Measurement of thickness of film deposited on the plasma-facing wall in the QUEST tokamak by colorimetry.

After several experimental campaigns in the Kyushu University Experiment with Steady-state Spherical Tokamak (QUEST), the originally stainless steel plasma-facing wall (PFW) becomes completely covered with a deposited film composed of mixture materials, such as iron, chromium, carbon, and tungsten. In this work, an innovative colorimetry-based method was developed to measure the thickness of the deposited film on the actual QUEST wall. Because the optical constants of the deposited film on the PFW were position-dependent and the extinction coefficient k1 was about 1.0-2.0, which made the probing light not penetrate through some thick deposited films, the colorimetry method developed can only provide a rough value range of thickness of the metal-containing film deposited on the actual PFW in QUEST. However, the use of colorimetry is of great benefit to large-area inspections and to radioactive materials in future fusion devices that will be strictly prohibited from being taken out of the limited area.

A randomized trial of early intravesical instillation of epirubicin in superficial bladder cancer. The Nagoya University Urological Oncology Group.

A total of 135 patients with superficial bladder cancer diagnosed as totally resectable were entered into a randomized multicenter trial to investigate the efficacy of early intravesical epirubicin instillation after resection in comparison with transurethral resection (TUR) alone. Epirubicin (40 mg/40 ml saline) was given within 24 h of TUR and once during the 1st week, weekly for 4 weeks and then monthly for 11 months. In all, 122 patients (90.4%) were eligible and 119 (88.1%) were evaluable. The interval to initial recurrence was significantly longer (P = 0.02) in the epirubicin group (36 months; 95% confidence interval, 32-40 months) than in the group receiving TUR alone (28 months; 95% confidence interval, 24-32 months). The recurrence rate per year in the epirubicin group was less than that in the TUR-alone group (0.13 versus 0.29 annual recurrences). Disease progression was observed in only one patient in the epirubicin-instillation group. The main toxicity encountered was bladder irritation (13.8%). These results demonstrate that early intravesical epirubicin instillation is efficacious in preventing local recurrence.

Four alkaloids, lucidine B, oxolucidine A, lucidine A, and lucidulinone from Lycopodium lucidulum.

The structures of four alkaloids extracted from Lycopodium lucidulum (Lycopodiaceae) were established by X-ray and 2D NMR spectroscopic analyses. The dihydro-derivative of oxolucidine A, which was obtained by NaBH4 reduction of oxolucidine A, was treated with p-bromobenzoyl chloride to afford crystals, whose X-ray crystallographic analysis established the stereostructure, including the absolute configuration. The 2D NMR spectra of tetrahydrodeoxylucidine B were fully analyzed to establish the full structure of lucidine B, and the hitherto unknown stereochemistry at the C-14 position was established as beta-H. The structure of a new alkaloid, lucidulinone, was determined by spectroscopic analysis to be luciduline lactam.

Cavernous hemangioma with bone formation in a child: case report.

A 13-year-old girl suffering from seizures who was found to have hemangioma calcificans in the frontal lobe was surgically treated. The favorable postoperative course of our patient as well as reported cases suggest early excision of the lesion if it is located in an accessible area. Histological examination confirmed ossification with marrow in the lesion. The literature regarding ossification in the brain is discussed briefly.

Quantitative evaluation of the IL-1 beta and IL-1 receptor antagonist obtained from BALF macrophages in patients with interstitial lung diseases.

Our previous reports demonstrated the concomitant release of IL-1 beta and IL-1 inhibitory activity in the culture supernatants of BALF macrophages in both healthy subjects and patients with interstitial lung diseases. IL-1 inhibitory activities decreased in healthy smokers (HS), and patients with sarcoidosis (Sar), or idiopathic pulmonary fibrosis (IPF), compared with those in healthy nonsmokers (HNS), though an increase in IL-1 beta release was not detected. IL-1 inhibitory activity was mainly characterized as IL-1 receptor antagonist (IL-1ra). In this study, we confirmed a decrease in IL-1ra in terms of the amounts of protein (enzyme-linked immunoassay) and gene transcripts (reverse transcriptase polymerase chain reaction followed by high performance liquid chromatography). Imbalance between IL-1ra and IL-1 beta was expressed as a molar ratio of IL-1ra/IL-1 beta protein: (Sar; 4.20 +/- 2.06, IPF; 4.26 +/- 3.41, HS; 3.44 +/- 3.09 versus NS 8.33 +/- 2.77: P < 0.001). These results were similar in terms of the amounts of gene transcripts. In conclusion, the imbalance of IL-1 beta and IL-1ra production was confirmed at three levels: biological activity, amounts of protein, and gene transcript obtained from BALF macrophages in chronic inflammatory processes in the lungs.

