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A 62-year-old man with left chest pain had left pleural effusion pointed out on a chest radiograph. Chest CT scans showed multiple nodules on the left parietal pleura and pleural effusion. He was referred to our hospital and we performed thoracoscopic examination. Malignant pleural mesothelioma (biphasic type) was diagnosed, based on the pathological findings of a parietal nodular mass, including immunohistological analysis. Chemotherapy using carboplatin and pemetrexed reduced the size of tumor and left pleural effusion. This is a rare case with atypical CT findings of malignant pleural mesothelioma.

We present two cases of relapsed adenocarcinoma of the lung: a 50-year-old male and a 67-year-old male. Both patients had previously been treated with platinum-containing systemic chemotherapy. In both cases, significant clinical efficacy was demonstrated with combination chemotherapy consisting of pemetrexed, carboplatin, and bevacizumab as salvage treatment. Adverse events were mild. This regimen might be a viable therapeutic option even after heavy treatment such as platinum-containing chemotherapy, especially for patients with preserved organ function and good performance status.

YOSHIDA, M. and ASANO, M. Direct Compression by Megadolichobasilar Anomaly as a Cause of Trigeminal Neuralgia, A Case Diagnosed by MRI. Tohoku J. Exp. Med., 1994, 172 (4), 327-332 A 49 year-old man with trigeminal neuralgia caused by megadolichobasilar anomaly was described. The patient having neuralgic attacks in the second branch of the right trigeminal nerve for two and a half years showed the angiographic evidence of a tortuous and elongated vertebrobasilar artery and MRI of the brain clearly visualized the root entry zone of the nerve having been compressed by the main trunk of ectatic basilar artery. Cases of trigeminal neuralgia due to the compression by the basilar artery itself have been rarely described previously. In order to evaluate trigeminal neuralgia, MRI is essential to determine the relationship of the involvedsite of nerve to the pathogenic artery.

The abilities to empathize and to systemize, two fundamental dimensions of cognitive style, are characterized by apparent individual differences. These abilities are typically measured using an empathizing quotient (EQ) and a systemizing quotient (SQ) questionnaire, respectively. The purpose of this study was to reveal any correlations between EQ and SQ scores and regional gray matter volumes in healthy children by applying voxel-based morphometry to magnetic resonance images. We collected MRIs of brain structure and administered children's versions of the EQ and SQ questionnaires (EQ-C and SQ-C, respectively) to 261 healthy children aged 5–15 years. Structural MRI data were segmented, normalized, and smoothed using an optimized voxel-based morphometric analysis. Next, we analyzed the correlation between regional gray matter volume and EQ-C and SQ-C scores adjusting for age, sex, and intracranial volume. The EQ-C scores showed significant positive correlations with the regional gray matter volumes of the left fronto-opercular and superior temporal cortices, including the precentral gyrus, the inferior frontal gyrus, the superior temporal gyrus, and the insula, which are functionally related to empathic processing. Additionally, SQ-C scores showed a significant negative correlation with the regional gray matter volume of the left posterior parietal cortex, which is functionally involved in selective attention processing. Our findings suggest that individual differences in cognitive style pertaining to empathizing or systemizing abilities could be explained by differences in the volume of brain structures that are functionally relevant to empathizing and systemizing.

Determinants of synesthetic color choice for the Japanese logographic script, Kanji, were studied. The study investigated how synesthetic colors for Kanji characters, which are usually acquired later in life than other types of graphemes in Japanese language (phonetic characters called Hiragana and Katakana, and Arabic digits), are influenced by linguistic properties such as phonology, orthography, and meaning. Of central interest was a hypothesized generalization process from synesthetic colors for graphemes, learned prior to acquisition of Kanji, to Kanji characters learned later. Results revealed that color choices for Kanji characters depend on meaning and phonological information. Some results suggested that colors are generalized from Hiragana characters and Arabic digits to Kanji characters via phonology and meaning, respectively. Little influence of orthographic information was observed. The findings and approach of this study contributes to a clarification of the mechanism underlying grapheme-color synesthesia, especially in terms of its relationship to normal language processing.

