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This paper presents an adaptive frequency Phase locked loop (PLL) based approach for grid connected multifunctional inverter is presented for residential applications. The proposed control structure deals with non-linear loads and also non ideal grid voltages like magnitude variation, frequency variation, unbalance harmonics, etc. and can effectively address the DC offset in a voltage signal which in turn improves the power quality. A third order generalized integrator based PLL with adaptive frequency and DC offset elimination blocks will effectively deal with the power grid voltage fluctuations, frequency variations and eliminate the phase difference between PLL output. This approach is implemented as control algorithm for single-stage single-phase grid connected multifunctional inverter topology for PV applications which feeds energy to the grid. The Maximum Power Point Tracking is obtained by Perturb & Observe method for extracting maximum power from a Photovoltaic system. A detailed analysis with the proposed control technique is presented in this paper. Experimental tests are conducted at various operating conditions to describe and verify the performance of the proposed control using MATLAB / Simulink.

Evidence for a large-scale supergalactic cosmic-ray multiplet (arrival directions correlated with energy) structure is reported for ultra-high-energy cosmic-ray (UHECR) energies above 1019 eV using 7 years of data from the Telescope Array (TA) surface detector and updated to 10 years. Previous energy–position correlation studies have made assumptions regarding magnetic field shapes and strength, and UHECR composition. Here the assumption tested is that, because the supergalactic plane is a fit to the average matter density of the local large-scale structure, UHECR sources and intervening extragalactic magnetic fields are correlated with this plane. This supergalactic deflection hypothesis is tested by the entire field-of-view (FOV) behavior of the strength of intermediate-scale energy–angle correlations. These multiplets are measured in spherical cap section bins (wedges) of the FOV to account for coherent and random magnetic fields. The structure found is consistent with supergalactic deflection, the previously published energy spectrum anisotropy results of the TA (the Hotspot and Coldspot), and toy-model simulations of a supergalactic magnetic sheet. The seven year data posttrial significance of this supergalactic structure of multiplets appearing by chance, on an isotropic sky, is found by Monte Carlo simulation to be 4.2σ. The 10 years of data posttrial significance is 4.1σ. Furthermore, the starburst galaxy M82 is shown to be a possible source of the TA Hotspot, and an estimate of the supergalactic magnetic field using UHECR measurements is presented.

A chrysotile disc is proposed as the fundamental seed structure for the formation of chrysotile asbestos fibres, polygonal serpentine fibres and polyhedral lizardite spheres. The curvature, fivefold symmetry and hydrogen-bonding alignment of the layers in the seed disc control the formation of the 15 or 30 sectors in polygonal serpentine and the orientations of the planar arrays of 15 or 30 radial crystals in polyhedral serpentine. A polygonized disc precursor to polygonal fibre formation has been observed at an arrested stage of growth in a synthesis experiment.

Recent activities of projection X-ray microscopy in Japan are reviewed. 1) By employing high brightness Schottky electron gun, resolution of 0.1 µm is realized by Tohken CO. group and some application examples are shown. 2) Deblurring of Fresnel diffracted image formed by synchrotron orbital radiation (SOR) X-rays is successfully tried by Chiba University group. Remarkable Fresnel fringes appearing at HeLa cell are mostly reconstructed by an iteration method. 3) Element analysis is carried out by Meiji University group utilizing absorption-edge characteristics between two kinds of X-ray targets without X-ray spectrometer. Actually, Cu and Ni targets are used with an inter-changeable system for elemental analysis of Fe2O3 particles and iron component in a mosquito larva.

Detached deuterium recombining plasma has been generated in the toroidal divertor simulator. The electron temperature (0.1–0.4 eV) and density (∼10 18 m −3 ) in the detached plasmas were evaluated with a spectroscopic method using a series of deuterium Balmer line emission from highly excited levels and the Stark broadening of D(2–12). We have investigated the role of volume plasma recombination through Electron–Ion Recombination (EIR) and Molecular Activated Recombination (MAR) processes. Moreover, the carbon erosion in the detached deuterium plasma has been studied with a weight loss method. It is found that deuterium neutrals generated by EIR process could have strong influence on the carbon chemical erosion.

We present density measurements from the application of interferometry and Fourier transform fringe analysis to the problem of nonstationary shock wave reflection over a semicircular cylinder and compare our experimental measurements to theoretical results from a CFD simulation of the same problem. The experimental results demonstrate our ability to resolve detailed structure in this complex shock wave reflection problem, allowing visualization of multiple shocks in the vicinity of the triple point, plus visualization of the shear layer and an associated vortical structure. Comparison between CFD and experiment show significant discrepancies with experiment producing a double Mach Reflection when CFD predicts a transitional Mach reflection.

We construct a magnetic type of transmission photoemission electron microscope (PEEM) which is similar in principle to a magnetic type of transmission X-PEEM called zooming tube developed by Hamamatsu Photonics. We aim to realize higher resolution and much remarkable compactness by optimized electron optical designs. The objective has lens parameters, Cs=8mm , Cc=7mm, fo'=8mrn, potential for photocathode Vp=-15-16kV and electric field strength in front of photocathode 5000V/mrn. The microscope is tested by various operation modes: TEM, X-PEEM(X-rays from Au-target and from BL12A at PF), UV-PEEM(He-Cd laser). A Chevron type of MCP is mainly used as the image detector besides a fluorescent screen. TEM mode shows fairly high resolution better than 40non The resolutions of X-PEEM and tJV-PEEM deteriorate as compared with TEM case showing a level of 200nm It is proved with biological samples that the microscope has wavelength-scan capability as expected, showing fairly high image quality.