Dissecting aneurysm of the vertebral artery. Report of seven cases and angiographic findings.

Seven cases of dissecting aneurysm of the vertebral artery, all appearing to be of fusiform type, are reported. Clinically, all seven cases initially showed symptoms of subarachnoid hemorrhage; however, three of these were associated with Wallenberg's syndrome. The characteristic angiographic findings in these cases were: 1) retention of contrast medium in the aneurysm; 2) the presence of a true (vertebral artery) and false (arterial wall) lumen in the late arterial and/or venous phase; and 3) irregular arterial narrowing proximal and/or distal to the aneurysm. Autopsy findings of one patient supported the angiographic findings. Recently, reports of fusiform aneurysms associated with subarachnoid hemorrhage have been increasing. As dissecting aneurysms are found in the fusiform group, it is very important to analyze serial angiograms in order to choose a method of surgical treatment.

Continuous intraventricular cerebrospinal fluid pressure recording in hydrocephalic children during wakefulness and sleep.

Continuous 24-hour recordings of intracranial pressure and electroencephalographic activity were made on five hydrocephalic children in whom, in the resting wakefulness state, the intracranial pressure (ICP) was considered normal. An increase in both the mean ICP and its oscillations related to cardiac systole was recorded during slow-wave sleep. Further episodic increases, up to a factor of 7 compared to wakefulness values, occurred during sleep. In three patients it was possible to correlate such episodic increases to the rapid eye movement phases of sleep. The authors discuss these phenomena and their possible implication in the progression of hydrocephalus.

Cerebral gumma. Case report.

A case of focal cerebral syphilitic gumma of the right temporal lobe is reported. Angiography showed moderate focal hypervascularity with stretched vessels, and irregularity of the vessel walls. Plain computerized tomography revealed an area of low density that enhanced strongly after intravenous administration of contrast medium.

Rathke cleft cysts.

Three cases of Rathke cleft cyst are presented. The clinical symptoms were disturbances of visual acuity and visual fields, and a functional disorder of the hypophysis. In two cases, there were associated meningeal signs. This meningitis was considered to be aseptic and ascribable to leakage of the cyst contents into the subarachnoid space. In one patient, the cyst extended to the suprasellar cistern; a computed tomography scan revealed an enhanced capsule, high-density spotting in a low-density area inside the cyst, and enhanced areas. In another patient, the tumor was localized in the sella turcica; high-density spotting was seen. Based on this finding, we suggest that computed tomography scanning facilitates differentiation from other sellar lesions to some degree. Electron microscopic studies of a cyst with cilia revealed the presence of a coating material around cells with microvilli. On the basis of this finding, Rathke cleft cysts may be considered to be namely, endodermal, inclusions from the upper respiratory tract.

An outbreak of acute hemorrhagic conjunctivitis due to Coxsackie virus type A24 variant in Japan.

An outbreak of acute conjunctivitis due to Coxsackie virus A24 (CA24) occurred in Okinawa, the southernmost island of Japan, from 1985 to 1986. From conjunctival scrapings of 85 acute hemorrhagic conjunctivitis patients, 39 isolates identified as an antigenic variant of CA24 were obtained and then cultured in HeLa cells. Paired sera taken from these patients with acute conjunctivitis in Okinawa were also tested against enterovirus 70 (EV70) and CA24 and showed rises in neutralizing antibodies to these agents. The subconjunctival hemorrhage among the clinical manifestations caused by the CA24 variant in this recent epidemic was similar to that due to EV70. EV70 conjunctivitis is more commonly known as acute hemorrhagic conjunctivitis (AHC), first named by the Japanese ophthalmologist, Prof. Seiji Sugiura. The present seroepidemiologic survey for the CA24 variant and EV70 in different districts of Japan revealed a low frequency of rise in neutralizing antibody titers against these two pathogens. The differentiation between EV70 and the CA24 variant as the agent causing AHC is very important in epidemiology, especially as there is a high possibility in Japan of outbreaks caused by these two agents.

