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In general, the dimensional relation between the rafter placement and the bracket complex is well known as Rokushigake. However, there are a few non-Rokushigake that need to be examined further. This paper evaluates some problems that are connected to the positions of the rafter placement, gagyou and the bracket complex, especially are located on the corner pillars among the non-Rokushigake architecture. As a result, it became clear and can be classified, basically there are three ways, such as: to adjust the rafter placement to the centre on both sides of the gagyou, to adjust the bracket complex system, and without adjusting them to set the rafter in order or disorder.

As for the relation between the rafter placement and the bracket complex, Rokushigake architecture, which is the combination of the outer surface of each block and the outer surface of the two rafters, is well known. However, there are quite a few non-Rokushigake Japanese shrines and temples designated as national treasure or important cultural properties. This paper will analyze the dimensional relation between the rafter placement and 3-on-1 bracket complex among the non-Rokushigake architecture. Consequently, it became clear that the outer surface of three-block bracket arms or its center are matched systematically with the inner surface of the rafter above and its center or the outer surface from the six-rafters placement to three-rafters placement.

OBJECTIVE—A1C levels have been shown to be elevated in relation to glycemia in late pregnancy, although the precise mechanisms remain undetermined. We hypothesized that iron deficiency is involved in the A1C increase in late pregnancy. RESEARCH DESIGN AND METHODS—In study 1, A1C, serum glycated albumin, erythrocyte indexes, and iron metabolism indexes were determined in 47 nondiabetic pregnant women not receiving iron supplementation who were divided into four groups according to gestational period (group I, 21–24 weeks; group II, 25–28 weeks; group III, 29–32 weeks; and group IV, 33–36 weeks). In study 2, these determinants were obtained at two gestational periods (20–23 weeks and 32–33 weeks) in 17 nondiabetic pregnant women. RESULTS—In study 1, A1C levels were higher in groups III and IV than those in groups I and II, whereas serum glycated albumin levels were not different among these four groups. Hemoglobin, mean corpuscular hemoglobin (MCH), serum transferrin saturation, and serum ferritin were lower in groups III and IV. A1C levels were negatively correlated with MCH, serum transferrin saturation, and serum ferritin. In study 2, A1C levels were significantly increased at gestational weeks 32–33 from those at weeks 20–23, whereas serum glycated albumin levels did not differ between the two gestational periods. MCH, serum transferrin saturation, and serum ferritin were decreased at gestational weeks 32–33. A1C levels showed a negative correlation with MCH, serum transferrin saturation, and serum ferritin. CONCLUSIONS—A1C levels were elevated in late pregnancy owing to iron deficiency. Serum glycated albumin may offer a better index for monitoring glycemic control in pregnancy.

The gastrointestinal stromal tumor cell line, GIST-T1, has a heterogenic 57-base pair deletion in exon 11 of the c-kit mutation, and the c-KIT protein in the GIST-T1 cells constitutively activated. We report that STI571 (Glivec; Novartis, Basel, Switzerland), a specific inhibitor of c-KIT, inhibits the clustering of c-KIT at the cell membrane of the GIST-T1 cells. Furthermore, STI571 prevents the interaction between c-KIT and the molecular chaperone, heat shock protein 90 (Hsp90). Geldanamycin, an inhibitor of Hsp90, also prevents interaction between c-KIT and Hsp90, and inhibits tyrosine phosphorylation of c-KIT. Our results indicate that c-KIT molecules are assembled on the cell surface of the GIST-T1 cells, and that the interaction between c-KIT and Hsp90 plays an important role in c-KIT activation.

