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A 63-year-old Japanese female in an immunocompetent state developed right Ramsay Hunt syndrome and left shoulder pain, and left upper limb motor paresis with herpes zoster (HZ) duplex in the right auricle and left shoulder regions. With her Ramsay Hunt syndrome, neural deafness, tinnitus and vestibular symptoms were observed, and she lacked facial nerve palsy. Cerebrospinal fluid (CSF) findings revealed an increase in lymphocytes (21 cells/μl) and protein content (29 mg/dl), and polymerase chain reaction for varicella-zoster virus DNA in CSF was negative. Cervical root MRI using 3D Nerve VIEW (Philips) imaging showed high-intensity lesions on the C5-C8 spinal roots with contrast enhancements. No abnormalities were observed in the median or ulnar motor sensory nerve conduction velocity conduction studies including the F wave. PubMed search revealed no report of a patient with this profile, and to the best of our knowledge HZ duplex with concomitant neurological impairments has not been reported. We compare our present case with several similar cases from the literature.

A 34-year-old man developed right-dominant lower limb paraplegia, and then upper limb paresis with radicular pain following disseminated herpes zoster (HZ) in his right forehead, back of the trunk, and lumbar and right lower limb regions. Cerebrospinal fluid (CSF) findings revealed an increase in lymphocytes (32 cells/μl) and protein content (50 mg/dl), and polymerase chain reaction (PCR) for varicella-zoster virus (VZV) DNA was negative in CSF, but VZV antigen was positive in the patient's vesicle smear. Lumbar root MRI using 3D Nerve VIEW (Philips) imaging showed high-intensity lesions on the L2-L5 spinal roots with contrast enhancements, and cervical MRI showed similar findings on both sides at the C4-Th1. Peripheral nerve conduction study revealed prolonged distal latency to 4.9 ms, decreased MCV to 38 m/s, and complete loss of F-wave was seen in the right peroneal nerve study. Minimal F-wave latency was prolonged in the right tibial nerve. Thus, the patient was diagnosed with VZV polyradiculoneuritis caused by disseminated HZ. Regarding the possible pathogenesis of polyradiculoneuritis in this patient with disseminated HZ, we speculate that VZV reached by retrograde transmission from the involved peripheral nerves to the spinal ganglia, which, then, produced polyradiculoneuritis.

We report a case of rheumatoid meningitis complicated with cryptococcal meningitis in a 59-year-old female with rheumatoid arthritis. Migraine symptoms were followed by abnormal behavior, and the patient was admitted with fever and headache. On admission, her cerebrospinal fluid (CSF) contained 115 cells/μl, a protein content of 95 mg/dl, and a sugar level of 47 mg/dl; Her serum anti-cyclic citrullinated peptide (CCP) antibody value was high (174 U/ml), and a brain MRI showed enhanced gadolinium lesions in the cerebral/cerebellar pia mater and subarachnoid space, etc. Probable rheumatoid meningitis was clinically diagnosed, and a prednisolone (PSL) pulse was started. Several days later, a CSF culture test was positive for Cryptococcus neoformans, and the antigen titer was 128-fold. Liposomal-amphotericin B (L-AMB) was started for cryptococcal meningitis, combined with three PSL pulses for rheumatoid meningitis. After about 4 weeks, the number of CSF cells and anti-CCP antibodies decreased rapidly. At 2 months after the onset, the meningitis recurred. The MRI contrast lesions reappeared, and the CSF cells increased to 24/μl. Serum and CSF anti-CCP antibodies increased at the time of recurrence, but the cryptococcal antigen titer decreased. Thus, we concluded that the rheumatoid meningitis mainly involved the pathogenesis of both types of meningitis. The number of PSL pulses was limited to four. Post-perioral therapy was avoided. Methotrexate was continued for the rheumatoid meningitis, fluconazole was continued for the cryptococcal meningitis, and neither type of meningitis has recurred.

A 76-year-old Japanese female who was treated with long-term use of prednisolone at 10 mg/day for interstitial pneumonia developed acute right-dominant lower limb paralysis and then upper limb paralysis with herpes zoster eruptions on the right C7-Th1 dermatomes. On admission, right predominant quadriplegia was observed with sensory symptoms; Hughes functional grade was level 4; the hand grip power was right, 0, and left, 7 kg, the deep tendon reflexes were abolished throughout without pathologic reflexes. Twenty days after the onset of the symptoms, the cerebrospinal fluid (CSF) revealed mild increases of lymphocytes (13 cells/μl) and protein content (73 mg/dl). Varicella-zoster virus (VZV) PCR was negative in the CSF, but an enzyme immunoassay for VZV was positive in her serum and CSF, and the high titers were prolonged. Peripheral nerve conduction and F wave studies suggested right-dominant demyelinating polyradiculoneuropathy. A T 1 -weighted MR contrast image exhibited right-dominant high-intensity lesions on the C7-Th1 spinal roots and similar lesions on the L4-5 spinal roots. We compared with several similar cases from the literature and proposed that VZV itself involves the pathogenesis of the polyradiculoneuritis in immunocompromised hosts.