A single crystal of natural zircon which is sliced to have (010) basal plane and thinned by ion thinning is electron microscopically observed after slow neutron irradiation to ascertain whether channeling of the nuclear fission fragments is taking place or not. A fairly large number of the induced fission tracks are recognized at low magnification images where a considerable number of them are parallel to low-index lattice planes such as 100, 001, 101, 301, 103 though their directions changed some time up to several degrees. High resolution images of fission tracks often show a variety of zigzag passing of the tracks along low-index lattice planes in atomistic level. The rate of the tracks which are parallel to these low-index lattice planes is fairly high as about 45% which strongly suggests that channeling of the fission tracks is taking place.

Study DesignThis study analyzed biomechanical characteristics of the cervical spinal cord, especially in relation to neck flexion. Intramedullary pressure was measured in different neck positions.ObjectivesThe results provided a rationale for dynamic changes in intramedulary pressure, with the flexe

The recognition of abnormalities relative to the lobular anatomy has become increasingly important in the diagnosis and differential diagnosis of lung abnormalities at clinical routines of CT examinations. The purpose of this study is to analyze microstructure of the lobular anatomy with isotropic spatial resolution in the range of several micrometers to quantitatively describe relation between the architectures and abnormalities. Recent commercial micro CT scanners play a vital role in imaging the lung micro-architectures. However, only a limited number of attempts have been conducted because of difficulties to image the secondary pulmonary lobule beyond the scan field of view and the limited contrast lung parenchyma. This paper demonstrates the ability of synchrotron radiation micro CT (SRμCT) using offset scan mode in microstructural analysis of the secondary pulmonary lobule. The inflated and fixed lung specimen was imaged with resolution of 5.87x5.87x5.87 μm3 by using offset scan mode of the SRμCT (15 keV) at the synchrotron radiation facility (SPring-8). The 3-D SRμCT image which was stacked 2624 slices (each slice:7287x7287 voxels) covered the secondary pulmonary lobule being included in the lung specimen. A proper threshold value for appropriate segmentation was interactively determined to the volume of interest representing the secondary pulmonary lobule. Following transformation of the segmented binary image to a skeletonized surface representation, each voxel was classified as a curve, surface, or junction. The interlobular septa region was extracted interactively by using the voxel classification result which offered geometrical information. Each component of lobular airway, artery, and vein were extracted by using a seeding technique, considering equal attenuation values and connectivity. The resulting volumetric image from the SRμCT using offset scan mode made 3-D microstructural analysis of the lobular anatomy possible.

The latest generation of nano computed tomography (nano-CT) systems with sub-micrometer focus X-ray source is expected to yield non-invasive imaging of internal microstructure of objects with isotropic spatial resolution in the range of hundreds nanometers. Most recently commercial systems have become available for purchase. The quantitative characterization of the performance of nano-CT systems is important for evaluating the accuracy of size and density measurements of fine details in nano-CT images. The point spread function (PSF) and modulation transfer function (MTF) are calculated most commonly from the measurement of thin wire phantom for measuring the spatial resolution of clinical CT systems. However, a consistent method for describing the spatial resolution of nano-CT has not been utilized due to the requirement of a nanowire which is a wire of diameter of the order of tens of nanometers. This paper presents a method to characterize the spatial resolution in x/y-scan plane (transversal orientation) of nano-CT systems using a relatively large microwire in the PSF measurement. In this method, the MTF computed from the PSF is estimated on the basis of a two-Gaussian PSF model. Experimenting with microwire images with three different diameter sizes (3μm, 10μm, 30μm) obtained by the synchrotron radiation CT, we demonstrate the potential usefulness of the method for describing the spatial resolutions of nano-CT systems.

症例は,64歳の男性.主訴は,便秘と下血.大腸内視鏡検査にて,S状結腸に直径約1cmのIIc+IIa型の病変が発見され,陥凹型大腸早期癌と診断された.生検標本で高分化腺癌と診断され,S状結腸部分切除術(R2)を施行した.肉眼診断では,13mm×10mmのIIc+IIa,深達度SM,S0,N0,H0,P0でstage Iと診断された.組織学的検討では,高分化腺癌,ly0,v0,n1,中心の陥凹部で深達度smのIIa+IIc型大腸早期癌と診断され,腺腫成分は認められず, de novo癌と考えられた.術後経過は良好で,現在外来にて経過観察中である.近年,本症例のような陥凹型もしくは扁平隆起型の大腸早期癌が発見されるようになってきている.これらの症例の集積によって大腸早期癌の病理学的背景や大腸癌の組織発生そのものの解明に役立つものと期待される.

A 10-day-old male neonate was admitted with bilious vomiting and gross hematochezia. Peripheral eosinophilia, delayed positive skin prick test to artificial milk, and elevated eosinophil cationic protein levels suggested cow's milk allergy. Fluid infusion with prohibition of oral intake improved the digestive symptoms. Breast-feeding was resumed on hospital day 3 and only casein hydrolysate formula was fed from day 7 onward. Nevertheless, eosinophilia and elevated transaminase levels developed on day 14. Liver dysfunction associated with casein hydrolysate formula was suspected and the infant was transferred to soy formula. Eosinophil counts decreased and transaminase levels were normalized on day 19. A cow's milk protein-specific lymphocyte proliferation test was positive for alpha-casein, beta-lactoglobulin, and bovine serum albumin, indicating sensitization of T cells to cow's milk proteins. These observations suggest that careful attention should be paid to liver dysfunction in non-immunoglobulin E-mediated cow's milk allergy, even when hypoallergenic formula is used.

