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Postpartum thyroiditis (PPT) is characterized by mild thyrotoxicosis occurring within one year of parturition commonly followed by transient hypothyroidism. Having genetic background of autoimmune thyroid disorders is a risk factor for it because the immune reactivation during postpartum period is a trigger for PPT. Pandemic of COVID-19: caused by SARS-CoV-2 infection is a global health problem, and occurrence of Graves' disease and Hashimoto's thyroiditis after the viral infection have been reported but occurrence of PPT with COVID-19 has never been reported. A 29-year-old woman developed general fatigue four and a half months after parturition, and was diagnosed as having PPT: one month before, she had COVID-19. Hereafter, we define the date of delivery as Day 0 to make timeline clear. SARS-CoV-2 infection was diagnosed by PCR on Day 103, its disappearance from the upper airway confirmed on Day 124, and the thyroiditis diagnosed on Day 136. She had been euthyroid on Day 0 and 95, but thyrotoxic on Day 136. Serum thyroglobulin (Tg) concentration was normal in the presence of anti-Tg antibody, other thyroid-related autoantibodies were negative, and by ultrasonography, the thyroid gland was normal in size and no evidence of increased vascularity. Thyroid function returned to normal by Day 172 without any specific drug therapy. In conclusion, although a clear causal relationship could not be found, we documented the world's first case of PPT developed following COVID-19.

The 2016 International Guidelines for the Management of Sepsis and Septic Shock recommend antibiotic therapy for 7-10 days for most patients with sepsis. However, evidence on critically ill patients is limited. Thus, we conducted the first systematic review and meta-analysis comparing the effectiveness and adverse events of shorter- (≤1 week) with longer-course antibiotics in adults with critical infections including sepsis.We searched the MEDLINE, Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi databases for randomised controlled trials (RCTs) and observational studies (OSs) from inception to 31 March 2021.We included 6 of 3,766 identified articles, incorporating data from 4 RCTs and 2 OSs (1,721 patients) in meta-analyses. Three RCTs and one OS focussed on ventilator-associated pneumonia, and one RCT and one OS investigated intra-abdominal infections. The severity score levels were similar to that of sepsis, but no study comprehensively focussing on sepsis was found. There were no significant differences in mortality at a maximum follow-up of 30 days (RR 1.08, 95%CI 0.80-1.46); 28-day mortality, clinical cure, the occurrence of new events, and the emergence of resistant organisms between the groups in the RCTs. The OSs findings were consistent. The quality of evidence was assessed as very low to moderate using the GRADE approach, with no uniform description of severity scores, sepsis, or adverse events.Shorter, fixed-duration antibiotic therapy for clinically heterogeneous sepsis or severe infections was not associated with poorer outcomes, but the overall quality of evidence was poor.

We describe the clinical features of a 75-year-old man who presented to our hospital with frequent urination for 3 months. Retrograde urethrography showed extended and continuous narrowing of the stricture in the anterior urethra. Cystourethroscopy showed extended narrowing of the urethral lumen without normal membrane. Urine acid-fast bacillus culture and polymerase chain reaction assays indicated a diagnosis of urethral tuberculosis. Anti-tuberculosis therapy was initiated. Urethral tuberculosis is a very rare cause of urethral stricture in developed countries that can be diagnosed by cystourethroscopy. Urethral tuberculosis should be considered in the differential diagnosis of urethral stricture.

We report a case series of 6 patients with confirmed coronavirus disease 2019 (COVID-19) in Wakayama prefecture, Japan. All 6 of the patients tested positive via pharyngeal swab polymerase chain reaction (PCR) tests, and 2 of the 6 were still positive at 3 weeks after onset. All of the patients exhibited bilateral ground glass opacities on computed tomography (CT). This article also reports narrative information on the spectrum of symptoms collected directly from the patients. It would be difficult to triage patients with COVID-19 based on the typical symptoms of fever and/or cough, although PCR and CT are definitive in diagnosis.

