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Orbital metastasis of lung cancer is rare. It often causes visual disorder. To date, there are only a few case reports. Crizotinib is an anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitor that leads to responses in most patients with ALK-positive non-small-cell lung cancer. Visual disorder is one of the popular adverse events of crizotinib, but the symptom almost decreases over time. We report a case of orbital metastasis as the disease progression of ALK-positive lung cancer treated with crizotinib. It should be kept in mind that orbital metastasis can be the disease progression of lung adenocarcinoma with ALK translocation treated with crizotinib. When physicians encounter a patient receiving crizotinib with visual disorder, we must distinguish between adverse events and orbital metastasis.

A project team headed by University of Tsukuba launched the development of a new accelerator based BNCT facility. In the project, we have adopted Radio-Frequency Quadrupole (RFQ)+Drift Tube Linac (DTL) type linac as proton accelerators. Proton energy generated from the linac was set to 8MeV and average current was 10mA. The linac tube has been constructed by Mitsubishi Heavy Industry Co. For neutron generator device, beryllium is selected as neutron target material; high intensity neutrons are generated by the reaction with beryllium and the 80kW proton beam. Our team chose beryllium as the neutron target material. At present beryllium target system is being designed with Monte-Carlo estimations and heat analysis with ANSYS. The neutron generator consists of moderator, collimator and shielding. It is being designed together with the beryllium target system. We also acquired a building in Tokai village; the building has been renovated for use as BNCT treatment facility. It is noteworthy that the linac tube had been installed in the facility in September 2012. In BNCT procedure, several medical devices are required for BNCT treatment such as treatment planning system, patient positioning device and radiation monitors. Thus these are being developed together with the linac based neutron source. For treatment planning system, we are now developing a new multi-modal Monte-Carlo treatment planning system based on JCDS. The system allows us to perform dose estimation for BNCT as well as particle radiotherapy and X-ray therapy. And the patient positioning device can navigate a patient to irradiation position quickly and properly. Furthermore the device is able to monitor movement of the patient׳s position during irradiation.

A 76-year-old female was implanted with a cardiac resynchronization therapy (CRT) device, with the left ventricular lead implanted through a transvenous approach. One day after implantation, diaphragmatic stimulation was observed when the patient was in the seated position, which could not be resolved by device reprogramming. We performed thoracoscopic phrenic nerve insulation using a Gore-Tex patch. The left phrenic nerve was carefully detached from the pericardial adipose tissue, and a Gore-Tex patch was inserted between the phrenic nerve and pericardium using a thoracoscopic technique. This approach represents a potential option for the management of uncontrollable phrenic nerve stimulation during CRT.

Background: Acute exacerbation of chronic fibrosing interstitial pneumonia (AE-CFIP) is an often fatal condition with no established treatment. Recently, macrolides were found to be beneficial in cases of acute lung injury. Objectives: To examine the clinical effectiveness and safety of intravenous azithromycin in patients hospitalized for AE-CFIP. Methods: A prospective, open-label study with historical controls was conducted. Twenty consecutive patients with AE-CFIP received azithromycin. They were compared with a historical cohort treated with fluoroquinolone (n = 56). All patients received high-dose steroid pulse therapy. The primary end point was mortality at 60 days. The secondary end point was safety of intravenous azithromycin in patients with AE-CFIP. Inverse probability of treatment weighting (IPTW) using the propensity score was performed to investigate the relationship between azithromycin use and survival time. Results: Mortality was significantly lower in the patients treated with azithromycin than in those treated with fluoroquinolone (mortality rate at 60 days: 20 vs. 69.6%, p < 0.001; median survival time: not reached vs. 29.5 days, p < 0.001). The IPTW adjusted hazard of mortality at 60 days in patients receiving azithromycin was 0.17 (95% CI 0.05-0.61). No serious adverse events were observed. Conclusions: Azithromycin was associated with improved outcomes in patients with AE-CFIP. Further studies are needed to verify this finding (Clinical trial JMA-IIA00095).

Hermansky–Pudlak syndrome (HPS) is an autosomal recessive disorder characterized by oculocutaneous albinism, bleeding tendency, and lysosomal accumulation of ceroid-like material, with occasional development of interstitial pneumonia (IP). Nine genetically distinct subtypes of HPS are known in humans; IP develops primarily in types 1 and 4. Most reported cases of HPS with IP are type 1, and there are no published reports of type 4 in Japanese individuals. A 58-year-old man with congenital oculocutaneous albinism and progressive dyspnea for 1 month was admitted to our hospital. We administered high-dose corticosteroids on the basis of a diagnosis of acute exacerbation of interstitial pneumonia. Respiratory symptoms and the findings of high-resolution computed tomography (CT) showed improvement. He was diagnosed with HPS type 4 with interstitial pneumonia on the basis of gene analysis. He has been receiving pirfenidone for 1 year and his condition is stable. This is the first report on the use of pirfenidone for HPS with IP caused by a novel mutation in the HPS4 gene. We conclude that HPS should be suspected in patients with albinism and interstitial pneumonia. High-dose corticosteroid treatment may be useful in cases of acute exacerbation of interstitial pneumonia due to HPS-4, and pirfenidone may be useful and well tolerated in patients with HPS-4.

