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Objective To investigate the cause of inner ear disturbances in cases of middle ear cholesteatoma with labyrinthine fistula. Setting University hospital. Study design Prospective case study. Patients Eight patients who were scheduled to undergo surgery for middle ear cholesteatoma with labyrinthine fistula were included in this study. Intervention Imaging analysis was performed using a 3-dimensional fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging sequence. Main outcome measures Three-dimensional FLAIR findings were compared with clinical symptoms associated with inner ear disturbance and surgical observations of the fistula. Results Three-dimensional FLAIR in 6 patients revealed areas of high signal intensity in the inner ears on the affected sides and areas with increased signal after the administration of gadolinium, especially in cases accompanied by acute sensorineural hearing loss. These images were considered to be indicative of breakdown of the blood-labyrinth barrier due to middle ear cholesteatoma. This finding was also present in a patient with no clinical symptoms of inner ear disturbances. Conclusion Three-dimensional FLAIR images of the inner ear are valuable in evaluating labyrinthine fistula in patients with cholesteatoma. Future studies are needed to better understand the role of 3-dimensional FLAIR in predicting the severity of inner ear disturbance.

Background The aim of this study was to investigate the effects of simple tonsillectomy on nasal resistance in patients with obstructive sleep apnea syndrome (OSAS). Methods Conventional tonsillectomy was performed in 20 patients who were refractory to treatment with continuous positive airway pressure. The subjects consisted of 17 men and 3 women (mean age, 32.9 ± 6.3 years). The effects of tonsillectomy were evaluated with preoperative and postoperative polysomnography and nasal resistance. Results After tonsillectomy, nasal resistance decreased significantly from 0.39 ± 0.30 Pa/cm3 per second to 0.27 ± 0.16 Pa/cm3 per second (p < 0.05). Simultaneously, the apnea–hypopnea index decreased significantly from 55.7 ± 22.5 to 21.2 ± 14.2 (p < 0.05). There was no significant correlation between tonsillar weight and percentage of change in bilateral nasal resistance (p > 0.05). Conclusion The reduction in nasal resistance induced by simple tonsillectomy could play an important role in improving OSAS, as does nasal surgery or adenotomy.

Conclusion. This study demonstrated that precise analysis shows that the inner ear shape in sudden deafness (SD) is different from that in controls in that the fluid-filled area of SD labyrinths is significantly larger than that of controls. Reduced cochlear modiolus area and inner area of the lateral semicircular canal (LSCC) may be associated with insufficient maturation of the inner ear. Objective. The aim of this study was to quantify the morphologies of the cochlea and LSCC using magnetic resonance imaging (MRI) and to evaluate their relationships with clinical symptoms in SD. Subjects and methods. Twenty-six unilateral SD patients with vertigo, 26 unilateral SD patients without vertigo and a matched control group without hearing loss were studied. The areas of cochlear modioli and LSCCs were traced on the MRI console and compared between SD patients with or without vertigo and control subjects. The ratio of the LSCC fluid-filled area to the total LSCC area was used to index the degree of dysplasia. Results. The cochlear modiolus area was significantly less in SD ears (4.190.2 mm 2 ) than in controls (4.390.4 mm 2 ). The LSCC inner area was significantly less in SD ears (6.99 1.7 mm 2 ) than in controls (9.191.8 mm 2 ). These results suggest that the fluid-filled area of SD labyrinths is significantly larger than controls. Morphology did not differ between affected and contralateral sides or between ears with or without vertigo in SD patients.

突発性難聴症例12例に対し Three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) MRIによる検討を行い, 造影前3D-FLAIRでは12例中9例 (75%) で患側内耳に高信号を認めた。その9例中2例は造影後3D-FLAIRで内耳に造影所見を認めた。この2例と造影後3D-FLAIRで患側内耳に造影所見を認めた感音難聴悪化の1例につき報告した。これらの症例では血液迷路関門破綻による内耳障害が疑われた。血液迷路関門の破綻と突発性難聴の予後との関連は今後の検討課題である。内耳性難聴における病態診断についてMRI3D-FLAIRは多大な貢献をすることが期待される。

Uvedafolin, 1, a new sesquiterpene lactone dimer, was isolated from the leaves of Smallanthus sonchifolius with five related compounds, 2-6, and their cytotoxicity was assessed against three tumor cell lines (HeLa, HL-60, B16-F10 melanoma). The stereostructure of 1 was newly elucidated by ESI-TOF-MS, 1D/2D NMR, and single-crystal X-ray diffraction. Dimers 1 and 2 had the most effective IC50 values, 0.2-1.9 μM, against the three tumor cell lines when compared with monomers 3-6 (IC50 values 0.7-9.9 μM) and etoposide (IC50 values 0.8-114 μM). The ester linkages of two sets of monomers, uvedalin, 5, and sonchifolin, 6, for 1, and enhydrin, 4, and sonchifolin, 6, for 2, as well as the acetyl group at the C-9 position, were essential for the high cytotoxicity. Dimers 1 and 2 would have potential as anticancer agents.

