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Central nervous system lomentosporiosis is a rare pathological condition in immunocompromised patients. We describe a fatal case of meningitis caused by Lomentospora prolificans (which was previously named Scedosporium prolificans), after an allogeneic hematopoietic stem cell transplantation (allo-HSCT). To our knowledge, no cases of Lomentospora meningitis following allo-HSCT have been reported previously. Particularly in neutropenic patients, it is important to consider L. prolificans when a fungal infection is suspected and antifungal agents are ineffective.

Understanding the cause of poor inkjet printing can aid in improving the technology. Furthermore, the effects of the structure of nonwoven fabrics on inkjet-printed image quality are largely unknown. Therefore, this study investigates the effect of fiber orientation and needlepunch density of nonwoven substrates on inkjet-printed line quality. The inkjet image quality was evaluated on several web structures: carded, crosslapped, and airlaid, resulting in different fiber orientations, all under varying needlepunch densities ranging from 98.6 to 197.2 penetrations per square centimeter. The resultant line quality on the nonwoven substrates was poor and under all needlepunch densities the effects of fiber orientation was found to be minimal. This indicates that other factors such as surface characteristics and not fiber orientation contribute more likely to the poor image quality.

Past statistical studies demonstrating the likelihood of slow blood flow in most ruptured aneurysms have sug gested that thrombogenesis plays an important role in ruptures of cerebral artery aneurysms. In the authors’ previous study, it was reported that the degree of platelet aggregation in an aneurysm had a significant cor relation with the flow pattern in the aneurysmal dome. It is, therefore, crucial to investigate flow structures in various different aneurysms in order to understand better the relationship between thrombogenesis and ruptures. In this study, patterns of blood flow in three models of cerebral artery bifurcation aneurysms were numerically analysed and compared to discern the likelihood of platelet aggregation. The three model aneurysms had comparable aspect ratios (depth/neck width) but one model was larger in volume than the other two. Experimentally captured images of visualised flow in one of the three models were available and the calculated flow patterns in this model were seen to agree well with the images. Strong impingements of incoming main flows against aneu rysmal necks were observed in all models regardless of the bifurcation angle and direction of the aneurysmal protrusion. These impingements presumably caused haemolysis, with ADP originating from haemolysed red blood cells inducing platelet aggregation. Dispersion of flow paths was observed only in the largest model and, consequently, fluid motion was slower than in the other two models. Thus, platelet aggregation was considered to be more active in the largest model. Validity of this discussion was confirmed by application of a platelet aggregation model, which had been proposed in the authors’ previous study. It was concluded that the volume of the aneurysmal dome had a significant influence on formation of a low-speed region, which is held to be responsible for active platelet aggregation. Geometric features such as the bifurcation angle and direction of aneurysmal protrusion are considered to be secondary factors contributing to active platelet aggregation.

Little is known about the pathology and pathogenesis of the rupture of intracranial aneurysms. For a better understanding of the molecular processes involved in intracranial aneurysm (IA) formation we performed a gene expression analysis comparing ruptured and unruptured aneurysm tissue to a control artery. Tissue samples of six ruptured and four unruptured aneurysms, and four cerebral arteries serving as controls, were profiled using oligonucleotide microarrays. Gene ontology classification of the differentially expressed genes was analyzed and regulatory functional networks and canonical pathways were identified with a network-based computational pathway analysis tool. Real time reverse transcription polymerase chain reaction (RT-PCR) and immunohistochemical staining were performed as confirmation. Analysis of aneurysmal and control tissue revealed 521 differentially expressed genes. The most significantly associated gene ontology term was antigen processing (P=1.64E-16). Further network-based analysis showed the top scoring regulatory functional network to be built around overexpressed major histocompatibility class (MHC) I and II complex related genes and confirmed the canonical pathway "Antigen Presentation" to have the highest upregulation in IA tissue (P=7.3E-10). Real time RT-PCR showed significant overexpression of MHC class II genes. Immunohistochemical staining showed strong positivity for MHC II molecule specific antibody (HLA II), for CD68 (macrophages, monocytes), for CD45RO (T-cells) and HLA I antibody. Our results offer strong evidence for MHC class II gene overexpression in human IA tissue and that antigen presenting cells (macrophages, monocytes) play a key role in IA formation.