Micro-electro discharge machining (MEDM) using water as a working fluid, with its advantages of high removal rate and low electrode wear without formation of carbonaceous material, for deep micro-hole drilling with large ratios of depth to diameter is applied to the fabrication of narrow slits used for ultra-violet spectrometers. The optimum condition for narrow slit fabrication is investigated concerning the electric discharge circuit and combinations of electrode, workpiece materials and electrode polarity. As a result, it is possible to fabricate fine slits as narrow as 20 μm wide and 3 mm long with fairly fine surface roughness of around 1 μm. Comparative estimation with an optical diffraction method shows that slits made by MEDM and commercially available ones made by photoetching are both of the same level in quality as determined from the higher order spots of the diffraction pattern. The MEDM method is superior to photoetching in fabricating finer and more accurate slits much faster.

Our purpose is to clear whether the interferential current (IFC) method is useful for information transmission of a myoelectric prosthetic hand to the user. IFC stimulation is composed of two AC output waves. In previously, we demonstrated that IFC method using the two waves with different frequencies could vary the intensity of perceived stimulus. In the present study, we evaluated that the relationship between a movement of position of perceived stimulus and IFC method, using two waves with the same median frequency and a different phase. Moreover, we investigated the effects of a distance of recording electrodes from stimulating electrodes on a degree of interference of IFC with EMG signals. The movement of position of perceived stimulus was caused by the phase difference changing. IFC interfered with EMG signals. Especially, the interference of IFC with EMG of the muscle under stimulating electrodes was large. In contrast, when recording electrodes was distant from the stimulating electrodes, the interference of IFC was small. Moreover, the interference was eliminated by the low-pass filter (500Hz). These results support the usefulness of a combination of the IFC method with EMG recording system equipped with the low-pass filter as a sensory feedback system for myoelectric prosthetic hand.

Foetal undernutrition may have important role in adult insulin resistance and diabetes but insulin kinetics in very early life has not been well studied. The present study was undertaken to determine insulin levels in low birth weight neonates and compare with the levels in normal weight and high birth weight neonates.Ten 7 day old children each of low birth weight (2500 g, Group 1), normal birth weight (2500-3500 g, Group 2) and high birth weight (3500 g, Group 3) selected successively over a period of one month were studied. All children were normally delivered at full term and were not suffering from any major illness. Detailed anthropometry was performed, a 6 h fasting blood sample was obtained for blood glucose, lipids, insulin and C-peptide estimation; 60 min after an intravenous glucose load a second sample was obtained for glucose and insulin. Insulin resistance was calculated using the homeostasis model assessment (HOMA).Levels of total cholesterol, triglycerides, low density and high density lipoprotein cholesterol and glucose were not significantly different in the three groups. Mean fasting and post-glucose load insulin levels (microU/ml) were 2.78 +/- 2.23 and 3.28 +/- 2.04 in Group 1, 1.67 +/- 1.20 and 2.60 +/- 2.32 in Group 2 and 3.37 +/- 2.08 and 4.40 +/- 3.05 in Group 3 and fasting C-peptide levels (microg/ml) were 0.296 +/- 0.22, 0.208 +/- 0.09 and 0.327 +/- 0.23 respectively. There was no inter-group difference in insulin-glucose ratio, insulin levels adjusted for ponderal index and HOMA indices. A significant inverse quadratic correlation (U-shaped curve) of body weight with insulin (fasting and post-glucose) and C-peptide levels was observed (P0.05).Both low and high birth weight term neonates have high fasting and post-glucose insulin levels. This U-shaped trend suggests influence of foetal undernutrition (environmental) as well as genetic factors in these children.

Shock wave reflection over a rotating circular cylinder is numerically and experimentally investigated. It is shown that the transition from the regular reflection to the Mach reflection is promoted on the cylinder surface which rotates in the same direction of the incident shock motion, whereas it is retarded on the surface that rotates to the reverse direction. Numerical calculations solving the Navier-Stokes equations using extremely fine grids also reveal that the reflected shock transition from RRdouble right arrowMR is either advanced or retarded depending on whether or not the surface motion favors the incident shock wave. The interpretation of viscous effects on the reflected shock transition is given by the dimensional analysis and from the viewpoint of signal propagation.

It was examined that the effect of beta-mercaptoethanol and dithiothreitol treatments, which should affect disulfide bond formation of proteins, on cellular protein components of Bacillus subtilis. In LB medium, the treatments induced the synthesis of a 50 kD protein (P50), which is synthesized constitutively under normal growth condition and is a major cytoplasmic protein. P50 was also induced by heat shock, but not by sporulation. In Schaeffer's sporulation medium, however, P50 was not induced by the sulfhydryl-reducing agents. This suggests that the sulfhydryl-reducing agent-inducibility of P50 might depent on specific physiological condition(s). The amino terminal sequences of two of the four main V8 protease fragments of P50 were determined. A search in databases revealed that P50 was highly homologous to protein synthesis elongation factor Tu of B. subtilis.

Image resolutions of previous so called “micro-focus” X-ray systems have been improved down to one micron from about 10 microns, but have stopped short the sub-micron resolution required in scientific fields. Development of a new X-ray inspection microscope is presented, having a vast improvement in image resolution by reducing X-ray source spot size below 0.4-microns. Resolution of final image is highly improved by the small bright X-ray spot source at the X-ray generating target. Key technological features and specifications are presented, along with discussion of the engineering obstacles overcome.