To evaluate the inner ear in sudden sensorineural hearing loss (SNHL) using three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) magnetic resonance imaging (MRI) at 3 Tesla (T).3D-FLAIR MRI has recently been developed to detect high concentrations of protein or hemorrhage. Application of this method to sudden SNHL has not been described.We used 3D-FLAIR at 3 T with and without gadolinium enhancement to evaluate eight patients with sudden SNHL.In four of eight ears with idiopathic sudden SNHL, high precontrast signals were observed within the inner ear on 3D-FLAIR. The high-signal areas observed on 3D-FLAIR were not detected by T1- or T2-weighted MRI in any of these patients. In one of these four ears, significant gadolinium enhancement was observed on 3D-FLAIR.Half the patients with sudden SNHL examined had high signals in the SNHL-affected ear on 3D-FLAIR at 3 T. High precontrast signals in the inner-ear fluid space may reflect minor hemorrhage, or an increased concentration of protein that had passed through blood vessels with increased permeability, or had originated from disrupted cells in the inner ear. Gadolinium enhancement in one ear suggested the breakdown of the blood-labyrinth barrier. 3D-FLAIR MRI should contribute markedly to the elucidation of pathologic conditions in the inner ears of patients with idiopathic sudden SNHL.

We speculated that meningeal pathologies might facilitate the permeability of cranial nerves at the fundus of the internal auditory canal (IAC), causing prompt enhancement after administration of Gd-DTPA. Using a 3D- fluid-attenuated inversion recovery (FLAIR) sequence, we evaluated the enhancement of the cerebrospinal fluid (CSF) space in the IAC fundus 10 min after Gd-DTPA administration in patients with meningeal diseases. Twenty patients (aged 22 to 79 years) were divided into 2 groups, a group with meningeal disease comprising 9 patients with meningeal abnormalities (6, tumor dissemination; 3, infection) and a control group of 11 patients with unilateral IAC pathology whose healthy sides were included as controls. Six of the 9 patients in the group with meningeal disease showed bilateral enhancement; one showed unilateral enhancement. None of the control group showed enhancement in the healthy side. One patient with Ramsay-Hunt syndrome showed only ipsilateral enhancement. Enhancement in the IAC fundus was frequently observed in patients with meningeal disease, even just 10 min after administration of contrast agent. This enhancement in the IAC fundus was never visible on T1-weighted 3D-FLASH images.

特発性低髄圧症候群は, 腰椎穿刺, 腰椎麻酔, 脳外科手術などの誘因がなく, 何らかの原因で髄液量が減少し, 頭蓋内圧が低下し, 起立性頭痛を特徴とする疾患である。本症候群はしばしば難聴, 耳鳴, めまいを合併し, 突発性難聴や低音障害型感音難聴との鑑別が重要となる。今回我々は, 両側変動性感音難聴をきたした特発性低髄圧症候群の一症例を経験したので報告する。症例は, 46歳女性, 初発症状は, 後頭部痛, 全身倦怠感, 左難聴, 左耳閉感であり, 経過中に回転性めまいあり, 頭・頸部痛も増強したため精査のため当科紹介され入院となった。純音聴力検査では両側低音部感音難聴を示し, 眼振は認めなかった。造影MRIでは肥厚した硬膜の増強を認めた。脳槽シンチでは頸椎領域より2ヵ所の髄液漏出を認めた。難聴や頭・頸部痛はステロイド投与では改善を認めず, 起立時に増悪する頭・頸部痛, 難聴, 耳鳴があり, 臥位で改善した。難聴感は発症後2ヶ月近くたって消失したが, その他の症状は硬膜外自家血パッチ術を施行し軽快した。術後2年にわたり経過観察しているが頭痛や難聴悪化は認めていない。

The Bing test is based on the principle that occlusion of the external auditory meatus improves the perception of bone-conducted sounds unless there is a conductive hearing impairment. An air-bone gap has been reported in patients with large vestibular aqueduct (LVA) syndrome without apparent middle ear dysfunction. We therefore performed the Bing test on nine patients with this syndrome to evaluate whether it is associated with an air-bone gap or middle ear dysfunction. Bone conduction thresholds did not change significantly during the Bing test in any patient. Because an air-bone gap is observed in patients with abnormal communication between the inner ear and cerebrospinal fluid through the LVA, dehiscent superior canal, or dilated inner ear meatus; we propose that a 'three windows' model (in which the abnormal communication provided by the enlarged endolymphatic duct and sac in LVA acts as the 'third window' for sound conductance) might explain the air-bone gap in such patients.

