Search for η

We measured missing mass spectrum of the ^{12}C(γ,p) reaction for the first time in coincidence with potential decay products from η^{'} bound nuclei. We tagged an (η+p) pair associated with the η^{'}N→ηN process in a nucleus. After applying kinematical selections to reduce backgrounds, no signal events were observed in the bound-state region. An upper limit of the signal cross section in the opening angle cosθ_{lab}^{ηp}<-0.9 was obtained to be 2.2 nb/sr at the 90% confidence level. It is compared with theoretical cross sections, whose normalization ambiguity is suppressed by measuring a quasifree η^{'} production rate. Our results indicate a small branching fraction of the η^{'}N→ηN process and/or a shallow η^{'}-nucleus potential.

Surgical strategy and outcomes for epileptic patients with focal cortical dysplasia or dysembryoplastic neuroepithelial tumor.

PURPOSE: The purpose of this study was to clarify and compare the influence of surgical strategy on relief from seizures in patients with focal cortical dysplasia (FCD) and those with dysembryoplastic neuroepithelial tumor (DNT). METHODS: Six patients with FCD and five patients with DNT, all of whom underwent surgical resection for medically intractable epilepsy, were compared in terms of presurgical seizure types and frequency, location of lesions, magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT) with 99mTc-ECD, scalp electroencephalogram (EEG), and long-term video-EEG recording. Prolonged subdural recordings and intraoperative electrocorticograms (ECoG) were analyzed. The influences of surgical strategies on seizure outcomes were retrospectively analyzed. RESULTS: In all the FCD patients, ictal SPECT revealed hyperperfusion in the regions where MRI showed FCD. Interictal epileptiform activity and ictal seizure onset on ECoG performed with subdural electrodes were localized on the FCD itself. In contrast, the tumors of all the DNT patients were depicted as hypoperfuse areas on interictal SPECT scans. Ictal SPECT in one DNT patient showed hyperperfusion in the area enclosing the tumor. Interictal spiking in all DNT patients and ictal seizure onset in two DNT patients were not in the lesions themselves but in an area enclosing the lesion. All but one patient with FCD who underwent total lesionectomy became seizure free. All DNT patients who underwent resection of the epileptogenic cortex associated with lesionectomy became seizure free or achieved a 90% reduction in seizures. CONCLUSIONS: FCD has intrinsic epileptogenicity, whereas DNT is encompassed by epileptogenic cortical areas. Therefore, total lesionectomy is an essential strategy for FCD, whereas resection of the epileptic focus associated with lesionectomy of a DNT lesion is necessary to control seizures.

Neuropsychological changes after surgical treatment for temporal lobe epilepsy.

PURPOSE: The effect of unilateral temporal lobectomy on seizure frequency is well recognized, but little is known about the neuropsychological changes that occur after surgical treatment. We assessed neuropsychological status in 26 patients with an average age of 35 years before and after unilateral temporal lobectomy for medically intractable TLE. METHODS: Neuropsychological examination to assess cognitive function, memory, attention, visuospatial analysis, language, and emotional functions was performed preoperatively and at 1 month and 1 year after the surgery. RESULTS: At both 1 month and 1 year after the surgery, the patients had improved scores, compared with the preoperative scores, on the Wechsler Adult Intelligence Scale-Revised (WAIS-R: verbal IQ, performance IQ, and full-scale IQ), Wechsler Memory Scale-Revised (WMS-R: verbal, general, and delayed paired associates memory), and Raven Colored Progressive Matrices. In the Minnesota Multiphasic Personality Inventory (MMPI), significant decreases were observed at 1 year after the surgery in the scores for infrequency, hypochondriasis, psychasthenia, and schizophrenia. Patients in whom the seizures had been relieved postoperatively also had improved scores on the WAIS-R, WMS-R, and Raven Colored Progressive Matrices. CONCLUSIONS: These data suggest that neuropsychological improvement postoperatively is influenced by the reduction in the frequency of seizures after surgery.

[Efficacy of sustained-released theophylline on peak expiratory flow rate in asthmatic patients].