Evaluation of myocardial perfusion in the early stage of acute myocardial infarction (MI) is clinically important for adjunctive therapies to minimize infarct size. To determine the role of early scintigraphic detection of impaired myocardial reperfusion after primary coronary angioplasty (PTCA) in patients with acute MI, semiquantitative technetium-99m tetrofosmin single-photon emission tomographic (SPET) imaging was performed before primary PTCA (before; area at risk), 60 min after PTCA (after) and at 1 month (1 M; final infarct) in 35 patients with acute MI. The left ventricle was divided into 13 segments and the defect score was calculated as the sum of the perfusion defect of each segment, from 3 (complete defect) to 0 (normal perfusion). A significant myocardial perfusion change after PTCA was defined as a change in the defect score (before minus after PTCA) of/=4. The echocardiographic asynergic score was defined as the number of asynergic (severe hypokinetic or akinetic) segments corresponding to the analogous segments on SPET images, and recovery of wall motion was calculated as absolute change in the asynergic score (before PTCA minus 1 M). Among the 35 patients, 15 (43%) had a change in the defect score of4 (no reflow: group 1) while 20 had a change in the defect score of/=4 (reflow: group 2). There were no significant differences between the two groups with respect to the time between admission to PTCA, revascularization time, collateral grade or Thrombolysis in Myocardial Infarction (TIMI) flow grade before PTCA. Despite the lack of a difference in area at risk between the two groups (group 1 = 12.8+/-4.3 and group 2 = 15.1+/-4.7), final infarct size in group 1 was significantly larger compared with that in group 2 (8.1+/-4.3 vs 4.9+/-3.0, P0.001). Recovery of wall motion was significantly smaller in group 1 than in group 2 (4.3+/-1.7 to 3.5+/-1.5 vs 4. 1+/-2.1 to 1.6+/-1.6, P0.001). In conclusion, a small change (4) in defect score (scintigraphic no-reflow phenomenon) after primary PTCA indicates persisting impaired myocardial perfusion or irreversible cellular damage just after PTCA which is associated with poor recovery of wall motion, as compared with that observed in cases of reflow (/=4 in defect score).

We recently experienced a case of abdominal leiomyosarcoma which was preoperatively diagnosed as mesosigmoid origin. A 66-year-old woman was admitted to the department because of a lower abdominal mass. A computed tomography revealed a large solid mass and angiographically it's localization was detected as mesosigmoid. We performed an extirpation of the mass with segmental sigmoidectomy. The tumor was diagnosed as leiomyosarcoma with the pathological and immunohistochemical evaluation. Leiomyosarcoms originated in the mesenterium are rare, and so far 54 cases have been reported in the Japanese literature including ours.

陣仮性嚢胞内出血より腹腔内出血をきたし, 手術により救命しえた1例を経験した. 症例は84歳男性で突然, 悪心と左側腹部痛を訴えショックとなり近医に緊急入院した. 保存的治療でショック状態は改善したが腹腔試験穿刺で血性腹水を認め, 腹腔内出血と診断された. その後, 2度ショック状態となり, 当科紹介入院となった. 入院時ショック状態は輸血, 輸液により改善していたが腹部は膨満し, 全体に圧痛を認めた. 検査成績では貧血, 高血糖, 低蛋白血症を認めたが際酵素, 腫瘍マーカーは正常であった. 腹部超音波, CT検査で腹水と際尾部の腫瘤を認めた. 腹腔動脈造影で陣動脈より造影剤の血管外への漏出と貯留を認め悌仮性嚢胞内への出血が疑われ緊急開腹術を施行した. 開腹時約2,000mlの血性腹水と膵尾部に直径約10cm大で凝血塊が充満する腫瘤を認めた. 膵尾側切除と障摘出術を施行した. 膵仮性嚢胞内出血から腹腔内出血をきたした報告例7例の検討を加えて報告する.

Patients on long-term hemodialysis are at risk of developing malnutrition,and poor nutrient intake is an important factor in this. In the present case, we encountered a 55-year-old Japanese woman with end-stage renal failure and a past history of schizophrenia. Severe systemic edema was observed. Hemodialysis was started, but after one year she suddenly became unable to consume food orally, despite provision of a dietary plan by the nutrition support team (NST). Tube feeding was eventually implemented. Because the systemic edema did not improve, we decided to remove body fluid by intense hemodialysis. Hypotension was often observed during this hemodialysis, requiring dopamine. Over approximately 2 months, the patient's dry weight fell from 73 kg to 62 kg, the patient's activity improved and she became able to eat orally again, allowing tube feeding to be stopped. Although the reason for the sudden anorexia has not been clarified, tube feeding and dry weight control was successful in the treatment of this malnourished hemodialysis patient.

Fournier's gangrene (FG) is rapidly progressing acute gangrenous infection of the anorectal and urogenital area. FG needs precocious diagnosis and aggressive treatment with the use of wide spectrum antibioticus and surgical debridement. In our case, a 91-year-old Japanese female who had rehabilitation after treatment of pneumonia and her past history was rheumatoid arthritis treated with steroid and chronic heart failure. Her activities of daily living was bedridden with dementia. Necrotic skin was observed in urogenital and anorectal area and skin redness enlarged to the hip with high fever. Surgical debridement was performed. Both Peptostreptococcus Sp. and Fusobacterium Sp. was cultured from resected necrotic tissue. We used antibioticus, PAPM and PIPC, which had sensitivity for them. But unfortunately, disseminated intravascular coagulation occurred after 4th day of operation, and finally she died after 10th day of operation. We discussed the treatment for FG in patient with complication.