It is well known that the transition criterion nearly agrees with the detachment criterion in the case of strong shocks, two-dimensional, and pseudosteady flow. However, when the shock wave diffracts over a wedge whose angle is below the detachment criterion, that is, in the domain of Mach reflection, precursory regular reflection (PRR) appears near the leading edge and as the shock wave propagates, the PRR is swept away by the overtaking corner signal (cs) that forces the transition to Mach reflection. It is clear that viscosity and thermal conductivity influences transition and the triple point trajectory. On the other hand, the reflection over concave and convex wedges is truly unsteady flow, and the effect of viscosity and thermal conductivity on transition and triple point trajectory has not been reported. This paper describes that influence of viscosity over convex and concave corners investigated both experiments and numerical simulations.

Shock wave interaction with a rotating circular cylinder is numerically and experimentally investigated. It is shown that the transition from regular reflection to Mach reflection on the lower surface of a rotating cylinder where cylinder motion is the same as the incident shock motion, is more quickly promoted than that on the upper surface. Numerical calculations solving the Navier-Stokes equations using extremely fine grids further reveal that the reflected shock transition from RR yields MR is either advanced or postponed depending on whether or not a surface motion favors the incident shock wave.

We experienced a rare case of leptomeningeal melanomatosis. The proliferative activity and nuclear accumulation of p53 in this tumor were examined, since the relationship between this tumor type and growth has not yet been elucidated. A 33-year-old Japanese man was shown to have leptomeningeal melanomatosis with multiple cutaneous pigmented nevi. The autopsy findings showed the presence not only of benign diffuse melanosis of the leptomeninges but also of leptomeningeal melanomatosis in the subarachnoid space and brain parenchyma. In the brain parenchyma, the direct invasion of tumor cells from the subarachnoid space and Virchow-Robin spaces filled with melanoma cells were observed. Multiple hemorrhagic areas invaded by melanoma cells were also present. Immunohistochemical staining with a monoclonal antibody to melanoma cells showed positivity in the tumor cells. Proliferation analysis using the MIB-1 antibody demonstrated that the labeling index of tumor cells invading brain parenchyma (2.54%) was higher than that in other lesions of the inner (0.89%) and outer layer (0.76%) of the subarachnoid space. Nuclear accumulation of p53 protein was rarely seen in the tumor cells. We reported a case of leptomeningeal melanomatosis. Higher proliferative activity was found in invading cells of the brain parenchyma. Malignant transformation of the tumor did not appear to be associated with p53 gene mutation.

Hepatocyte growth factor (HGF) induced apoptosis and decreased the DNA synthesis in Hep G2 cells. In the HGF group interleukin-1β converting enzyme, ornithine decarboxylase (ODC) activity and intracellular polyamine concentrations were increased compared to those of the control group. Administration of the ODC inhibitor decreased polyamine concentration, and inhibited apoptotic changes in the cells. These changes were reversed by exogenous addition of polyamine. These findings suggest that one of the mechanisms by which HGF exerts its antiproliferative effect is induction of apoptosis and that increase in intracellular polyamine concentration may be one of the triggers of cell death.

In cervical radiculopathy, neurological findings for the upper extremities and the responsible level of the radices have been precisely detailed. However, in cases of cervical spondylotic myelopathy, it is not always easy to determine the responsible level of the cervical spine solely based on neurological findings. To disclose characteristic neurological lesions of the upper extremities, if any, for different locations of disc disease, 49 patients with cervical disc protrusion at single levels, confirmed by magnetic resonance imaging, were analyzed. Thirty-six patients demonstrated long tract signs (LTS) concomitant with segmental signs in the upper extremities, and 13 patients had no LTS. Except for deep tendon reflexes and the extent of dysesthesia in the upper extremities, there were no characteristic neurological findings, such as muscle atrophy, loss of muscle strength, extent of hypalgesia, or hypesthesia, pointing to the responsible compression site. In the 13 patients without LTS, the extent of dysesthesia and diminution of deep tendon reflexes proved to be completely in agreement with results for radiculopathy: 9 had protruded discs at the C56 level and described dysesthesia in the thumb and the index finger with deep tendon reflexes in the biceps and brachioradialis being diminished. The remaining 4 had protruded discs at the C67 level and described dysesthesia in the middle finger. Their deep tendon reflexes in the triceps were diminished. A clear contrast was observed for the patients with LTS. Four out of 36 patients had C34 protruded discs and did not complain of dysesthesia in any digits. Their deep tendon reflexes were exaggerated in all muscles in the upper extremities.(ABSTRACT TRUNCATED AT 250 WORDS)

We studied the protective effect of human macrophage colony-stimulating factor (M-CSF) of fungal infection due to systemic aspergillosis in normal mice. We also examined the effect of M-CSF against the activities of mouse peritoneal macrophage which were relating to the phagocytosis, the killing, the production of superoxide after contacting with phorbol myristate acetate and the production of nitric oxide after contacting with interferon-gamma in vitro. M-CSF improved the median survival time and the survival rate of systemic aspergillosis. Combination therapy with M-CSF and amphotericin-B (AMPH-B) showed the therapy with either M-CSF or AMPH-B alone. M-CSF enhanced the activities of phagocytosis and the killing of ingested Candida albicans H and spores of Aspergillus fumigatus K by macrophage. Furthermore, M-CSF promoted the production of superoxide and nitric oxide in macrophage. These results indicate that M-CSF can enhance the fungicidal activity of macrophages by activation in vivo, thereby preventing the dissemination of fungal infection.