Sleep is essential for living beings, and sleep loss has been shown to affect hippocampal structure and function in rats by inhibiting cell proliferation and neurogenesis in this region of the brain. We aimed to analyze the correlation between sleep duration and the hippocampal volume using brain magnetic resonance images of 290 healthy children aged 5-18 years. We examined the volume of gray matter, white matter, and the cerebrospinal fluid (CSF) space in the brain using a fully automated and established neuroimaging technique, voxel-based morphometry, which enabled global analysis of brain structure without bias towards any specific brain region while permitting the identification of potential differences or abnormalities in brain structures. We found that the regional gray matter volume of the bilateral hippocampal body was significantly positively correlated with sleep duration during weekdays after adjusting for age, sex, and intracranial volume. Our results indicated that sleep duration affects the hippocampal regional gray matter volume of healthy children. These findings advance our understanding of the importance of sleep habits in the daily lives of healthy children.

Two experiments explored rapid extraction of gist from a visual text and its influence on word recognition. In both, a short text (sentence) containing a target word was presented for 200 ms and was followed by a target recognition task. Results showed that participants recognized contextually anomalous word targets less frequently than contextually consistent counterparts (Experiment 1). This context effect was obtained when sentences contained the same semantic content but with disrupted syntactic structure (Experiment 2). Results demonstrate that words in a briefly presented visual sentence are processed in parallel and that rapid extraction of sentence gist relies on a primitive representation of sentence context (termed protocontext) that is semantically activated by the simultaneous presentation of multiple words (i.e., a sentence) before syntactic processing.

To investigate gender differences in brain perfusion, this study utilized pulsed arterial spin-labeling magnetic resonance imaging (MRI) in a large number of healthy children. Data on structural and perfusion MRI in the brain were collected from 202 healthy children aged 5–18 years. Gender differences in brain perfusion using partial volume correction (PVC), which was calculated by dividing the normalized perfusion MRI by the normalized gray-matter segments, were analyzed by applying voxel-based analysis and region-of-interest (ROI) analysis. Girls showed significantly higher brain perfusion with PVC in the bilateral medial aspect of the parietal lobes, including the posterior cingulate cortex and precuneus, as compared to boys using voxel-based analysis. In addition, brain perfusion with PVC in the bilateral posterior cingulate cortex, bilateral precuneus, and left thalamus was significantly higher in girls than in boys in the ROI analysis. In contrast, no regions were seen in which boys exhibited higher brain perfusion with PVC than girls in both analyses. The findings showed significant differences between boys and girls in brain perfusion with PVC, and these differences may contribute to gender differences in the cognitive ability of healthy children.

We examined the correlation between brain perfusion and age using pulsed arterial spin‐labeling (ASL) magnetic resonance images (MRI) in a large number of healthy children. We collected data on brain structural and ASL perfusion MRI in 202 healthy children aged 5–18 years. Structural MRI data were segmented and normalized, applying a voxel‐based morphometric analysis. Perfusion MRI was normalized using the normalization parameter of the corresponding structural MRI. We calculated brain perfusion with an adjustment for gray matter density (BP‐GMD) by dividing normalized ASL MRI by normalized gray matter segments in 22 regions. Next, we analyzed the correlation between BP‐GMD and age in each region by estimating linear, quadratic, and cubic polynomial functions, using the Akaike information criterion. The correlation between BP‐GMD and age showed an inverted U shape followed by a U‐shaped trajectory in most regions. In addition, age at which BP‐GMD was highest was different among the lobes and gray matter regions, and the BP‐GMD association with age increased from the occipital to the frontal lobe via the temporal and parietal lobes. Our results indicate that higher order association cortices mature after the lower order cortices, and may help clarify the mechanisms of normal brain maturation from the viewpoint of brain perfusion. Hum Brain Mapp, 2011. © 2011 Wiley‐Liss, Inc.

