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A 75-year-old man was admitted for combined low-frequency repetitive transcranial magnetic stimulation (rTMS) and intensive occupational therapy. Five days after the initiation of rTMS, he developed hypotension and temporary exacerbation of the right hemiplegia with thunderclap headache. MRA showed segmental stenosis of the left middle cerebral artery, which findings were improved at 9 days after the onset of the headache. He was diagnosed as having the reversible cerebral vasoconstriction syndrome (RCVS). The rTMS was recognized as safe rehabilitation treatment. However, it is necessary to recognize that RCVS can become one of the precipitants. This is the first report of RCVS triggered by rTMS.

Here we report a case of a 68-year-old man with severe stenosis of the right middle cerebral artery (MCA) following herpes zoster ophthalmicus. He presented with right-sided ptosis and ophthalmoplegia 2 months after herpes zoster ophthalmicus. Cerebrospinal fluid (CSF) analysis revealed monocytosis, increased protein levels, and positivity for herpes zoster virus immunoglobulin M (IgM). Brain magnetic resonance imaging (MRI) revealed a small asymptomatic infarct in the right basal ganglia and severe stenosis of the right MCA (M1 segment). One month later, he presented with muscle weakness of the fingers of the left hand. Repeat CSF analysis revealed similar abnormalities to the previous analysis, and MRI showed a new small infarct in the right-sided motor area corresponding to the left fingers. He was treated with acyclovir (750 mg/day), prednisolone (1 mg/kg/day), and aspirin (100 mg/day). O2-gas positron emission tomography (PET) revealed decreased cerebral blood flow (CBF) after acetazolamide injection and normal cerebral vascular reactivity (CVR). He was on continuous treatment with prednisolone and aspirin for 1 year. The muscle weakness of the fingers of the left hand and right-sided ophthalmoplegia improved, and magnetic resonance angiography revealed considerable decrease in the stenosis of the right middle cerebral artery. CBF before and after acetazolamide injection and CVR on O2-gas PET also normalized. These results suggested that long-term treatment may prevent subsequent infarcts following herpes zoster ophthalmics.

A 68-year-old man was admitted to our hospital for rehabilitation of topographical disorientation. Brain magnetic resonance imaging revealed infarction in the right medial side of the occipital lobe. On neuropsychological testing, he scored low for the visual information-processing task; however, his overall cognitive function was retained. He could identify parts of the picture while describing the context picture of the Visual Perception Test for Agnosia but could not explain the contents of the entire picture, representing so-called simultanagnosia. Further, he could morphologically perceive both familiar and new scenes, but could not identify them, representing so-called scene agnosia. We report this case because simultanagnosia associated with a right occipital lobe lesion is rare.

Background New modalities for local treatments that destroy tumor effectively but which are less invasive and less damaging to normal lung tissue must be developed for patients who are unable to undergo even video-assisted thoracic surgery (VATS) due to poor cardiopulmonary function, severe adhesion, or advanced age, etc. We evaluated the use of microwave coagulation therapy (MCT), which has been used successfully for coagulation of hepatic tumors, in normal canine lung tissue to evaluate its efficacy and safety. Materials and methods Measurements of thermal response and coagulation area and histological examinations after microwave coagulation were performed in normal canine lung tissue. Results The temperature in normal canine lung tissue increased to 90–100°C at 5 mm from the electrode after 60 s and 70–80°C at 10 mm after 90 s at 40 or 60 W. The coagulation area was approximately 20 mm in diameter at 40 W and 60 W. Histological analysis demonstrated thickening of collagen fiber shortly after coagulation, stromal edema and granulation tissue after 3 months, and, finally, scar tissue was seen after 6 months. Conclusions Microwave coagulation therapy (MCT) is a useful modality for minimally invasive therapy in peripheral lung tumors.

Objective: We report our experience in the diagnosis and surgical treatment of central type lung cancer (CTLC) and discuss the prognostic significance of clinicopathological factors including the T factor.Methods: Subjects were 151 patients with CTLC undergoing surgery from 1984 to 1999. Surgical procedures include lobectomy in 111, pneumonectomy in 35, and segmentectomy in 5. Bronchoplasty was done in 44, including sleeve lobectomy in 33, carinal resection in 8, and bronchoplasty without resection of pulmonary parenchyma in 3. Data on CTLC was compared to that on peripheral lung cancer during the same period.Results: Compared to peripheral tumors, central lung tumors showed a higher ratio in male gender, pN1 in pN factors, squamous cell carcinoma in histology, and pneumonectomy and bronchoplasty in surgery. No statistical differences were seen between groups in surgical outcome, mean age, distribution pattern in pT factors, and extended surgery. The positive predictive cT factor has improved. No significant difference was seen in 5-year survival based on 8 factors—period, cT factors, tumor histology, bronchoplasty, extended surgery, cellular atypia, additional chemotherapy, and radiotherapy. Five-year survival differed significantly for 12 other factors—pT, cN, and pN factors; surgical method; number of resected organs in extended surgery; curability (complete/incomplete); tumor size; N1 and N2 station metastasis; p factor, and blood vessel and lymphatic invasion. Multivariable analysis indicated only 2 independent prognostic factors—cN and p factor.Conclusions: CTLC appears to belong to a subgroup other than peripheral tumors, requiring a more accurate diagnosis of cT factors, particularly in the proximal bronchus, because cT and cN factors are the only 2 used preoperatively.