At present, the clinical trials of Boron Neutron Capture Therapy (BNCT) are being performed at research reactor facilities. However, an accelerator based BNCT has a merit that it can be built in a hospital. So, we just launched a development project for the BNCT based on an accelerator in order to establish and to spread the BNCT as an effective therapy in the near future. In the project, a compact proton linac installed in a hospital will be applied as a neutron source, and energy of the proton beam is planned to be less than about 10 MeV to reduce the radioactivity. The BNCT requires epithermal neutron beam with an intensity of around 1x109 (n/cm2/sec) to deliver the therapeutic dose to a deeper region in a body and to complete the irradiation within an hour. From this condition, the current of the proton beam required is estimated to be a few mA on average. Enormous heat deposition in the target is a big issue. We are aiming at total optimization of the accelerator based BNCT from the linac to the irradiation position. Here, the outline of the project is introduced and the moderator design is presented.

Alkaline phosphatase (ALP) flare phenomenon documented as scintigraphic flare phenomenon due to elevated serum ALP levels produced by osteoblasts reflects an osteoblastic reaction in response to the effective therapy of non-small cell lung cancer (NSCLC). Here, we report a case of ALP flare following gefitinib treatment for NSCLC. We also retrospectively analyzed the prevalence of ALP flare in lung cancer patients treated via epidermal growth factor receptor-tyrosine kinase inhibitor in our hospital. Recognition of this phenomenon is important for physicians treating NSCLC patients to avoid discontinuation of a potentially beneficial treatment because of misdiagnosis for refractory multiple bone metastasis or adverse effect.

Three cases of patients with synchronous multiple thymoma are reported. Two patients had two thymomas each and the remaining patient had three. The thymomas in each patient all displayed similar histological findings, of which the WHO histological classification were type B2, A and B1, respectively. With a modified Masaoka staging system, the thymomas were determined to be stages II-1 and I in patient 1, one of stage III and two of stage I in patient 2, and two of stage II-1 in patient 3. We reviewed nine reported cases of multiple thymoma in which histological findings were provided and discuss whether they developed from multi-centric origin or from intra-thymic metastasis.

CTでは胸水，胸膜結節を認めなかったが，PET CTにて胸膜へのFDG集積を認めた癌性胸膜炎の症例を経験した．60歳女性．56歳時，高分化肺腺癌，pStage IAにて右中葉切除とリンパ節郭清術を受けた．3年9ヵ月後のCTで，上葉との葉間切離部断端再発と残存下葉の異時性多発癌を認め，開胸術を行った．術前CTでは，癌性胸膜炎を疑う所見はなかった．PET CTで，断端再発病巣の他に第8胸椎近傍の胸膜にもFDGの集積があった．術中所見と病理組織診断で，この集積が癌性胸膜炎病巣であることが判明した．肺癌症例において，CTで胸水や結節影を認めなくても，PETで胸膜にFDGの集積があれば，癌性胸膜炎を念頭に置いて，手術適応を慎重に検討すべきであると考えられた．

特徴的な胸部レントゲン, CT所見を呈し, 特に造影3D CTが異常動脈と正常肺血管の支配領域把握に有効で, 胸腔鏡補助下に安全に切除できた左肺底動脈大動脈起始症を経験した. 56歳, 女性. 無症状. 46歳時, 検診の胸部レントゲンで要精査となり, 肺分画症と診断され, 手術を勧められたが拒否. 10年後の検診で再び異常を指摘された. 胸部レントゲンでは, 心陰影の背側に異常血管による結節影を認めた. 胸部CTでは, 左下葉全体の容積が減少し, 血管影が強く拡張し, 肺実質のうっ血像を認めた. 造影3D CTでは, 下肺静脈のすぐ背側に接して下行大動脈から径13mmの異常血管が肺底区に流入しており, 左肺底動脈大動脈起始症と診断. 葉全体の萎縮と, 強い肺うっ血を伴っていたために手術適応とし, 胸腔鏡補助下に左下葉切除術を行った. 術後肺活量・一秒量の低下は極僅かであった.