We studied the protective effect of human macrophage colony-stimulating factor (hM-CSF) on fungal infection due to systemic candidiasis in vivo and the activities of macrophages in vitro, in order to demonstrate the usefulness of M-CSF on fungal infection. The effect of hM-CSF on systemic candidiasis was examined by using normal and immunosuppressed mice. In addition, the effects of hM-CSF on the activity of reticuloendothelial system (RES) organ and on the phagocytic activity and NBT reduction activity of mouse macrophage were also examined in vitro. HM-CSF improved the survival rate of systemic candidiasis in both normal and immunosuppressed mice. Combination therapy with hM-CSF and fluconazole showed higher survival rate more than in the therapy with either hM-CSF or fluconazole alone. Furthermore, hM-CSF enhanced the activity of RES organ, phagocytosis by macrophages and NBT reduction by macrophages, significantly. These results indicate that hM-CSF enhances the phagocytic cactivity and candicidal activity by macrophages in vivo, thereby preventing dissemination of fungal infection.

I examined the effects of intracellular pH (pHi) and the growth factors, epidermal growth factor (EGF) and human hepatocyte growth factor (HGF), on DNA synthesis in non-regenerating hepatocytes, regenerating hepatocytes and hepatoma cells. Non-regenerating and regenerating hepatocytes were isolated from the livers of intact adult rat and of the adult rat 24 hours after 70% hepatectomy, respectively. Hep G2 cells, a human hepatoma cell line, was employed as hepatoma cells. Regenerating hepatocytes and Hep G2 cells, but not non-regenerating hepatocytes displayed increased DNA synthesis with increasing pHi in the absence of EGF and HGF. However, non-regenerating hepatocytes displayed little increase, regenerating hepatocytes displayed substantial increase in DNA synthesis with increasing pHi in the presence of EGF or HGF. In contrast, Hep G2 cells displayed decreased DNA synthesis in the presence of HGF but not EGF. These findings indicate that pHi influences the fashion of proliferation in hepatocytes and cancer cells. EGF and HGF stimulate DNA synthesis in hepatocyte and inhibit that in cancer cell, suggesting that increasing pHi and administration of these growth factors may be one of the effective treatment for hepatoma.

This study analyzed biomechanical characteristics of the cervical spinal cord, especially in relation to neck flexion. Intramedullary pressure was measured in different neck positions.The results provided a rationale for dynamic changes in intramedullary pressure, with the flexed neck position playing a role in syrinx growth.Dynamic changes in intramedullary pressure in the flexed position have been postulated to play an important role in syrinx growth. However, intramedullary pressure of the spinal cord has not been measured.The authors designed a balloon method to assess, experimentally, intramedullary pressure dynamics of the spinal cord. A system was incorporated to examine the reliability of the balloons. Using 15 mongrel dogs, two balloons were embedded in the cervical spinal cord. Intramedullary pressure of the spinal cord was measured in several neck positions. In 5 of them, the same measurements were repeated when the spinal cord and roots were transected.When filled with a suitable volume of water, the balloons faithfully transmitted the pressure of the environment. No pressure differences were observed with the neck in the extended or neutral positions. However, when the neck was flexed, intramedullary pressure significantly increased. This increase in intramedullary pressure in the flexed neck position was not observed after spinal cord and roots were transected.The results indicated that the intramedullary pressure of the cervical spinal cord increases when the neck is flexed. This phenomenon might play an important role in syrinx growth.

The authors report a rare case of acute cervical epidural hematoma caused by the hemorrhage from extradural arterio-venous malformation. The patient was a 74-year-old Japanese man with a past history of total gastrectomy after being diagnosed as having gastric cancer 12 years before. Six hours prior to admission, the patient had experienced a sudden episode of severe nuchal pain radiating to both scapular areas, followed by rapid development of left-side Brown-Sequard Syndrome below the C4 cord level, and urinary incontinence. Plain cervical X-ray films did not show any destructive lesion suggesting a metastatic tumor. T1 and T2 weighted images of MRI demonstrated a high intensity mass lesion, suggesting an acute epidural hematoma, extending from C3 to C6 and compressing severely the left side spinal cord posteriorly. Twelve hours after the onset of symptoms, emergency laminectomy from C3 to C6 was performed and a fresh epidural clot with small vascular tissue was totally removed. Histological examination of the small vascular tissue in the hematoma revealed arterio-venous malformation. The postoperative recovery of the patient was dramatic. He regained full muscle strength and there was complete disappearance of sensory deficits 2 weeks after the operation. Although acute spinal epidural hematoma caused by extradural arterio-venous malformation is a rare clinical entity, MRI is the most helpful diagnostic tool for this condition. It should be stressed that accurate neuroradiological diagnosis and prompt surgical decompression of the spinal cord are essential to obtain an excellent surgical outcome.

