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臨床例における断裂アキレス腱修復過程の経時的変化を dynamic MRI を用いて評価した。Dynamic MRI から得られる時間一輝度曲線にγ-fitting による smoothing 処理を行い, そこから得られるパラメーターの定量評価を行った。加えて, 家兎を用いてアキレス腱断裂モデルを作成し, 経時的に microangiography 及び光顕での組織学的観察を行い, 血行動態の経時的変化の意義を推察した。臨床例における dynamic MRI の時間-輝度曲線は術後4～8週で, 漸増-漸減型からやや急峻な漸増-漸減型へと変化し術後はぼ12週で急峻な急増-急減型となりその後分類不能型( 正常型) へと移行する傾向を示した。定量評価でのパラメーターの2次回帰関数のピークは術後13～14週頃であった。家兎実験では, 断裂後4週までは新生血管の増生を認めるが静脈還流が不十分な状態であり, 臨床例での術後4～8週頃に相当すると考えられた。断裂後8週にかけて毛細血管の減少と小血管の線維方向への整列が起こり断裂後10週でピークを迎え, この時期が臨床例での術後13～14週頃と考えられた。この時期には膠原線維の長軸方向への整列が認められ腱組織の形態が整っていると推察された。臨床例での腱修復は術後約12～14週で起こり, この間の修復過程の定量的評価が dynamic MRI によって可能であると考えられた。, Dynamic MR imaging with a combination of fast MR imaging technique and intravenous bolus administration of Gd-DTPA is a useful method to evaluate the vascularity of the soft tissue. By using this technique, we evaluated the healing processes of ruptured Achilles tendon. Eighteen patients who underwent percutaneous suture of the ruptured Achilles tendon were examined monthly by dynamic MRI in their course of healing. We evaluated time intensity curve obtained from each data of dynamic MRI. Time intensity curve showed slow fill in-slow wash out pattern 4 weeks after operation. 8 weeks after operation, the time course of the fill in-wash out changed to be shorter. Rapid fill in-rapid wash out pattern was observed about 12 weeks after surgery. After that period, time intensity curve tended to change into non-fitting pattern. (normal pattern) Eight functional parameters were obtained from time-intensity curve. We analyzed which parameters are useful for evaluation of tendon healing. In addition, we studied the healing processes of rabbit Achilles tendon following surgical incision. Twelve rabbits underwent tenotomy of Achilles tendon. The tendons excised at 1, 2, 4, 6, 8, 10, 12weeks after operation were examined using microangiography and a light microscope. weeks after tenotomy, many capillary vessels filled with Gd-DTPA were observed in the ruptured area. About 10 weeks after operation, the capillary vessels decreased and collageneous fibers were arranged along the long axis of the tendon. This term would be thought to correspond to the condition about 12-14 weeks after surgery in clinical cases. From this study, dynamic MRI is thought to be useful method to know the hemodynamic conditions of the healing tendons. Especially, four parameters-Mean Transit Time, Corrected Transit Time, Time to Peak, Inflection Width, -seemed to have absolute value and be useful for the quantitative evaluation of the healing processes in human Achilles tendon.

Pneumocephalus is a well-known condition following head trauma, but is rare as an injury or as a result of surgery of the spine. We present a 76-year-old patient with a rare case of pneumocephalus associated with a cerebrospinal fluid fistula as a complication of surgical treatment for cervical myelopathy. Although cerebrospinal fluid leakage was noted and the injured dura was carefully sutured at operation, tension pneumocephalus occurred. The resultant pneumocephalus was diagnosed based on neurogenic symptoms including sudden convulsion, head radiograph, and computed tomography scan. The benign course of the pneumocephalus postdiagnosis did not require secondary operation.

Four patients with neurofibromatosis (von Recklinghausen's disease) manifesting mictional disturbance are presented. They were a man aged 41 years (A) and 3 women aged 26 (B), 46 (C) and 32 (D) years, and their chief complaints included urinary retention, dysuria, urinary frequency and urinary retention. None of them had any organic obstructive disorders in the lower urinary tract. Case A who had neurofibroma at the C2 and L1-2 vertebral bodies had inactive bladder and his urinary flow rate was less than 10 ml/sec. In case B, cystometrogram was initially normal, but changed to inactive bladder type one year later and neurofibromas were found in the vertebral bodies of Th7-8 and L2. Case C, who had inactive bladder cystometrically, underwent removal of 1-acoustic neurinoma and neurinomas of cauda equina. Case D had hyperactive bladder and received resection of the neurofibroma of vertebral bodies from C6 to Th4. The finding of cystometrogram and type of urinary miction disorders suggested vertebral neurofibroma at an early stage.

The HMG CoA reductase and cholesterol 7α-hydroxylase activities were determined and fecal bile acids were analyzed in rats fed with a low (0.16%) or a high (1%) cholesterol diet in order to investigate the influence of dietary cholesterol on the lithogenesity of bile in rats treated with clofibrate（α-p-chlorophenoxy isobutyl ethyl ester). The HMG CoA reductase activity displayed no change five days after administration of 200 mg/kg/day clofibrate to both the rats treated with a low or high cholesterol diet, although the activity fell considerably by administration of the cholesterol diet. But clofibrate produced a slight elevation of cholesterol 7α”hydroxylase activity in both diet groups. The fecal output of deoxycholic acid significantly increased in the rats fed with a low cholesterol diet but not in those fed with a high cholesterol diet after clofibrate administration. The foregoing results indicate the possibility that the enlarged poolsize of trihydroxy bile acids after clofibrate administration in the rats fed with a low cholesterol diet as seen in the previous experiment 1) will be due to the increased conversion of cholesterol into bile acids but not due to inhibition of bile acid output into feces. On the contrary, the absence of increase in the bile acid pool size in the rats fed with a high cholesterol diet after clofibrate administration 1) appeared to be due to deficiency of substrate in the liver. The substrate is meant to be the newly synthesized cholesterol in the liver, which was reduced by the feed back inhibition of exogenous cholesterol, and led to production of lithogenic bile with the aid of excess biliary cholesterol accelerated by another action of clofibrate. Clofibrate produced an increase in the liver weight of these animals, but failed to cause not only any light microscopic changes in the liver tissue but also any changes in the serum liver function tests.

Four patients with neurofibromatosis (von Recklinghausen's disease) manifesting mictional disturbance are presented. They were a man aged 41 years (A) and 3 women aged 26 (B), 46 (C) and 32 (D) years, and their chief complaints included urinary retention, dysuria, urinary frequency and urinary retention. None of them had any organic obstructive disorders in the lower urinary tract. Case A who had neurofibroma at the C2 and L1-2 vertebral bodies had inactive bladder and his urinary flow rate was less than 10 ml/sec. In case B, cystometrogram was initially normal, but changed to inactive bladder type one year later and neurofibromas were found in the vertebral bodies of Th7-8 and L2. Case C, who had inactive bladder cystometrically, underwent removal of 1-acoustic neurinoma and neurinomas of cauda equina. Case D had hyperactive bladder and received resection of the neurofibroma of vertebral bodies from C6 to Th4. The finding of cystometrogram and type of urinary miction disorders suggested vertebral neurofibroma at an early stage.