Rationale: ARDS is a life threatening condition, and associated with a poor prognosis. Drugs are important risk factor of ARDS as well as other major risk factors such as pneumonia, sepsis, aspiration. To our knowledge, there have been few reports concerning about clinical features and prognosis of drug-associated ARDS compared with those of non-drug associated ARDS. Methods: 181 patients with ARDS who met the Berlin Criteria were enrolled from 1 October 2004 to 31 December 2014 at our institution. We divided the patients into two groups: drug-associated ARDS (DARDS) group (n= 21) and non-drug-associated ARDS (non-DARDS) group (n = 160), followed by the definition of Dhokarh et al (Chest 2012; 142: 845-850). We evaluated each group for 28 days prognosis, ventilation free days, and other clinical features. Results: The APACHE II scores (18 vs 23, p= .001) and SOFA scores (5 vs 7, p= .003) were significantly lower, and P/F ratio (138.0 vs 101.4, p= .008) was higher in the DARDS group compared with those of the non-DARDS group. In the DARDS group, HRCT scores (median, 293.1 vs 208.3, p= .000) suggestive of the extent of fibroproliferation (Radiology 2006; 238: 321-329) and serum LDH (440 vs 312, p= .001) were significantly higher than those of the non-DARDS group. Furthermore, the ventilator-free days were higher (17 days vs 0 day, p= .011), and the 28 days mortality tended to be better (28.6% vs 38.1%, p= .476) in the DARDS group compared with those of non-DARDS group. Conclusion: In patients with drug associated ARDS, although lung damage with fibroproliferation was more severe, ventilator weaning was significantly earlier and prognosis was not worse than those of non-drug associated ARDS.

Background: Sepsis, pneumonia, aspiration are major causes of ARDS, but other various diseases may cause ARDS. Objective: To evaluate significance of bronchoalveolar lavage (BAL) or bronchial lavage (BL) in ARDS. Methods: 180 patients met the Berlin definition in our institution from Oct. 2004 to Dec. 2014. When we could not identify the cause of ARDS by clinical history, physical findings, blood tests, culture tests, we performed BAL or BL under mechanical ventilation. We analyzed their results of examinations, final diagnoses and outcomes. Results: BAL(n=22) or BL (n=5) was performed in 27 of 180(15%) cases. In 19 of 27(70%) cases, we obtained diagnostic information about causes of ARDS by BAL or BL Thirteen (48%) cases were due to infection, 6(22%) were suspected to drug-associated. In patients whose BALF represented neutrophilic cellular pattern, 28-day and 60-day survival rates were significantly lower (P < 0.05) and ventilator free days was shorter than in patients whose BALF represented lymphocytic or eosinophilic cellular pattern (P=0.005). Although 28-day and, 60-day survival rates tended to be higher in patients whose causes of ARDS were identified than those in patients whose causes not identified, there were no statistically significant differences. Conclusion: Bronchoscopic evaluation in ARDS may be beneficial to identify the cause and to predict prognosis.

The iBNCT project team with University of Tsukuba is developing an accelerator-based neutron source. Regarding neutron target material, our project has applied beryllium. To deal with large heat load and blistering of the target system, we developed a three-layer structure for the target system that includes a blistering mitigation material between the beryllium used as the neutron generator and the copper heat sink. The three materials were bonded through diffusion bonding using a hot isostatic pressing method. Based on several verifications, our project chose palladium as the intermediate layer. A prototype of the neutron target system was produced. We will verify that sufficient neutrons for BNCT treatment are generated by the device in the near future.

Dark current measurements are performed for Mo and Ti electrodes and the results are analyzed to separate the primary field emission current from the total observed dark current. The analysis shows that Mo exhibits very low primary field emission current as a cathode, reaching 1 nA of primary field emission current at a DC field gradient of 170 MV/m. The equivalent measure for Ti is 124 MV/m, and Ti also exhibits a lower enhancement effect of dark current due to electron and ion bombardments of cathode and anode. An electrode configuration with Mo cathode and Ti anode is thus examined, and it is confirmed by experiments that a field gradient of as high as 130 MV/m for 1 nA total dark current is possible for an electrode gap of 0.5 mm and an effective cathode area of 7 mm 2 .

第Ⅴ部 エネルギー開発としての核融合研究 第5章, 吉岡正和［高エネルギー加速器研究機構 加速器研究施設・教授］

重症筋無力症症例に胸腺摘出術を行い, 2例の気管切開に関連した創感染を経験した.症例1は68歳, 女性.歩行困難で発症.1997年5月クリーゼを生じ, 気管内挿管した.免疫吸着後, 胸骨縦切開下に拡大胸腺摘出術を施行.人工呼吸より離脱できず, 術後11日目に気管切開を施行.その後, 創感染を認め, 持続吸引・間欠洗浄を施行.徐々に感染消退し, 1ヵ月後に人工呼吸から離脱できた.症例2は60歳, 男性.1993年胸腺腫摘出術を受けた.2002年8月クリーゼに陥り, 気管切開を受けた.免疫吸着後, 胸骨縦切開下に拡大胸腺胸腺腫摘出術を施行.当初は良好に経過したが, 3週間後に創感染を生じた.同部の掻爬等を行い, 4ヵ月後に治癒に至った.当科の胸腺摘出後創感染はすべて気管切開例で生じており, 気管切開の施行には十分な検討すべきであり, 避けられない場合は厳重な気管切開管理が必要と考えられた.