Acute appendicitis often presents as right lower quadrant (RLQ) pain, severe tenderness at the point of McBurny or Lanz, and Blumberg's sign. Scrotal events with appendicitis are very rare. In our case, a 63-year-old Japanese man presented with severe RLQ pain and high fever. Physical examination revealed severe tenderness (including both points of McBurny and Lanz) and Blumberg's sign. The scrotum was slightly swollen and showed local heat with severe testicular pain. Abdominal computed tomography revealed ascites in a pelvic space and the right side of the spermatic cord was swollen. Emergency operation was performed and the final diagnosis was catarrhal appendicitis and acute epididymitis. This is the first report of acute appendicitis concomitant with acute epididymitis.

We experienced a case of chronic pancreatitis causing extensive retroperitoneal abscess due to acute relapse of the disease, which was successfully managed by ultrasonic retroperitoneal drainage and conservative treatment. A 61-year-old man had been treated at elsewhere for chronic pancreatitis for the past ten years. He had experienced 3 episodes of acute relapse of the disease during the same period, and on each occasion, the conservative treatment was effective. Recently, the patient was transfered to the hospital because of epigastralgia, back pain and fever, and probable suspicion of having a retroperitoneal abscess caused by an acute relapse of chronic pancreatitis. Ultrasonography and CT allowed a diagnosis of extensive retroperitoneal abscess extending to the pelvic cavity. Because surgery was judged to involve a high risk, he was treated with ultrasonic drainage and conservative therapy. About two months after the admission, the abscess has completely disappeared on ultrasonic and CT images, consequently cured.

肝細胞癌の十二指腸浸潤を内視鏡的に診断しえた1例を経験したので報告する. 症例は47歳の男性で, 全身倦怠感を主訴に近医受診. 上部消化管透視, CTにて十二指腸平滑筋肉腫とその多発性肝転移の疑いで当科紹介入院となる. 貧血と肝機能障害を認め, HBs Ag (+), α-fetoprotein高値で血管造影で肝細胞癌と診断された. 内視鏡で十二指腸球部前壁に茶褐色の不整な潰瘍を認め, 生検でEdmondson III型程度に相当する肝細胞癌の所見が得られた. 以上より肝細胞癌の十二指腸浸潤と診断し十二指腸球部の潰瘍からの出血のため開腹術が施行された. 肝左葉より肝外性に発育した腫瘍が十二指腸球部に直接浸潤していた. 術後38日目に肝不全で死亡した. 剖検所見では肝細胞癌が肝左葉を中心として発育し, 両葉に多数の肝内転移を認め連続性に十二指腸へ浸潤し瘻孔様になっていた. 十二指腸への転移, 浸潤例はまれで, 本邦での報告例はわずか11例のみである. 文献的考察を加えた.

We evaluated the usefulness of helical CT scanning with drip-infusion cholangiography for the delineation of choleductal anatomy in preparation for laparoscopic cholecystectomy.One hundred and five cases underwent laparoscopic cholecystectomy for cholecystolithiasis in our department from March 1993 to July 1998. Endoscopic retrograde cholangiography was carried out in 58 cases and helical CT scanning with drip-infusion cholangiography, including, three-dimensional CT in 31 cases. We, retrospectively, investigated three-dimensional helical CT scanning with drip-infusion cholangiography in the point of three-dimensional demonstration of cystic duct anatomy and try to classify the findings.Three-dimensional helical CT scanning with drip-infusion cholangiography visualized three-dimensional anatomy of the cystic duct clearly. For the detection of the biliary disease such as stones and polyps, however, endoscopic retrograde cholangiography is superior (sensitivity; 89.7%) to two-dimensional helical CT scanning with drip-infusion cholangiography (sensitivity; 64.5%) and three-dimensional helical CT scanning with drip-infusion cholangiography (sensitivity; 22.6%) except for large lesions. We have classified the three dimensional helical CT scanning with drip-infusion cholangiography findings in three types.Three-dimensional helical CT scanning with drip-infusion cholangiography is not only less invasive but also more useful for the delineation of three-dimensional anatomy of the bile duct.