The authors report a rare case of primary mucinous carcinoma of the skin initially diagnosed as a metastatic adenocarcinoma. The tumor occurred in the right axilla in a 75-year-old man. Initial pathological diagnosis was metastatic adenocarcinoma. However, no primary focus was found in the body. The revised diagnosis by the authors was primary cutaneous mucinous carcinoma. The tumor (1.5 cm) was characterized by proliferation of atypical epithelial cells arranged in cell nests with many pseudolumens resembling adenoid cystic carcinoma. It was also characterized by much mucinous stroma or pool around tumor cells. No apparent eccrine or apocrine differentiation was noted histologically and immunohistochemically. The present case suggests that primary cutaneous mucinous carcinoma may be misdiagnosed as metastatic adenocarcinoma, and that it may resemble adenoid cystic carcinoma.

Pendred syndrome (PDS) is characterized by profound deafness in childhood, positive perchlorate challenge, and goiter. PDS is often associated with enlarged endolymphatic duct and sac (EEDS), and recently, PDS gene mutations have been reported even in those patients with EEDS without classic Pendred syndrome. In a previous report, the number of mutant alleles was correlated with the degree of subclinical thyroid abnormality, but not with hearing loss, in patients with missense mutation H723R. It also has been reported that the hearing loss in EEDS was not correlated with the EEDS volume, cochlear modiolar area, or signal intensity of the endolymphatic sac. We evaluated the correlations between the number of mutant alleles and these parameters in patients with EEDS to investigate the mechanisms underlying this condition. The study group was comprised of 16 Japanese patients with EEDS diagnosed by MR imaging. The H723R mutation was homozygous in six patients and heterozygous in six patients, with no mutation found in four patients. The modiolar area, EEDS volume, and signal intensity ratio (sac signal/cerebrospinal fluid signal) were not significantly correlated with the number of mutant alleles. PDS gene mutations may not be the only cause of EEDS, and the mechanisms underlying EEDS remain unclear.

We report a rare case of pigmented squamous cell carcinoma (SCC) of the cheek skin probably arising from solar keratosis. An 80-year-old man was referred to our clinic because of a black skin nodule in the right cheek. The nodular lesion was 1 cm in diameter, dome-shaped, hard, sharply demarcated, partially erosive and telangiectatic at the border. The lesion was completely excised under the clinical diagnosis of probable seborrheic keratosis. Microscopically, cutaneous horn and mildly atypical squamous epithelia suggestive of previous solar keratosis were present in the surface of the lesion. The lesion consisted of atypical squamous cells with keratinization and intercellular bridges, and it was regarded as SCC. The SCC cells were seen to invade lightly into the upper dermis, where lymphocytic infiltrations and melanophages were noted. Characteristically, heavy deposition of melanin pigment was recognized in the SCC cells as well as in proliferated dendritic and pigment blockade melanocytes that were scattered or colonized within the SCC cell nests. Masson-Fontana stain revealed numerous melanin granules in the SCC cells, as well as in dendritic and pigment blockade melanocytes. Immunohistochemically, the SCC cells were positive for cytokeratins and epithelial membrane antigen, and negative for S-100 protein and HMB45 antigen. Dendritic and pigment blockade melanocytes were negative for cytokeratins, epithelial membrane antigen, and HMB45 antigen, but positive for S-100 protein. The present case suggests that SCC cells of the skin may induce proliferation of melanocytes. The differential diagnosis and the histogenesis of pigmented SCC of the skin are discussed.

Characteristics of alcoholic neuropathy have been obscured by difficulty in isolating them from features of thiamine-deficiency neuropathy. We assessed 64 patients with alcoholic neuropathy including subgroups without (ALN) and with (ALN-TD) coexisting thiamine deficiency. Thirty-two patients with nonalcoholic thiamine-deficiency neuropathy (TDN) also were investigated for comparison. In ALN, clinical symptoms were sensory-dominant and slowly progressive, predominantly impairing superficial sensation (especially nociception) with pain or painful burning sensation. In TDN, most cases manifested a motor-dominant and acutely progressive pattern, with impairment of both superficial and deep sensation. Small-fiber-predominant axonal loss in sural nerve specimens was characteristic of ALN, especially with a short history of neuropathy; long history was associated with regenerating small fibers. Large-fiber-predominant axonal loss predominated in TDN. Subperineurial edema was more prominent in TDN, whereas segmental de/remyelination resulting from widening of consecutive nodes of Ranvier was more frequent in ALN. Myelin irregularity was greater in ALN. ALN-TD showed a variable mixture of these features in ALN and TDN. We concluded that pure-form of alcoholic neuropathy (ALN) was distinct from pure-form of thiamine-deficiency neuropathy (TDN), supporting the view that alcoholic neuropathy can be caused by direct toxic effect of ethanol or its metabolites. However, features of alcoholic neuropathy is influenced by concomitant thiamine-deficiency state, having so far caused the obscure clinicopathological entity of alcoholic neuropathy.