To elucidate the mechanism of hydrogen embrittlement, the behaviour of hydrogen in metals is investigated by the hydrogen microprint method. This is an attractive method in that it enables the hydrogen released from the metal surface during plastic deformation to be observed. The hydrogen behaviour in fatigue and sustained-load crack growth of γ-TiAl intermetallic compounds has been studied by means of the hydrogen microprint technique. Both fatigue crack growth and sustained-load crack growth were accelerated by the hydrogen. The region of hydrogen accumulation could easily be observed by the hydrogen microprint technique. In the case of sustained-load crack growth, it is found that hydrogen is released from the surface in the high hydrostatic stress field around the crack tip. The hydrogen microprint technique revealed that the effect of the hydrostatic stress is very large in the hydrogen accumulation around the crack tip. In fatigue crack growth, the amount of silver precipitation is discussed, which is correlated with the amount of hydrogen accumulation.

KEKB has been operated since December, 1998, to deliver BB pairs for a physics detector. In this paper,we describe the commissioning procedure of KEKB.

The KEKB accelerator control system including a control computer system, a timing distribution system, and a safety control system are described. KEKB accelerators were installed in the same tunnel where the TRISTAN accelerator was. There were some constraints due to the reused equipment. The control system is based on Experimental Physics and Industrial Control System (EPICS). In order to reduce the cost and labor for constructing the KEKB control system, as many CAMAC modules as possible are used again. The guiding principles of the KEKB control computer system are as follows: use EPICS as the controls environment, provide a two-language system for developing application programs, use VMEbus as frontend computers as a consequence of EPICS, use standard buses, such as CAMAC, GPIB, VXIbus, ARCNET, RS-232 as field buses and use ergonomic equipment for operators and scientists. On the software side, interpretive Python and SAD languages are used for coding application programs. The purpose of the radiation safety system is to protect personnel from radiation hazards. It consists of an access control system and a beam interlock system. The access control system protects people from strong radiation inside the accelerator tunnel due to an intense beam, by controlling access to the beamline area. On the other hand, the beam interlock system prevents people from radiation exposure by interlocking the beam operation. For the convenience of accelerator operation and access control, the region covered by the safety system is divided into three major access control areas: the KEKB area, the PF-AR area, and the beam-transport (BT) area. The KEKB control system required a new timing system to match a low longitudinal acceptance due to a low-alpha machine. This timing system is based on a frequency divider/multiply technique and a digital delay technique. The RF frequency of the KEKB rings and that of the injector Linac are locked with a common divisor frequency. The common divisor frequency determines the injection timing. The RF bucket selection system is also described. r 2002 Elsevier Science B.V. All rights reserved.

The transport lines of the KEKB for positrons and electrons convey the beams separately from the injector linac to the KEKB rings. The length is about 500 m for each line. In order to make the maximum use of the existing tunnels and also to avoid interference with the AR, the beam lines took a serpentine course, resulting in a rather large curvature in the arcs. The consequences were a large number of bends in the arcs with high fields and also a large dispersion function and, thus, a large R56 component. The latter issue is crucial for the KEKB rings, since it results in a longer bunch length at injection. We adopted a special optics that reduces the R56 coefficient sufficiently. We have developed novel water-cooled ceramic chambers for kickers, eddy-current type septum magnets for injection, and a beam-abort system for the rings. The present paper describes the design and current status of the beam lines, the injection system, and the beam-abort system.

An asymmetric-energy collider of 8 GeV electrons and 3.5 GeV positrons, KEKB, has been operating at KEK since 1998. On July 9, 2001 it achieved the highest record of luminosity, 4.5×10 33 cm −2 s −1 . This paper describes the interaction region (IR) extending about 8 m from the interaction point (IP) along each beam direction. The main machine components in the IR are focusing quadrupole magnets, compensation solenoids, and vacuum chambers, which are positioned on movable stages. They are designed to focus both beams into collisions with a finite angle crossing.

