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We conducted a targeted literature review on patient burden during the interictal period of migraine. The results of the literature review revealed that: (1) migraine-associated burden persists into the interictal period and is not confined to the headache episodes themselves; (2) anxiety over the possible recurrence of headache episodes is a factor that reduces daily activities and quality of life (QOL); and (3) prophylactic treatment with calcitonin gene-related peptide (CGRP) antibody drugs may reduce the burden during the interictal period. From these findings, it is considered important in migraine treatment to identify the unmet needs of patients, including the burden during the interictal period, and to select an appropriate treatment method based on the burden experienced by individual patients.

Purpose: Typically, grades are compiled using spreadsheet software, and the file is then emailed with the password sent in a separate email. The government has pointed out that this method does not provide robust security. Introducing a new system is difficult due to the psychological factor of status quo bias. Therefore, we devised a new grade compilation system that uses spreadsheet software that can be easily implemented. The research aims to develop an automatic grade compilation system that implements RSA encryption., Methods: As Excel's specifications do not allow for the display of more than 16 significant digits, we devised a method of applying modular exponentiation to modular arithmetic. The time required for encryption was measured five times and the average value was calculated., Results: The time required for encryption was approximately 2.3 seconds, and RSA encryption is highly secure, it has the advantage of being able to distribute files with e-mail, and a paperless workflow could be established., Conclusion: The developed system is highly secure and can be sent via email, and its automation is effective as a means of preventing disputes caused by human error.

A 23-year-old woman was presented with fever and epigastric pain. Contrast enhanced computed tomography revealed a 40mm mass in the lateral segment. Blood tests showed the elevation of WBC and CRP. With the diagnosis of liver abscess, the antibiotics were administered, and the clinical findings were promptly improved. One year later, she complained of the same symptoms, and the mass had increased to 50mm in diameter. Percutaneous liver biopsy led to the diagnosis of fibrolamellar hepatocellular carcinoma.

Proton magnetic resonance spectroscopy( 1 H-MRS)is a non-invasive method for evaluating brain function and metabolism. 1 H-MRS can quantify low-molecular-weight metabolites in a living brain; it shows their spectra without tracer administration. In this paper, we introduce 1 H-MRS and MRS for imaging the distribution of metabolites. The applications of 1 H-MRS imaging for several neurological disorders will be outlined.

Objectives　This study elucidated the relationship between work and family conflicts of employees working in small and medium-sized businesses in Japan and its association with their lifestyle and working conditions.Methods　A self-report questionnaire survey was conducted with 294 employees of four small and medium-sized businesses that agreed to participate in the study. The survey included items on demographics, working conditions, lifestyle, the Japanese version of the multidimensional Work-Family Conflict Scale (WFCS), and subjective health and stress. Based on the scores of both the subscales of the WFCS, Work Interference with Family (WIF), and Family Interference with Work (FIW), participants were divided into two groups (high and low score groups). Using these scores as dependent variables, a logistic regression analysis was performed to examine factors related to the WIF and FIW.Results　Of the 227 collected responses, 185 responses with no missing values were determined as valid for the analysis. Participants were 146 men (78.9%) and 39 women (21.1%) with an average age of 43.6±11.2 years. The proportion of spouses and children was about 60%. The median values of WIF and FIW were 3.0 and 2.3, respectively. There were statistically significant differences in "average working hours per day," "ease of taking vacations," "skipping or not skipping meals," and others, between the two groups of WIF, and in "ease of taking vacations" and "subjective health" between the two groups of FIW. A significant difference was found in "subjective stress." Logistic regression analysis showed that the WIF was related to "skipping or not skipping meals," "subjective stress," "average working hours per day," "age," "subjective health," and "ease of taking vacations." FIW was related to "subjective health" only and different factors were extracted.Conclusions　The results of this study suggest that an acceptable lifestyle and better workplace environment is essential to reduce the WIF. Thus, employees should work fewer hours and feel comfortable to take vacations. Additionally, it is necessary to deal with stress skillfully and improve mental and subjective health to reduce FIW.