This paper presents efficiency improvement of switched reluctance motors (SRMs) by stepped-skewing rotor (SSR). The cross sectional configuration of the SRM tested including size and shape of salient poles is almost same as those of a conventional SRM. The tested SRM is divided into 3 stacks, and only rotor is skewed. The skew angle has been designed to reduce both of torque ripple and radial force. The experiments have been carried out to confirm the effectiveness of efficiency improvement of the SRM with SSR. As a result, the highest efficiency of the SRM with SSR is achieved compared with that of the conventional SRM.

To further development of a simplified fertigation system using controlled-release fertilizers (CRF), we investigated the effects of differing levels of fertilizers and plant density on leaf area index (LAI), fruit yields, and nutrient use in soilless tomato cultures with low node-order pinching and high plant density during spring-summer (SS), summer-fall (SF), and fall-winter (FW) seasons. Plants were treated with 1 of 3 levels of CRF in a closed system, or with liquid fertilizer (LF) with constant electrical conductivity (EC) in a drip-draining system. Two plant densities were examined for each fertilizer treatment. In CRF treatments, LAI at pinching increased linearly with increasing nutrient supply for all cropping seasons. In SS, both light interception by plant canopy at pinching and total marketable fruit yield increased linearly with increasing LAI up to 6 m(2) · m(-2); the maximization point was not reached for any of the treatments. In FW, both light interception and yield were maximized at an LAI of approximately 4. These results suggest that maximizing the LAI in SS and FW to the saturation point for light interception is important for increasing yield. In SF, however, the yield maximized at an LAI of approximately 3, although the light interception linearly increased with increasing LAI, up to 4.5. According to our results, the optimal LAI at pinching may be 6 in SS, 3 in SF, and 4 in FW. In comparing LAI values with similar fruit yield, we found that nutrient supply was 32-46% lower with the CRF method than with LF. In conclusion, CRF application in a closed system enables growers to achieve a desirable LAI to maximize fruit yield with a regulated amount of nutrient supply per unit area. Further, the CRF method greatly reduced nutrient use without decreasing fruit yield at similar LAIs, as compared to the LF method.

脂漏性皮膚炎の治療には,従来からステロイド外用剤が広く用いられてきたが,外用抗真菌剤であるケトコナゾールクリーム(商品名;ニゾラール®クリーム)は海外において高い評価を得ており,また国内で実施された治験においても改善率は70～80%であることが報告されている。今回我々は,顔面に病変部を有する脂漏性皮膚炎患者54例において,ケトコナゾールクリームと非ステロイド系抗炎症外用剤であるイブプロフェンピコノールクリーム(商品名:スタデルム®クリーム)との比較検討を行った。その結果,両群の治癒率および改善率·有用性は,ケトコナゾールクリーム投与群ではそれぞれ59%,93%,93%,イブプロフェンピコノールクリーム投与群ではそれぞれ8%,56%,56%であり,両群間には有意な差が認められた。ケトコナゾールクリームは,脂漏性皮膚炎に対してイブプロフェンピコノールクリームより有用性が高いと考えられた。

High concentration of acetylcholine (ACh) caused a rapid and long lasting relaxation response in age-matched controls, whereas this response was significantly weaker in streptozotocin (STZ)-diabetic and cholesterol fed mice. The levels of basal and ACh-stimulated cyclic GMP in the aorta was also significantly smaller in STZ-diabetic and cholesterol-fed mice. The attenuated relaxation responses to ACh in both STZ-diabetic and cholesterol-fed mice were ameliorated by the chronic administration of cholestyramine. A prior incubation of aortic strips with superoxide dismutase (SOD, 60 U/ml) improved the recovery phase of the relaxation of diabetic aorta after single administration of ACh, whereas SOD had no effects on ACh-induced relaxation of aortic strips from cholesterol fed mice. These results suggest that superoxide anion may be responsible for an impairment of endothelium-dependent relaxation of aorta from STZ induced diabetic mice. It is further suggested that impairment of endothelium-dependent relaxation in STZ-diabetic and cholesterol fed mice may be caused by different mechanisms.