症例は14歳, 男性.8歳時に左S6の肺動静脈瘻を指摘され, 経カテーテルコイル塞栓術を受けた.経過良好であったが, 6年後CT上, 再発が疑われた.精査にて, 左S6に大きさ4cmおよび右S2に大きさ5mmの肺動静脈瘻が発見された.CT, DSAでは, 左S6に, 3本の流入血管と2本の流出血管を有する瘻を認めた.その内の1本は肺底区静脈に還流していた.頭部MRIでは脳梗塞等を思わせる所見は認めなかった.手術はまず胸腔鏡下に右S2の病変を部分切除した.体位変換後, 左側方開胸をし, 下葉S6および葉間面に血管怒張が著明で, 左肺葉切除が必要と判断した.切除に際し, 血管処理および葉間形成に残存コイルの悪影響はなかった.なお, 周術期合併症は認めなかった.手術によりPaO2は, 術前73.7mmHgから術後94.2mmHgに上昇し, 肺内シャントの改善が認められた.塞栓療法後の再発性肺動静脈瘻は, 一般的な再手術と同様, 肺実質温存が難しい場合があり, 手術選択には注意が必要である.

Hydrogen behavior in fatigue crack growth of lamellar TiAl intermetallic compounds has been studied by means of hydrogen microprint technique. We can visualize the hydrogen in metal using the silver reduced by the hydrogen. Hydrogen was introduced to specimens by cathodic charging technique, and then metal-hydride on the charged specimen surface were removed by electropolishing. For the hydrogen microprint technique, specimen surface was covered with collodion and photographic emulsion before pre-cracking. Fatigue crack growth tests were performed by using the hydro-servo testing machine in a darkroom. The relationship between the stress intensity factor range and crack growth rate was studied, and region of reduced silver particles was detected for all test conditions. The fatigue crack growth was accelerated with hydrogen-charged specimens as compared with non-charged specimens. In parallel type specimens, in which cyclic load was applied perpendicular to the lamellar boundaries, the main crack grew along lamellar boundaries and large amount of silver precipitates was observed in charged specimens. It was deduced that hydrogen reduced the strength of lamellar boundaries. In perpendicular type charged specimens, in which cyclic load was applied parallel to the lamellar boundaries, it was observed that silver precipitates accumulated on the slip lines and the main crack grew partially along the slip lines. Based on the observation, it was deduced that the hydrogen promoted slip and reduced the strength of slip plane.

The current from copper electrodes treated by four different types of surface cleaning procedures was measured under DC high field gradient condition. The best results were obtained by using the electrode rinsed with ultra-pure water after diamond turning. A field gradient of 47 MV/m was achieved with dark current at the level of 1 nA, and the microscopic field enhancement factor was estimated to be a very low value of 56. The dark current from this electrode was dependent only on the field gradient at the cathode and not affected by the total voltage applied to the gap. In this case the surface would be covered by a Cu2O layer, which creates few secondary ions by the electron bombardment. On the other hand, a large total voltage effect and a large vacuum increase were observed for the electro-polished electrode. Cu(OH)2, which would be formed at the copper surface during the electro-polishing process, would emit H2O molecules during the electron bombardment.

It is well known that intermetallic compounds are embrittled by exposuring to the hydrogen environment. However, there are only a few reports investigating the effects of hydrogen-embrittlement on TiAl intermetallic compounds. In this study, the effects of hydrogen and metal-hydride on mechanical properties in TiAl intermetallic compounds were investigated. Hydrogen was introduced to specimens by corroded in acidic solution, and a metal-hydride formed on the specimen surface was analyzed by an X-ray diffraction method. To dissolve the metal-hydride, some specimens were heat -treated at 623 K in vacuum. Some mechanical properties—fracture stress, fracture strain, hardness and so on—were compared by using with or without corrosion and heat-treated specimen. Also, the hydrogen microprint technique was applied to visualize the behavior of hydrogen in TiAl. It is found that fracture strength and fracture strain were decreased by effects of hydrogen. Also silver grains indicating hydrogen emanation were revealed along slip lines and around crack tips.

Clinically amyopathic dermatomyositis (CADM), a subtype of dermatomyositis with subtle or no muscle involvement, is occasionally accompanied by fatal, rapidly progressive interstitial lung disease (RP-ILD) that is resistant to aggressive immunosuppressive therapy. The presence of anti-CADM-140/MDA5 antibodies is diagnostic for patients with dermatomyositis (particularly CADM) and is known to be strongly associated with the pathogenesis, disease activity, and mortality of RP-ILD. Polymyxin-B direct hemoperfusion (PMX-DHP), originally developed for the removal of endotoxin, has been demonstrated to be effective for treating various types of acute respiratory failure. We describe a patient with amyopathic dermatomyositis who developed RP-ILD characterized by elevated anti-CADM-140/MDA5 autoantibodies, was resistant to combined steroid and immunosuppressant therapy, and was treated successfully with PMX-DHP. To our knowledge, this is the first case to indicate a serial reduction of anti-CADM-140/MDA5 autoantibodies, associated with clinical improvement, following PMX-DHP. Early intervention using PMX-DHP may improve the prognosis of RP-ILD accompanied by CADM.