To evaluate the diagnostic performance of chest CT to differentiate coronavirus disease 2019 (COVID-19) pneumonia in non-high-epidemic area in Japan. This retrospective study included 21 patients clinically suspected COVID-19 pneumonia and underwent chest CT more than 3 days after the symptom onset: six patients confirmed COVID-19 pneumonia by real-time reverse-transcription polymerase chain reaction (RT-PCR) and 15 patients proved uninfected. Using a Likert scale and its receiver operating characteristic curve analysis, two radiologists (R1/R2) evaluated the diagnostic performance of the five CT criteria: (1) ground glass opacity (GGO)-predominant lesions, (2) GGO- and peripheral-predominant lesions, (3) bilateral GGO-predominant lesions; (4) bilateral GGO- and peripheral-predominant lesions, and (5) bilateral GGO- and peripheral-predominant lesions without nodules, airway abnormalities, pleural effusion, and mediastinal lymphadenopathy. All patients confirmed COVID-19 pneumonia had bilateral GGO- and peripheral-predominant lesions without airway abnormalities, mediastinal lymphadenopathy, and pleural effusion. The five CT criteria showed moderate to excellent diagnostic performance with area under the curves (AUCs) ranging 0.77–0.88 for R1 and 0.78–0.92 for R2. The criterion (e) showed the highest AUC. Chest CT would play a supplemental role to differentiate COVID-19 pneumonia from other respiratory diseases presenting with similar symptoms in a clinical setting.

Background: The incidences of metastatic brain tumors from malignant melanomas have increased and survival has been prolonged by novel molecular targeted agents and immunotherapy. However, malignant melanomas are uncommon in Asian populations. Objectives: We retrospectively analyzed treatment efficacy and identified prognostic factors impacting tumor control and survival in Japanese melanoma patients with brain metastases treated with gamma knife radiosurgery (GKRS). Methods: We retrospectively reviewed the medical records of 177 patients with 1,500 tumors who underwent GKRS for brain metastases from malignant melanomas. This study was conducted by the Japanese Leksell Gamma Knife Society (JLGK1501). Results: Six and 12 months after GKRS, the cumulative incidences of local tumor recurrence were 9.2 and 13.8%. Intratumoral hemorrhage (p < 0.0001) and larger tumor volume (p = 0.001) in GKRS were associated with significantly poorer local control outcomes. The use of immune checkpoint inhibitors before GKRS was significantly associated with symptomatic adverse events (p = 0.037). The median overall survival time after the initial GKRS was 7.3 months. Lower Karnofsky performance status scores (p = 0.016), uncontrolled primary cancer (p < 0.0001), and multiple brain metastases (p = 0.014) significantly influenced unfavorable overall survival outcomes. The cumulative incidences of neurological death 6 and 12 months after GKRS were 9.7 and 17.4%, those of neurological deterioration were 14.2 and 19.6%, and those of new tumor appearance were 34.5 and 40.5%. Conclusions: The results of the present multicenter study suggest that GKRS is a relatively effective and safe modality for control of tumor progression in Japanese patients with brain metastases from malignant melanomas.

Although hypervirulent Klebsiella pneumoniae (hvKp) has been associated with severe community-acquired infections that occur among relatively healthy individuals, information about hvKp infections in health care settings remains limited. Here, we systematically analyzed the clinical and molecular characteristics of K. pneumoniae isolates causing bloodstream infections in a cross-sectional study. Clinical characteristics of K. pneumoniae bloodstream infections from hospitals across Japan were analyzed by a review of the medical records. Whole-genome sequencing of the causative isolates was performed. Bacterial species were confirmed and hvKp were identified using whole-genome sequencing data. Clinical characteristics of hvKp infections were compared with those of non-hvKp infections by bivariate analyses. Of 140 cases of K. pneumoniae bloodstream infections, 26 cases (18.6%) were caused by various clones of hvKp defined by the carriage of cardinal virulence genes. Molecular identification revealed that 24 (17.1%) and 14 (10%) cases were caused by Klebsiella variicola and Klebsiella quasipneumoniae, respectively. Patients with hvKp infections had higher proportions of diabetes mellitus (risk ratio [RR], 1.75; 95% confidence interval [CI], 1.05 to 2.94), and their infections had significantly higher propensity to involve pneumonia (RR, 5.85; 95% CI, 1.39 to 24.6), liver abscess (RR, 5.85; 95% CI, 1.39 to 24.6), and disseminated infections (RR, 6.58; 95% CI, 1.16 to 37.4) than infections by other isolates. More than one-half of hvKp infections were health care associated or hospital acquired, and a probable event of health care-associated transmission of hvKp was documented. hvKp isolates, which are significantly associated with severe and disseminated infections, are frequently involved in health care-associated and hospital-acquired infections in Japan.