Nocturnal worsening is an important problem in asthma management. We evaluated the efficacy of two sustained-released theophylline formulations, administered twice-a-day (TD) and once-a-day (UP). In 20 asthmatic patients with low peak expiratory flow rate (PEF) in the morning (< 80% of predicted) administered TD (mean dose 475 mg/day) for 2 weeks, we evaluated PEF, diurnal variability of PEF, symptom score, results of spirometry and serum theophylline concentration (STC) and then changed theophylline, from TD to UP (mean dose 470 mg/day) for 2-4 weeks. PEF in the morning was higher during the UP period (mean +/- SD: 335 +/- 110 L/min) than during the TD period (mean +/- SD: 308 +/- 95 L/min) (p < 0.05), and diurnal variabirity of PEF was lower during the UP period (17.1 +/- 8.0%) than TD period (22.9 +/- 13.4%) (p < 0.05). However, there were no changes in PEF at night or daytime, symptom score, spirometry parameters or STC during the study period. The improvement in morning PEF observed in this study was consistent with the differences in pharmacokinetics between the two theophylline formulations. Morning PEF was increased during the UP period, probably because STC in the early morning during the UP period was higher than STC during the TD period.

[Juvenile ischemic type of moyamoya disease: a case report].

Moyamoya disease is a rare, chronic cerebrovascular disorder characterized by progressive stenosis of the arteries composing the circle of Willis. The ischemic type of Moyamoya disease progresses insidiously. To prevent irreversible cerebral damage and psychomotor deterioration, early surgical treatment is considered indispensable. The patient may present with nonspecific symptoms and no specific abnormalities on brain MRI, and might be erroneously suspected as having psychosomatic disorder. The disease must be diagnosed as early as possible. Electroencephalography (EEG) is of little value in the diagnosis of the juvenile type of Moyamoya disease, except for the demonstration of "re-build up" after hyperventilation. Half of the children with Moyamoya disease have been demonstrated to exhibit "re-build up" after hyperventilation. Our patient showed normal background activities, no spike discharges and no slowing during hyperventilation. Nonetheless, we emphasize the appearance of irregular high voltage slow waves de novo after hyperventilation. The findings may be potentially useful for the screening of patients with the juvenile type of Moyamoya disease.

[Epilepsy surgery for focal cortical dysplasia and dysembryoplastic neuroepithelial tumor].

We studied six patients with focal cortical dysplasia (CD) and four patients with dysembryoplastic neuroepithelial tumor (DNT) who had surgical resection for medically intractable epilepsy. In all CD patients, ictal single photon emission computed tomography (SPECT) using 99mTc-ECD revealed hyperperfusion in the regions where magnetic resonance (MR) imaging showed CD abnormalities. Interictal epileptiform activity and ictal seizure onset on electrocorticography using subdural strip or grid electrodes were demonstrated in the CD itself. In contrast, in all DNT patients, interictal SPECT disclosed hypoperfusion in the area of the lesions. Ictal SPECT in one DNT patient disclosed hyperperfusion in the superior area of the region where MR imaging showed cystic abnormalities. Interictal spiking in all DNT patients and ictal seizure onset in two DNT patients were demonstrated not in the lesions themselves but in the distinct zone from the region of the tumor-involved brain. All CD patients who underwent lesionectomy became seizure-free with a mean follow-up period of 33.5 months. All DNT patients who underwent lesionectomy and resection of the epileptogenic cortex became seizure-free or had their seizure significantly reduced a mean follow-up period of 41.5 months. We conclude that CDs have intrinsic epileptogenicity, while DNTs have epileptogenicity not intrinsically but in encompassed cortical surface areas.

Anomalous insertion of the right hepatic duct into the cystic duct: report of a case diagnosed before laparoscopic cholecystectomy.

Although an aberrant hepatic duct entering the cystic duct is not especially rare, the main right hepatic duct entering the cystic duct is extremely rare, with only six cases reported thus far. All of the reported patients underwent open cholecystectomy, during which one patient received a bile duct injury. The anomaly was unsuspected preoperatively in all of these cases. We report an additional patient with this anomaly, the first such case diagnosed before laparoscopic cholecystectomy using direct cholangiography. Cholangiography may be mandatory whenever biliary anomalies are suspected during laparoscopic cholecystectomy. As the right hepatic duct entering the cystic duct can lead to ductal injury, this anomaly should be kept in mind when performing laparoscopic cholecystectomy.

Helical computed tomography diagnosis of pleural dissemination in lung cancer: comparison of thick-section and thin-section helical computed tomography.