A 56-year-old man noted sudden onset of headache, fever, right pupil-spared oculomotor nerve palsy and consciousness disturbance. Swelling of pituitary with T 1 high intensity on brain MRI suggested the diagnosis of pituitary apoplexy. Considering significant decrease of pituitary anterior lobe hormone and central diabetes insipidus, high dose of hydrocortisone was administered. Eight days after onset, consciousness level and headache improved. On day 30, brain MRI revealed the reduction of mass size, and on day 46, photophobia and double vision disappeared. Following the rapid response to steroid and disappearance of pituitary lesion, pituitary apoplexy was probably caused by panhypophisitis. Thin-slice brain MRI confirmed the compression of oculomotor nerve at inlet zone of cavernous sinus, suggesting the mechanism of oculomotor palsy was perfusion impairment of feeding artery.

The clinical entity idiopathic normal pressure hydrocephalus (iNPH) is characterized by dementia, urinary incontinence, gait ataxia. An 80-year old man with a past history of Type 2 diabetes mellitus admitted to our hospital. Combination of twice Aspart and Aspart premixed30/70 insulin were used. Although, he was unable to inject insulin by himself recently. On physical examination, he walked in a mildly wide based manner. According to his family, urinary incontinence was existed. Laboratory data were as follows: Postrandial blood glucose 243 mg/dl and glycated hemoglobin 8.0% (NGSP). Brain magnetic resonance imaging (MRI) scans showed thinning of the corpus callosum with enlargement of the lateral ventricles on a colonal image. Evan's ratio was 0.29. The revised version of Hasegawa's Dementia scale (HDS-R) was 10. The patient showed no evidence a related antecedent event, such as head trauma, intracerebral hemorrhage and meningitis. Thus, he was diagnosed as having possible Idiopathic normal pressure hydrocephalus (iNPH). The following several psychological tests and walking test were applied. Before and after the tap, he was evaluated using the HDS-R, Mini mental state examination (MMSE), Timed Up and Go test (TUG). Insulin was replaced by glargine, and Sitagliptin was added. On the 31 day, the patient underwent Ventriculo-perioneal shunt. Laboratoly data and memory impairment were also improved. 8 month's later, HbA1c was 7.5%. iNPH occurs in the elderly and is characterized by a clinical triad of gait disturbance, urinary incontinence and dementia. In the present case, thinning of the corpus callosum with enlargement of the lateral ventricles was detected by MRI. 49% of iNPH patients had Diabetes mellitus. However, we were unable to detect a relationship iNPH and Diabetes mellitus. Cognitive impairment may interfere with the insulin therapy. In the present case, failure of insulin self-injection was the first clinical sign to appear. We were able to reduce dose of insulin. We conclude that iNPH is a treatable disorder, especially when treatment is started early in the course of the disease.

A 65-year-old male visited our hospital because of fever and difficulty in walking. He was suffering from left-sided hypochondrial pain for a month. Laboratory tests performed on admission revealed a white blood cell count of 1700/μl and C-reactive protein level of 9.51mg/dl, which were suggestive of severe inflammation. Contrast-enhanced computed tomography revealed a subphrenic abscess around the spleen, which we considered to be caused by gastric penetration into the gastrosplenic ligament. Upper esophagogastroduodenoscopy revealed a gastric ulcer together with a fistula that connected to the left subphrenic abscess. We thus performed endoscopic transgastric drainage through the fistula. Antibiotics and a proton pump inhibitor were administered, and drainage was continued. The patient's clinical and inflammatory symptoms subsequently improved. We thus consider that endoscopic transgastric drainage is an appropriate treatment option for subphrenic abscesses.