Optimal management of cavernous sinus hemangiomas remains unclear. Total microsurgical removal of these neoplasms may be extremely difficult due to their rich vascularization. Three cases of cavernous sinus hemangioma treated with low-dose Gamma Knife radiosurgery are presented. Marginal dose varied from 10 to 13 Gy. Treatment planning and radiation dosimetry were done with a goal of conformal and selective coverage of the lesion with 50% prescription isodose line using multiisocenter technique. In all cases significant shrinkage of the neoplasm was marked at 3 months after treatment. Mean volume reduction at 12 months after radiosurgery was 60% (range: 45-75%). In all patients the shrinkage of the neoplasm was accompanied by notable improvement of the preexistent oculomotor nerve palsy. No radiosurgery-related complications were met during follow-up. In conclusion, low-dose Gamma Knife radiosurgery seems to be very effective for management of cavernous sinus hemangiomas, and can be considered as a treatment modality of choice for these lesions.

Printing textiles can be a cheaper way of incorporating different colors and designs than weaving or knitting the patterns into the fabric. Once a fabric has been prepared (see Chapter 18 ), there are a variety of printing techniques and methods that can be used to achieve the desired results. Digital inkjet printing technology is becoming increasingly important in textile printing. This chapter is a combination of technical information, design considerations, and business aspects, all of which must be taken into account when selecting designs, colors, and printing techniques for textiles.

It is generally difficult to interpret MFM images. Information about the magnetic structure of the tip apex is needed to define the origin of a detected magnetic force. Magnetic dipole interaction affecting the magnetic states of the tip and samples should be considered. In some case, however, a simple analytical method is valid. We propose a new graphical method for interpreting the MFM image contrast, which based on the interaction lines mapping around 90° and 180° domain walls. MFM images of a cross-tie wall can be explained by using the proposed methods. Gaphical drawings of the MFM images are compaed with experimental MFM images of patterned Ni80Fe20 thin films taken with a Ni80Fe20-coated tip.

This chapter discusses computer technologies used in the domain of textile design from the textile designer’s perspective. The chapter starts with a brief explanation of the history and role of CAD, CAM and CIM for textile weave, knit and print design. Then, it describes the main computer technologies, which encompass computer technologies as tools for (1) information gathering, (2) designing, (3) design editing and (4) presentation in textile design workflows. In addition, the chapter explains benefits and limitations in the textile design process from the initial design concept to final production and presentation.

Basilar artery (BA) trunk aneurysms are rare and still remain a formidable surgical challenge. The purpose of this retrospective study was to report the clinical entities and results of endovascular surgery of BA trunk saccular aneurysms. Between 1995 and 2009, 14 patients with 14 BA trunk saccular aneurysms underwent endovascular surgery. Six patients presented subarachnoid hemorrhage (SAH), three patients had another associated aneurysm which developed SAH, one patient presented with mass effect to the brain stem, and four patients were incidentally discovered. Five ruptured and seven unruptured aneurysms were successfully treated by endovascular surgery. Another one incompletely embolized aneurysm had grown to huge size five years later and the patient underwent a Hunterian ligation with a radial artery graft between the extracranial vertebral artery and the posterior cerebral artery. In one ruptured case, we attempted neck clipping, but this was abandoned because of concern for neck tearing by clipping. The aneurysm was embolized using detachable coils later. BA trunk aneurysms showed characteristic features such as so-called lateral aneurysm (43%), multiple aneurysms (43%) and four BA fenestrations (36%). The unusual high incidence of associated various vascular anomalies suggests that focal wall weakness must be based on the mechanism of aneurysm initiation on the BA trunk. Most patients presented with SAH. Pre-treatment neurological state was predictive for clinical outcome. Endovascular surgery is an effective therapeutic alternative that is associated with low morbidity and mortality rates, and should be considered the first choice treatment.

Thrombogenesis in cerebral aneurysms is considered to play an important role in rupture. It is crucial, for better rupture prediction, to scrutinize any correlation between the probability of rupture and the extent to which thrombi are generated in the aneurysm. Numerical techniques such as computational fluid dynamics (CFD) are promising tools in this area. However, there are, at present, no models that allow us to evaluate the degree of thrombogenesis in aneurysms. In this study, the process of platelet aggregation, which is the first stage of thrombogenesis, was modeled. Making reference to actual aggregation curves of human plasma for various ADP concentrations, the authors proposed an expression for the rate at which the density of aggregated platelets continues to increase. The present aggregation model was combined with CFD and applied to two model aneurysms. The present aggregation model produced distributions of aggregated platelets similar to a thrombogenesis pattern observed in an experiment. It was also shown that platelet aggregation in a model aneurysm with a smaller aspect ratio was less active.