Pleural dissemination in lung cancer was prospectively evaluated by helical computed tomography (CT), and the usefulness of thick-section CT (10-mm collimation; pitch 1) and thin-section CT (2-mm collimation; pitch 1) were compared. The study included 54 patients with pulmonary adenocarcinoma in whom plain chest radiographs showed no evidence of pleural effusion and in whom the primary lesion was seen to be contiguous with the pleural surface on thick-section CT. Thin-section CT was performed for evaluation of the costal, mediastinal, interlobar, and diaphragmatic pleural surfaces. Pathologic examination revealed pleural dissemination in 20 patients (8 resected, 12 nonresected). Pleural dissemination was diagnosed in 12 patients on thick-section CT, and in 20 patients on thin-section CT. False negatives occurred in ten and two patients, respectively. The same two patients were false positives by both methods. Accuracy was 78% for thick-section CT and 93% for thin-section CT, and sensitivity was 50% and 90%, respectively. Thin-section CT provided more useful information than thick-section CT for the evaluation of pleural dissemination in lung cancer.

Utility of low-dose helical CT as a second step after plain chest radiography for mass screening for lung cancer.

We evaluated the usefulness of low-dose helical computed tomography (CT) as a routine second step in patients screened for lung cancer with plain chest radiography (PCR). Of 5,437 people who underwent mass screening for lung cancer by PCR, further work-up was required for 230 because of abnormal findings. Of 221 subjects who had CT as a second step, abnormal shadows were detected in 110 and no abnormal shadows were seen in 111. Screening CT (helical scan; beam collination, 10 mm; pitch of 2:20 mm/s; and tube current, 50 mA) detected 17 lung cancers, 87 benign lesions, and 6 extrapulmonary lesions, with an average diameter of 10 mm (range, 2-35 mm). All lung cancers were peripheral (12 stage I, 4 stage IIIA, and 1 stage IV). In 40% of screened subjects, 37 with benign lesions and 7 with lung cancer (6 stage I), lesions were delineated only by screening CT. In conclusion, low-dose helical CT was found to be useful as a second step in patients who have been screened for lung cancer by PCR and can delineate the early stage of lung cancer.

[Differentiation of extravillous trophoblast during normal pregnancy].

The implantation site in 25 pregnant uteri was studied morphologically and immunohistochemically to clarify the developmental process of extravillous trophoblasts (EVTs). 1. Dense trophoblastic invasion of the decidua was observed. Multinuclear trophoblasts appeared in the deciduo-muscular junction from the 10th week. Trophoblasts infiltrated decidual vessel walls, where extensive perivascular degeneration existed. EVTs may be indispensable for construction of the placenta. 2. In villous trophoblasts (VTs) the location of hCG and hPL was limited to multinuclear cells, whereas in EVTs hCG was present in a few mononuclear cells and hPL was observed in most mononuclear and multinuclear cells. The immunoreactivity of trophoblast-related monoclonal antibodies also differed: neither anti-Tropl (reactive with cytotrophoblasts (CTs)) nor NDOG1 (reactive with syncytiotrophoblasts (STs)) was reactive with EVTs. 3. The absence of hCG and hPL in mononuclear trophoblasts of the cell column indicates that EVTs differentiate after invading the decidua. Kurman et al. proposed the term intermediate trophoblast, indicating cells in transition from CTs to STs and EVTs, and this is based on the concept that the developmental processes of EVTs and VTs are identical. But the results of this study suggested an independent developmental process for EVTs and therefore it seemed that the term intermediate trophoblast should not be employed for EVTs.

[A study on the association between glandular dysplasia and cervical squamous neoplasia in surgical specimens].

To clarify the pathogenesis of cervical adenocarcinoma, we studied the biological properties of glandular dysplasia (GD). The coexistence of squamous neoplasia with cervical adenocarcinoma has been demonstrated. We analyzed the incidence of the coexistence of GD with squamous neoplasia in this study. Materials were surgically removed uterine cervix specimens (n = 142), 52 benign disease cases, 19 squamous dysplasias of the uterine cervix, 66 squamous cell carcinomas of the uterine cervix and 5 cervical adenocarcinomas. Diagnosis of GD was based on the general rules for clinical and pathological management of uterine cervical cancer and Ng's criteria (1983). We divided GD into two types: I: endocervical type, and II: endometrioid type. These fell into subtypes, a (mild) and b (severe) based on the observed degrees of cell atypia. 1. GD coexisted in 17.3% of benign disease cases, 15.8% of squamous dysplasias, 24.2% of squamous cell carcinomas and 100% of cervical adenocarcinomas. 2. GD Ib and IIb were not found in any of the benign disease cases, but were present in 15.8% of squamous dysplasias, 13.6% of squamous cell carcinomas and 100% of cervical adenocarcinomas. If GD was defined as only Ib and IIb, GD coexisted with squamous neoplasia in this study. Our results support the theory that both cervical squamous atypia and cervical glandular atypia are derived from reserve cells.