Changes in parameters of the coagulation-fibrinolysis system and platelet function after OKY-046 administration to patients with ruptured aneurysm of the cerebral artery.

The influence of the TXA2-synthetase inhibitor OKY-046 (Xanbon) on haematological findings for the coagulation-fibrinolysis system and platelet aggregation was investigated in patients with subarachnoid bleeding during or after the administration. Changes in alpha 2-PI activity and the levels of fibrinogen, t-PA and PAI antigen were observed. Especially, PAI activity and PAI antigen were found to be significantly increased as compared with levels before the administration. On the other hand, the platelet aggregation induced by various agents and the activity of AT-III were not greatly altered after the administration of OKY-046.

[Rupture of intracranial aneurysm due to intravascular metastasis of choriocarcinoma. Case report].

A 55-year-old female was admitted to the Juntendo Izunagaoka Hospital, because of sudden onset of motor aphasia and right hemiparesis. Neurological examination on admission revealed drowsy state, bilateral papilledema, motor aphasia, and right hemiparesis. Computed tomography showed a subcortical hematoma in the left frontoparietal region associated with perifocal edema. Left carotid angiography revealed a fusiform aneurysm at a peripheral branch of the central artery. There was no tumor stain on cerebral angiograms. A combination procedure was carried out during emergency surgery, including evacuation of the intracerebral hematoma and removal of the thrombus-like material from the aneurysmal cavity followed by wrapping the aneurysm with fascia. Histological examination of the thrombus-like material demonstrated that it was a neoplastic embolus of choriocarcinoma. Serum (2600 mIU/ml) and urinary (7200 mIU/ml) human chorionic gonadotropin levels were elevated. The features of neoplastic aneurysm due to choriocarcinoma are reviewed and discussed.

Ciliated epithelial cell cluster in Rathke's cleft cyst--report of two cases.

The authors report two cases of symptomatic Rathke's cleft cyst. Cytological examination of the cyst contents identified clusters of ciliated epithelial cells. Rathke's cleft cyst is normally defined by mucoid fluid in the cyst cavity and cyst wall biopsy. However, intraoperative cytology was found useful in diagnosis and deciding operative strategy.

Surgical treatment of renal cell carcinoma metastases: prognostic significance.

Between January 1980 and March 1993, 166 patients with renal cell carcinoma were treated at Nagoya University Hospital. Among them 16 (9.6%) underwent surgical removal of 21 metastatic lesions: 12 patients had distant metastases at diagnosis and the other 4 demonstrated new distant metastases during their clinical course after nephrectomy. The metastatic lesions involved the brain in 6 patients, bone in 4, lung in 2, contralateral adrenal glands in 2, soft tissues in 2, lymph nodes in 2, pleura in 1, pancreas in 1, and contralateral renal pelvis in 1. All of the 16 patients underwent nephrectomy and 15 of them (93%) received interferon-alpha therapy. Patients with lesions which were completely resected had significantly longer survival than those with lesions which were palliatively treated and those with metastatic lesions at other sites (p = 0.02). Improvement of performance status was observed in 5 of 6 (83%) patients undergoing palliative surgical treatment. The present study suggests that surgical removal of metastatic lesions prolongs survival in a limited number of renal cell carcinoma patients and that it improves performance status in those symptoms related to metastasis.

Clinicopathological characteristics of small renal cell carcinomas.