症例は21歳女性.眼筋型重症筋無力症と診断され, 加療を受けていた.胸部CT上胸腺腫を疑われ, 胸骨縦切開下に拡大胸腺摘出術を行った.術直後の胸部X線写真で右上葉の無気肺を認めた.気管支鏡で観察すると右上葉気管支は気管分岐部直上の右側気管より分岐し, 同部に疾の貯留を認めた.気管支鏡で吸疾し, 無気肺は改善した.術後, 胸部CTを再検討すると, 右気管支分岐異常を確認することが出来た.患者はその後は良好に経過した.気管支分岐異常は比較的稀な疾患であるが, 今回は術中無気肺を生じており, 術中術後の呼吸管理に問題を生じる可能性がある.胸部手術の際, 念頭に置くべき疾患であると考えられた.

症例は14歳男子.左膝痛のため, 当院整形外科を受診.骨肉腫と診断された.化学療法施行後, 切断術を受けた.入院時の胸部CTにて, 左S6に直径5mmの結節陰影を認め, その大きさは術前および術後の化学療法にても変化しなかった.このため, 骨肉腫の肺転移を疑い, 胸腔鏡下に肺部分切除を行った.術後の病理検索にて腺癌が疑われ, 免疫染色にてもEMA, Cytokeratin陽性, Vimentin陰性であった.術後, 他臓器癌の検索を行ったが, 異常を認めず, 原発性肺癌と診断した.本症例は直径5mmと微小であり, 稀である小児原発性肺癌の発生機序を考慮する際に, 貴重な症例と考えられた.

症例は43歳の男性で, 健康診断にて胸部X線写真上右肺尖部の異常陰影を指摘された.腫瘤はMRI上, 腕神経叢に連続していた.神経学的な異常は認めなかった.縦隔の良性腫瘍が疑われたが術前に確定診断には至らず, 診断と治療目的で開胸下に腫瘤摘出術を施行した.腫瘍は類球形で内部は多房性の嚢包状であり, 腕神経叢下神経幹に連続していた.組織診断上は神経鞘腫 (Antoni type A) であった.

Most cases of thymic carcinoma have some invasion to neighboring organs when diagnosed, and it is generally difficult to completely remove. We adopted selective cerebral perfusion as a cerebral protection and successfully performed resection of a thymic adenocarcinoma that involved the superior vena cava, left brachiocephalic vein, right brachiocephalic artery and vein, and left common carotid artery in a 47-year-old woman. Even if multiple great vessels were involved by mediastinal malignant tumor, complete resection with selective cerebral perfusion could be safely performed.

Background: In 2005, Cheuk et al reported two patients with microscopic-sized thymomas and proposed the term microthymoma to distinguish it from the nodular hyperplasia of thymic epithelium, so-called microscopic thymoma . Here, we present microthymomas that were found in 196 patients with myasthenia gravis (MG) who had undergone thymectomy. Materials and methods: Thymic tissues in 196 patients with MG who underwent thymectomy or thymothymomectomy were examined. Of these patients, 73 patients had thymoma indicated by CT before surgery, and the other 123 patients had no mediastinal tumors. From the resected thymic tissues, an average of 14 hematoxylin-eosin–stained sections (range, 4 to 55 sections) were prepared for microscopic examination. The histologic type of the thymoma was classified according to the World Health Organization (WHO) classification. Results: From the 196 patients, we found three microthymomas in 3 patients (1.5%). While these three tumors could not be seen grossly in pathology section, they were found microscopically (range, 2 to 4 mm). The histologic subtype according to the WHO classification system was B1 in one patient and B2 in two patients. Conclusion: Microthymoma was found in 3 of 196 patients (1.5%) with MG. Microthymoma might exist in thymus of patients with MG, even in patients who have no thymoma indicated by CT.

We report herein the case of a 66-year-old woman who has survived for more than 9 years without recurrence since undergoing a right trisegmentectomy of the liver with biliary reconstruction using the jejunum for stage IV (T1, N1a, M0, UICC) gallbladder cancer. The resected tumor, which was histologically diagnosed as moderately to poorly differentiated adenocarcinoma, was approximately 8 cm in diameter and infiltrated from the gallbladder to the medial, anterior, and posterior segments of the liver, involving the right hepatic and common hepatic ducts and the right hepatic artery; no intrahepatic distant metastasis was found. Although preoperative imaging diagnosis showed swollen lymph nodes at the hepatoduodenal ligament and paraaortic region, histological analysis of the resected lymph nodes revealed only one metastasis, located at the cystic duct which was involved in the tumor. This case demonstrates that curative resection may be the appropriate surgical intervention for patients with a stage IV tumor and direct infiltration to the liver and surrounding organs but no distant metastases.

