical, mediastinal and thoracotomic drainage. In some cases, it may be appropriate to drain the abscess during the early stage.

Between 1990 and 2002, 91 cases underwent excision of parotid tumors at St. Marianna University School of Medicine. The most prevalent tumor among benign parotid tumors was pleomorphic adenoma (52.8%), followed by Warthin's tumor (33.3%). Malignant tumors (20.9%) consisted of 4 adenocarcinomas, 3 metastases, 2 carcinomas in pleomorphic adenoma, 2 squamous cell carcinomas, and 2 undifferentiated carcinomas. Tumors that were accompanied by spontaneous pain or facial nerve palsy were frequently malignant. It is important to diagnose parotid tumors by the history, symptoms, and local findings. Ultraysound examination and MRI showed a high accuracy rate (73-80%). The incidence of facial palsy was 4.1% in benign tumors and 10.5% in malignant tumors.

Various biological reaction models have been proposed which estimate concentrations of soluble and insoluble components in effluent of sewage treatment plants. These models should be effective to develop a better operation system and plant design, but their formulas consist of nonlinear equations, and there are many model constants, which are not easy to calibrate. A technique has been proposed to decide the model constants by precise experiments, but it is not practical for design engineers or process operators to perform these experiments regularly. Other approaches which calibrate the model constants by mathematical techniques should be used. In this paper, the optimal regulator method of modern control theory is applied as a mathematical technique to calibrate the model constants. This method is applied in a small sewage treatment testing facility. Calibration of the model constants is examined to decrease the deviations between calculated and measured concentrations. Results show that calculated values of component concentrations approach measured values and the method is useful for actual plants.

非言語ヒューマンインタフェースを構築することは, 人に優しい情報環境を実現する上で重要である. 将来的には人間の動作を理解し, CGの動作生成などによってインタラクティブに対応できる非言語ヒューマンインタフェースの構築を目指す. 本研究では, 非言語表現を, 実際の身体動作, 動作の計測データ, 物理的動作特徴, 言語的動作特徴, 人物の感情・意図の5段階の理解構造モデルとして捉えることを提案した. 本論文では頭部の動きがかかわるコミュニケーション動作に着目し, 動作計測実験を経て身体動作の時系列計測データを収集し, そこから物理的動作特徴の指標を構築することで, 質問紙調査によって抽出された人物の言語的動作特徴と感情・意図の関連構造を多変量解析手法によって分析した. 得られた分析結果等から, 構造モデル, 分析方法については, 数理的アプローチの有効性が確認され, 非言語ヒューマンインタフェース技術への展開の可能性が示唆された.

First, we evaluated the patency of inferior meatal antrostomy for the treatment of maxillary lesions. Patients were followed for at least one year, with a mean follow-up duration of 23.3 months. There was no closure observed in 22 procedures. Secondly, we reported three cases of maxillary lesions. Recurrent mucosal lesions of antrochoanal polyps were successfully treated using a micro-debrider through the trocar at the canine fossa, while monitoring via the middle meatal window. A dental foreign body in the maxillary sinus was removed through the inferior meatal window, while monitoring via the trocar at the canine fossa. Blow-out fracture was successfully treated using canine fossa and inferior meatal approaches. An inferior meatal approach is useful postoperatively as well as intraoperatively. It is also useful when recurrent maxillary lesion is expected. A canine fossa approach is useful for improving intraoperative procedure without necessitating the use of special instruments. A canine fossa approach using the trocar is useful because it is minimally invasive for the patient. It can be safely concluded from the present results that the surgeon should choose the appropriate approach (or combine two or three approaches) for each maxillary lesion after considering several factors, including the general condition and bone structure of the patient, patient age, the location of the lesion and the treatment required, anesthesia, instrumentation availability at the institute, the skill of the surgeon, and the expected postoperative status.

2.5D packaging technology utilizing silicon interposers is being developed and used for high-performance applications as the demand for miniaturization and higher density continues to increase. Silicon interposers enable very high density interconnects using standard semiconductor fabrication process technology, but are challenged as size increases. An alternative solution, high density laminate interposer, can offer advantages in cost, form factor, and infrastructure over other interposer options available today. However, it is difficult to manufacture high density wiring and flip chip bump pads on laminate interposer because conventional build-up technology limits fine line and via diameter. Our solution is the combination of an integrated organic interposer substrate with high density interconnects and thermo-compression flip chip bonding. Our solution eliminates the backside integration process for silicon interposer and assembly of interposers onto substrates. Conventional assembly processes can be utilized for assembling dies onto the integrated organic interposer substrate. Feasibility of this 2.5D package has been demonstrated by assembling dual-die with 40um pitch copper pillar bumps onto this novel integrated organic interposer substrate with 2μm line and space.

