[7 fractionated cyberknife radiotherapy for giant skull metastasis: a case report].

This is a report on the experience of using stereotactic radiotherapy for a large symptomatic metastatic skull tumor. The stereotactic radiotherapy was delivered in 7 fractions using the Cyberknife and produced excellent therapeutic results. This case concerns a 75-year-old female. Nineteen months after uterine cancer surgery, the patient demonstrated metastasis to the mediastinum lymph node and a tumor at the parietal bone tumor but was still undergoing observation. An increase of the parietal bone tumor became evident and the appearance of right hemiplegia, aphasia, and cognitive dysfunction caused her to consult this hospital. We observed a large 236 cm3 tumor spread over the subcutaneous tissue of the superior sagittal sinus, pressing the brain out of the dura mater and causing bone destruction. As a result of our findings, we began stereotactic Cyberknife radiotherapy delivered in 7 fractions. At the follow up visit one month after the treatment, the image of the tumor had already decreased, and after three months it was confirmed that the image of the tumor had disappeared. The patient's symptoms ameliorated rapidly. As a result, the patient has returned to an independent home-lifestyle, with amelioration of her quality-of-life defects. Six months after irradiation, there is no evidence of tumor regrowth or complications such as dermatopathy, cerebral edema, or necrosis. Cyberknife radiotherapy could shorten the treatment period and result in a reduction of the amount of irradiation to unaffected parts of the brain. In this case, though the tumor had spread widely in the subcutaneous tissue, the exposure doses were delivered at 2Gy/time and could be limited to under 70Gy. It is thought that Cyberknife radiotherapy will become one of the key treatments to help improve quality of life when treating symptomatic metastatic tumors.

High temperature air-blown woody biomass gasification model for the estimation of an entrained down-flow gasifier.

A high temperature air-blown gasification model for woody biomass is developed based on an air-blown gasification experiment. A high temperature air-blown gasification experiment on woody biomass in an entrained down-flow gasifier is carried out, and then the simple gasification model is developed based on the experimental results. In the experiment, air-blown gasification is conducted to demonstrate the behavior of this process. Pulverized wood is used as the gasification fuel, which is injected directly into the entrained down-flow gasifier by the pulverized wood banner. The pulverized wood is sieved through 60 mesh and supplied at rates of 19 and 27kg/h. The oxygen-carbon molar ratio (O/C) is employed as the operational condition instead of the air ratio. The maximum temperature achievable is over 1400K when the O/C is from 1.26 to 1.84. The results show that the gas composition is followed by the CO-shift reaction equilibrium. Therefore, the air-blown gasification model is developed based on the CO-shift reaction equilibrium. The simple gasification model agrees well with the experimental results. From calculations in large-scale units, the cold gas is able to achieve 80% efficiency in the air-blown gasification, when the woody biomass feedrate is over 1000kg/h and input air temperature is 700K.

Spinal cord decompression sickness associated with scuba diving: correlation of immediate and delayed magnetic resonance imaging findings with severity of neurologic impairment--a report on 3 cases.

BACKGROUND: There are few reports detailing an association between immediate and delayed changes in MR imaging findings and severity of neurologic impairment in patients with spinal cord DCS. We report on the cases of 3 patients diagnosed with spinal cord DCS presenting with severe neurologic symptoms after scuba diving. CASE DESCRIPTION: Of 175 patients with DCS referred to the Tokyo Metropolitan Ebara Hospital Department of Neurosurgery, 3 were determined by MR imaging and neurologic examination to have a spinal cord injury. Hyperbaric oxygen, methylprednisolone, and rehabilitation therapies were applied to these patients. We examined whether the severity of the patients' neurologic dysfunction, classified according to Fränkel's grade, was associated with the extent of abnormal signals depicted by spinal MR imaging in these patients at the acute phase and monthly follow-up points. T2-weighted MR imaging performed within 24 hours of the onset of the patients' neurologic symptoms revealed signals of increased intensity located predominantly in the dorsolateral regions, involving spinal segments 1 through 4, and a neurologic examination upon admission revealed severe sensory and motor dysfunction (Fränkel's grade A) in all 3 patients. The abnormal signals on MR images at 1 month postinjury were markedly decreased in size as compared with those at the acute phase. However, neurologic function showed minimal or no improvement (Fränkel's grade A or B). CONCLUSION: In patients with spinal cord DCS, the improvement in MR imaging findings was not associated with improved clinical status. This discrepancy suggests that intricate pathophysiologic changes, reversible and persistent damage subsequent to initial cord injuries (ie, edematous and neurotoxic lesions), underlie the disease and affect the clinical course.