In the present study, we established an in vitro system representing the Burkitt’s lymphoma (BL)-type Epstein-Barr virus (EBV) infection which is characterized by expression of EBV-determined nuclear antigen 1 (EBNA-1) and absence of EBNA-2 and latent membrane protein 1 (LMP1) expression. EBV-negative cell clones isolated from the EBV-positive BL line Akata were infected with an EBV recombinant carrying a selectable marker, and the following selection culture easily yielded EBV-infected clones. EBV-reinfected clones showed BL-type EBV expression and restored the capacity for growth on soft agar and tumorigenicity in SCID mice that were originally retained in parental EBV-positive Akata cells and lost in EBV-negative subclones. Moreover, it was found that EBV-positive cells were more resistant to apoptosis than were EBV-negative cells. EBV-infected cells expressed the bcl-2 protein, through which cells might become resistant to apoptosis, at a higher level than did uninfected cells. This is the first report that BL-type EBV infection confers apoptosis resistance even in the absence of expression of LMP1 and BHRF1, both of which are known to have an antiapoptotic function. Surprisingly, transfection of the EBNA-1 gene into EBV-negative Akata clones could not restore malignant phenotypes and apoptosis resistance, thus suggesting that EBNA-1 alone was not sufficient for conferring them. Our results suggest that the persistence of EBV in BL cells is required for the cells to be more malignant and apoptosis resistant, which underlines the oncogenic role of EBV in BL genesis.

Previous work from this laboratory has shown that cellobiose octaalkanoate (COA) functions as a thermotropic discotic mesogen, forming a hexagonal ordered columnar phase (D ho ). In this work, we prepared the COA-based discotic twin and triplet derivatives and examined the mesomorphic properties of the derivatives by DSC, polarization microscopy and X-ray diffraction. In the former derivative, two cellobiose heptadecano-ate (CHD) molecules (monomers) are combined through an alkyl spacer of varying length by ether and ester linkages at the C-1 position of the reducing end units of the monomers. Three CHD molecules having an alkyl spacer are connected with a coupling agent for the latter derivative. The results revealed that (i) all the twin derivatives form a distinct discotic columnar phase, (ii) the thermal stability of the mesophases of the twins is enhanced, compared with that of the monomer, when the length of the flexible spacer is appropriate, (iii) the twins with a relatively short spacer form a discotic rectangular ordered (D ro ) phases while those with a longer spacer form a pseudo-D ho , Phase, (iv) thc triplets also form a discotic columnar mesophase, but not a hexagonal ordered columnar (D ho ,) phase, (v) the thermal stability of the mesophases of the triplets strongly depends on the chemical nature of coupling cores, and (vi) the packing structures of the cellobiose cores within the columns of both derivatives are markedly different from that of the monomer.

BACKGROUND Adult T-cell leukemia/lymphoma (ATLL) is a neoplasm of the mature helper T-lymphocyte. Human T-lymphotropic virus type 1 (HTLV-1) has been shown to be the cause of this neoplasm. Recently, however, the HTLV-1 genome has been found in some patients with cutaneous T-cell lymphoma (CTCL), which suggests a causal relation of HTLV-1 to CTCL. Thus, the relation between the HTLV-1 genome and CTCL, as well as the difference between ATLL and CTCL, have come into question. METHODS The authors examined two patients with CTCL whose serum anti-HTLV-1 antibodies were constantly positive. The Southern blot technique, inverse polymerase chain reaction (IPCR), and polymerase chain reaction (PCR) with four sets of primers for gag, pol, env, and pX regions of HTLV-1 were used to clarify the distinctions between ATLL and CTCL. RESULTS Clinically, one patient presented with multiple subcutaneous nodules with involvements of the internal organ, and the other patient was typical for mycosis fungoides. No integration of HTLV-1 DNA was detected by IPCR or the Southern blot technique in either patient. PCRs with the four sets of primers were all found to be positive for HTLV-1 except one. CONCLUSIONS The authors conclude that ATLL should be differentiated from CTCL in view of the responsibility of HTLV-1 for promoting or maintaining CTCL. Cancer 1997; 79:269-74. © 1997 American Cancer Society.

A rapidly enlarging leg ulcer appeared in a 54-year-old woman with systemic lupus erythematosus receiving aggressive immunosuppressive therapy. Skin biopsy revealed proliferation of hyphae in the midst of a neutrophilic abscess. Culture yielded Rhizopus azygosporus. As no organ involvement was detected by thorough examination, the patient was diagnosed as having primary cutaneous mucormycosis. Although intravenous amphotericin B therapy seemed to be very effective, it had to be discontinued due to nephrotoxicity. She unfortunately died of subsequent disseminated fungal infection and cerebral infarction in which the primary cause could not be determined. Minimum inhibitory concentrations of several antifungal drugs to the isolate were examined and amphotericin B proved to be the only agent that may potentially reach the effective plasma concentration. This is the first case report of cutaneous mucormycosis caused by R. azygosporus.

