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Purpose: To evaluate a new method that registers phase-contrast magnetic resonance angiography images to time-of-flight magnetic resonance angiography images. Methods: Magnetic resonance angiography datasets of 10 healthy volunteers obtained by using two modalities (phase-contrast magnetic resonance angiography and time-of-flight magnetic resonance angiography) were preprocessed. Specifically, vessel regions were extracted using the region growing method with a threshold of 10% of the signal intensity maximum or 50% of the signal intensity maximum for phase-contrast magnetic resonance angiography images and time-of-flight magnetic resonance angiography images, respectively. Then, the normalized mutual information method was used to determine spatial positions, and registration between non-preprocessed phase-contrast magnetic resonance angiography and time-of-flight magnetic resonance angiography was performed using the spatial position information. Misalignment of 3 anatomical points was used to compare the accuracy of registration in this data group (the proposed method group) to that in the data group without registration (the non-registration group) and that in the data group subjected to normalized mutual information-based registration without preprocessing (the non-preprocessing group). Results: The mean misalignment of 3 anatomical points ± standard error was 1.69 ± 0.11 mm in the proposed method group, and 2.77± 0.13 mm and 90.28 ± 8.24 mm in the non-registration group and non-preprocessing group, respectively. The mean misalignment of 3 anatomical points was significantly smaller in the proposed method group than in the non-registration group (p = 0 001). Conclusions: The proposed preprocessing and registration method improved the accuracy of normalized mutual information-based registration between phase-contrast magnetic resonance angiography images and time-of-flight magnetic resonance angiography images.

A voxel-based specific regional analysis system for Alzheimer's disease (VSRAD) was used for quantitative analysis of parahippocampal atropy with 1.5-tesla (T) MRI in a voxel-wise manner. The analysis of images acquired under a different imaging condition provides an error factor that has a calculated value. Clinical application of 3T-MRI is necessary for establishing a normal data base (N-DB) specific for 3T-MRI data, which permits appropriate application of VSRAD. We established an N-DB specific for 3T-MRI for use in VSRAD. The "Z-score of the parahippocampal gyrus" was 0.79 +/- 0.32, and the N-DB of each age group did not have a big deflection when we analyzed a group of physically unimpaired persons in an N-DB specific for 3T-MRI. Therefore, we were able to confirm the validity of the customized N-DB. The "Z-score of the parahippocampal gyrus" was 1.62 +/- 0.47 for the N-DB of VSRAD. The numerical value was high for the group of physically unimpaired persons.

Image evaluation with Response Evaluation Criteria in Solid Tumors (RECIST) evaluates the change in a measurable lesion as determined by ruler or micrometer caliper. However, there is no definition of the conditions thought to influence the precision of measurement. We therefore examined the effects on measurement precision by changing image amplification, WW, WL, and time phase. Moreover, to determine response rate, one-dimensional evaluation with RECIST was compared with the two-dimensional evaluation of World Health Organization (WHO) for a hepatocellular carcinoma. The results of measuring the object lesion for measured value variation were as follows. Under image conditions of 1 time expansion/ WW 150/ WL 100 was (4.92+/-1.94)%. Under image conditions of 1 time expansion/ WW 350/ WL 75 was (4.42+/-1.70)%. Under image conditions of 4 times expansion/ WW 150/ WL 100 was (2.52+/-0.82)%. Under image conditions of 4 times expansion/ WW 350/ WL 75 was (2.83+/-1.10)%. When an image was enlarged to 4 times, precision doubled. There was no a difference in comparing RECIST to WHO in terms of response rate. Thus the best method was considered to be RECIST because of its convenience.

We prove two first eigenvalue pinching theorems for Riemannian symmetric spaces (Theorems 1 and 2). As their application, we answer negatively a question raised by Elworthy and Rosenberg, who proposed to show that for every compact simple Lie group G G with a bi-invariant Riemannian metric h h on G G with respect to − 1 2 B -\frac {1}{2} \,B , B B being the Killing form of the Lie algebra g \mathfrak {g} , the first eigenvalue λ 1 ( h ) \lambda _{1}(h) would satisfy ∑ j = 1 2 ∑ ℓ = 3 n | [ v j , v ℓ ] | 2 > n ( 2 λ 1 ( h ) − 1 ) , \begin{equation*}\sum _{j=1}^{2}\sum _{\ell =3}^{n} |[v_{j},v_{\ell }]|^{2}>n(2\lambda _{1}(h)-1),\end{equation*} for all orthonormal bases { v j } j = 1 n \{v_{j}\}_{j=1}^{n} of tangent spaces of G G (cf. Corollary 3). This problem arose in an attempt to give a spectral geometric proof that π 2 ( G ) = 0 \pi _{2}(G)=0 for a Lie group G G .