A 59-year-old man was referred to our hospital due to of a right pulmonary hilar mass shadow found on a chest X-ray film in October 2008. Bronchoscopy and transbronchial biopsy at that time revealed squamous cell carcinoma. The clinical stage was IIIB (T4N2M0). He was readmitted 2 months later because of appetite loss and severe anemia. An abdominal CT scan showed thickening of the stomach wall. Gastroendoscopy showed a submucosal tumor with central depression in the middle body of the stomach. We histologically confirmed that the gastric lesion was metastasis from the squamous cell lung carcinoma. Here we report a rare case of squamous cell lung carcinoma with gastric metastasis diagnosed by gastroendoscopic biopsy while the patient was alive.

Purpose: The steadily elevating cost of the contrast-enhanced CT has been a problem in last decade. One approach to curtail the cost is to reduce the amount of contrast media (CM). The purpose of this study was to examine the possibility of reducing the volume of CM in single-detector CT (SDCT) without compromising diagnostic ability., Materials and Methods: One hundred ml of Iohexol 300 and 75 ml of Ioversol 320 were compared in a prospective CT study about their imaging quality. One hundred patients were randomly divided into two parallel groups (A and B). The former agent was used for group A and the latter for B. CT attenuations of the aorta, central vein, spleen and kidney were measured and each imaging quality was reviewed by three radiologists., Results: CT attenuations and the imaging quality were significantly superior (p<0.05) in A group, however, comparing in the condition under 50 kg patients, they showed no significant differences and the quality was tolerable for diagnosis in both group., Conclusion: This demonstrates the difficulty to perform the high-quality CT with a reduced CM in SDCT. However, this does not negate the diagnostic ability of low dose of CM, but reflects the importance of determining the acceptable lowest doze of CM for diagnosis.

Purpose: The purpose of this study was to evaluate the usefulness of CT or MR imaging findings in patients with spinal epidural hematoma (SEH) for predicting neurological outcome., Materials and Methods: MR images of our six patients with SEH were evaluated retrospectively: complete recovery was achieved in two patients; paresis remained in two patients; and paraplegia remained in two patients. The ratio of the maximum anteroposterior diameter of the SEH to that of the spinal canal was calculated in each patient on midline on axial images in our six patients and 23 previously reported patients., Results: Among our six patients, the ratio was less than 60% in two patients with total recovery, whereas all four patients with remaining motor impairment had ratios of 60% or more. Of 29 cases, 18 of 22 patients without residual motor impairment had ratios of less than 60%, but five of seven patients with residual motor deficits had ratios of 60% or more (p = 0.023)., Conclusion: The degree of spinal cord compression by hematoma may be a prognostic factor in SEH.

Objects: This study examined the nutritional intakes of elderly people with care needs and of the caregivers, using data of the Comprehensive Survey of the Living Conditions of People on Health and Welfare and the National Nutrition Survey in 1995., Methods: Four groups were categorized: elderly people with care needs (65 and older, n = 83), female caregivers (40 and older, n = 95), other elderly people (65 and older, n = 1,818), and other women (40 and older, n = 3,477). The ratios of intakes to dietary reference intakes (DRIs) for energy and 8 nutrients (protein, fat, calcium, iron, vitamin A/B1/B2/C), as well as salt, were compared among those four groups., Results: Mean ratios to DRIs in elderly people with care needs were 108% for energy, 85% for calcium, and 101-224% for the other 7 nutrients. Mean salt intake in this group was 11.0 g/day. For many nutrients, ratios to DRIs were significantly lower than those in other elderly people. Mean ratios to DRIs in caregivers were 104-294% for energy and the 8 nutrients, and mean salt intake was 12.8 g/day, with no significant differences from date for other women., Conclusion: This study cast light on the status of the nutrient intake in elderly people with care needs and their caregivers. It was suggested that calcium intake was insufficient in the former.