The authors report 3 cases in which, in addition to venous angioma, other types of vascular malformations coexisted. They discussed the pathological significance of this coexistence, and the treatment to be given in these conditions. Case 1: A 38-year-old man was admitted to the hospital because of progressive headaches of 3 days' duration. X-ray CT revealed a large hematoma in the left cerebellar hemisphere. Vertebral angiogram showed a caput medusae in the venous phase, which is a typical picture of venous angioma. The hematoma was surgically removed and careful inspection of the cavity wall was made. A thick vein and many thin walled dilated venules draining to the vein were observed in the cavity wall. These abnormal vessels were completely removed. Because of reaccumulation of the hematoma and massive edema of the hemisphere, reoperation was performed. On removing a part of the cerebellar hemisphere, a small mass of vascular network was found and removed together with the hematoma. Histologically, the first specimen was a typical venous angioma, and the second one was a arteriovenous malformation. Case 2: A girl 9 years of age was admitted because of headache and left sided ataxia. CT and MRI revealed a multi staged hematoma in the left cerebellar hemisphere. Vertebral angiography, however, failed to demonstrate any kind of vascular malformations. The hematoma was removed with its wall. The histological appearance was compatible with venous angioma. 4 years later she bled again, and reoperation was performed. Histological examination this time revealed a cavernous angioma.(ABSTRACT TRUNCATED AT 250 WORDS)

A 19 year old male was admitted for evaluation after a seizure. Physical and neurological examination was normal. CT demonstrated an enlarged, high density mass in the right parietal lobe. MRI showed a homogeneous high intensity T1 weighted mass, surrounded by a low intensity T2 weighted rim in the right parietal lobe. Angiography did not show any abnormal findings. A diagnosis of cavernous angioma with primary bleeding in the subcortical region of the right parietal lobe was made after radiological examination. Histological examination showed a completely thrombosed aneurysm. The mechanism of the complete thrombosis and the growth of this large aneurysm and the shortcomings of radiological examination are discussed.

Carcinoid tumor is regarded as a tumor with low grade malignancy, mostly originating from the gastrointestinal tract with little danger of metastasis. The authors encountered a very rare case of bronchial carcinoid tumor that had multiple metastasis to the intracranial space. The characteristics of radiological and hormonal examinations of this tumor are reported and discussed. The patient was a 73-year-old woman who gradually developed unsteadiness in walking and somnolence in daytime one month prior to admission. Those symptoms were aggravated and she began to vomit. On admission, neurological examination showed slight ataxia of left upper and lower extremities and dominant truncal ataxia. Chemical and hormonal examinations of blood and urine showed, gastrin was 230 pg/ml (37-172), ACTH was 67 pg/ml (60), serotonin was 565 ng/ml (53-200), and urinary 5-HIAA was 9.9 mg/day (0.8-4.8). Tumor markers (CEA, AFP, HGG, NSE) were all negative. Radiological examinations (chest X-P, CT scan) of her lung demonstrated a 3 x 3 cm tumor mass adjacent to the hilum of the left lower lobe. CT-scan of the head demonstrated cystic tumor in the vermis of the cerebellum (3 x 3 cm), the right posterior parietal lobe and the right temporal lobe. The wall of each tumor was enhanced by contrast medium. T1 weighted MRI demonstrated the walls of cystic tumors as iso intensity and the contents as low and high intensity with niveau formation. Little edema was recognized around the tumors. The wall of each cystic tumor was enhanced by Gd-DTPA.(ABSTRACT TRUNCATED AT 250 WORDS)

We report here a case with meningioma showing malignant transformation in its course of multiple recurrences. A 59-year-old woman developed a right-sided hemiparesis in June, 1982 and CT scan disclosed a parasagittal well-enhanced mass. The tumor was subtotally removed (Simpson grade III) by an operation in September, 1982. Histological findings of the tumor were consistent with a meningothelial meningioma but showed no malignant features, such as high cellularity, necrotic foci, high mitotic rate, or nuclear pleomorphism. However, the tumor did invade the underlying cerebral cortex. In August, 1986, a recurrent tumor was detected by CT scan and was removed (Simpson grade III). The tumor tissue at the second operation showed the same histological features as the first specimen. In September, 1990, the patient developed multiple intracranial recurrences. There were three tumor nodules, all of which were removed. Histologically, significant histological differences between the second and the third operative specimens were found. In the last tumor tissue, one nodule showed a papillary pattern. In the other tumor nodules, each tumor cell had proliferated separately instead of adhering to other tumor cells to form a syncytium. This histological pattern was consistent with an epithelial meningioma described by Cushing and Eisenhardt in 1938. The papillary portion of the tumor was stained with monoclonal antibody Ki-67 in frozen section. The labelling index was 9.7%, which was as high as malignant meningioma. Electron microscopic examination of the papillary portion of the tumor showed that the tumor cells had irregular nuclei, interdigitations between the adjacent plasma membranes and a few ill-developed desmosomes.(ABSTRACT TRUNCATED AT 250 WORDS)

We have recognized a characteristic distribution of cisternal blood in 10 (43%) of 23 patients with subarachnoid hemorrhage (SAH) of unknown etiology. On the initial CT examination undertaken within 48 hours of the onset, blood from 10 patients was found to be more densely distributed in the cisterns around the brainstem. In this study, clinical characteristics and CT findings in those 10 cases were carefully evaluated and the CT findings were compared to those of 416 patients with aneurysmal SAH (anterior circulation aneurysm 368 cases, posterior circulation aneurysm 48 cases). There were seven men and three women, with an age ranging from 39 to 64 years (average age, 50.6 years). The follow-up period ranged from 4 to 45 months (average follow-up period, 23 months). Neurological grade (WFNS) on admission was I in 9 cases and III in one case. None of the patients suffered symptomatic vasospasm, hydrocephalus or rebleeding. All the patients had favourable outcome and were categorized as good recovery according to the Glasgow Outcome Scale. In comparison with the cases of aneurysmal SAH, especially in comparison with 48 cases with SAH caused by posterior circulation aneurysm, 43 cases could be easily distinguished on CT. The other 5 cases showed almost the same pattern of SAH on CT, but 4 cases could be differentiated by either the extension of SAH to the interhemispheric fissure or the presence of intraventricular hemorrhage. Only one case could not be differentiated on CT. Thus SAH located only around the brainstem differs from aneurysmal SAH in its clinical course, and in distribution and severity of bleeding on CT. This could be recognized as a new clinical entity and could be called benign SAH.