Thrombi are often found in aneurysms and are considered to play an important role in rupture. It is crucial to scrutinise any correlation between the probability of rupture and the extent to which thrombi are generated in the aneurysm. Numerical techniques such as computational fluid dynamics (CFD) are promising tools in the biomedical field. However, there are, at present, no models that allow us to evaluate thrombus generation. The authors aim at the proposal of such a model. In the present study, the process of platelet aggregation is considered. In blood flow near the entry to an aneurysm, red blood cells are haemolysed due to high shear stress or high pressure. The ensuing release of adenosine diphosphate (ADP) induces the aggregation. Making reference to actual aggregation curves of human plasma for various ADP concentrations, the authors have modelled the rate at which the density of aggregated platelets continues to increase in the aggregation process. A combination of CFD and the present model enables us to obtain the distribution of platelets clotting in an aneurysm.

In the CDMA digital mobile communication network the system timing of the base stations are generated by referring the clock signals to CPS satellites. To keep precise system timing, the GPS receivers must constantly receive the radio waves from the satellites constantly. It is, however, impossible to receive the radio wave in a long term by the receiver location or the failure of the RF circuits. In those cases, the reliability of the communication system will be degraded because of the drift, such as aging, of the system clock in the receiver. This paper describes a technique, based on the wavelet transform, which reduces the frequency drift of the master oscillators in the GPS receivers when the carrier signals could not receive. By simulations and experiments, we have achieved that the phase error is less than 10 /spl mu/s within 48 hour period without GPS signals, demonstrating the efficiency of the proposed technique.

We performed a retrospective clinical study to estimate the morphological index such as aspect ratio (aneurysm depth/neck) and area ratio (ratio of the cross-sectional area of bifurcated arteries) of 64 cases with saccular aneurysms (ruptured aneurysms: 41, unruptured aneurysms: 23) at the bifurcation of the middle cerebral artery (MCA) and made a flow visualization study using a flat three dimensional acrylic aneurysm model to define the flow characteristics in conditions similar to those obtained from the clinical study. The mean aspect ratio and area ratio of the ruptured and unruptured aneurysm cases were 2.81 +/- 1.45, 2.52 +/- 0.91 and 1.56 +/- 0.59, 1.73 +/- 0.38. These respective values differ statistically. The area ratio of the MCA bifurcation with no aneurysm was 1.25 +/- 0.35. This value was also statistically different from the ruptured aneurysm case. The visualization study was performed changing the neck size and flow ratio into the peripheries to simulate various aspect ratio and flow ratio into peripheries. The results showed that intraanerysmal flow was definitely influenced by aspect ratio and area ratio. The aspect ratio over 2.0 and area ratio below 2.0 failed to drive the inflow inside the aneurysms and developed as a stagnant area in the dome side. The morphological index of aspect ratio and area ratio reflected the flow characteristics in the aneurysm and was statistically different in ruptured and unruptured aneurysm cases. The unruptured aneurysms with an aspect ratio of more than 1.6 and an area ratio of more than 2.0 must be followed up, because of the risk that they might rupture in the near future.

A rare operative case of thrombosed arteriovenous malformation (AVM) in the brain stem was reported focusing on its differential diagnosis from cavernous malformation. A 49-year-old woman had developed pontine hemorrhage twice during the last two years. She was diagnosed by neurologists as having cavernous malformation in the brain stem, and then referred to our institute. Neurological examinations showed left hemi motor and sensory disturbance, right abducent palsy and right auditory disturbance. A computed tomography (CT) scan revealed a high density mass in the brain stem considered as a hematoma with slight enhancement. Magnetic resonance imaging (MRI) revealed a high intensity mass in T1 and T2 weighted MRI with marginal hemosiderin rim, but neither flow void sign nor enhancement effect was detected. Angiography depicted no abnormal vasculature in the posterior fossa. The patient underwent surgical resection of the lesion 43 days after a second hemorrhage. Midline sub-occipital craniotomy and the infrafacial route were chosen. Surgery was troubled by arterial bleeding, and pathological examination revealed a thrombosed AVM. She newly developed right facial palsy, right abducent palsy and disturbance of right conjugate gaze, but she is recovering step by step. Although the radiological feature of thrombosed AVM in the brain stem is similar to that of cavernous malformation, the operative procedure for thrombosed AVM is very difficult due to aggressive arterial bleeding that easily leads to surgical injury in the small surgical corridor in the brain stem. We reported a rare case that was pathologically well identified as thrombosed AVM in the brain stem focusing on its differential diagnosis and surgical treatment.