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created as revised from J-SSCG 2016 jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in September 2020 and published in February 2021. An English-language version of these guidelines was created based on the contents of the original Japanese-language version. The purpose of this guideline is to assist medical staff in making appropriate decisions to improve the prognosis of patients undergoing treatment for sepsis and septic shock. We aimed to provide high-quality guidelines that are easy to use and understand for specialists, general clinicians, and multidisciplinary medical professionals. J-SSCG 2016 took up new subjects that were not present in SSCG 2016 (e.g., ICU-acquired weakness [ICU-AW], post-intensive care syndrome [PICS], and body temperature management). The J-SSCG 2020 covered a total of 22 areas with four additional new areas (patient- and family-centered care, sepsis treatment system, neuro-intensive treatment, and stress ulcers). A total of 118 important clinical issues (clinical questions, CQs) were extracted regardless of the presence or absence of evidence. These CQs also include those that have been given particular focus within Japan. This is a large-scale guideline covering multiple fields; thus, in addition to the 25 committee members, we had the participation and support of a total of 226 members who are professionals (physicians, nurses, physiotherapists, clinical engineers, and pharmacists) and medical workers with a history of sepsis or critical illness. The GRADE method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members.As a result, 79 GRADE-based recommendations, 5 Good Practice Statements (GPS), 18 expert consensuses, 27 answers to background questions (BQs), and summaries of definitions and diagnosis of sepsis were created as responses to 118 CQs. We also incorporated visual information for each CQ according to the time course of treatment, and we will also distribute this as an app. The J-SSCG 2020 is expected to be widely used as a useful bedside guideline in the field of sepsis treatment both in Japan and overseas involving multiple disciplines., other authors: Satoru Hashimoto,Daisuke Hasegawa,Junji Hatakeyama,Naoki Hara,Naoki Higashibeppu,Nana Furushima,Hirotaka Furusono,Yujiro Matsuishi,Tasuku Matsuyama,Yusuke Minematsu,Ryoichi Miyashita,Yuji Miyatake,Megumi Moriyasu,Toru Yamada,Hiroyuki Yamada,Ryo Yamamoto,Takeshi Yoshida,Yuhei Yoshida,Jumpei Yoshimura,Ryuichi Yotsumoto,Hiroshi Yonekura,Takeshi Wada,Eizo Watanabe,Makoto Aoki,Hideki Asai,Takakuni Abe,Yutaka Igarashi,Naoya Iguchi,Masami Ishikawa,Go Ishimaru,Shutaro Isokawa,Ryuta Itakura,Hisashi Imahase,Haruki Imura,Takashi Irinoda,Kenji Uehara,Noritaka Ushio,Takeshi Umegaki,Yuko Egawa,Yuki Enomoto,Kohei Ota,Yoshifumi Ohchi,Takanori Ohno,Hiroyuki Ohbe,Kazuyuki Oka,Nobunaga Okada,Yohei Okada,Hiromu Okano,Jun Okamoto,Hiroshi Okuda,Takayuki Ogura,Yu Onodera,Yuhta Oyama,Motoshi Kainuma,Eisuke Kako,Masahiro Kashiura,Hiromi Kato,Akihiro Kanaya,Tadashi Kaneko,Keita Kanehata,Ken-ichi Kano,Hiroyuki Kawano,Kazuya Kikutani,Hitoshi Kikuchi,Takahiro Kido,Sho Kimura,Hiroyuki Koami,Daisuke Kobashi,Iwao Saiki,Masahito Sakai,Ayaka Sakamoto,Tetsuya Sato,Yasuhiro Shiga,Manabu Shimoto,Shinya Shimoyama,Tomohisa Shoko,Yoh Sugawara,Atsunori Sugita,Satoshi Suzuki,Yuji Suzuki,Tomohiro Suhara,Kenji Sonota,Shuhei Takauji,Kohei Takashima,Sho Takahashi,Yoko Takahashi,Jun Takeshita,Yuuki Tanaka,Akihito Tampo,Taichiro Tsunoyama,Kenichi Tetsuhara,Kentaro Tokunaga,Yoshihiro Tomioka,Kentaro Tomita,Naoki Tominaga,Mitsunobu Toyosaki,Yukitoshi Toyoda,Hiromichi Naito,Isao Nagata,Tadashi Nagato,Yoshimi Nakamura,Yuki Nakamori,Isao Nahara,Hiromu Naraba,Chihiro Narita,Norihiro Nishioka,Tomoya Nishimura,Kei Nishiyama,Tomohisa Nomura,Taiki Haga,Yoshihiro Hagiwara,Katsuhiko Hashimoto,Takeshi Hatachi,Toshiaki Hamasaki,Takuya Hayashi,Minoru Hayashi,Atsuki Hayamizu,Go Haraguchi,Yohei Hirano,Ryo Fujii,Motoki Fujita,Naoyuki Fujimura,Hiraku Funakoshi,Masahito Horiguchi,Jun Maki,Naohisa Masunaga,Yosuke Matsumura,Takuya Mayumi,Keisuke Minami,Yuya Miyazaki,Kazuyuki Miyamoto,Teppei Murata,Machi Yanai,Takao Yano,Kohei Yamada,Naoki Yamada,Tomonori Yamamoto,Shodai Yoshihiro,Hiroshi Tanaka,Osamu Nishida, Guidelines