To prevent the recurrence of irradiation accidents, monitor-unit (MU) verification that is independent of the MU values calculated using the radiation treatment planning system (RTPS) is required. In this study, we investigated whether independent verification of MU values is being conducted in medical settings and examined the types and methods used. Our results indicate that 93.8% of facilities conduct independent MU verification. The methods used vary according to the facility: 30.4% conduct actual measurements, 18.6% use MS-Excel calculation sheets, 16.7% use specialized commercially-available software, 14.7% use spreadsheets 13.7% use calculators, and 5.9% use other methods. In this study, we were able to formulate basic data that can be used for information-sharing between facilities.

The human mind develops through history within the passing of time. Thus, what determines the passing of time in the human mind? For example, when you are asked about yourself 10 years before now, you are able to answer by tracing back through your own experiences. You will be confident of your answer as far as you rely on your memory. Therefore, your personal memory is critical for the passage of time; however, how memory that allows for mental time travel is formed or maintained in the brain is largely unknown. This type of memory may exist only in humans. In this article, we review past studies on memories that emerge from time information in human and experimental animals.

The Japanese Headache Society and the Japanese Society of Neurology has published the 2013 guidelines for the diagnosis and treatment of chronic headache. A new CQ has been set up in the guidelines on the topic of "How to treat chronic migraine." In the past, lomerizine was the only prophylactic medication of migraine that was eligible under insurance coverage. However, afterward in 2010, valproate was added to the list of antimigraine medications approved under insurance coverage, followed by propranolol, amitriptyline, and verapamil, with rapid advances in the treatment of migraine. Valproate, topiramate (not approved under insurance coverage until date), and amitriptyline could potentially be used in the treatment of chronic migraine in Japan; further, considering the clinical outcomes thus far, lomerizine could also be added to the list. As a drug for migraine prophylaxis, valproate is contraindicated in pregnant women and needs to be used with caution.

Migraine is a common neurological disorder that produces substantial disability for sufferers. Chronic migraine (≥ 15 headache days/month; CM) was significantly more disabling than episodic migraine (< 15 headache days/month; EM). CM was associated with greater impairment of occupational and social aspects of quality of life. Lost productivity time was substantially higher among CM participants than persons with EM. Full time employment was lower in CM participants because of medical leave. The medical costs were two or three times higher for CM than EM. These results suggest that migraine chronification is associated with substantial economic burden.

A 70-year-old man presented with a 0-IIc lesion in the lower esophagus. He underwent esophageal endoscopic submucosal dissection (ESD). The pathological diagnosis was squamous cell carcinoma with small cell carcinoma. The patient received chemoradiotherapy after ESD, but this was interrupted because of myelosuppression. Follow-up endoscopic ultrasonography (EUS) at 5 months after the ESD revealed paracardial lymph node swelling (17mm). He underwent EUS-guided fine-needle aspiration (FNA), and lymph node metastasis of small-cell-type endocrine cell carcinoma was diagnosed. He received VP-16 chemotherapy but died 22 months after the ESD.

A very elderly patient with primary non-Hodgkin lymphoma of the esophagus is reported. An 87-year-old woman presented with dysphagia. Endoscopy revealed an elevated lesion with ulceration in the middle and lower esophagus. Endoscopic biopsy demonstrated pathological diagnosis and immunochemistry typical of non-Hodgkin lymphoma (Ann Arbor stage IIIEA), diffuse large B-cell lymphoma on the WHO classification. Systemic chemotherapy with 6 courses of a 50% dose of R-CHOP followed by 8 courses of rituximab for maintenance, successfully resulted in complete remission. Complete remission has been maintained for 58 months.

Proton magnetic resonance spectroscopy ((1)H-MRS) non-invasively provides in vivo biochemical information on tissue metabolites. In acute stage of cerebral ischemia, N-acetyl aspartate (NAA), one of (1)H-MRS observable metabolite, declines gradually reflecting energy impairment due to oxygen depletion. In our study, decline of NAA in ischemic core linearly correlated with the time from the onset of ischemia. Therefore NAA can be utilized to time clock biomarker for the acute stage cerebral ischemia.