Conservative management of idiopathic pneumoperitoneum masquerading as peritonitis: report of a case.

Pneumoperitoneum is most commonly caused by the perforation of a hollow viscus, in which case an emergency laparotomy is indicated. We report herein the case of a patient who presented with the signs and symptoms of peritonitis, but who was found to have idiopathic pneumoperitoneum which was successfully managed by conservative treatment. A 70-year-old man presented with epigastric pain, nausea, and a severely distended and tympanitic abdomen. Abdominal examination revealed diffuse tenderness with guarding, but no rebound tenderness. He was febrile with leukocytosis and high C-reactive protein. Chest X-ray and abdominal computed tomography demonstrated a massive pneumoperitoneum without pneumothorax, pneumomediastinum, pneumoretroperitoneum, or subcutaneous emphysema, and subsequent examinations failed to demonstrate perforation of a hollow viscus. Thus, a diagnosis of idiopathic pneumoperitoneum was made, and the patient was managed conservatively, which resulted in a successful outcome. This experience and a review of the literature suggest that idiopathic pneumoperitoneum is amenable to conservative management, even when the signs and symptoms of peritonitis are present.

A follow-up study of patients with cervical cancer after resection, with special emphasis on the incidence of second primary cancers.

The causes of death in long-term survivors after resection of cervical cancer were investigated in a follow-up study of 375 women, focusing especially on the postoperative development of second primary cancers. The 5- and 10-year overall survival rates were 75.0 and 66.0%, respectively, in cases that showed frank invasion, 94.7 and 92.8%, respectively, in those showing microinvasion, and 96.2 and 96.2% respectively, in those showing carcinoma in situ. Multivariate analysis identified patient age and cancer stage at the time of diagnosis as separate factors prognostic for overall survival. During the observation period, 10 patients developed a second primary cancer, but no significantly elevated risk of developing a second primary cancer was demonstrated. However, during the same period, 20 patients also died of noncancerous disease, 9 of this number succumbing to acute myocardial infarction and/or heart failure. These results suggest that patients with cervical cancer may not have an increased risk of developing second primary cancer. It is felt that continued follow-up of long-term cervical cancer survivors should be pursued in order to prevent or arrest the development of noncancerous disease and/or second primary cancer, so that increased prolongation of survival can be achieved.

Detection of nodular lesions in the lung helical computed tomography: comparison between 360 degrees and 180 degrees reconstruction algorithms.

The present study has evaluated helical computed tomography (HS-CT) performed at a fast couch-top sliding speed (20 mm/sec, sufficient to cover the entire lung field during the holding of a single breath) with regard to its ability to detect pulmonary nodules in patients with metastatic lung disease. The detectability of lesions by HS-CT was compared between 360 degrees and 180 degrees reconstruction algorithms. The subjects were eight consecutive patients with metastatic lung tumors, in whom 214 lesions had been detected by conventional CT. The average diameter of the nodules detected was 7.7 mm (2-22 mm). To scan the entire lung, we first used conventional CT (10-mm slice thickness, 10-mm stepping) and then HS-CT with a couch-top speed of 20 mm/sec and a tube current of 50 mA. Both 360 degrees and 180 degrees algorithms were used to reconstruct images at intervals of 20 and 10 mm from HS-CT data. Detection rates of 79% for 20-mm images and 94% for 10-mm images were achieved with the 360 degrees algorithm. Detection rates of 81% for 20-mm images and 99% for 10-mm images were achieved with the 180 degrees algorithm. The detection of nodules was greater for 10-mm images than 20-mm images (P < 0.01). There was no significant difference between the 360 degrees and 180 degrees algorithms. Images acquired using the 180 degrees algorithm, however, depicted lesions with greater sharpness than those acquired using the 360 degrees algorithm. It is presumed that they indirectly show the superiority of the 180 degrees algorithm over the 360 degrees algorithm. HS-CT should prove a useful screening technique for lesions in the lung field.

[Identification of Mycobacterium avium and Mycobacterium intracellulare using DNA probe test, and their ratio in Niigata area].