We described a case of cerebellar hemorrhage after trapping of a vertebral artery dissecting aneurysm. A forty-eight-year-old man had suffered from severe headache, vomiting and disturbance of consciousness. He was transferred to our hospital in an ambulance. Emergency CT scan showed subarachnoid hemorrhage in the posterior fossa predominantly, intraventricular hemorrhage and hydrocephalus change. Chest X-ray showed radiological evidence of pulmonary edema. The initial blood-gas determinations demonstrated a marked reduction in PaO2 and increased PaCO2. Five days after admission, the patient's condition was improving. Cerebral angiography was performed using the Seldinger method. It revealed a right vertebral artery dissecting aneurysm just distal to the posterior inferior cerebellar artery. We performed an operation to trap the VA dissecting aneurysm. Blood pressure was well controlled under 140 mmHg during the operation and he recovered from anesthesia completely. On the day after the operation, suddenly the patient's consciousness began to deteriorate. Emergency CT scan was performed and it showed SAH, cerebellar hemorrhage and diffuse swelling of the cerebellum on the same side as the operation. We suspected rebleeding of the aneurysm due to a clip's having slipped. Reoperation was performed, but the clip was not displaced and there were no definite bleeding vessels on the operative field. Consequently only external decompression and resection of the right cerebellum were performed. We discuss pathogenesis of the occurrence of hemorrhage in this particular case after trapping. We also review the relevant literature.

Subarachnoid hemorrhage (SAH) due to non-traumatic dissecting aneurysms is uncommon. Most of such cases are reported to occur in the posterior circulation. We encountered three cases of non-traumatic dissecting aneurysms on the intracranial internal carotid artery. Two cases developing SAH from the dissecting aneurysms were surgically treated by such means as proximal ligation and trapping. Two cases, which were treated surgically during the acute phase, showed poor surgical outcome, because a large cerebral infarction took place during the course of vasospasm. Trapping of the ICA or the contralateral ICA with the dissecting aneurysm failed to keep enough blood supply despite hypervolemic hypertensive therapy. Operative results seemed to depend on the collateral circulation during vasospasm, so appropriate bypass surgery was recommended in cases of dissecting aneurysm on the ICA manifesting SAH. Furthermore, the mechanism of initiation of a dissecting aneurysm on the intracranial carotid artery was discussed from the biorheological aspect.

The frequency of infection in recipients of allogeneic bone marrow transplants (BMT) who received oral new quinolones (NQ) was compared with that in BMT recipients who were given oral vancomycin/tobramycin (V/T). Between 1984 and 1997, our hospital treated 79 patients with V/T and 90 patients with NQ. Number of febrile days, duration of intravenous antibiotics administration, and frequency of documented infections were statistically the same for both groups. However, the frequency of grampositive bacterial infections, especially staphylococcal infections, was slightly higher in patients receiving NQ than in patients receiving V/T (p = 0.12). Of the patients who received NQ, those who underwent unrelated donor BMT procedures were generally febrile for slightly longer periods than those who underwent related donor BMT procedures (p = 0.10). These results suggest that oral NQ is as effective as oral V/T for the prevention of serious gramnegative bacterial infections in patients who undergo BMTs.

Sixty-two episodes of fungemia which occurred in patients with hematological disorders between 1976 and 1996 in our hospital were analyzed with respect to background and prognostic factors. Forty-four of the patients were male and 18 were female. The underlying diseases were acute leukemia in 36 cases, chronic myelogenous leukemia in 9, malignant lymphoma in 9 and others in 8 cases. Trichosporon beigelii and Candida tropicalis were the most frequently isolated fungal pathogens. The prevalence of C. crusei increased while that of C. albicans decreased after 1988. Fuungemia frequently occurred in patients with following factors: 1) advanced disease, such as relapse of acute leukemia or malignant lymphoma or blast crisis of chronic myelogenous leukemia; 2) neutrophil count less than 100/microliter; 3) administration of antibiotics; 4) focal infection, gastrointestinal hemorrhage or urinary catheterization; and 5) isolation of causative organisms from surveillance cultures obtained just before the onset of fungemia. The mortality rate of patients with fungemia was 74%. Absence of hypotension, increased neutrophil count for a week after the onset of fungemia, and the intravenous administration of Amphotericin B (AMPH) were good prognostic factors. Fungemia frequently occurred in patients with advanced disease and had a very poor prognosis. These results emphasized the importance of isolation of fungus from surveillance cultures, early initiation of AMPH administration, and attempts to increase neutrophil counts with G-CSF and other measures for improving the prognosis of fungemia in patients with hematological disorders.