Toxocariasis causes a variety of symptoms. We experienced a case of toxocariasis which was initially treated with steroids for Eosinophilic Granulomatosis with Polyangitis (EGPA). A 53-year-old woman with the past medical history of bronchial asthma presented at the outpatient department in the middle of August. She complained of chest discomfort lasting for one week. Ischemic heart disease was initially suspected due to ST depression on ECG and positive Troponin I. However coronary angiography did not reveal any abnormality. Her symptoms continued and after one month she presented at the hospital again with an elevated eosionophil count. Chest computed tomography showed ground glass opacities on both lungs. She was diagnosed as having EGPA based on her clinical symptoms and the results of the blood test which were consistent with the diagnostic criteria of EGPA. After prednisolone was prescribed, her symptoms and eosinophilia dramatically improved. However, we found that the histology of the lung and kidney was not compatible with EGPA and the result of serum parasite antibodies turned out to be strongly positive for toxocariasis after initiating predonisolone. Based on this result, we concluded that our patient had a case of toxocariasis and prescribed albendazole in addition to prednisolone. The patient completed a 3-week course of albendazole and a 3-month course of prednisolone without any problems. In general, steroids are not commonly used as a treatment of toxocariasis, however it seems to have been effective in this case. Toxocariasis shows a variety of symptoms and can be misdiagnosed as other diseases such as EGPA.

Summary Background We aimed to examine whether stereotactic radiosurgery without whole-brain radiotherapy (WBRT) as the initial treatment for patients with five to ten brain metastases is non-inferior to that for patients with two to four brain metastases in terms of overall survival. Methods This prospective observational study enrolled patients with one to ten newly diagnosed brain metastases (largest tumour Findings We enrolled 1194 eligible patients between March 1, 2009, and Feb 15, 2012. Median overall survival after stereotactic radiosurgery was 13·9 months [95% CI 12·0–15·6] in the 455 patients with one tumour, 10·8 months [9·4–12·4] in the 531 patients with two to four tumours, and 10·8 months [9·1–12·7] in the 208 patients with five to ten tumours. Overall survival did not differ between the patients with two to four tumours and those with five to ten (HR 0·97, 95% CI 0·81–1·18 [less than non-inferiority margin], p=0·78; p non-inferiority vs 18 [9%] with five to ten; p=0·89). Four patients died, mainly of complications relating to stereotactic radiosurgery (two with one tumour and one each in the other two groups). Interpretation Our results suggest that stereotactic radiosurgery without WBRT in patients with five to ten brain metastases is non-inferior to that in patients with two to four brain metastases. Considering the minimal invasiveness of stereotactic radiosurgery and the fewer side-effects than with WBRT, stereotactic radiosurgery might be a suitable alternative for patients with up to ten brain metastases. Funding Japan Brain Foundation.

Erysipelothrix rhusiopathiae is a major causative organism of swine erysipelas, but the infection has rarely occurred in humans. A soft-tissue infection with this organism is described as “erysipeloid.” Most reported cases in human are related to occupational exposure. Endocarditis is a common complication of E. rhusiopathiae bacteremia in human.We report the case of a previously healthy 52-year-old Japanese female who presented with fever and an inflamed hand after being bitten by a stray cat. Blood culture was positive for E. rhusiopathiae, but no sign of infective endocarditis was observed. It may be prudent to consider E. rhusiopathiae infection in patients with animal bites. Keywords: Erysipelothrix rhusiopathiae, Animal bites, Bacteremia