The patient was an 1-year-old male infant with a soft palate injury from falling down. Oral bleeding was noted immediately after the accident, and he was treated conservatively by a local doctor. However, two weeks later, he was admitted to the Department of Otolaryngology St. Marianna University Touyoko Hospital with a mucosal fistula on the soft palate and a continuing low grade fever of unknown origin. An endoscopic examination of the nasal cavity did not show any marked pathological changes or any traces of a foreign body. ACT scan revealed no abnormal findings except for the edematous mucosal swelling in the maxillary sinus. Endoscopic observation revealed an wooden foreign body in the palate, which was subsequently removed successfully using the endoscope. Foreign bodies should be removed as soon as possible, because they may become a focus of severe infection. But because of the radiolucency of small wooden foreign bodies, plain radiographs and CT scan are often not useful in imaging the objects. The endoscope provides significantly improved diagnostic and therapeutic options in oral surgery.

The brain maintains saccade accuracy by modifying saccades that are consistently inaccurate (e.g. hypermetric). To determine whether this adaptation is influenced by the visual background we used several different target and background movements to elicit changes in saccade gain. In almost all cases, the target spot drove gain changes. The background had no effect on, or slightly reduced, adaptation. We conclude that the saccade adaptation mechanism is driven almost entirely by stimuli on or near the fovea and is affected very little by visual stimuli falling more peripherally.

It has been shown that the nucleus of the optic tract (NOT) is an important visuomotor relay between the retina and preoculomotor structures, and is responsible for mediating horizontal optokinetic nystagmus (OKN) in monkeys, cats, rabbits, and rats. The details between the NOT and the vestibular nucleus in the brain stem concerning the morphology of fibers-of-passage and axon terminals have been disclosed in cats and monkeys. One is that they project to the contralateral NOT via the posterior commissure. In order to evaluate the role of the commissural fibers between the NOTs, the posterior commissure was cut in the present experient. Three fuscata monkeys (M17, M19, M22) were used. A magnetic search coil was sutured to the right eye to record eye position. Several bolts were embedded and secured with dental acrylic cement to fasten the animal's head during experiments. The animal was mounted on a turn table covered by an OKN screen, onto which OKN stripes were projected from above. The animals viewed the OKN stripes under three conditions: right eye viewing, left eye viewing, and bilateral eye viewing. OKN was recorded in response to counter clockwise (CCW) and clockwise (CW) stimulation at stimulus velocities of 30°/s, 60°/s, and 90°/s. After the control experiment was completed, the posterior commissure was transected by an operator knife. After follow-up studies were completed, an anterograde tracer was injected in the left NOT to ascertain the complete block between NOTs. Rapid rise (RR) and steady state (SS) of slow-phase OKN velocity and time-constants (TC) of optokinetic afternystagmus (OKAN) were measured. In three aniamis, OKN gains elicited with monocular viewing were approximately equal to the those of binocularly-evoked OKN before and after surgery. In the three monkeys, the commissurectomy decreased RR and SS to both sides during the three weeks immediately after surgery. In M22, TC showed the tendency to decrease by only 30°/s and 60°/s after surgery. There were no significant differences in TCs of other experiments.In conclusion, gain reduction in RR and SS can be explained by decrease of inhibiting the resting rate in NOT, which is conducted via commissural fibers. This was caused by interruption due to a middle-line lesions. Furthermore, interrupting the commissural fibers has nothing to do with the velocity storage mechanism.

A 27-year-old female with tinnitus and fullness of the left ear was audiologically studied. Results of pure tone audiometry and tympanometry were normal with intact otoscopy. Tinnitus was at a level of 12126 Hz, 6 dB SL, according to a tinnitus audiometer. The blood pressure was 100/64 and the Schellong test showed a positive finding.Because tinnitus is frequently accompanied by high frequency sensorineural hearing loss, we evaluated the hearing in higher frequency regions using a tinnitus audiometer. As a result, thresholds above 13.9kHz of the left ear were elevated by 20dB higher than those of the right ear. Hearing loss at higher frequency was evidently shown. Considering the hypothesis that the cochlear damage may be generated by a perfusion deficit due to the combined effect of hypotension and imperfect vasomotor regulation, treatment was started with midodrine hydrochloride medication of 4mg, 2 times daily. Seven days after the start of treatment, tinnitus disappeared, thresholds in the high frequency range recovered to normal, and the Schellong test showed a negative finding.High frequency audiometry above the conventional frequency range was useful in this case.