Angiographic Thrombolysis in Myocardial Infarction (TIMI) flow gradeor=2 after primary percutaneous transluminal coronary angioplasty (PTCA), defined as angiographic no reflow, predicts poor left ventricular functional recovery and survival in patients with acute myocardial infarction (MI). To determine the relation between angiographic coronary flow and myocardial salvage in the acute phase of MI, serial technetium-99m tetrofosmin imaging was performed before, immediately after and 1 month after PTCA in 117 patients. Angiographic no reflow was observed in 23 patients (20%; group 1), while 94 patients did not have angiographic no reflow (group 2). Although there was no significant difference in the defect score before PTCA between the two groups (group 1, 14.4+/-5.7; group 2, 13.5+/-4.6), the defect score immediately after PTCA in group 1 was significantly higher than that in group 2 (group 1, 12.8+/-5.1; group 2, 8.9+/-4.6; P0.0001). A significantly smaller change in the defect score after PTCA (before minus immediately after PTCA) was observed in group 1 as compared with group 2 (group 1, 1.7+/-2.0; group 2, 4.5+/-2.9; P0.0001). Twenty patients in group 1 (87%) had impaired myocardial reperfusion (4 change in the defect score immediately after PTCA), as compared with 36 patients (38%) in group 2; this difference was significant (chi(2)=17.5, P0.0001). The sensitivity, specificity and accuracy of angiographic no reflow in estimating impaired myocardial reperfusion were 36%, 95% and 67%, respectively. Thus, angiographic no reflow is a highly specific, although not sensitive, marker of impaired myocardial reperfusion immediately after primary PTCA.

By evaluating concordant or discordant perfusion and systolic wall thickening patterns, resting quantitative electrocardiographic (ECG) gated single-photon emission tomography (SPET) can identify various myocardial pathological conditions with different functional recovery after revascularisation therapy. However, no data are available on the ability of this methodology to predict regional functional recovery after primary percutaneous transluminal coronary angioplasty (PTCA). This study evaluated whether single-injection ECG gated SPET imaging performed at rest with 99mTc-tetrofosmin early after successful PTCA can predict recovery of regional wall motion. ECG gated SPET was performed 3 days and 3 weeks after successful PTCA in 26 patients. Regional functional parameters were automatically calculated with a 20-segment model on the day 3 image, and segments with perfusion/thickening mismatch were defined as showing preserved perfusion (55% uptake on the end-diastolic image: mean-standard deviation of the normal value) without systolic wall thickening (mean-standard deviation of the normal value). On the third day, the regional wall motion score of 37 mismatched segments (3.8+/-2.1) was significantly lower than that of 41 matched normal segments (6.0+/-2.9), but was significantly higher than that of 108 matched abnormal segments (1.4+/-1.9, both P0.01). At 3 weeks after acute MI, the regional wall motion score of mismatched segments (6.4+/-3.9) improved to the level of matched normal segments (7.1+/-3.0) and was significantly higher than that of matched abnormal segments (2.5+/-3.0, P0.01). Absolute change in the regional wall motion score (3 days to 3 weeks) of mismatched segments (2.6+/-3.5) was significantly greater than that in the regional wall motion score of matched normal segments and matched abnormal segments (1.1+/-1.3 and 1.2+/-2.6, respectively, both P0.05). Twenty-seven of 37 segments (73%) with perfusion/thickening mismatch showed significant improvement in regional wall motion, whereas improvement in regional wall motion was observed in 22 of 108 segments (20%) with matched abnormal segments and 6 of 41 segments (15%) with matched normal segments. Segments with perfusion/thickening mismatch had a significantly higher incidence of regional functional improvement than did matched abnormal or matched normal segments (chi2=42.3, P0.01). Thus, by estimating both perfusion and wall thickening, single-injection resting ECG gated SPET imaging with 99mTc-tetrofosmin early after primary PTCA can predict recovery of regional wall motion after successful reperfusion.

To evaluate the relation between ST-segment analysis and microvascular reperfusion in patients with acute myocardial infarction (AMI), we studied 51 patients with first AMI who were successfully treated by percutaneous transluminal coronary angioplasty (PTCA). The lead showing the greatest ST-segment elevation on the 12-lead electrocardiogram (ECG) was serially investigated until 24 hours after PTCA. Successful reperfusion was determined by technetium-99m tetrofosmin single-photon emission computed tomography. Impaired reperfusion (group 1:4 change in the sum of the defect score from before to immediately after PTCA) was observed in 24 patients, and successful reperfusion (group 2) was observed in 27 patients. Although ST-segment elevation was reduced significantly at 30 minutes after PTCA in group 2 (2.2 +/- 1.4 to 1.7 +/- 1.3 mm, p = 0.01), there was no significant change in group 1 (1.9 +/- 1.9 to 2.4 +/- 1.7 mm). Ten of 14 patients (71%) with persistent ST-segment elevation (DeltaST0 mm change in ST segment from before to 30 minutes after PTCA0) were in group 1, whereas 23 of 37 patients (62%) with ST-segment resolution (DeltaSTor = 0) were in group 2. The sensitivity and specificity of persistent ST-segment elevation for predicting impaired microvascular reperfusion were 42% and 85%, respectively. Thus, persistent ST-segment elevation 30 minutes after primary PTCA was a highly specific electrocardiographic marker of impaired reperfusion in patients with AMI.