Using Gen-Probe test, both the Mycobacterium avium and Mycobacterium intracellulare strains were identified in the 76 disease-associated Mycobacterium-avium complex (MAC) strains isolated in the NIIGATA area. The following results were obtained: 1) Fifty-four MAC strains (71.1%) reacted with M. avium-probe and 22 strains (28.9%) reacted with M. intracellulare-probe. 2) There were no significant differences between the ratio of two strains before and after 1991. 3) The ratio of female cases with M. avium was significantly higher (22/32) in the later period (after 1991) than in the former period (9/22).

Detection of nodular lesions in the lung using helical computed tomography: comparison of fast couch speed technique with conventional computed tomography.

The present study assessed the ability of helical CT performed at fast couch speeds (20 mm or 25 mm/sec), sufficient to cover the entire lung field during a single breath hold, compared with conventional CT for detecting pulmonary nodules in patients with metastatic lung disease. The subjects were seven consecutive patients with metastatic lung tumors in whom 152 lesions were detected by conventional CT. The average diameter of the nodules was 8.3 (range 2-23 mm). To scan the entire lung, we first employed conventional CT (10-mm slice thickness, 10 mm couchtop slide). We then used helical CT with couchtop speeds of 20 and 25 mm/sec, permitting easy scanning of the entire lung field during a single breath hold (images of reconstruction intervals; 25, 20, 12.5 and 10 mm). We assessed each image to compare detection capabilities in the lung. The detection capabilities for each reconstruction interval were 78, 83, 91 and 97%, respectively. The detection of nodules was superior for 12.5 and 10 mm images than for 25 and 20 mm images (P < 0.01). In 25 and 20 mm images, the detection capability was significantly lower in the apical area than in the middle area (P < 0.01). For nodules 5 mm in diameter, 10 mm images permitted complete detection. Helical CT fast couch speeds (20 or 25 mm/sec), which allow imaging of the entire lung during a single breath hold, may be useful in detecting metastatic pulmonary nodules, and helical CT is expected to be a useful method for lung screening.

Mediastinal lymph node metastasis from lung cancer: evaluation with Tl-201 SPECT--comparison with CT.

PURPOSE: To assess the usefulness of thallium-201 single photon emission computed tomography (SPECT) in detection of mediastinal lymph node metastasis from lung cancer. MATERIALS AND METHODS: Computed tomography (CT) and Tl-201 SPECT were performed in 113 patients with lung cancer. Surgical staging was performed in all patients, and the results of the two modalities were compared with the pathologic findings in 364 node stations. RESULTS: Cancerous nodes were found in 32.7% of the patients. The sensitivity of CT in detecting mediastinal node metastasis was 62%; specificity was 80%. These rates were higher for Tl-201 SPECT (76% and 92%, respectively). Furthermore, these rates were excellent in patients with enlarged mediastinal nodes at CT (87% and 93%, respectively). However, Tl-201 SPECT had more limited spatial resolution than did CT. CONCLUSION: Tl-201 SPECT is useful in evaluation of mediastinal node metastasis in lung cancer, especially for patients with enlarged nodes at CT.

Blood levels of leukotrienes (LTC4, D4, E4, B4) in asthmatic patients during attack and remission.

To assess the contribution of the leukotrienes, LTC4, D4, E4 and B4 during bronchial asthma attacks, simultaneous determination was made of their levels in venous blood. 25 patients with bronchial asthma (15 atopic types, 10 non-atopic types) participated in this study and 4 normal controls were used. Samples were obtained using heparinized syringe from the patients before treatment. A radioimmunoassay was conducted to measure LTs after purification with a Sep-pak column and separation by HPLC. In normal subjects, the levels were less than the minimal detectable amounts. LTC4, D4, E4 and B4 during asthmatic attacks were 100 +/- 179, 88 +/- 116, 479 +/- 291, and 55 +/- 73 (Mean +/- SD) pg/ml respectively (n = 27). Peptide LTs in remission were below minimal detectable levels. LTD4 in patients with moderate attacks was significantly (p < 0.05) higher than in those with mild attacks. Peptide LTs in moderate attack exceeded those in mild attacks, although not to a statistically significant degree. No significant differences in LT during attacks could be detected in atopic or non-atopic type patients. LTs would thus appear importantly involved in asthmatic attacks in atopic and non-atopic type patients, although other chemical mediators may give rise to airway inflammation.