Spondylodiscitis: diagnosis and treatment.

BACKGROUND: We present our experience in the diagnosis and treatment of spondylodiscitis. METHODS: 27 patients with spondylodiscitis were studied. There were 15 men and 12 women, with ages ranging from 26 to 85 years. Of the 27 cases, there were 21 patients with pyogenic spondylodiscitis, 6 patients with tuberculosis spondylodiscitis, and 8 patients with diabetes mellitus complication. Two patients presented with tetraparesis, 13 with paraparesis, and 1 with hemiparesis. Seventeen patients underwent surgical treatment, among whom surgical intervention with instrumentation was performed on 5 patients, and emergency operation was performed on 6 patients. RESULTS: Fourteen patients were judged as "excellent," 8 patients as "good," and 4 patients as "no change." One patient died because of infection by penicillin-resistant Staphylococcus pneumoniae. CONCLUSION: It is very difficult to diagnose spondylodiscitis at the first medical examination. Most spondylodiscitis patients often first visit a department of internal medicine. We strongly recommend that all doctors, especially doctors examining diabetes mellitus patients daily, should be well informed of spondylodiscitis in order to improve its diagnosis.

Brown-Sèquard syndrome produced by cervical disc herniation: report of two cases and review of the literature.

BACKGROUND CONTEXT: Brown-Sèquard syndrome is most commonly seen with spinal trauma and extramedullary spinal neoplasm. A herniated cervical disc has rarely been considered to be a cause of Brown-Sèquard syndrome. PURPOSE: To report and discuss two cases of Brown-Sèquard syndrome produced by herniated cervical disc. STUDY DESIGN/SETTING: Case studies in Japan. PATIENT SAMPLE: The first patient was a 64-year-old man who presented with right leg weakness and diminished sensation to pain and temperature in the left side below the T4 dermatome. The second patient was a 39-year-old man who presented with right-sided weakness and diminished sensation to pain and temperature in the left side below the T6 dermatome. OUTCOME MEASURES: American Spinal Cord Injury Association (ASIA) impairment scale (only our cases). METHODS: These patients were diagnosed to have Brown-Sèquard syndrome produced by herniated cervical disc. Anterior cervical discectomy with fusion was performed for these patients. RESULTS: These cases revealed contralateral deficit in sensation of pain and temperature of more than a few levels below the cord compression, and showed paracentral protruded disc in magnetic resonance images and cervical spinal stenosis in cervical spine X-rays. Postoperatively, motor and sensory function of these patients returned to normal. CONCLUSIONS: Characteristic finding in discogenic Brown-Sèquard syndrome are contralateral deficit in sensation of pain and temperature of more below than a few levels below the cord compression and paracentral protruded disc with cervical spinal stenosis. Outcomes are favorable in rapid diagnosis by magnetic resonance images and performance of anterior approach.

Spontaneous regression of herniated cervical disc.

BACKGROUND CONTEXT: Spontaneous regression of herniated lumbar disc has been well established. However, spontaneous regression of herniated cervical disc is rare, and such reports are few. PURPOSE: To present a rare case of spontaneous regression of herniated cervical disc. STUDY DESIGN: A case study. METHODS: A 27-year-old man presented with severe pain on the left C6 level. Magnetic resonance imaging (MRI) revealed a lateral extruded disc at the C5-C6 level. The patient refused discectomy. RESULTS: The patient's pain disappeared after 3 weeks. Follow-up MRI revealed partial spontaneous regression in the extruded disc after 3 weeks and complete spontaneous regression after 12 months. CONCLUSION: All previous cases of herniated cervical disc that regressed spontaneously have been of the extruded type. In the patient with the cervical extruded disc, nonsurgical conservative observation should be considered an option for treatment.