A 55-year-old woman had a history of left mastectomy due to early breast cancer in 1998. She had been suffering from dyspnea on effort and dry cough since August in 2007, and visited our hospital 6 months later because the symptoms had been becoming worse. She was hypoxic and her chest radiograph showed bilateral diffuse shadows, so she was hospitalized. The specimen of transbronchial lung biopsy showed undifferentiated adenocarcinoma cells in lymphatics identified by lymphatic endothelium antibody D2-40 stain, so we diagnosed carcinomatous lymphangiosis. It also revealed the cells staining positive for Cytokeratin 7, negative for Cytokeratin 20, and positive for both estrogen receptor and progesterone receptor. These features were identical to the immunohistological findings of the specimen from the previously resected breast cancer. Chemotherapy with docetaxel was effective and improved her respiratory condition and the chest radiograph. The immunohistological findings are useful for diagnosis and selection of cancer therapy. We cannot find any case reports of recurrence with carcinomatous lymphangiosis over 10 years after resection of breast cancer in Japan. We must keep in mind that some cancers relapse after a long disease-free interval.

We report a case with a history of occupational asbestos exposure in which malignant pleural mesothelioma (MPM) was suspected clinically and diagnosed postmortem as pleural involvement of extrapulmonary small cell carcinoma (SCC). An 85-year-old man with a 65 pack-year history of smoking was referred to our hospital in June 2011. The patient had been exposed to asbestos in the iron production industry over the course of 30 years, and an irregular thickening of the right pleura was observed on chest CT at a medical check-up. The patient had a history of chronic hepatitis C and had been undergone transurethral resection for urothelial bladder cancer five times since 2006. Chest CT revealed neoplastic thickening of the right pleura, which had grown over 6 months (figure 1). The CT scan demonstrated bilateral pleural plaques, but no mass-like lesion in other organs, including the lungs, or mediastinal lymphadenopathy. The patient was suspected as having MPM and scheduled for thoracoscopic pleural biopsy, but his general condition worsened rapidly and he …

The purpose of this study was to clarify how eicosapentaenoic acid (EPA), an omega-3 polyunsaturated fatty acid, modulates the vascular action of vasopressin in rat aortic smooth muscle cell lines. The effects of EPA on Ca2+ mobilization and DNA synthesis elicited by vasopressin were investigated and compared to those of Ca2+ channel blocking agents, by means of Ca2+ measurements and the incorporation of [3H]thymidine. Patch-clamp techniques were also employed. Vasopressin (100 nM) elicited an initial peak of intracellular Ca2+ ([Ca2+]i), followed by a sustained phase due to Ca2+ entry. Nifedipine or nicardipine (1 microM), a potent L-type Ca2+ channel blocker, partly inhibited the sustained phase, but La3+ completely abolished it. EPA (10 microM) also inhibited it even in the presence of nicardipine. Under voltage-clamp conditions with CsCl-internal solution, depolarizing pulses positive to -30 mV from a holding potential of -40 mV elicited a slow inward current. The inward current was blocked by La3+, nicardipine, and nifedipine (1 microM), suggesting that the inward current mainly consisted of the voltage-dependent L-type Ca2+ channel (ICa.L). EPA (1-30 microM) also inhibited ICa.L in a concentration-dependent manner. The inhibitory effect of EPA was observed at concentrations higher than 1 microM, and its half-maximal inhibitory concentration (IC50) was 7.6 microM. Vasopressin induced a long-lasting inward current at a holding potential of -40 mV. The vasopressin-induced current was considered as a non-selective cation current (Icat) with a reversal potential of approximately +0 mV. Both nifedipine and nicardipine (10 microM) failed to inhibit it significantly, but La3+ completely abolished Icat. EPA also inhibited vasopressin-induced Icat in a concentration-dependent manner; its IC50 value was 5.9 microM. Vasopressin (100 nM) stimulated [3H]thymidine incorporation. Exclusion of extracellular Ca2+ with EGTA or La3+ markedly inhibited it. EPA (3-30 microM) also inhibited the incorporation induced by vasopressin, while nifedipine and nicardipine (1 microM) only partly inhibited it. These results suggested that EPA, unlike nifedipine and nicardipine, inhibited vasopressin-induced Ca2+-entry and proliferation in rat vascular smooth muscle cells, where the inhibitory effects of EPA on Icat as well as ICa.L might be involved. Thus, EPA would exert hypotensive and antiatherosclerotic effects.