We experienced anesthesia for a female patient of BMI 39.2 with unanticipated lingual tonsillar hyperplasia. At the induction of anesthesia, both mask ventilation and tracheal intubation were difficult due to the lingual tonsillar hyperplasia. However, tracheal intubation was performed by Intubating LMA with the fiberoptic bronchoscopy. After the placing of TE (the catheter for tracheal tube exchanger), the tracheal tube was extubated without any airway trouble. Following the extubation, the opening of the respiratory tract was evaluated by TE and the fiberoptic bronchoscopy. In this case we confirmed that the ASA difficult airway algorithm was also useful in the presence of lingual tonsillar hyperplasia.

The aim of this phase I/II study was to evaluate the tolerability and efficacy of combination chemotherapy with gemcitabine (GEM) and UFT for advanced pancreatic cancer. In phase I study UFT was given orally every day for 14 days and GEM was infused on day 1 and 8 at three dose levels (800, 900, 1,000 mg/m(2)/week) every 21 days. GEM 1,000 mg/m(2) and UFT 400 mg/m(2) did not reach the maximum tolerated dose. We decided that the recommended dose (RD) was GEM 1,000 mg/m(2)and UFT 400 mg/m(2). In phase II study 27 patients were enrolled and received GEM and UFT at RD. The tumor response rate was 17.6%, and the median survival was 221 days, which was very similar to that of GEM monotherapy. Due to adverse events, especially liver dysfunction, protocol therapy was discontinued in 12 patients. This study could not revealed the superiority of the GEM monotherapy.

Inoculation tests of Staphylococcus aureus were performed to evaluate the risk of toxic hazard in cheese manufacturing processes. S. aureus was inoculated into pasteurized milk or cheese curd, and the survival and growth were examined. S. aureus grew only slightly or decreased in cell number under the manufacturing condition of semi-hard type cheese or soft-type cheese. Under the conditions of the fresh cheese making process, S. aureus slightly increased in cell number, though no enterotoxin was detected. In processed cheese, S. aureus did not grow at all. Growth inhibition of S. aureus by lactic acid produced from starter culture was suggested to be the cause of growth inhibition in the natural cheese.

Goal of initial imaging study for acute-stage ischemic stroke are to detect focal lesion accurately and to assist the therapeutic decision. With the goal in mind, we investigated feasibilities of MRI for acute-stage ischemic stroke. Firstly, we assessed whether diffusion weighted images (DWI) raised diagnostic accuracy for acute-stage ischemic stroke. We investigated how DWI study changes the diagnosis for the patients with neurological symptom in emergency room. Out of 164 patients who visit the emergency room with neurological symptom, sensitivity, specificity and efficiency for ischemic stroke diagnosis before DWI study were 0.87, 0.85 and 0.89 respectively. DWI raised them to 0.99, 0.98 and 0.99. These result proves feasibility of DWI on diagnosis of acute-stage ischemic stoke. Secondly, we assess whether DWI and perfusion imaging (PI) can provide any information about fate of acute ischemic lesion. We compared the relationships between DWI and PI parameters (ADC, rCBF, MTT, rCBV) and tissue outcome (infracted or survived). In patients with successful recanalization, best predictor was ADC and the cut-off value was 0.90 against contra-lateral hemisphere. In patients without recanalization, rCBF at 0.66 against contra-lateral hemisphere predicted the pathological fate most accurately. This simple guidepost can be help therapeutic decision of acute-stage stroke.

The facial edema and tongue swelling after oral surgery are not rare complications and many case reports were published, but they were limited after anesthesia for surgery of other parts. A 70-year-old woman who had underwent thoraco-abdominal aortic graft surgery showed severe facial edema and tongue swelling after the surgery in the right lateral position. The tongue was largely protruded outside of the mouse when entering ICU and was gradually improved. Twelve hours later, the tongue was shrunken into the mouse. The patient was moved to a general ward without any complications on the 5th postoperative day. The patient had taken anti-hypertensive drugs including candesartan for a long period. She might have become susceptible to angioedema by angiotensin receptor blocker such as angiotensin-converting enzyme inhibitor and stress of surgery, and anesthesia might have induced a complication of the acute tongue swelling. Although, prevention and treatment of angioedema have not been established, careful observation would be required.