Objective Central neurocytoma (CN) is a rare benign neuronal tumor, and a limited number of reports have described the usefulness of radiosurgery for a relatively large group of patients. We evaluated the effectiveness and outcomes of Gamma Knife radiosurgery (GKS) for CN in a Japanese multi-institutional study. Methods We performed retrospective analysis of 36 patients with CN who were treated with GKS in 12 institutes in Japan. All patients underwent surgery before GKS. The median tumor volume at GKS was 4.9 mL (range, 0.07–23.4 mL), and the median radiation dose prescribed to the tumor margin was 15 Gy (range, 10–20 Gy). The median follow-up period was 54.5 months (range, 3–180 months). Results The local tumor progression-free survival rates at 5 and 10 years were 94% and 86%, respectively. Three patients developed distant dissemination 16–90 months later. Overall progression-free survival was unrelated to the prescribed dose ( P = 0.62), tumor size ( P = 0.46), gender ( P = 0.36), age ( P = 0.37), target of GKS (residual vs. recurrence, P = 0.90), and type of enhancement (homogeneous vs. inhomogeneous, P = 0.19). Two permanent complications occurred with 1 intratumoral hemorrhage and 1 radiation injury. Conclusions GKS is effective for CN because of its high rate of long-term local tumor control. GKS may have a potential role as a primary treatment for asymptomatic, relatively small tumors in the absence of hydrocephalus without surgical resection.

The authors report an unusual case of a dural arteriovenous fistula (dAVF) draining only to the diploic vein and causing intracerebral hemorrhage. A 62-year-old woman presented with disturbance of consciousness and left hemiparesis. Brain CT scanning on admission showed a right frontal subcortical hemorrhage. Digital subtraction angiography revealed an arteriovenous shunt located in the region around the pterion, which connected the frontal branch of the right middle meningeal artery with the anterior temporal diploic vein and drained into cortical veins in a retrograde manner through the falcine vein. The dAVF was successfully obliterated by percutaneous transarterial embolization with N-butyl-2-cyanoacrylate. The mechanism of retrograde cortical venous reflux causing intracerebral hemorrhage is discussed.

Cephalic tetanus is defined as a combination of trismus and paralysis of one or more cranial nerves. Since it is a rare cause of facial nerve palsy, it is often overlooked as a differential diagnosis. We present the case of a 75-year-old man admitted to our emergency department with left facial nerve palsy, left ptosis and dysphagia 2 weeks after a head laceration. Soon after admission, he was orally intubated because of massive aspiration. A delayed diagnosis of cephalic tetanus was reached only when he was extubated and trismus and risus sardonicus were identified in addition to facial nerve palsy. The patient was re-intubated and successfully extubated on day 20 postadmission. In orally intubated patients, trismus and risus sardonicus may be overlooked, and although rare, cephalic tetanus should be considered to be a differential diagnosis of facial nerve palsy.

This report describes a neonatal case in whom a large interhemispheric cyst associated with agenesis of the corpus callosum was revealed by fetal ultrasonography and demonstrated by MRI to be multilobulated. Endoscopic fenestration of cysts was initially designed in view of the development of the patient’s brain and surgical invasiveness. One year later, when motor paresis of the left arm and progressive enlargement of the cyst on MRI were revealed, open surgery was performed. The histological diagnosis was a neuroepithelial cyst with the feature of choroid plexus epithelia. The clinicopathological features of interhemispheric epithelial cysts associated with agenesis of the corpus callosum are reviewed in the light of differential diagnosis and therapeutic considerations.

We report a case of mucoepidermoid carcinoma in the nasopharynx. A woman, aged 59, who suffered from chronic otitis media with effusion was referred to our department due to a mass lesion on the Rosenmuller's fossa. The mass lesion was pathologically diagnosed as a mucoepidermoid carcinoma. CT and MRI scans showed a well bordered round shadow which was limited to the orifice of the left eustachian tube, without invasion of the skull base.As the patient did not agree to surgical treatment, we selected radiotherapy using a gamma knife for treatment of the nasopharyngeal tumor. The tumor responded well to gamma knife treatment and disappeared with 30Gy irradiation (Edge dose). The patient has shown no recurrence of the tumor for a year and 6 months after treatment. Gamma knife radiotherapy may be one potential treatment strategy for intractable lesions of the head and neck such as mucoepidermoid carcinoma in the nasopharynx.