We have developed the protocol for selective cerebral perfusion (SCP) and pharmacological cerebral protection, and used it successfully in cases of aortic arch aneurysm. The subjects of the present study were 34 patients (28 males, 6 females) whose aortic arch aneurysm were surgically treated. Preoperative brain CT and brain scintigram showed high incidence of brain ischemia. However only 4 patients experienced a neurological episode. We conclude that our SCP technique and pharmacological cerebral protection are useful component to surgery of the aortic arch.

A rare case of yolk sac tumor of the testis which metastasized to the brain parenchyma with repeated intra-tumoral hemorrhage is reported. The patient was a 38 year-old-man admitted to the Department of Urology with the chief complaint of painless swelling of the left testis for a period of one year. He underwent orchiectomy with highly suspected malignancy, because chest X-ray examination demonstrated metastatic coin lesions. Pathological examination of the operated specimen showed typical yolk sac tumor of the testis. Postoperative clinical course was uneventful. However, on the 4th postoperative day, the patient suddenly fell into a coma with left hemiplegia and dilated right pupil. CT scan demonstrated an intra-parenchymal hematoma in the right parietal lobe. Emergency craniotomy with evacuation of the hematoma clot was performed. Histological examination of the hematoma clot showed the same histology (yolk sac tumor) as found in the operative specimens of the left testis. After regaining full consciousness, chemotherapy (PEB and PVB) was started. It was effective to reduce the high serum AFP level and the size of the metastatic coin lesions in the lung. However, it was not effective in preventing brain metastasis. He again relapsed into coma due to a newly-developed intra-tumoral hematoma with multiple brain metastasis and died 6 months after the orchiectomy. Yolk sac tumor of the testis is rare in adult Japanese and there is no previous report of its metastasis to the brain parenchyma with intratumoral hemorrhage. We have reviewed the previously reported cases and discussed the brain metastasis of this malignant urogenic tumor.

Intractable epistaxis developed in a 13-year-old girl after she fell down a flight of stairs sustaining facial fractures and fracture of the skull base. Epistaxis was found to emanate from a right ascending pharyngeal artery, which the authors promptly and successfully embolized using polyvinyl alcohol particles and microfibrillar collagen.

To investigate the possibility that the two subtypes of craniopharyngioma, adamantinous type and squamous papillary type, are tumors arising from different origins, the authors conducted an electron microscopic study in 10 cases of craniopharyngioma. Light microscopic study revealed distinct differences between the two subtypes, but their ultrastructure was fundamentally similar. In this report, the authors propose an explanation of the origin of these subtypes to account for the findings.

PURPOSE: To assess the hemodynamics and pathophysiology of stagnating arteries after removal of arteriovenous malformations (AVMs). SUBJECTS: 50 patients with supratentorial pial AVMs underwent pre- and postoperative angiographic studies. RESULTS: The following characteristics were found to correlate with stagnating arteries: 1) advanced patient age, 2) large AVM size, 3) markedly dilated feeders, 4) early postoperative angiograms, and 5) delayed restoration of feeding artery diameter. CONCLUSIONS: The rate of blood flow in the former feeding arteries, expressed as v x pi x r2 (v = mean velocity, r = vessel radius), suddenly decreases after removal of AVMs. When dilatation persists postoperatively in these arteries the flow velocity decreases and stagnation takes place. Delayed postoperative restoration of feeding artery diameter may be caused by a decrease of elasticity due to long-standing hemodynamic stresses, and by increased postoperative vascular resistance of these arteries.

We conducted a study to investigate whether an association exists among histologic findings, labeling index determined by the labeling index (LI) of proliferating cell nuclear antigen (PCNA) and recurrence in a population of 30 meningioma patients. All of 6 patients (invasive meningioma) with brain invasion had a PCNA LI in excess of 5%. Recurrence was found in 4 of these patients. In 24 patients who did not have brain invasion, PCNA LI was 4% or less and only 1 case had recurrence. Recurrence occurred in 3 of 25 patients who underwent macroscopic total resection and all of these 3 cases had brain invasion and a PCNA LI in excess of 5%. The findings of this study indicated the existence of a close correlation between peripheral invasiveness of meningioma and its biological behavior.

The patient was an unmarried, 25-year-old woman who presented herself with amenorrhea and lactation as her chief complaints. Radiography revealed a tumor in the sella turcica. Upon neurological examination at the time of admission, there were no abnormal findings affecting the field of vision or visual acuity, and no abnormalities were seen in the fundus oculi. In endocrinological tests, the basal plasma values of pituitary hormones were normal except for that of prolactin, which was 69.1 ng/ml. The preoperative diagnosis was nonfunctioning pituitary adenoma, and this neoplasm was resected by the transsphenoidal approach. Postoperative histological investigation showed vermiculous destruction of the anterior lobe of the pituitary gland, and also scattered lymph follicles accompanying infiltration by numerous lymphocytes and multinucleated foreign-body giant cells, and deposition of calcium. These findings, together with the epithelioid cells gathered around them, pointed to a diagnosis of granulomatous hypophysitis. The causes of granulomatous hypophysitis are known to include syphilis, tuberculosis, sarcoidosis, mycotic granuloma, and foreign-body granuloma due to the rupturing of a Rathke's cleft cyst, but no evidence of any of these was found in this patient. Another known source of inflammatory lesions in the hypophysis is lymphocytic hypophysitis, which resembles Hashimoto's autoimmune disease of the thyroid gland, and which is characterized both by the formation of lymph follicles and by extensive lymphocyte infiltration. In relation to the cause of granulomatous hypophysitis, thinking that it might possibly be an autoimmune disease, we conducted an immunological investigation, and also made a serological study of autoantibodies, but obtained no positive results.(ABSTRACT TRUNCATED AT 250 WORDS)