An amendment concerning the enforcement of the law on the prevention of radiation hazards due to radioisotopes, etc., and the medical service law enforcement regulations were promulgated on June 1, 2005. This amendment concerned international basic safety standards and the sealing of radiation sources. Sealed radiation sources < or =3.7 MBq, which had been excluded from regulation, were newly included as an object of regulation. Investigation of the SPECT system instituted in hospitals indicated that almost all institutions adhere to the new amendment, and the calibration source, the checking source, etc., corresponding to this amendment were maintained appropriately. Any institutions planning to return sealed radioisotopes should refer to this report.

Progress in imaging techniques has contributed to improvements in reliable diagnosis and surgical decision making in neurosurgery. From the viewpoint of neurosurgeons, there are two major needs in the development of imaging techniques. One is greater accuracy in demonstrating the anatomy of the brain at microscopic resolutions and the other is visualization of function or metabolism that is invisible on surgical views. Use of 3.0 T magnetic resonance imaging (MRI) in clinical patients has revealed anatomy appropriate for microsurgery at high resolution, and three-dimensional reconstruction of MRI on high-specification computers helps neurosurgeons to understand the anatomy of the brain in individual patients. Functional imaging methods such as functional MRI, positron emission tomography, and magnetoencephalography have provided new insights in brain surgery, visualizing various cerebral functions on anatomic images. Recently, diffusion tensor imaging is used to visualize neural tracts passing through subcortical white matter and MR spectroscopy is used to show the metabolic status of lesions. These tools are also forms of functional imaging. New noninvasive imaging techniques are still being developed to visualize function more easily. Here, we summarize the roles of recent imaging techniques in our previous studies and discuss the future of imaging in neurosurgery.

A thrombolytic agent, recombinant tissue plasminogen activator (rt-PA), was recently approved in Japan for use on patients within 3 hrs of the onset of cerebral infarction. In order to salvage cerebral tissue after an ischemic insult, it is crucial to detect the ischemic lesion before it becomes irreversible and to detect the core and penumbra areas of the lesion for guidance in selecting the suitable therapy. In this symposium we discuss the detection of ischemic lesions using plain CT, perfusion CT, and MRI. In the section on plain CT, we present a typical case with early CT signs. In the section on perfusion CT, we report on the feasibility and limitation of the technique for the diagnosis of acute cerebral infarction. In the section on MRI, we study the usefulness of DWI for the early and highly reliable detection of ischemic stroke.

This study attempted to clarify whether medical radiological technologists of the Japanese Society of Radiological Technology in Gunma sought to obtain Bachelor degrees and Master of Science degrees. In September 2005, a postal questionnaire survey was conducted on a sample of 153 technologists, and 68.0% (104/153) of the questionnaires were returned. The percentage of respondents who wished to obtain a degree was 25.0% (26/104) . The first reason for wishing to obtain a degree was to improve the quality of their work 47.8% (11/23) . Moreover, 28.8% (30/104) of respondents indicated a desire to obtain a master's degree. A total of 103 respondents indicated the subject they wished to study: 45.6% (47/103) indicated their own specific area, and 34.0% (35/103) indicated clinical psychology. The results of the survey showed that a high ratio of radiological technologists in Gunma would like to obtain an advanced degree. Even the radiological technologists who did not wish to obtain an advanced degree indicated their desire to continue in more specialized areas of radiology. The above investigation suggested some ways to implement lifelong education at the Gunma Prefectural College of Health Sciences.