Objective: Results of Gamma Knife radiosurgery (GKS) were retrospectively evaluated in 16 patients with histologically confirmed atypical and anaplastic intracranial meningiomas.

BACKGROUND Acute infectious purpura fulminans (AIPF), a rare syndrome of infection-induced ischemic necrosis of the extremities (symmetric peripheral gangrene), is due most often to Neisseria meningitidis in the US and the UK, but is not endemic to Japan. PURPOSE We reviewed clinical AIPF manifestations in Japan. METHODS (A) We retrospectively analyzed six cases of AIPF in the last seven years. (B) We reviewed the medical literature up to 2008 using PubMed search and Japana Centra Revuo Medicina (Igakuchuozasshi) findings. RESULTS (A) None of the 6 subjects-5 men and 1 woman aged 44 to 69 old- had a history of splenectomy. Except for one case, their disease was community-acquired and immunocompetent. Causative organisms were Streptococcus pneuomoniae (66.7%), Gram negative rods, and Legionella pneumophilla. No localized infectious focus was apparent except for one of Legionella pneumonia. Systemic purpura progressed rapidly within 12 to 96 hours of initial fever or influenza-like symptoms. Main AIPF manifestations are shock and disseminated intervascular coagulation, but not all subjects had both. Six-month mortality was 33.3%, with death within two days of admission. Survivors all required at least two limbs to be amputated. (B) The Japanese literature reported AIPF occurring in 64 cases- 11 neonatal due to congenital protein C deficiency, seven pediatric, and 46 adults. Organisms most commonly involved were S. pneumoniae at 41.3%, and Neisseria meningitidis at 15.2%. The most common pathogen reported in a PubMed search was Neisseria meningitidis. CONCLUSIONS In Japan, S. pneumoniae is the most frequent isolate associated with AIPF, and progression to AIPF occurs mainly in adults, who commonly suffer frequent amputations and high mortality. Rapid progressing systemic purpura following common-cold-like symptoms is the key to early diagnosis, even if the patient is immunocompetent, not splenectomized, or has no apparent infectious foci.

This study reports two patients with tumours arising from the splenium of the corpus callosum that caused a memory disturbance consistent with retrosplenial amnesia as well as a variety of cognitive deficits including agraphia, acalculia, constructional apraxia and ideomotor and ideational apraxia involving both hands, but not aphasia. Patients showed disorientation to time and place, impaired recent memory and memorizing capacity; immediate and remote memory were preserved. Despite impaired performance intelligence quotients (IQ), verbal IQ was relatively spared. Patients also showed disconnection symptoms including bilateral crossed visuomotor ataxia and alexia to stimuli presented in the right visual field. In both cases, the tumour of the splenium had provoked surrounding oedema extending to the left parietal and occipital lobes.

A scheme for the speed control of rolling mill drives is presented. The proposed speed controller is based on a two degree of freedom (TDF) structure and uses an observer-based state feedback compensator for the major control loop. The control method yields a robust system with respect to system uncertainties and modeling errors and is very effective for vibration suppression. Experimental verification is carried out on a prototype rolling mill mini-model system. The experimental drive system has a three-mass-model structure (motor-gear-load) connected by low stiffness shafts. The mechanical resonances and the inertia ratios between the motor, gear, and load are comparable to those of an actual rolling mill system (resonant frequencies are at 17.4 Hz and 51.32 Hz). The proposed scheme is compared to the conventional proportional plus integral controller, and the performance of each scheme is presented. A high closed loop speed bandwidth was obtained with the proposed TDF speed controller. >

The authors describe the control problems associated with rolling mill drive systems and propose a robust speed controller for the suppression of the torsional vibrations. The undesirable mechanical vibrations inherent in a rolling mill drive system impose severe limitations on the dynamic performance of the speed control loop. Plant parameter variations uncertain dynamics, and load torque disturbances are among the major factors which must be addressed to guarantee the system stability and the high-performance operation of the system. To solve these problems, a robust speed controller based on a state feedback control structure is developed. The control law is derived using the loop transfer recovery design methodology, where plant and disturbance uncertainties are incorporated in the design to achieve a robust speed control loop. The design steps of the state controller and the state observer are described, and the constraints imposed on the system are discussed. Analysis and simulation results of the total speed drive system are presented. >