Background —It has been suggested that intracellular Ca 2+ overload in cardiac myocytes leads to the development of diabetic cardiomyopathy. Troglitazone, an insulin-sensitizing agent, is a promising therapeutic agent for diabetes and has been shown to prevent diabetes-induced myocardial changes. To elucidate the underlying mechanism of troglitazone action on cardiac myocytes, the effects of troglitazone on voltage-dependent Ca 2+ currents were examined and compared with classic Ca 2+ antagonists (verapamil and nifedipine). Methods and Results —Whole-cell voltage-clamp techniques were applied in single guinea pig atrial myocytes. Under control conditions with CsCl internal solution, the voltage-dependent Ca 2+ currents consisted of both T-type ( I Ca,T ) and L-type ( I Ca,L ) Ca 2+ currents. Troglitazone effectively reduced the amplitude of I Ca,L in a concentration-dependent manner. Troglitazone also suppressed I Ca,T , but the effect of troglitazone on I Ca,T was less potent than that on I Ca,L . The current-voltage relationships for I Ca,L and the reversal potential for I Ca,L were not altered by troglitazone. The half-maximal inhibitory concentration of troglitazone on I Ca,L measured at a holding potential of −40 mV was 6.3 μmol/L, and 30 μmol/L troglitazone almost completely inhibited I Ca,L . Troglitazone 10 μmol/L did not affect the time courses for inactivation of I Ca,L and inhibited I Ca,L mainly in a use-independent fashion, without shifting the voltage-dependency of inactivation. This effect was different from those of verapamil and nifedipine. Troglitazone also reduced isoproterenol- or cAMP-enhanced I Ca,L . Conclusions —These results demonstrate that troglitazone inhibits voltage-dependent Ca 2+ currents (T-type and L-type) and then antagonizes the effects of isoproterenol in cardiac myocytes, thus possibly playing a role in preventing diabetes-induced intracellular Ca 2+ overload and subsequent myocardial changes.

The present study was performed to evaluate the effects of physical exercise at altitudes on serum vascular endothelial growth factor (VEGF) levels. Eight subjects underwent intensive swimming training for 21 days at 1886 m. After altitude training commenced, red blood cell (RBC) counts and erythropoietin levels increased, but both haemoglobin and haematocrit levels did not change significantly. The serum level of VEGF, measured by means of a highly sensitive chemiluminescence (ELISA), showed a transient decrease 10 days after start of the altitude training, thereafter increasing significantly to reach a peak level 19 days later, rising from 23.0 +/- 5.3 to 46.0 +/- 14.6 pg mL-1 (P < 0.05 vs. before). On return to low altitude in Japan, the level of VEGF decreased, and 1 month later had returned to initial levels. Endurance training at altitudes increases serum VEGF levels; this could be an adaptive reaction to hypoxic conditions. This result suggests that VEGF may provide a new physiological parameter for hypoxic stress imposed by high altitude training.

The acute effects of a newly synthesized thromboxane dual blocker (KDI-792), a combined thromboxane synthase inhibitor and receptor antagonist, on lower limb circulation were examined using two-dimensional color and pulse Doppler ultrasonography and laser Doppler flowmetry. A randomized single-masked, placebo-controlled trial was performed on 36 type 2 diabetic patients with minimally impaired baseline flow. The anatomical cross-sectional area (CSA), maximum flow velocity (MFV) and flow volume index (FVI) in the right dorsal pedis artery (DPA) and right femoral artery (FA) were determined by Doppler ultrasonography before and 45 and 90 minutes after the administration of either 100 or 200 mg of KDI-792 to the dose groups or placebo to the control group. Periflux blood flow (PBF) in the right foot was determined simultaneously by laser Doppler flowmetry. Both CSA and MFV in the dose groups were significantly increased in both the FA and DPA. FVI was markedly increased from 21.4 +/- 3.7 to 68.3 +/- 26.8 in the DPA (M +/- SD, P0.01) and from 365.4 +/- 35.3 to 771.7 +/- 75.7 in the FA (P0.01) in the 200 mg dose group. In the 100 mg dose group, FVI was markedly increased from 20.0 +/- 8.7 to 68.3 +/- 26.8 (P0.01) in the DPA and from 372.5 +/- 130.0 to 677.5 +/- 187.8 (P0.01) in the FA. PBF was also increased in both dose groups (from 4.15 +/- 1.4 to 7.0 +/- 4.0 ml/min/100 g tissue in the 200 mg dose group, P0.01), whereas there were no significant changes in either measurement in the control group. There were no significant changes in pulse rate or blood pressure after administration in either the dosage group or the placebo group. These and previous findings indicate that a single administration of KDI-792 markedly increases lower limb blood flow and might have a more potent vasodilating effect than that of prostaglandin I2 derivatives.