To clarify the clinicopathological characteristics of small renal cell carcinomas (RCCs) the authors reviewed data for 154 RCC patients treated between January 1980 and September 1992. Of 20 patients with tumours of 3 cm or less in diameter, 12 (60%) had no related symptoms: 6 (30%) were found during routine physical check-ups and 6 (30%) were incidentally detected during examinations for diseases other than RCC. The remaining 8 (40%) patients demonstrated indicative symptoms. Most small tumours showed expansive growth and nuclear atypia was minimal or moderate. In all 20 cases, the lesions of 3 cm or less were confined to the kidney (pT1 to pT2b) and no lymph node metastasis was found. Only one (5%) had a distant metastasis, and venous involvement was also microscopically observed in only one patient (5%). The 5-year survival rates were 95% for patients with tumours of 3 cm or smaller, 74% for those of 3.1 to 5 cm, and 68% for those of greater than 5 cm. These findings revealed small RCC to demonstrate biologically less malignant behaviour. Early detection of such small lesions by ultrasonography should therefore improve the overall survival of patients with RCC.

Intravesical bacillus Calmette-Guérin (Tokyo 172 strain) therapy for carcinoma in situ of the bladder.

To evaluate the clinical response to intravesical instillation therapy with bacillus Calmette-Guérin (BCG) Tokyo 172 strain for carcinoma in situ (CIS) of the bladder and subsequent patient prognosis, we reviewed data for 30 patients treated between 1985 and 1994. Median follow-up was 56 months. The CIS cases comprised two groups: primary (19 patients) and subsequent to development of a gross neoplasm (11 patients). Either 40 mg (n = 20) or 80 mg (n = 10) doses of BCG were instilled weekly for 8 weeks. This intravesical therapy resulted in apparent eradication of tumour cells in 25 of the 30 patients for a complete response (CR) rate of 83%, with no difference found between primary and secondary groups. Tumours later recurred in 6 of the 25 patients (24%) and disease progression was found in only 3 (12%). In contrast, progression occurred in 3 of 5 patients (60%) for which a complete response was not achieved with intravesical BCG therapy. The difference between these two groups was significant (p = 0.04). Total cystectomy was performed in 2 of 25 CR patients (8%) first and in 4 of the 5 unresponsive (80%), the statistical difference being highly significant (p = 0.003). The 5-year survival rate was 96% for the study subjects as a whole. In conclusion, CIS unresponsive to BCG therapy should be treated with immediate total cystectomy while cases demonstrating a complete response should be followed up for a long period.

[Clinical findings of cefoxitin in the treatment of serious infections and the prevention of postoperative infections (author's transl)].

UNLABELLED: This clinical trial was designed to evaluate the efficacy, safety and patient tolerance of cefoxitin in 23 patients who were admitted to the hospital from March 1980 to November 1980. The daily dose of cefoxitin for 21 adult patients (ages ranged from 26 to 74 years old) were 6 g for the treatment of infections, and 2 to 6 g for the prevention of infections by either direct or intermittent intravenous infusions. Two children were given 100 mg/kg of cefoxitin either by direct or intermittent intravenous infusions 2 to 3 times a day in divided doses. SUMMARY OF FINDINGS: I. Treatment of intracranial infections 1. A 60-year-old man with a brain abscess was admitted to the hospital after the unsuccessful treatment with a cephalothin for 9 days. After, the initiation of therapy with cefoxitin, given 6 g a day for 3 days, the abscess was surgically removed. On the second day of treatment with cefoxitin following the operation, his highest temperature was 37.0 degrees C and was normal on the third day of treatment. He was discharged after 12 days after the surgical procedure. 2. A 56-year-old woman with cerebrospinal rhinorrhea and meningitis after the transsphenoidal removal of pituitary microadenoma responded satisfactorily to therapy with cefoxitin, given 6 g a day for 14 days after the unsuccessful treatment with a cephalothin. II. The prevention of infections following surgical operation of the central nervous system 1. Seventeen patients undergoing surgical procedures were treated with cefoxitin for the prevention of postoperative infections. None of the 17 patients developed postoperative infections. 2. A 53-year-old man undergoing repair of cerebrospinal rhinorrhea in the possibly contaminated area was successfully treated with cefoxitin, given intravenous 2 g every 8 hours for 10 days without meningitis having developed. III. The treatment and prevention of complications 1. A 74-year-old comatose male with a brain stem concussion, who was expectorating insufficiently and had difficulty swallowing and developed into pneumonia as a complication. He was successfully treated with cefoxitin, given intravenous 6 g a day for 2 weeks. 2. A 26-year-old male with a brain stem concussion complicated by pneumonia and a urinary tract infection was successfully treated with the same dose regimen of cefoxitin as the previous patient. 3. The prevention of complications A 58-year-old male with pontine glioma undergoing a tracheotomy was administered cefoxitin for the prevention of pulmonary complication. He died of pontine glioma after the three-month treatment. IV. Side effects Results of skin sensitivity tests given prior to the administration of cefoxitin were negative in all of the 23 patients. Neither anaphylaxis nor other allergic reactions or thrombophlebitis occurred with the intravenous administration of cefoxitin. No abnormalities in blood, hepatic function or renal function were observed. Anorexia occurred in 1 patient who was given cefoxitin, 6 g a day.