Let M be a d-dimensional Riemannian manifold of class C∞ with Riemannian metric and let D be a connected domain in M having a non-empty smooth boundary and a compact closure . Suppose that are given and that converges uniformly to on D′ as for some neighborhood D′ of D. Consider the diffusion process on D′ with a small parameter generated by(1.1)

We examined the effects of taurine on levels of low-density lipoprotein (LDL) cholesterol and glucose, and an endothelium-dependent relaxation in response to acetylcholine in cholesterol-fed or streptozotocin-induced diabetic mice. The acetylcholine-induced concentration-dependent relaxation was significantly attenuated in aortic rings from cholesterol-fed and streptozotocin-induced diabetic mice. The attenuated vasodilation in both cholesterol-fed and streptozotocin-induced diabetic mice was normalized by the chronic administration of taurine. The endothelium-independent relaxation of aortic rings induced by sodium nitroprusside was not significantly different between control, cholesterol-fed and streptozotocin-induced diabetic mice. The increased serum levels of LDL cholesterol in cholesterol-fed and diabetic mice were returned to normal by the chronic administration of taurine. The chronic administration of taurine had no effects on serum glucose levels. These results suggest that the impaired endothelium-dependent vasodilation seen in both cholesterol-fed and streptozotocin-diabetic mice can be normalized by the chronic administration of taurine and this effect may be, at least in part, due to lowering of serum LDL levels.

Sensory neuropathy with prominent ataxia reflecting kinesthetic sensory impairment is a well recognised form of neuropathy associated with Sjogren’s syndrome.1–4 Pathologically, T cell invasion of dorsal root ganglia, loss of large sensory neurons, and secondary large fibre degeneration is seen in this neuropathy.4 However, a form of neuropathy associated with Sjogren’s syndrome, presenting with pain and superficial sensory involvement without sensory ataxia has been described anecdotally5 and in a case report.6 Clinicopathological details of the second form of neuropathy have not been elucidated. In this report we describe seven patients with Sjogren’s syndrome showing painful sensory neuropathy without sensory ataxia. Patients studied were referred for painful neuropathy to Nagoya University Hospital and its affiliated institutions. All seven patients fulfilled diagnostic criteria for Sjogren’s syndrome by the American-European Consensus Group7 and showed painful peripheral neuropathy (table 1). Patients included six women and one man, ranging from 25 to 72 years old. In all patients initial symptom of neuropathy was paraesthesia or painful dysaesthesia in the most distal portions of the extremities, later extending proximally to involve the entire legs and arms. The trunk became involved in three patients, and the trigeminal nerve was impaired in three patients. Asymmetry in sensory impairment was present in four patients. None of the patients showed sensory ataxia in the initial phase. Most patients retained essentially normal muscle strength, but patient 1 showed slight weakness in distal limb muscles. …

Squamous cell carcinoma (SCC) arising within seborrheic keratosis (SK) is rare. We report an 84-year-old woman who presented with a rapidly growing black tumor on her left palpebral eyelid of several years' duration. Clinical examination revealed an elevated hemorrhagic black tumor that measured 0.9 x 0.9 x 0.6 cm. A clinical diagnosis of SK was made, but basal cell carcinoma could not be ruled out; therefore, excision with wide margins was performed. Histologically, the tumor was symmetrical and composed of benign basaloid cells with pseudohorn cysts in a reticulated pattern. The tumor showed heavy melanin deposition. The features were indicative of SK. An atypical cell cluster was seen in the central low area. These cells showed keratin pearls, individual keratinization, mitotic and apoptotic figures, nuclear atypia, and microinvasion, indicating microinvasive SCC. Immunohistochemistry revealed the microinvasive SCC area was true SCC. This case suggests that microinvasive SCC can arise within pigmented reticulated SK.

Our study showed that patients with atypical Meniere's disease had endolymphatic hydrops (EH) in both the cochlea and the vestibule. Using an imaging method, we provide evidence that atypical Meniere's disease is a true variant of classic Meniere's disease.The aim of present study was to investigate images of the endolymphatic space in patients with atypical Meniere's disease (cochlear and vestibular Meniere's disease).Sixty-four patients divided into two groups were enrolled in this study. The first group included 36 patients who had fluctuating hearing loss without vertigo, as candidates for cochlear Meniere's disease (CMD). The second group included 28 patients who had recurrent vertigo without hearing loss, as candidates for vestibular Meniere's disease (VMD). The patients underwent 3 T magnetic resonance imaging (MRI) after injection of gadolinium enhancement medium intratympanically or intravenously. We evaluated EH using MRI.Of 56 ears (36 patients) with CMD, 38 showed EH in the cochlea and 44 showed EH in the vestibule. Of 56 ears (28 patients) with VMD, 29 showed EH in the cochlea and 47 showed EH in the vestibule. The VMD group had a significant vestibular predominance in EH distribution whereas the CMD group showed no significant regional predominance of EH.