It is unclear whether the abnormal relaxation seen in diabetes is due to decreased levels of nitric oxide (NO) and how eicosapentaenoic acid (EPA, C20:5 omega 3) affects the endothelial production of NO. We investigated the effects of EPA ethyl ester (EPA-E) and elevated glucose on NO production by human endothelial cells (HUE). EPA-E (0.3 mM) significantly enhanced [NO2] production and the intracellular concentration of free Ca2+ within 3 min after EPA-E was added to the cultures. High levels of glucose (27.5 mM) significantly increased endothelial glucose, sorbitol and fructose, and inhibited [NO2-] production. However, EPA-E (0.3 mM) prevented the inhibition of [NO2-] production due to the activation of the Ca(2+)-calmodulin system of NO synthase. EPA-E decreased the glucose-mediated inhibition of NO production by HUE. These results suggest this agent might ameliorate endothelial dysfunction associated with diabetes.

The effects of extracellular Mg2+ on receptor-mediated Ca(2+)-permeable non-selective cation currents were investigated in a cultured aortic smooth muscle cell line (A7r5) from rat thoracic aorta, using the whole-cell voltage-clamp technique. Under the Cs(+)-containing internal solution, both vasopressin and endothelin-1 (100 nM) activated a long-lasting inward current with a high noise level. The reversal potential of these agonists-induced current was approximately +0 mV, and was not significantly altered by the replacement of [Cl-]i or [Cl-]o, suggesting that the inward current was a cation-selective channel. La3+ and Cd2+ (1 mM) almost completely abolished the vasopressin or endothelin-induced non-selective cation current; however, nifedipine (10 microM) failed to inhibit it significantly. Extracellular Mg2+ (3-20 mM) also markedly inhibited the vasopressin- or endothelin-induced non-selective cation current in a concentration-dependent manner. When a non-hydrolysable GTP-analogue, GTP gamma S (1 mM), was applied from the patch pipette, the non-selective cation current was gradually activated even in the absence of agonist (vasopressin or endothelin-1), probably due to the direct activation of GTP-binding proteins coupled to the receptors. Extracellular Mg2+ (3-20 mM) also suppressed the activation of non-selective cation current induced by GTP gamma S, suggesting that the inhibitory sites of Mg2+ are not located on the receptors. These results suggest that extracellular Mg2+ inhibits receptor-mediated non-selective cation current, which may contribute to the relaxation effects of Mg2+ in vascular smooth muscle cells.

The acute effects of beraprost sodium (sodium (±)-(1R ∗ , 2R, 3aS ∗ , 8bS ∗ )-2, 3, 3a 8b-tetrahydro-2-hydroxy-l-((E)-(3S ∗ )-3-hydroxy-4-methylI-octen-6-yny1] -1H-cyclopenta [b] bensofuran-5-butyrate), a stable analogue of prostaglandin I 2 which works as a vasodilator and anti-platelet agent, were investigated in patients with non-insulin dependent diabetes mellitus. Its effects on the dorsal pedis artery were examined using a new real-time two-dimensional Doppler ultrasonographic technique and by laser blood flowmetry. Before and 60 min after oral administration of beraprost sodium (Dolner ® 40 μg) and elastase (Elaszym ® 1800 U), the cross-sectional area (CSA) of the dorsal pedis artery and its blood flow index (BFI), calculated from the maximum flow velocity and area, were determined. Dermal microcirculatory blood volume (MBV) was also measured by laser blood flowmetry. In the beraprost sodium group, the CSA, BFI and MBV were significantly increased, while in the elastase group, no significant changes were observed. These result suggest that beraprost sodium has a beneficial effect on diabetic macro- and microangiopathy.

