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We describe a technique for studying living cells with the atomic force microscope (AFM) in tapping mode using a thermostated, controlled-environment culture system. We also describe the integration of the AFM with bright field, epifluorescence and surface interference microscopy, achieving the highest level of integration for the AFM thus far described. We succeeded in the continuous, longterm imaging of relatively flat but very fragile cytoplasmic regions of COS cells at a lateral resolution of about 70 nm and a vertical resolution of about 3 nm. In addition, we demonstrate the applicability of our technology for continuous force volume imaging of cultured vertebrate cells. The hybrid instrument we describe can be used to collect simultaneously a diverse variety of physical, chemical and morphological data on living vertebrate cells. The integration of light microscopy with AFM and steady-state culture methods for vertebrate cells represents a new approach for studies in cell biology and physiology.

We report a rare case of giant cell glioblastoma that was difficult to distinguish from cerebral metastasis. The MRI finding was a ring-enhancing well-circumscribed solitary brain tumor that was very similar to cerebral metastasis. Even when MRI results were considered together with the findings by magnet resonance spectroscopy and perfusion-weighted MRI, it was hard to distinguish between giant cell glioblastoma and cerebral metastasis before surgery. When we find a solitary ring-enhancing intracranial mass with little tendency of invasion, we need to consider the possibility of giant cell GBM as a differential diagnosis., 緒言：画像所見上，転移性脳腫瘍との鑑別が困難であった巨細胞膠芽腫の症例を報告する．症例：失行を主訴とする64 歳の女性が当院脳外科に紹介された．CT およびMRI で左頭頂葉にリング状増強を示す境界明瞭な腫瘤がみとめられ．MRI 灌流画像では，増強腫瘤周囲のT2延長域において局所血液量の増加をみとめず，MRスペクトロスコピーでは，同部にコリン/クレアチン比の増加をみとめなかった．これらの画像所見から，転移性腫瘍が疑われた．開頭腫瘍摘出術が行われ，病理組織学的に巨細胞膠芽腫と診断された．考察：巨細胞膠芽腫は膠芽腫の一亜型であるが，その画像診断所見についての報告は少ない．本症例では増強腫瘤の境界が明瞭だったことに加え，増強腫瘤周囲のT2 延長域において，局所血液量の増加やコリン/クレアチン比の増加などの腫瘍の浸潤を示唆する所見がみられなかったことから，転移性脳腫瘍との鑑別が困難であった．結語：画像上浸潤傾向に乏しいリング状増強腫瘤がみとめられた場合，巨細胞膠芽腫は鑑別診断として考慮すべきである．

Background : Intraarterial therapy (IAT) for acute cerebral infarction has been proven to be profitable. However,the criteria for the indications,the choice of the thrombolytic agents, and the use of adjunctive agents are controversial. We retrospectively analyzed the prognostic factors of IAT. Materials and methods: From 1994 to 2003, 28 patients underwent IAT due to middle cerebral artery occlusion (17 women and 11 men ; median age,69 years old). We evaluated the following prognostic parameters: institution of treatment, degree of paralysis at visit, size of high-intensity area on diffusion-weighted images, dose of intraarterial urokinase administration, elapsed time from symptom onset to completion of IAT, presence of penetration of embolus by microcatheter and microguidewire, recanalization after IAT, intracranial hemorrhage (ICH) within 24 hours after IAT, and intravenous heparin administration after IAT. The outcome was evaluated at discharge and was classified into the following categories according to the modified Rankin Scale: independence (0 to 2), dependence (3 to 5), and death (6). Results: Seven patients were judged to be independent, 16 patients were judged to be dependent, and five patients died. Patients with recanalization after IAT had a better outcome than those without (p＜0.05); patients with intracranial hemorrhage had a worse outcome than those without (p＜0.05); and patients with intravenous heparin administration after IAT had a better outcome in activities of daily living than those without (p＜ 0.05). Conclusion :In addition to ICH and recanalization,our results suggested that intravenous heparin administration after IAT had a favorable effect on patient outcome.