Acylated derivatives of chitosan oligomers with a relatively high degree of polymerization (DP=4, 5, or 6) were synthesized and their mesophase properties were studied in comparison with those of the lower-DP homologues (DP=2 and 3) previously reported. By differential scanning calorimetry (DSC), all the compounds were found to show thermotropic mesomorphism in a temperature region below 150°C. The isotropization temperatures decreased with increasing DP, while the melting point remained at around 65°C, independent of DP. In addition to the narrowing of the mesomorphic region, the optical anisotropy as observed under a polarizing microscope remarkably decreased with increasing DP, indicating that the mesophase becomes less stable and ordered with an increase in DP. An X-ray diffraction analysis revealed that the tetramer as well as the dimer and trimer form a hexagonal ordered columnar phase (Dho), while the pentamer forms a disordered one (Dhd). On the other hand, the phase formed by the hexamer was not a columnar but a discotic nematic phase (ND). This is attributable to the highly anisotropic shape of the oligosaccharide core in the hexamer.

A 76-year-old man presented with a 3-month history of a cutaneous nodule on the right thigh. The tumour was composed of CD3+, large atypical cells, and CD20+, small normal-appearing cells. Flow cytometry showed that CD20+ cells outnumbered CD3+ cells. By Southern blot hybridization analyses, the malignant cells were shown to be of T-cell origin, because of the presence of rearranged bands for the beta chain of the T-cell receptor, but not for the immunoglobulin heavy chain. This case represents a T-cell lymphoma intermingled with a large number of non-neoplastic B cells.

n-Alkyl 1-O-β-D-cellobiosides with an alkyl length ranging from 7 to 18 in carbon number m were synthesized, and their thermal properties were studied in comparison with those of the already-known monosaccharide homologues, n-alkyl 1-O-β-D-glucopyranosides. The cellobiosides were found to exhibit a thermotropic mesophase at higher temperatures than the glucopyranosides. Depending on m and thermal history, the cellobiosides showed various textures such as homeotropic, transient bâtonnets, polygonal, and fan-shaped textures. Like in the case of the monosaccharide homologues, the difficulty of aligning the samples prohibited a full classification of the mesophase, but the X-ray diffractograms of the unaligned cellobiosides indicated that their mesophase belongs to smectic A(or less possibly, smectic C). The m dependence of the lamella thickness was much weaker than (about half) that of the monosaccharide homologues. Possible molecular arrangements of the cellobiosides in the mesophase were presented.

In oder to get the fundamental conditons on the removal of impurity of metallic ions such as Fe2+, Mn2+, Cu2+ and Zn2+ ions, synthetic sulphuric acid solution was used.NaCIO was used as oxidation reagent for Fe2+→Fe3+ and Mn2+→Mn4+. Selective optimum ORP was+1, 000-1, 150 mv, pH was 3.3-3.4 and oxidation temperature was 50-70°C for oxidation of Fe2+→Fe (OH)3 and Mn2+→MnO2 while Ni2+, Co2+, Cu2+ and Zn2+ ions were remained in the solution. After removal of Fe2+ and Mn2+ ions, as secondary stage, Cu2+ and Zn2+ ions were selectively sulphurized and precipiteted with H2 S while Ni2+ and Co2+ ions were remained in the solution. Selective optimum ORP was -130--140 mv and pH was 3.4-3.5.

Charcot-Marie-Tooth type 1B (CMT1B) is a demyelinating neuropathy caused by mutations in the myelin protein zero (MPZ) gene. Here, we describe a patient with CMT1B with focally folded myelin, a rarely reported phenotype of CMT1B, who initially presented with multiple entrapment neuropathies. She complained of palmar dysesthesia on both sides and on both soles of her feet in her 30's. She underwent bilateral carpal and tarsal tunnel release at age 44, which provided transient relief from the symptoms. A sural nerve biopsy performed at age 49 revealed focally folded myelin. Molecular genetic analysis revealed a novel Asn131Ser mutation in MPZ.

Objective. We investigated the efficiency of laser speckle flowgraphy for evaluating blood flow in free flaps used for plastic surgery.Methods. We measured blood flow using a visual laser meter capable of providing two-dimensional color graphic representations of flow distribution for a given area using a dynamic laser speckle effect. Using laser speckle flowgraphy, we examined the blood flow of 20 free flaps applied following the excision of head and neck tumors.Results. After anastomosis of the feeding and draining blood vessels and sewing the flap, musculocutaneous (MC) flaps showed significantly lower blood flow than jejunal or omental flaps (P<.05). The ratio of blood flow decrease from the edge to the center was significantly greater in MC flaps than in jejunal or omental flaps (P<.001).Conclusion. Laser speckle flowgraphy is useful for the perioperative measurement of blood flow in free flaps used in plastic surgery. This method is a highly useful, practical, and reliable tool for assessing cutaneous blood flow and is expected to be applicable to several clinical fields.