We reported a case of 67-year-old man with malignant fibrous histiocytoma (MFH). He noticed a subcutaneous tumor on the right lateral lower leg three years ago. Tumor was totally excised by a primary physician about two years ago, and histological examination revealed the tumor to be MFH. The lesion recurred one year ago and he presented us on february 24, 1994. Physical examination revealed 45×45mm, well-demarcated, elastic hard, subcutaneous tumor with pain. A detailed evaluation showed no evidence of metastatic disease, however a invasion to the peroneus muscle was suggested. Surgical resection of the tumor was carried out along clinically 3cm normal skin margin, including peroneus longus, brevis and soleus.Postoperative radiation therapy was performed before the reconstructive surgery for fear of microscopic subclinical residual tumor. The defect was reconstructed with a free LD flap. Two years and six months postoperatively, there has been no sign of recurrence. We think that the free flap transfer is useful for the defect after tumor excision.

Metastatic adrenal tumor is found in a high incidence at autopsy, but is rarely resectable clinically. A resected case of metastatic adrenal tumor arising from the lung cancer is reported, with a review of the questionnaire survey about resectable cases. A 46-year-old male, who had been operated on for adenocarcinoma of the lung in vain because of invasion to the major vessel and had been treated by chemotherapy and irradiation 26 months earlier, complained of abdominal pain at the left side. Computed tomography, abdominal ultrasonography, and angiography showed a left metastatic adrenal tumor from the lung cancer. The tumor was successfully resected, because the primary lesion was wellcontrolled. The adrenal tumor was confirmed a metastasis from the lung cancer by pathological examination. Resectable metastatic adrenal cancer from lung cancer have been reported in only 12 cases in Japan including present case. As far as we could know, all cases, excluding this one, died within six months after adrenectomy, and only this patient still survive for more than three years. The excision of metastatic adrenal tumor should be performed from the viewpoint of removal of local complaints, when the adrenal metastasis is diagnosed as solitary and the primary lesion is well-controlled.

Gallbladder injuries due to abdominal trauma are rarely observed clinically because of the anatomical protection by the liver, kidney, costal arch, spinal bone and intestine, so the incidence of the injuries is less than 1%. Four cases of solitary gallbladder injury, three of which were caused by blunt trauma and one by penetrating injury, have been encountered over the past seven years in the hospital. A 44-year-old male was admitted with a stab-wound, a 20-year-old female, a 37-year-old male and a 6-year-old boy were injured by blunt trauma, all of whom excluding a boy were drunk. All cases were preoperatively diagnosed as gallbladder injury based on findings of abdominal ultrasonography and computed tomography, including a fluid collection around the gallbladder, intracystic high density area, and intraluminal heterogenous picture. Cholecystectomy was performed in them. Only 26 cases of solitary gallbladder injury have been reported in Japan including these cases. It is important for preoperative diagnosis that ultrasonography and computed tomography are repeated at different times.

症例は37歳, 男性.下血を主訴として来院し, 上部消化管内視鏡検査, 直腸診などにて診断がつかぬまま出血性ショックにおちいった, 腹部血管造影にて, 空腸起始部に病変が疑われ, 緊急手術を施行, 視診にて空腸の腫瘤に由来する出血と診断し, 同部を切除した.術後経過は良好である.病理学的には虫体の一部と思われる角皮の周囲に好酸球が浸潤した膿瘍で, 肉芽組織に包囲されており, 緩和型の空腸アニサキス症と診断した.このような病変から大量出血をきたした例は文献上類を見ないので報告した, なお, 症例の抗アニサキス抗体価は高値を示した.

膵頭十二指腸切除後の再建法として今永法を基本術式としているので, われわれの施行している術式と成績について検討した.1981年7月より1986年4月までの4年10カ月間に膵十二指腸切除術を83例に施行した.術式は膵全摘術43例, 膵頭十二指腸切除術40例であり, 膵頭十二指腸切除術40例中, 今永法で再建した34例を中心に術後成績について検討した.今永法膵頭十二指腸切除術施行34例中, 直死例は認めなかったが, 膵空腸縫合不全を3例 (8.8%) に認め, 2例がその合併症で入院死した.1984年以後は重篤な合併症もなく, 術後膵内外分泌能の検討でも比較的良好に維持されており, 今永法は簡便かつ生理的な再建法と考えられる.