A 61-year-old woman with chronic renal failure was scheduled for posterior spinal fusion. The duration of surgery was over ten hours and the patient was placed on prone position almost whole period of surgery. Although the surgery was finished without any obvious complications, laboratory examinations revealed marked liver dysfunction the day after the surgery. On the third postoperative day, computed tomography examination strongly suggested the liver infarction. Liver infarction has been considered as a rare complication because of two kinds of blood streams, the hepatic artery and the portal vein, but we should suspect the liver dysfunction from ischemia after the surgery of prolonged prone position.

The aim of prophylactic treatment of migraine is to reduce the frequency and severity of migraine attacks. Identifying relevant trigger factors can help reduce the frequency of migraine attacks. The headache diary is useful to identify trigger factors and pattern of headaches and to assess the efficacy of medication. Prophylactic drugs should be considered when attacks are frequent or severe and the acute treatments such as triptans or NSAIDs are not effective. Lomerizine, propranolol, valproate and amitriptyline are useful. Lomerizine is recommended as the first-line prophylactic drug because it is licensed as a preventive drug for migraine in Japan. If attacks has not improved after using a prophylactic drug for 2 months, the drug can be changed to another drug. Propranolol is particularly useful if a patient has hypertension. Amitriptyline is useful if there is associated depression and/or tension-type headache. Valproate is considered if attacks are frequent. Patients should be informed benefits and potential side-effects of the medicine.

Difficult Airway Management (DAM) is one of the most important skills for medical practice, especially for anesthesiologists. A seminar of DAM was held in the 51 st annual meeting of Japan Society of Anesthesiologists. It consisted of a 60-minute lecture about ASA difficult airway management algorithm, and a 120-minute hands-on training session using a mid-fidelity human simulator. The lecture was held twice, and was opened to every JSA member without pre-registration. More than 100 participants attended each lecture. The hands-on training session, which required preregistration, was held three times. Each training session was limited to 8 participants, and a total of 23 participants attended the session. The training session was restricted to only participants and staffs so that their privacy was secured. The questionnaire about DAM was collected after the lectures or the training sessions. Most of the participants of lectures were certified anesthesiologists, and they agreed that the DAM seminar was useful. The questionnaire revealed that the most popular technique for DAM was insertion of laryngeal mask airway (ILMA). Otherwise the invasive techniques were difficult to be experienced in the clinical practice. We suspected that the DAM seminar was useful, especially for the invasive technique without substitute training methods under clinical situation.

Because the exposure dose in X-ray computed tomography examinations is sometimes difficult to determine, it is important to be able to estimate the dose for these examinations. The effective energy of the X-ray CT scanner is required to estimate exposure dose. Although the half-value-layer (HVL) method has been used to calculate effective energy, it is not an easy method. This paper proposes a technique by which effective energy can be easily calculated. Certain details were found to cause change in effective energy, and the ratio (inner-metal center-air ratio: IMCAR) between air dose and dose in fixing the metallic pipe in the isocenter of an X-ray CT scanner was necessary. The IMCAR from a different X-ray CT scanner was required, and, when effective energy was calculated, it showed an error of less than 0.7% for the half-value-layer method. The effect of this error on dose estimation was slight (0.4%). This technique is useful, because effective energy can easily be calculated with a high degree of accuracy.

The semi-axial-view method is used to measure humeral retroversion angles by a single x-ray exposure. We examined the clinical utility of this method using a humerus model and normal volunteers. In an experiment with a humerus model, humeral retroversion angles were measured at various positioning angles by the semi-axial-view method, and compared with the angles measured by the CT method, which is considered the standard, and the best position was determined. The upper arms of three volunteers were photographed by the semi-axial-view method in the most suitable position, and humeral retroversion angles were compared with those obtained by the CT method. As a result of examination with a humerus model, the best positioning angles were 20 degrees of shoulder abduction angle, 90 degrees of shoulder flexion angle, and 90 degrees of elbow flexion angle. There were no significant differences between the humeral retroversion angles of the CT and semi-axial-view methods with the best position determined in volunteers. In conclusion, the semi-axial-view method is a useful, easy method for measuring the humeral retroversion angle. This method will be a great asset in researching large numbers of samples.