[A pathogenesis of chronic subdural hematoma; it's relationship to subdural membrane].

Our report concerns 112 cases of chronic subdural hematoma (CSH). M:F ratio is 3.5:1. (Fig. 1). The etiology of CSH is as follows; mild head injury (71 pts.), post-craniotomy (3 pts.), post-V-P shunt (1 pt.) and unknown (37 pts.). All patients are diagnosed by CT scan. Twenty patients were followed up after the subdural space was expressed as low density on CT (Fig.2). 14 of these were found to have extremely thin subdural fluid collection without compression of the brain. Cisternography by using radioisotope and/or metrizamide was carried out in seven patients in whom the subdural fluid collection was found on CT, and in five of whom the dye flowing into the subdural space was retained for 24-48 hours (Fig. 3 a). For treatment, burr holes and irrigation of the hematoma was carried out and then a drain was inserted into the subdural space. The inner membrane of the chronic subdural hematoma was looked at in 19 patients during surgery. All but one showed the inner membrane totally covering the brain surface. However, in one patient the inner membrane didn't entirely cover the brain surface, suggesting that this was the condition just before the entire encapsulation of the hematoma (Fig. 4 b). It used to be considered that a blood clot in the subdural space is needed to develop a chronic subdural hematoma. However, since the introduction of CT scan, there have been many reports suggesting that chronic subdural hematoma has developed from subdural fluid collection without apparent evidence of blood clot after head injury. Therefore, it has been controversial whether the blood clot is absolutely essential to develop into the chronic subdural hematoma or not.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of up-beat nystagmus associated with Chiari malformation type I (author's transl)].

A case of Chiari malformation type 1 with sign of upbeat nystagmus was reported. The patient was a 9-year-old girl who was admitted to the Department of Neurosurgery with the chief complaints of snoring and headaches. The neurological examination on admission revealed a lower cranial nerve disturbance bilaterally and upbeat nystagmus in the primary ocular position that increased in amplitude upon gazing upward, and horizontal nystagmus on gazing laterally. The skull tomogram showed platybasia. The vertebral arteriogram and the pneumoencephalotomogram showed downward displacement of cerebellar tonsils to the level of C2. The patient received suboccipital craniectomy and C1, C2 laminectomy for decompression and the foramen of Majendie was opened. From the operative findings the diagnosis was confirmed as Chiari malformation type 1. In the first two postoperative weeks, the upbeat nystagmus as well as other symptoms was gradually improved. It was therefore considered that the responsible lesion of the upbeat nystagmus in this case might be in the lower brain stem or the inferior vermis due to mechanical compression or circulatory disturbance.

[A case of pycnodysostosis].

Pycnodysostosis is a term introduced by Maroteaux and Lamy in 1962 to describe characteristic features such as dwarfism, separated cranial sutures, open fontanelles, hypoplasia and absence of mandibular angle, partial aplasia of the terminal phalanges of the fingers and toes, generalized condensation of bone shadow, bone fragility, and autosomal recessive inheritance. We reported a such case in a 13-years old boy associated with an epidural hematoma. Four weeks after removal of the hematoma, lumbar puncture was performed with the initial pressure of 200mm H2O in an awake state and the plateau waves were observed several times during sleep. Such increased intracranial pressure may have caused the open fontanelle and cranial sutures in addition to dysostosis. Thus such patients require careful attention in order to prevent major bleeding from the superior sagittal sinus directly beneath the separated sagittal suture.