To avoid the haemorrhagic risk of unnecessary thrombolysis in acute myocardial infarction (MI), early and precise diagnosis of spontaneous recanalization (SR) of the infarct-related artery is required. To clarify the accuracy of technetium-99m tetrofosmin myocardial single-photon emission tomography (SPET) in the detection of SR in patients with acute anterior MI, electrocardiography (ECG), echocardiography and 99mTc-tetrofosmin SPET imaging were performed in 49 patients with acute anterior MI before emergency coronary angiography. Defect score was calculated as the sum of the perfusion defects of each segment: from 3 (complete defect) to 0 (normal perfusion). Echocardiographic asynergic score (the sum of asynergic grades) and the greatest ST elevation of the 12-lead ECG on admission were also measured. SR was defined as Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow on emergency coronary angiography. Defect score in 11 patients with SR (9.2 +/- 3.7) was significantly lower than that in 38 patients without SR (18.5 +/- 5.0) (P0.001), whereas there were no significant differences in asynergic score and ST elevation between the two groups. From the receiver operating characteristic curves, the optimal cut-off points of defect score, asynergic score and ST elevation for the detection of SR were calculated to be 12, 13 and 3.5, respectively. The sensitivity and specificity of the scintigraphic defect score (91% and 89%) were significantly higher than those of the asynergic score (64% and 68%) and ST elevation (73% and 71%). Thus, 99mTc-tetrofosmin SPET imaging on admission is a very accurate method for the detection of SR in patients with acute anterior MI.

The suprachiasmatic nucleus (SCN) of mammals is considered to be a circadian oscillator and it also demonstrates circadian rhythmicity of its multiple unit activity. A number of neuropeptides have been found in the SCN. Vasoactive intestinal peptide (VIP)- and vasopressin-containing neurons comprise large populations of these cells and have a distinct distribution within the nucleus. Therefore we attempted to examine whether the VIP neurons show a diurnal alteration of their immunoreactivity by combined immunocytochemistry and color image analysis. Our results demonstrate that VIP-like immunoreactive neurons show a diurnal change in the amount of immunoreactivity. Immunoreactivity was most intense in the sections from rats maintained in the cyclic photoperiod and sacrificed at 02.00 h and weakest in teh SCN from animals sacrificed at 14.00 h. We considered that VIP-like immunoreactive neurons showed diurnal variation of VIP synthesis depending strongly on the light from the retina.

OBJECTIVESThe purpose of this study was to evaluate whether higher coronary blood flow, estimated by the corrected Thrombolysis In Myocardial Infarction (TIMI) frame count (CTFC), is related to better functional and clinical outcome after successful percutaneous transluminal coronary angioplasty (PTCA) in patients with acute myocardial infarction (AMI).BACKGROUNDExperimental studies have found that functional recovery of the infarcted myocardium was associated with increased blood flow (reactive hyperemia) to the infarcted bed shortly after reperfusion.METHODSWe measured CTFC immediately after successful (TIMI 3) primary PTCA in 104 consecutive patients with their first AMI. Wall motion score index (WMSI) and the presence of pericardial effusion were assessed by two-dimensional echocardiography before and one month after PTCA.RESULTSThe patients were divided into two groups according to mean CTFC for corresponding coronary artery of the control group: TIMI 3 slow group (45 patients, 40 > CTFC ≥ 23) and TIMI 3 fast group (59 patients, CTFC < 23). There were no significant differences in the baseline characteristics and WMSI before reperfusion between the two groups. Improvement of WMSI in the TIMI 3 fast group was significantly greater than that of the TIMI 3 slow group (1.33 ± 0.52 vs. 0.60 ± 0.34, p < 0.001). Pericardial effusion and intractable heart failure were observed more frequently in the TIMI 3 slow group than in the TIMI 3 fast group (27 vs. 10%; p < 0.05, 36 vs. 17%; p < 0.05). Corrected TIMI frame count, assessed as a continuous variable, had a significant correlation with the change in WMSI (r = 0.60, p < 0.001) after adjusting for age, gender, history of hypertension, history of diabetes, elapsed time to PTCA, collateral grade, presence of antegrade flow before PTCA and number of diseased vessels.CONCLUSIONSLower CTFC of the infarct-related artery immediately after PTCA was associated with greater functional recovery; and hence, CTFC can predict clinical and functional outcome in patients with successful PTCA.