To investigate clinical and microbiological features of streptococcal toxic shock syndrome (STSS), clinical, epidemiological, and bacteriological data obtained from 250 patients between 1992 and 2001 were analyzed. Among these 250 cases, 16 cases were excluded from the study because the causative microorganism were not Streptococcus pyogenes. 234 strains of S. pyogenes obtained from the aforementioned 234 cases were tested for T-type by a serological method, and for streptococcal pyrogenic exotoxin (SPE) by in vitro productivity of the toxin as well as molecular genetic methods. The number of patients was 141 (56.4%) for males, and 107 (42.8%) for females. The highest frequency of STSS was observed in those patients in their sixties in both sexes. The overall mortality rate was 43.2%. The mortality rate for male was 36.9%, and 52.3% for female. Bacteriological studies revealed that most common T types were T1 and T3. These strains consisted 54.3% of the strains collected. Among strains of T1 type, 98.8% possessed genes of spe A, and 46.1% were shown to produce SPE A in vitro. Among strains of T3 type, 82.9% possessed spe A gene, and all of these strains were shown to produce the toxin in vitro. It is concluded that certain strains of S. pyogenes, such as those with T1, or T3 type, and those with spe A gene or in vitro production of SPE A, are the most frequent cause of STSS. Although infections caused by such bacteria are quite common, STSS rarely occurs in most such patients. Additional factors, such as host factors, may play a crucial role in the pathogenesis of STSS.

Recently, the number of scans for X-ray computed tomography (CT) examinations has been rising due to the wide-spread use of multi-slice CT (MSCT) scanners. There is a concern that the total medical exposures will be increased by these examinations. In order to lower exposures, routine parameters for head CT examinations done at several hospitals in Gunma were investigated. In this study, the computed tomography dose index (CTDI(100, C)), noise, and low contrast resolution were measured. The CTDI(100, C) for all the hospitals exceeded the guideline (40mGy) suggested by the Japan Association of Radiological Technologists (JART). Low contrast resolution showed the coefficient of variation of +/-5% between hospitals. In conclusion, it was proposed that the technologists should reconsider the parameters of the head X-ray CTs, in cases where their output dose far exceeds the standard.

Recent advances in MRI technology and the development of effective neuroprotective agents has improved the outcome of stroke. In order to salvage tissue after an ischemic insult it is important to differentiate the core and penumbra area of the ischemic lesion. The penumbra surrounds the ischemic core, damage in this area is reversible if effective neuroprotective agents are given and reperfusion occurs. In this symposium detection of penumbra in an ischemic lesion using diffusion weighted imaging (DWI) and perfusion imaging (PI), diffusion-perfusion mismatch, and indications for thrombolytic therapy are discussed. If a hypoperfusion area is revealed with PI without a corresponding lesion indicated with DWI or when the DWI lesion is less than one third of the PI lesion, combined thrombolytic and neuroprotective therapies are recommended. In contrast, when both PI and DWI show an identical lesion, only neuroprotective therapy is advised. Additionally, newly developed neuroprotective agents, especially the combined effect of rt-PA and the immunosuppressant, FK506, on an embolic infarct model are discussed.

We performed experimental and clinical MR studies to determine the optimal imaging conditions for the uterine three-layer structure on fast spin-echo T2-weighted imaging. In the experimental study, we used our original phantom. Imaging studies were carried out with different TRs, TEs, and ETLs, and the contrast-to-noise ratio (CNR) was evaluated. TR was the most important factor for contrast in both the phantom and clinical studies. The longer TR was, the better the contrast became. In the clinical study, TRs of 5500-6000 msec provided clear visualization of the uterine three-layer structure. Longer TRs would be useful for the detection of disease, differential diagnosis, and grading in patients with uterine diseases.