Purpose: To investigate the relationship between skipping breakfast and cardiovascular disease risk factors such as blood pressure, serum lipids, smoking, and lock of exercise., Materials and Methods: Data from the National Nutrition survey conducted by the Ministry of Health and Welfare, from 1995 through 1997 were employed for the analysis. Data were used only if subjects were between 20 and 59 years old and had participated in the nutrition survey, and values for height and weight, blood pressure, serum lipids, blood sugar, number of steps per day, and smoking, drinking, and exercise habits were available. The number of subjects with data available for all of the above was 11,778 (4,438 men and 7,340 women). Analyses were performed separately by sex. The relationship between skipping breakfast and continuous variables such as nutrient intake ratio (nutrient intake divided by recommended dietary allowances), body mass index, blood pressure, serum lipids, blood sugar, and the number of steps per day was examined controlling for age using analysis of covariance (ANCOVA). The relationship between skipping breakfast and categorical variables such as smoking, drinking, and exercise habits was assessed controlling for age using Cochran-Mantel-Haenszel statistics., Results: The younger the generation, the higher the rate of skipping breakfast. The rate of skipping breakfast in men was twice as high as in women. The breakfast skippers tended to intake less energy and calcium, both in men and women, that non-skippers. Female skippers tended to intake less iron and vitamin D. The number of steps per day was smaller in breakfast skippers than that in non-skippers both in men and women. Male skippers tended to have higher blood pressure than non-skippers, and female skippers tended to have a higher serum total cholesterol level than non-skippers. The breakfast skippers tended to smoke more than non-skippers, both in men and women, and female skippers tended to drink more alcohol and take less exercise., Conclusions: Skipping breakfast is related to cardiovascular risk factors such as lack of exercise, smoking, high blood pressure, and high serum total cholesterol.

We report a case of pneumoperitoneum at the end stage of lung cancer. The patient was an 81-year-old man who experienced only mild abdominal pain and fullness. The pneumoperitoneum spontaneously disappeared. Ruptured viscera and peritonitis were not observed at autopsy. We speculated that air had moved from the lung cancer lesion to the mediastinum, and then through the retroperitoneal space into the peritoneal space. When pneumoperitoneum is observed, lung cancer and other intrathoracic diseases should be suspected as causes. Also, it may be necessary to carefully examine the patient for fever, general appearance, abdominal findings, and laboratory findings, including white blood cell count and C-reactive protein level, and on that basis differentiate from ruptured viscus, which requires an emergency laparotomy.

T2* weighted gradient echo image has heightened diagnostic sensitivity to hemorrhage, which is attributed to magnetic susceptibility-induced static field inhomogeneities arising from paramagnetic blood breakdown products such as hemosiderin, which shorten T2*. We examined 4 cases of head injury in chronic stage by T2* weighted images and assessed the clinical application of this sequence for diagnosis of the intracranial lesion. All patients underwent CT scan on acute stage and long-term follow up was performed. In all cases, abnormally low signals in the brain and subarachnoid space were more conspicuous with the T2* weighted image than with any of the conventional sequences. In 2 cases with diffuse axonal injury, of which lesions were not detected on acute stage CT scan, hypointensity area was clearly demonstrated in the cerebral peduncle and corpus callosum on T2* weighted images. Selection of T2* weighted image into the routine MR examination of patients with chronic stage of the head injury is recommended.

In order ot clarify the working conditions and health of dry cleaning workers, we investigated dry cleaning workshops in C ward of Nagoya City. We had the responses from 52 (91%) workshops and 181 (97%) workers. 26 (50%) of the workshops used petroleum solvents, 23 (46%) perchloroethylene, two (4%) 1, 1, 2-trichloro-1, 2, 2-trifluoroethane (R 113), and one (2%) petroleum solvent plus perchloroethylene. Average amounts of solvents consumed per workshop were 1280 kg/year of petroleum solvents, 1450 kg/year of perchloroethylene, and 275 kg/year of R 113. Average number of workers employed in 19 workshops per workshop was 3.6 persons (median 2.0), and the remaining 33(63%) workshops had no employee. The workers complained of strange smell, irritation of eyes, unsteady feeling of head at high rate during week. They also had the high rate of complaints of shoulder stiffness, fatigability, lumbago, and the percentages of them were higher in the workers using petroleum solvents than those in the workers using perchloroethylene. More detailed surveys were made in 13 workshops out of 52. In these cases, average working hours were 11.1 per day and average years of using solvents were 12.9 in workshops using petroleum solvents, 8.4 in those using perchloroethylene including 3.1 years of petroleum solvents. Relatively high concentrations of solvents were detected under the nose of the workers pulling clothes out of dry cleaning machines, near the clothes just pulled out, and about 30 cm above the clothes at brushing with solvents before putting them into the machines. Perchloroethylene leaked from the dry cleaning machine in a workshop. Amount of the total trichlorinated compounds (TTC) in the urine of the workers directly engaged in dry cleaning with perchloroethylene tended to be larger than those of the indirect workers. TTC in both groups, however, were significantly larger than those in the control and in the workers using petroleum solvents. RBC, Hb, an Ht of the female workers in the petroleum solvents workshops were lower than those in perchloroethylene workshops. Liver function tests showed that the average values in the workers directly engaged in dry cleaning with perchloreothylene were significantly larger than those in the indirect workers. A case of malignant lymphoma, a case of liver dysfunction and a case of diabetes mellitus were found among workers directly engaged in dry cleaning. Workers in the small-sized dry cleaning workshops would not be prevented from exposure to organic solvents without the further improvement of administrative guidance and cooperation of the makers of dry cleaning machines and solvents.