Gamma knife radiosurgery (RS) has been introduced as a modern therapy for brain tumors. However, the effects of RS for neuroepithelial tumors are still obscure. The present study investigates the radiological and histological changes after RS to elucidate the biological effect. There were seven cases (two males and five females), ranging from 4 to 71 years with a mean age of 33 years. Two cases were located in the brainstem, another two in the cerebellum, and one each in the thalamus, the hypothalamus, and the frontal lobe. Histologically, two cases had gangliogliomas, four astrocytomas (1 pilocytic, 1 fibrillary, 2 anaplastic), and one glioblastoma. RS was performed after surgery with a central dose of 30-36 Gy. All cases were evaluated radiologically on MRI before and after RS. Four cases (3 astrocytomas and 1 glioblastoma) which neurologically deteriorated after RS were reoperated. These cases were examined using HE and immunohistochemical studies with antibodies of CD34, alpha-smooth muscle actin (SMA), p53, p21 and MIB-1 on the sections before and after RS. MRI demonstrated perifocal edema and intratumoral hypointensity on T2 weighted imaging (T2WI), suggesting radionecrosis in most of the cases within 6 months after RS. In the central part of the RS, destructive changes were observed in the tumor cells and endothelial cells: decrease in the tumor cell population, coagulation necrosis, and fibrinoid degeneration of vascular walls were revealed. In the peripheral part, however, some tumors contained viable tumor cells intermingled with blood vessels showing endothelial and pericytic proliferations. The increase of MIB-1 staining index was found in only one case. The p21 immunoreactivity was increased in endothelial cells, although the p53 immunoreactivity was unchanged. These results suggested that radionecrosis occurred earlier and more frequently in neuroepithelial tumors after RS than after conventional radiation.

A 37-year-old woman was admitted in a comatose state, after exhibiting fever and diarrhea. Diabetic ketoacidosis was diagnosed due to an increased blood glucose level (672 mg/dl), metabolic acidosis, and positive urinary ketone bodies. On the fifth hospital day, despite recovery from the critical state of ketoacidosis, the patient suffered from dysphagia, hypesthesia and motor weakness, followed by respiratory failure. Cerebrospinal fluid analysis was suggestive of Guillain-Barre syndrome (GBS). Autonomic dysfunction was manifested as tachycardia and mild hypertension in the acute stage. Marked orthostatic hypotension persisted long after paresis was improved, indicating an atypical clinical course of GBS.

A case of cranial metastasis of hepatocellular carcinoma associated with epidural hematoma in a 58-year-old male is presented. The epidural hematoma demonstrated an unusual chronic clinical course and computed tomographic appearance. Associated bleeding from either the diploic marrow or emissary veins might be a cause of the slowly expanding hematoma, and the outward displacement of the artificial bone-flap implanted previously may also have contributed to the chronic course.

A fully digitalized speed regulator is proposed which executes all regulatory processing by using a multimicroprocessor. The hardware configuration of the regulator is standardized. A vector control algorithm is used to perform fast response speed control of an induction motor. Microprocessors execute a PWM gate pulse generation and current component detection in addition to speed control processing. In applications of the regulator to a 1.5-kW induction motor drive system, Its effectiveness is confirmed.

A pulse counting method has been used to determine gains of an electron multiplier for various ions. A16-stage box and grid type electron multiplier with copper-beryllium dynodes has been employed in equipment to a single focusing mass spectrometer. The condition, where the gain determined by the pulse counting method becomes almost identical to that by a Faraday cup method for each of various ions, has been discussed.

A new servo system suitable for robot control is proposed. An optical serial transmission is applied in its servo-control loops to reduce the number of signal cables and the cable length between the robot mechanism and the controlling equipment, as well as to increase flexibility for expanding control functions.

A case of posttraumatic hypopituitarism was studied. A 46-years-old man suffered from adrenal crisis after he showed symptoms of hypopituitarism which was caused by the head injury of 26 years ago. Hyponatremia was prominent at the time of admission. Clinical and laboratory studies revealed hypothyroidism, hypofunction of adrenal gland and hypogonadism. Blood pituitary hormones-ACTH, GH, TSH and LH were determined by radioimmunoassay. Plasma ACTH levels were not detectable (below 10pg/ml) even after metyrapone administration. Base-line serum GH level was low and did not respond to the administration of insulin or L-arginine. Although the response was subnormal, serum TSH levels were increased in response to synthetic thyrotropin releasing hormone (TRH). Serum LH levels were low. Mechanism about the hyponatremia at the time of adrenal crisis in this case was discussed.