The present study was undertaken to investigate the efficacy of a new, highly purified (purity greater than 91%), ethyl esterification product from natural eicosapentaenoic acid (EPA-E, C20:5 omega 3) in patients with type II diabetes mellitus (NIDDM). Hemodynamic changes were assessed at the level of the dorsalis pedis artery using an ultrasonic color Doppler duplex system before and after oral administration of EPA-E at a dose of 1800 mg/day for 48 weeks. The cross-sectional area of the dorsalis pedis artery increased significantly from 2.5 +/- 0.2 to 3.9 +/- 0.4 mm2 (48 weeks, mean +/- SE, p < 0.05). Moreover, EPA-E improved the clinical symptom (coldness, numbness) as well as the vibration perception threshold sense of the lower extremities [from 32.1 +/- 8.5 to 16.1 +/- 4.8 (48 weeks) microns]. A significant decrease of serum triglycerides was also noted by EPA-E administration. Furthermore, significant decrease of the excretion of albumin in urine [from 24.4 +/- 3.3 to 13.9 +/- 1.8 (48 weeks) mg/g.Cr, p < 0.05]. The results of this study suggest that EPA-E has significant beneficial effects on diabetic neuropathy and serum lipids as well as other diabetic complications such as nephropathy and macroangiopathy.

Ibudilast is a prostacyclin-mediated vasodilator and antiplatelet agent. The hemodynamic effects of ibudilast were evaluated in 41 patients with non-insulin-dependent diabetes mellitus by means of two-dimensional Doppler ultrasonography and laser Doppler blood flowmetry. Before and one hour after oral administration of ibudilast (10 mg), or elastase (1800 U) as a control, the cross-sectional area (CSA) of the dorsal pedis artery, its blood flow index (BFI), and dermal microcirculatory blood volume (MBV) were measured. In the ibudilast group, all of the parameters (CSA, BFI, and MBV) significantly increased as compared with the elastase group. These data suggest that ibudilast is effective in amelio rating diabetic macroangiopathy and microangiopathy of the lower limbs.

A 67-year-old man with SIADH complicated by slowly progressing autonomic failure was described. The patient noticed constipation at the age of 57. In the following years, he suffered from urinary incontinence, depletion of sweating, impotence, sleeplessness with snore, and dizziness while walking. Physical examination revealed a masked oily face with slight cerebellar disturbance. Abnormality of autonomic function tests was recognized and he was diagnosed as Shy-Drager syndrome with gradually progressing, diffuse autonomic failure accompanied by slight cerebellar ataxia and Parkinsonism. Both serum sodium level and plasma osmotic pressure were reduced, whereas daily sodium excretion was more than 100mEq and urinary osmolality was about 500mOsm/kgH2O. His renal function was intact, and the adrenocortical and thyroid hormone levels were normal, then criteria of SIADH was fulfilled. SIADH was thought to have occurred on the basis of Shy-Drager syndrome. Water load test showed failure of adequate water diuresis, but intravenous phenytoin administration following the water load test ameliorated the diuresis to normal. The relationship between plasma osmolality and the ADH response indicates that ADH was adequately secreted in response to the increase in plasma osmolality but not suppressed in response to the decrease in plasma osmolality below 280mOsm/kgH2O. These results suggest that ADH synthesis in the hypothalamus and its secretion from the pituitary gland were both intact. The response of ADH secretion to the orthostatic hypotension induced by head-up tilt was quite blunted, being compatible with Shy-Drager Syndrome. Sleep disturbance was studied by polysomnography and laryngoscopy, and was revealed to be based upon severe sleep apnea due to incomplete paralysis of the bilateral vocal cords. Sleep apnea due to vocal cord paralysis is sometimes found to be complicated in patients with multiple system atrophy (MSA) including Shy-Drager syndrome, and is known as Gerhardt syndrome. This is the first report on a case of Shy-Drager syndrome complicated with SIADH and bilateral vocal cord paralysis. In this case, SIADH is caused by impaired afferent pathways from baroreceptors to the hypothalamus, which transfer inhibitory stimuli on ADH secretion. It is suggested that Shy-Drager syndrome should be considered one of the causes of SIADH.