A case of pheochromocytoma discovered at pregnancy is reported. The patient was a 27-year-old woman who had no symptoms before pregnancy. A sudden hypertensive attack occurred during vaginal examination at the 36th week of pregnancy. Magnetic resonance imaging (MRI) and ultrasonography showed a right adrenal mass. The level of catecholamine in blood and urine was beyond the normal limit. This patient was diagnosed as pheochromocytoma with pregnancy. Cesarean section was immediately done to avoid hypertensive crisis caused by spontaneous delivery. Blood pressure and blood volume were controlled by an alpha-blocker for one month after delivery, and, then the tumor was removed surgically. Pheochromocytoma with pregnancy is life-threatening for the mother and the fetus because of difficult diagnosis and complex clinical features. Early diagnosis and appropriate treatment are mandatory. Pathophysiological characteristics and the treatment of such specified statics are mainly discussed through our successful achievement.

A rare case of primary intracranial melanoma is presented in a 34-year-old man with initial symptoms of persistent headache. In magnetic resonance imaging(MRI), this case had all the characteristic findings of intracranial melanoma which had been reported previously. In 123I-iodoamphetamine-single photon emission CT (123I-IMP-SPECT), abnormal accumulation of 123I-IMP was recognized in early and late phase imaging, which was very specific to the lesion. This is the first report of 123I-IMP-SPECT performed on a primary intracranial melanoma. Tumor mass originated from pia mater was surgically resected, but the dissemination of tumor cells was recognized macroscopically. Pathological examination of the specimen showed very little malignant changes of melanoma cells, which was in contrast to the previous reports. Although, no standard chemotherapy of the primary intracranial melanoma has been established, DAV therapy to the dissemination of tumor cells into the subarachnoid space, and intravenous administration of interferon-beta were performed in this case. Methods of differential diagnosis and treatments of primary intracranial melanoma are reviewed and discussed.

BALT magic catheter (PURSIL catheter) is a new catheter which is more flexible and plaint than the TRACKER-18 catheter because its mid-section and distal portion are made from polyurethane and silicon rather than polyethylene. Because the PURSIL catheter is flexible, it cannot be inserted with a guide wire, although it can be inserted into circulation during injection of contrast medium. Its inner diameter, 3.5mm, is smaller than that (5mm) of the TRACKER. There are few reports of embolization with the PURSIL catheter, and these describe only embolization using adhesive liquid embolus material. Embolization using small particles through the PURSIL catheter has never been reported. We report the catheterization using the PURSIL catheter of 26 arteries in 15 patients. The catheter was used for superselective angiography to clarify feeder and amytal tests in 5 patients with AVM, and embolization using PVA particles (150-250 microns) was performed in 1 patient with AVM, 3 patients with dural AVM, 4 cases with meningioma and 1 patient with vertebral aneurysm. Small PVA particles were easily injected without resistance through this catheter. In only one patient with dural AVM, was catheterization with this catheter not successful, and that was because the distal portion of the internal maxillar artery was extremely tortuous because of severe atherosclerosis. No complications associated with the use of this catheter were observed. We think that the greatest advantage of this catheter is the safety afforded by not using a guide wire. A disadvantage of this catheter is that, because of its small inner diameter, only small particles, or liquid embolus material can be injected through it.(ABSTRACT TRUNCATED AT 250 WORDS)

A 62-year-old woman was admitted complaining of clumsiness in both hands. On neurological examination, bilateral hand muscles were weak, both legs were spastic and hyperreflexic, all the extremities were hypoesthetic. Urological examination revealed detruser sphincter dyssynergia. Spinal CT scan demonstrated an iso density mass lesion in the cervical spinal cord, and it was markedly enhanced. On MRI, it was also markedly enhanced by Gd-DTPA. The operative finding was that an oval shaped tumor was buried in the spinal cord and was totally removed. Its histological diagnosis was neurofibroma. Intramedullary neurofibroma is rare and only 18 cases have been reported. In this case the tumor seemed to have arisen at the root entry zone and to have grown sub-pially.

Twenty-three patients (twenty males and three females) with acute cervical spinal cord injury were cared for within a defined protocol and followed for 14 to 589 days (mean. 133 days). We evaluated the relationship between neurological recovery and neurological examination, myelography (MLG), CT-myelography (CTM) on admission. All of them were admitted to Kitasato University Hospital within 24 hours after injury. Thirteen of the 23 patients had complete injury, and the others had incomplete injury.Four factors were found to be related to neurological recovery. They included: 1) complete injury; 2) areflexia; 3) cord swelling on CTM; and 4) complete block on MLG. Fourteen of 15 patients who had at most two of the four factors improved. But, no patients with three or four factors improved.These four factors have been recognized as indicators of bad neurological outcome. However, our result indicates that by our result, improvement of neurological function can be expected in patients affected by only one or two of these four factors. In other words these four factors have prognostic value for predicting the neurological outcome after acute cervical spinal cord injury.