Objectives To examine whether the extent of fibroproliferative changes on high-resolution CT (HRCT) scan influences prognosis, ventilator dependency and the associated outcomes in patients with early acute respiratory distress syndrome (ARDS). Design A prospective observational cohort study. Setting Intensive care unit in a teaching hospital. Participants 85 patients with ARDS who met American-European Consensus Conference Criteria and eligible criteria. Interventions HRCT scans were performed and prospectively evaluated by two independent observers on the day of diagnosis and graded into six findings according to the extent of fibroproliferation. An overall HRCT score was obtained by previously published method. Primary and secondary outcomes The primary outcome was 60-day mortality. Secondary outcomes included the number of ventilator-free days, organ failure-free days, the incidence of barotraumas and the occurrence of ventilator-associated pneumonia. Results Higher HRCT scores were associated with statistically significant decreases in organ failure-free days as well as ventilator-free days. Multivariate Cox proportional hazards model showed that the HRCT score remained an independent risk factor for mortality (HR 1.20; 95% CI 1.06 to 1.36; p=0.005). Multivariate analysis also revealed that the CT score had predictive value for ventilator weaning within 28 days (OR 0.63; 95% CI 0.48 to 0.82; p=0.0006) as well as for an incidence of barotraumas (OR 1.61; 95% CI 1.08 to 2.38; p=0.018) and for an occurrence of ventilator-associated pneumonia (OR 1.46; 95% CI 1.13 to 1.89; p=0.004). A HRCT score, Article summary Article focus Whether the extent of fibroproliferation on high-resolution CT (HRCT) scan at the time of diagnosis of acute respiratory distress syndrome (ARDS) would impact 60-day and 180-day mortality? Whether the extent of fibroproliferation on HRCT scan at the time of diagnosis of ARDS would impact ventilator dependency and its associated outcomes? Whether the extent of fibroproliferation on HRCT scan at the time of diagnosis of ARDS would impact multiple organ failure? Key messages Pulmonary fibroproliferation assessed by HRCT in patients with early ARDS predicts increased mortality. Pulmonary fibroproliferation assessed by HRCT in patients with early ARDS predicts ventilator dependency and its associated outcomes (barotraumas, ventilator-associated pneumonia). Pulmonary fibroproliferation assessed by HRCT in patients with early ARDS increases susceptibility to multiple organ failure. Strengths and limitations of this study The CT score is based on our previous published studies correlating HRCT findings with pathology and has been evaluated in the other diseases. A relatively small number of patients from a single institution. Lack of correlation with either clinical parameters or pathologic findings.

To examine the role and significance of in vitro chemosensitivity testing on cells cultured from endoscopic biopsy specimens, we evaluated outcomes in 57 patients with squamous cell carcinoma of the thoracic esophagus. Over 3 1/2 years, 57 patients were treated with a single course of preoperative combination chemotherapy based on the results of chemosensitivity testing utilizing eight antineoplastic agents. A radiologically evident response (partial response) was seen in 23 patients (40.4%) and histologic effects on grade IIb tumors were seen in six patients (10.5%). The median survival time of all 57 patients was 16.3 months. The median survival time of nine patients who received palliative resection was 4.5 months. The median survival times after curative resection of the 19 patients with a partial response and 29 patients with no response were 27.7 months and 17.3 months, respectively (p0.009). The most frequent combination chemotherapy used was cis-dichlorodiammine platinum (II) vindesine/5-fluorouracil, and a high rate of response was noted after therapy with etoposide and 4'-D-tetrahydropyranyl-doxorubicin. Chemosensitivity testing appears to be useful in selecting preoperative chemotherapeutic agents for patients with esophageal cancer, decreasing tumor recurrence after surgery and resulting in more partial responses than conventional chemotherapy.

The next generation of linear colliders — represented by the Japanese Linear Collider (JLC) and the Next Linear Collider (NLC) — will probably utilize polarized electrons generated by a photocathode gun. A photocathode gun with high polarization ( P e ) photocathodes (up to P e ∼ 80% achieved to date) is currently providing polarized electrons for the SLC. The SLC source requires subharmonic bunching at low energy to reduce the bunch length prior to S-band bunching and a damping ring at high energy to reduce the transverse emittance. The use of an rf gun can eliminate the former and possibly simplify the latter. However, rf guns as presently developed have serious problems with vacuum contamination, which would quickly lower the quantum efficiency (QE) of a semiconductor photocathode. In addition, the “charge limit” previously reported for high peak current pulses puts a limit on the laser power usable for photoexciting a low QE cathode near the bandgap threshold. These problems have so far precluded any serious attempt to design an rf gun for polarized electrons. Several technical advances that now improve the prospects for a practical polarized electron rf gun are described. Finally, new ideas for high polarization photocathodes that permit operation in a relatively poor vacuum and techniques being explored to mitigate the low QE “charge limit” are discussed.