A 71-year-old man was admitted to the hospital because of hypochondlarigia and hepatic dysfunction. On ultrasonography of the liver, a cyst-like mass 5 cm in diameter having internal mobile strong echos was found in the lateral segment. CT revealed irregular thichening of the cystic wall, and ERC showed pooling of the contrast medium in the peripheral area of S2 intraheptic bile ducts. In addition, angiography disclosed an avascular area agreeing with the site of the mass. A diagnosis of hepatic cystadenoma or cystadenocarcinoma was obtained, and a lateral segmental hepatectomy was performed. A unilocular cyst having a smooth wall and containing infected serous bile and four bilirubin calculi were found in the resected specimen. Histopathological examination revealed papillary proliferation of atypical epithelium showing intestinal metaplasia including goblet cells, leading to a diagnosis of hepatic cystadenoma. There is no previous report of the presence of internal caliculi in this condition. Communication with the bile duct is also rare, with only 17 cases including the present case having been reported in the literature. These case are also discussed in this paper.

New modalities for local treatments that destroy tumor effectively but which are less invasive and less damaging to normal lung tissue must be developed for patients who are unable to undergo even video-assisted thoracic surgery (VATS) due to poor cardiopulmonary function, severe adhesion, or advanced age, etc. We evaluated the use of microwave coagulation therapy (MCT), which has been used successfully for coagulation of hepatic tumors, in normal canine lung tissue to evaluate its efficacy and safety.Measurements of thermal response and coagulation area and histological examinations after microwave coagulation were performed in normal canine lung tissue.The temperature in normal canine lung tissue increased to 90-100 degrees C at 5 mm from the electrode after 60 s and 70-80 degrees C at 10 mm after 90 s at 40 or 60 W. The coagulation area was approximately 20 mm in diameter at 40 W and 60 W. Histological analysis demonstrated thickening of collagen fiber shortly after coagulation, stromal edema and granulation tissue after 3 months, and, finally, scar tissue was seen after 6 months.Microwave coagulation therapy (MCT) is a useful modality for minimally invasive therapy in peripheral lung tumors.

We conducted combination chemotherapy with gemcitabine (GEM) and paclitaxel (TXL) for stage III non-small cell lung cancer. The chemotherapy schedule consisted of GEM 800 mg/m2 and TXL 70 mg/m2 once a week for 6 consecutive weeks. The patients were 7 males and 3 females with a median age of 66 years. There were 5 adenocarcinomas and 5 squamous cell carcinomas, 7 stage IIIA and 3 IIIB. Eight patients completed 6 cycles of planned administration. Of 9 patients who were evaluable for response, 6 patients achieved PR (66.7%), 2 patients had SD, and 1 patient had PD. The cancers were resectable in 7 out of 9 patients, and were resected completely in 5 patients. Grade 3 anemia and leucopenia were observed in 1 patient and 2 patients, respectively, but they were mild. In our experience, a non-platinum weekly regimen with GEM and TXL is well tolerated and effective, which suggests the possibility of induction chemotherapy and outpatient treatment.

For the past decade not a few test facilities have been introduced at the Experimental Tank of the University of Tokyo, especially corresponding to the recent theoretical advances in ship hydrodynamics. These are illumination technique of water surface by aluminium powder coating, facilities for photogrammetry using sub-carriage with the stereo plotter of double projection type, and the digitally controlled speed regulator system most of which we owed to Toyo Rayon Science Foundation.Following these developments, we decided to build the new towing carriage with the innovation of motor generator and trolley wire into rigid type of square section provided that speed regulator system should be remained. The design of new carriage was started on Sept. 1965 under the works of “TCG” and completed on Feb. 1967. As shown in Fig. 12 (b), the resistance test is now performed with high accuracy and other capabilities of flow & waves photographing equipments are working successfully. This paper describes the experiences of these design and construction.