The ischemic area surrounding the cerebral infarction in the eloquent area was salvaged by STA-MCA bypass surgery. Both the misery perfusion area evaluated by positron emission tomography (PET) using the [15O] gas inhalation steady-state method and clinical symptoms improved within a year after surgery. To confirm the ischemic area and select the suitable recipient artery was important for successful bypass surgery, because only an artery covering the ischemic area is expected to have low resistance. In this case a large ischemic area with disturbed, vasodilatation by Diamox was detected on the SPECT. However, PET clearly exposed the localized misery perfusion area in the overestimated ischemic area by SPECT. We describe our experience and discuss the technique and efficacy of PET for STA-MCA anastomosis surgery.

The patient was a 72-year-old man who underwent operation for bilateral pneumothorax due to rupture of cystic lung lesions. Two months after the operation, intrathoracic bleeding redeveloped. The patient developed a tumor on his head. Pathological examination of the scalp lesion revealed cutaneous angiosarcoma. A biopsy of thickened pleura showed that the bleeding was due to pleural metastatic angiosarcoma of the skin. The multiple cystic lesions were considered to be metastases of angiosarcoma. We conclude that pneumothorax or hemothorax in the elderly should be differentiated from malignant metastatic lung tumor. Cystic lung lesions should be considered as possible metastatic angiosarcoma from the skin.

We developed a new procedure to close the entry of dissecting aneurysm in acute stage with a specially designed cylinder-shaped balloon catheter. The balloon catheter consists of 7F double lumen catheter and a silicone rubber balloon at the tip. The balloon has a central tube 14 mm caliber made of rigid silicone and it inflates into the shape of a cylinder with an injected solution. The central tube serves as a route for maintaining the aortic blood flow to the distal site. The catheter with a deflated balloon is inserted into the thoracic aorta ascendingly through a 14 or 16 mm caliber Dacron vascular graft sutured at the side of the distal aorta in a similar manner to intra-aortic balloon pumping. The tip of the catheter is carried to the entry tear of the pseudo-lumen. Then the cylinder-shaped balloon is inflated with solution. The entry is, therefore, closed with the side wall of the balloon and the blood stream into the dissected lumen is occluded while maintaining an aortic blood flow to the distal site. To prevent any possible occlusion due to thrombosis, some type of anticoagulant is administered via the catheter connected to a continuous injector. The healing process of the dissected lumen can be enhanced by injecting some type of coagulant directly into the lumen. The treatment is completed when the blood in the false lumen coagulates and stabilizes. The cylinder-shaped balloon is then deflated and the catheter withdrawn. The graft is removed and the stump is sutured.(ABSTRACT TRUNCATED AT 250 WORDS)

We report three cases of ruptured cerebral aneurysms associated with systemic lupus erythematosus (SLE). A 52-year-old woman (case 1) with a fifteen-year history of systemic lupus erythematosus suddenly lost consciousness. She was admitted in a state of deep coma. A computed tomography (CT) scan revealed acute hydrocephalus and diffuse subarachnoid hemorrhage in the basal, interhemispheric and bilateral Sylvian cisterns. Fifteen years prior to this admission, cerebral angiograms demonstrated no cerebral aneurysm. She underwent ventricular drainage immediately. Postoperatively, her condition did not improve, and she died on the 18th day. During the autopsy, two saccular cerebral aneurysms were found: one aneurysm was at the right middle cerebral artery bifurcation, and another one was on the anterior communicating artery, which had disruption of the internal elastic lamina and medial smooth muscle, and infiltration of inflammatory cells. In the major cerebral arteries, for example the bilateral internal carotid arteries, disruption or dissection of the internal elastic lamina, intimal fibrosis and transmural infiltration of inflammatory cells were observed. The second patient, a 36-year-old woman with a six-year history of SLE, was admitted to our hospital with sudden severe headache. A CT scan showed subarachnoid hemorrhage, and cerebral angiograms disclosed saccular cerebral aneurysms on the anterior communicating artery and the left superior cerebellar artery, and a fusiform one on the left posterior cerebral artery. Surgery was not recommended because of her multiple medical problems. Her consciousness improved gradually over 2 months. She was transferred to the department of internal medicine for treatment of renal failure.(ABSTRACT TRUNCATED AT 250 WORDS)

Progressive systemic sclerosis (PSS) commonly involves the esophagus. Dysphagia and heartburn are the most common esophageal symptoms. In this study we evaluated the relationship between esophageal symptoms and esophago-gastric motility. On esophageal manometry, loss of peristalsis, peristaltic contraction amplitude of distal esophagus less than 30 mmHg and decreased LES pressure were critical for esophageal symptoms. The degree of symptoms correlated to esophageal dysmotility. The gastric emptying in PSS patients was delayed, but there was no significant difference in gastric emptying between the patients with and without reflux esophagitis. Esophageal dysmotility is considered to be much responsible for the reflux esophagitis in PSS patients than gastric emptying.