We have studied the polarization of photoemission from an AlGaAsGaAs superlattice as a function of the total thickness of the superlattice. In three samples with thicknesses of 0.4, 0.1, and 0.05 μm the measured polarizations were 51.0, 69.9, and 73.9% respectively. We obtain 75.5% when we extrapolate these results to the case of a sample so thin that depolarization occurs only at the surface. We tested a fourth sample for which the thickness was 0.1 μm and the Be dopant concentration was a factor of ten below the high concentration of the first three samples. The fourth sample produced a polarization of 74.8%. This result confirms the expectation that reduced doping lowers the spin relaxation in the interior of the superlattice. We conclude that depolarization at the surface dominates interior depolarization when the sample is thin or the dopant concentration is low.

A 27-year-old man had undergone orchiectomy and chemotherapy for testicular cancer. Despite normalization of raised tumor marker levels after postoperative chemotherapy, computed tomographic scanning demonstrated multiple swellings of the para-aortic lymph nodes with extension from beneath the aortic arch to the bifurcation of the descending aorta. Open biopsies of the para-aortic lymph nodes disclosed mature teraroma without malignant cells. The patient presented the typical features of mediastinal and retroperitoneal growing teratoma syndrome. A two stage resection of the tumors was performed via laparotomy and left thoracotomy. Histological examination of the resected specimens revealed a mature teratoma component without malignant cells. Upon follow-up sixteen months later, the patient was well and without recurrence.

A 50-year-old female complained of back pain. Computed tomography showed a well-defined spindle-shaped mass 3.4 x 1.0 cm in size in the left paravertebral posterior mediastinum at the Th 3-4 level. The tumor was completely resected via thoracoscopic surgery, which showed no invasion into the surrounding tissue. It consisted of a cyst with a tiny mural solid element. By means of histological and immunohistochemical examinations, we diagnosed the tumor as ependymoma, and the patient remains alive 59 months after resection. As far as we know, 8 reported cases with primary mediastinal ependymoma have been reported. They had the following specific characteristics: (1) All patients were adult females; (2) The tumors were usually located at the paravertebral upper mediastinum; (3) Most of the tumors consisted of cystic and solid elements; (4) The tumors usually made no invasion into the surrounding tissues, though 2 cases had lymph-node metastases.

KEK has proposed to build an accelerator test facility (ATF) capable of producing a 2.5 GeV electron beam for the purpose of stimulating R&D for linear colliders in the TeV region. The ATF consists of a 1.54 GeV S-band linear accelerator, a 1.54 GeV damping ring and a 1.0 GeV X-band linear accelerator. The ATF project will be carried out in three phases. In phase I and phase II the S- and X-band linacs will be constructed, respectively, and in phase II the damping ring will be completed. The construction of ATF phase I has started, and the 0.3 GeV S-band injector linac is almost complete. The heart of the control system for the phase-I linac is based on two microVAX systems. At present these computers are connected to the KEK network (Ethernet). A CAMAC-enhanced byte-serial highway extends to the controlled equipment. Optical-fiber cables are used for the serial CAMAC highway in order to obtain high reliability in a noisy environment. The transmission rate on each optical fiber in 5 Mbyte/s. In this paper we present the status of the control system of the phase-I linac and the design of the computer control system for the ATF.

肝切除術後に骨転移部位に関連して特有の臨床症状を呈して発見された再発肝細胞癌の3例を, 若干の文献的考察を加えて報告する.症例1: 58歳男性, 術後2年3か月目にC4以下の神経支配領域の対称性知覚鈍麻, 四肢の運動麻痺, 膀胱直腸障害が認められ脊髄横断症状を呈した.Magnetic resonance imagingで第4頸椎の棘突起から左椎弓にかけての腫瘍陰影と脊髄の右方偏位が認められ, 肝細胞癌の頸椎転移と診断した.症例2: 53歳男性, 術後6か月目に突然左胸部痛, 呼吸困難が出現した.血胸を認め, Computed tomogra-phyにより左第3肋骨に連続する腫瘍陰影を認めたことより, 肋骨転移巣破裂による胸腔内出血と診断した.Transcatheter arterial embolizationにより止血し一時的に症状は緩解した.症例3: 61歳男性, 術後6か月目に止血困難な鼻出血が出現した.生検の結果, 肝細胞癌の鼻中隔, 鼻腔粘膜転移が強く疑われ, 右外頸動脈結紮術が行われたが, 止血しえず死亡した.