Saccadic accuracy, measured as the ratio of the size of a saccade to the size of the target step that elicits it, i.e., saccade gain, can be altered by jumping the target surreptitiously during the targeting saccade. The gain change produced by this paradigm does not generalize or transfer to saccades of all sizes. Instead, the amount of transfer decreases the more the tested saccade differs in amplitude and direction from that adapted. Here, we tested the limits of this saccade-size specificity by attempting to impose quite different gain states on saccades in the same direction. We altered the saccadic gain by intrasaccadic target jumps of 30% of the initial target step, either forward to produce a gain increase or backward to produce a gain decrease. Three different conditions were studied: (1) saccades to target steps of 20 degrees or 7 degrees were adapted in individual sessions with backward and forward jumps, respectively; (2) saccades to target steps of 20 degrees caused backward target jumps during the same session in which saccades to 7 degrees target steps caused forward steps; (3) the target jumps accompanying 20 and 7 degrees saccades were the same as in (2), but in addition, there were intermediate-sized saccades to 13.5 degrees target steps with no intrasaccadic target jumps. Saccadic gain adaptation was quite flexible. In condition 2, we could simultaneously increase the gain of saccades to 7 degrees target steps while decreasing the gain of saccades to 20 degrees steps in the same direction. Intermediate horizontal saccades to 13.5 degrees target steps experienced gain reductions (average: 6.9%), which were not the sum of gain changes expected from separate 20 degrees gain decreases and 7 degrees gain increases alone, as predicted from condition 1. If adaptation at 20 degrees and 7 degrees occurred while an animal also tracked a non-adapting 13.5 degrees target step (paradigm 3), the gain reduction of saccades to the 13.5 degrees step was reduced considerably (3.4%). Thus, the mechanism that adapts saccade size can support a robust gain increase for saccades of one size while simultaneously supporting a robust gain decrease for saccades only 13 degrees larger. Furthermore, the presence during adaptation of a non-adapted target step with a size intermediate to the two adapting steps reestablishes a nearly normal gain within only 6.5 degrees of a robust gain increase and decrease. These data indicate that saccadic gain adaptation can set very different gain states for saccades with rather similar vectors.

The gain of saccadic eye movements can be altered gradually by moving targets either forward or backward during targeting saccades. If the gain of saccades to targets of only one size is adapted, the gain change generalizes or transfers only to saccades with similar vectors. In this study, we examined the spatial extent of such saccadic size adaptation, i.e., the gain adaptation field. We also attempted to adapt saccade direction by moving the target orthogonally during the targeting saccade to document the extent of a direction or cross-axis adaptation field. After adaptive gain decreases of horizontal saccades to 15 degrees target steps,82% of the gain reduction transferred to saccades to 25 degrees horizontal target steps but only approximately 30% transferred to saccades to 5 degrees steps. For the horizontal component of oblique saccades to target steps with 15 degrees horizontal components and 10 degrees upward or downward vertical components, the transfer was similar at 51 and 60%, respectively. Thus the gain decrease adaptation field was quite asymmetric in the horizontal dimension but symmetric in the vertical dimension. Although gain increase adaptation produced a smaller gain change (13% increase for a 30% forward adapting target step) than did gain decrease adaptation (20% decrease for a 30% backward adapting target step), the spatial extent of gain transfer was quite similar. In particular, the gain increase adaptation field displayed asymmetry in the horizontal dimension (58% transfer to 25 degrees saccades but only 32% transfer to 5 degrees saccades) and symmetry in the vertical direction (50% transfer to the horizontal component of 10 degrees upward and 40% transfer to 10 degrees downward oblique saccades). When a 5 degrees vertical target movement was made to occur during a saccade to a horizontal 10 degrees target step, a vertical component gradually appeared in saccades to horizontal targets. More than 88% of the cross-axis change in the vertical component produced in 10 degrees saccades transferred to 20 degrees saccades but only 12% transferred to 4 degrees saccades. The transfer was similar to the vertical component of oblique saccades to target steps with either 10 degrees upward (46%) or 10 degrees downward (46%) vertical components. Therefore both gain and cross-axis adaptation fields have similar spatial profiles. These profiles resemble those of movement fields of neurons in the frontal eye fields and superior colliculus. How those structures might participate in the adaptation process is considered in the DISCUSSION.

We encountered a 32-year-old Philippino man with primary nasal tuberculosis. He developed increasing nasal obstruction and persistent epistaxis. His general health was quite good and chest X-ray showed no abnormality in the lung field. A CT-scan showed no granulation or inflammation in bilateral paranasal sinuses.Granulomatous changes in the mucosa of the right inferior turbinate were the only finding. Biopsy of the inferior turbinate showed caseating granuloma. Finally, we diagnosed his illness as primary nasal tuberculosis because tubercle bacillus was identified using the polymerase chain reaction methods, which found to be useful in precisely diagnosing nasal tuberculosis.The differential diagnosis of nasal granulomatous disease usually includes Wegener's granulomatosis, midline malignant reticulosis, sarcoidisis and tuberculosis. However, tuberculosis of the nose has become so infrequent that it is a virtually forgotten disease. We point out the necessity of including tuberculosis in this differential diagnosis.