左右鼻根部から頬部にかけて八の字形に分布する, 境界明瞭な不整形肉芽腫性びらん局面を呈した85歳, 女性のスポロトリコーシス例を報告した. 外傷やステロイド等の外用の既往はなく, 自家接種により特異な皮疹を呈したものと考えられた. 病理組織学的にPAS及びGrocott染色では明らかな真菌要素は認められなかったが, ファンギフローラY蛍光染色を施行したところ, 速やかに真菌要素を見出すことができた. ファンギフローラY蛍光染色は各真菌に対する特異性は認められないが, 染色時間も短く, 手技も簡単で, PASやGrocott染色に比べて共染するものが少なく, 短時間で組織中の真菌要素が見出し得る点で有用と思われた.

Double patterning is one of the most promising techniques for sub-30nm half pitch device manufacturing. Several techniques such as dual-trench process (litho-etch-litho-etch: LELE) and dual-line process (litho-litho-etch : LLE) have been reported. Between them, the dual-line process attracts a great deal of attention due to its higher throughput. The key issue in the dual-line process is preventing damage of the first resist pattern during the second lithography process. As a solution, we have developed a process to alleviate this issue using a chemical material called "freezing agent." More recently, we have further simplified the process by developing a simple freezing technique called "self-freezing" or "thermal-freezing." The "self-freezing resist" material can accomplish the freezing process by applying only one bake to the resulting first pattern. In addition, our self-freezing resist also has added water shedding properties to meet non-topcoat (non-TC) immersion resist requirements, which further simplifies the process and materials. In this study, imaging results of Non-TC self-freezing resist including critical dimension uniformity, defectivity and processing properties of the resulting patterns is shown.

This paper deals with the preparation of two series of chito-oligosaccharide derivatives, chitobiose octaalkanoates, and chitotriose undecaalkanoates, in which the amino- and hydroxyl groups were blocked with alkyl pendants of differing lengths via an ester linkage. By differential scanning calorimetry(DSC) and optical microscopic observations, these compounds were found to exhibit an enantiotropic mesophase at temperatures ranging from ca. 50 °C to ca. 200 °C. The texture of the mesophases were similar to those of the discotic columnar liquid crystals formed by the cellobiose and cellotriose equivalents. However, the amido group in the chito-derivatives seems to stabilize the mesophase to an appreciable extent, bringing about higher temperatures and a longer temperature span of the mesophase than those of the cello-equivalents.

Among patients with facial nerve paralysis, significant difference was observed on three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging (3D-FLAIR MRI) between those with and without audio-vestibular disturbance. This MRI technique may contribute to elucidation of the pathology of Ramsay Hunt syndrome and Bell's palsy.To evaluate the 3D-FLAIR MRI findings in patients who have facial nerve paralysis with and without audio-vestibular disturbance.3D-FLAIR MRI was performed with and without gadolinium enhancement in 15 patients (5 men and 10 women) with unilateral facial nerve paralysis: 3 patients with Ramsay Hunt syndrome, 3 patients having facial nerve paralysis with hearing loss or vertigo without vesicles, and 9 patients with Bell's palsy.Five of the six patients with audio-vestibular disturbance showed high signals in the inner ear on precontrast 3D-FLAIR. In comparison, among nine patients with Bell's palsy, only one patient showed high signals in the inner ear on precontrast 3D-FLAIR (p0.05).

Magnetic resonance imaging (MRI) after intratympanic gadolinium injection can reveal endolymphatic hydrops (ELH) in patients with delayed ELH (DELH). Patients with contralateral DELH may have bilateral ELH.DELH has previously been diagnosed based on clinical history, hearing and vestibular examinations. DELH is classified into three types: ipsilateral, contralateral and bilateral indicate the side with the longstanding hearing loss. Ipsilateral DELH occurs in the ear with a profound hearing loss, contralateral DELH in the better hearing ear and bilateral DELH in both ears. Imaging diagnosis of the endolymphatic space may add a new dimension to the diagnosis and treatment of DELH.Gadodiamide hydrate was diluted eightfold with saline. The diluted gadodiamide hydrate was injected intratympanically through the tympanic membrane in two patients with ipsilateral DELH and five patients with contralateral DELH. One day after the injection, 3 Tesla MRI was performed to evaluate the endolymphatic space.ELH was observed in all patients. In three patients who underwent bilateral intratympanic injection of gadolinium and were diagnosed with contralateral DELH, ELH was observed bilaterally. In one of these three patients, ELH was observed in the cochlea on the left and in the vestibule on the right.

Acylation or regio-selective alkylation of cello-and/or chito-oligosaccharides provides a new family of thermotropic liquid crystals. Some of the mesophase textures and thermal properties exhibited by these compounds were presented.