Walking assistance apparatus using a spatial parallel link mechanism and a weight bearing lift.

A prototype for a walking assistance apparatus for the elderly or motor palsy patients was developed as a next-generation vehicle or movable neuro-rehabilitation training appliance, using a novel spatial parallel link mechanism and a bearing lift. The flat steps of the apparatus move in parallel with the ground; the apparatus can support entire leg alignment (including soles) and assist; walking behavior at ankle, knee and hip joints simultaneously. In order to respond the variation of equipped person's walking velocity, the length of stride and walking cycle while walking with wearing the apparatus were compensated by using the relation of walking ratio. Therefore the apparatus can be controlled in response to equipped person's will. Motor palsy and muscle weakness patients can walk by themselves by using the apparatus; patients who have ambulation difficulty can use the apparatus with weight bearing lift that we developed. Using the apparatus with the weight bearing lift prevents stumbling and enables input of walking movement to the brain motor area. It is very effective for rehabilitation to use the apparatus with the weight bearing lift. This newly developed system facilitates motor palsy and muscle weakness patients in the rehabilitation program.

An autopsy case of disseminated cryptococcosis manifesting as acute diarrhea in a patient with primary biliary cirrhosis.

A 58-year-old woman with an 18-year history of primary biliary cirrhosis was admitted because of pneumococcal pneumonia. She was treated with antibiotics and mechanical ventilation. After the pneumonia improved, she developed severe watery diarrhea. Although vancomycin was administered enterally, the diarrhea persisted. She died of multiple organ failure within 16 days of the onset of diarrhea. An autopsy showed intracapillary cryptococci in the systemic organs, especially in the intestinal tract. The cause of diarrhea was considered to be extensive intestinal mucosal necrosis due to disseminated cryptococcosis. This is a rare case of cryptococcal infection manifesting as acute diarrhea.

[Case of Legionella pneumonia caused by a household humidifier].

A 60-year-old-man with diabetes mellitus was admitted to our hospital because of pyrexia of up to 40 degrees and dyspnea. Chest radiograph revealed ground glass infiltrates in both lung fields. Legionella pneumonia was diagnosed as a consequence of the urinary examination performed for Legionella antigen detection; further, we initiated intravenous pazufloxacin administration. Despite an antibiotic, sivelestat sodium, and mechanical ventilation, the condition of the patient worsened and he died of respiratory failure 5 days following admission. Pulse-field gel electrophoresis (PFGE) was performed to investigate the route of infection: this technique was applied to patient sputum samples and water from the humidifier in the room of the patient. The same DNA pattern as Legionella pneumophilla serogroup 1 was identified via analysis with PFGE.

[A case of multiple sclerosing hemangiomas of both lungs].

A 16-year-old Chinese girl was found to have abnormalities on chest roentgenography at a school health checkup in 2004, and she visited our outpatient clinic for the first time on July 2. Based on the imaging, there were multiple nodules ranging in size up to 5cm in the longest dimension, with regularly shaped clear margins, in both lungs. We considered lung metastases of a malignant neoplasm as the most likely diagnosis and performed a systemic workup but failed to make a clinical diagnosis. We therefore performed an open lung biopsy on November 8. Microscopically, the tumors consisted of a mixture of areas with a papillary pattern, a solid pattern and a sclerosing pattern. Component tumor cells were of two types: epithelial-like cells that covered the surface of the papillary structures and round or polygonal cells that showed a solid pattern of growth underneath. Immunohistochemical examinations revealed that these tumor cells were positive for an alveolar epithelium marker. From these results, we made a diagnosis of sclerosing hemangioma. Here we report a rare case of multiple sclerosing hemangiomas together with a review of the literature.

[A case of acute exacerbation of chronic pulmonary thromboembolism with essential thrombocythemia during treatment for hemoptysis].

An 89-year-old woman with essential thrombocythemia and chronic respiratory failure was admitted for treatment of hemoptysis. She stopped taking aspirin and was given tranexamic acid. Though her hemoptysis improved, respiratory failure suddenly worsened. As a result of various examinations and laboratory findings, acute exacerbation of chronic pulmonary thromboembolism was diagnosed. Though there was the risk of recurrence of hemoptysis, she started taking aspirin again. Her respiratory failure improved but hemoptysis did not reappear. Thrombosis and hemorrhage are common complications of essential thrombocythemia, however, pulmonary thromboembolism is a rare complication. There is a possibility that the exacerbation of this case was caused by tranexamic acid as well as rest and cessation of aspirin. If a patient with essential thrombocythemia bleeds, we should be careful when using tranexamic acid.

[Two cases of meningeal carcinomatosis during gefitinib therapy for non-small cell lung cancer].

"Case 1" A 56-year-old woman who suffered from postoperative recurrent non-small cell lung cancer received gefitinib therapy. Approximately 7 months after the therapy was begun, although the intrathoracic disease responded to the treatment, she developed meningeal carcinomatosis and died of rapidly progressive central nervous system disease. "Case 2" A 46-year-old man with stage IV non-small cell lung cancer started gefitinib therapy after chemotherapy. The pulmonary lesions markedly improved responding to gefitinib therapy, however, approximately 6 months after the therapy was begun, multiple brain metastasis and meningeal carcinomatosis were detected. Approximately 4 months after the diagnosis of meningeal carcinomatosis, he died of disease progression and disturbance of consciousness. It has been reported that the central nervous system is a frequent metastatic site of non-small cell lung cancer in patients treated with gefitinib. We report two cases of meningeal carcinomatosis that occurred during the period in which their intrathoracic disease was responding to gefitinib therapy. We should consider the possibility of metastatic central nervous system disease, even in patients in whom gefitinib therapy is apparently successful.

Delayed onset acute renal failure associated with Amanita pseudoporphyria Hongo ingestion.

A 66-year-old man with diabetes developed acute renal failure after ingestion of Amanita pseudoporphyria Hongo. Laboratory data showed acute nonoliguric renal failure. A renal biopsy showed acute tubular necrosis with glomerular minor abnormalities. He received hemodialysis treatment for 3 weeks and his renal function normalized 2 months after admission. We discuss the differences in acute renal failure caused by possible toxins of Amanita pseudoporphyria Hongo from that caused by other poisonous mushrooms.