Objective : We analyzed the clinical presentation, therapeutic outcome, and intraoperative findings of thoracolumbar dural arteriovenous fistula (T-L dAVF).

  Method and material : We experienced 19 cases (16 men) of T-L dAVF between 1996 and 2011 and analyzed the clinical characteristics and outcome after intravascular embolization and direct surgery. Additionally, we analyzed intraoperative findings among the cases that underwent direct surgery.

  Result : The mean patient age was 63.8 years, and the mean follow-up period after intravascular embolization and/or direct surgery was 72.2 months. All patients suffered congestive myelopathy. Intravascular embolization was performed in 15 cases. All 4 patients who underwent feeder occlusion with coil material had a relapse and required direct surgery. Eight of eleven patients treated with n-butyl cyanoacrylate (NBCA) were cured. One patient suffered a spinal infarction after embolization. Three cases treated by NBCA showed recurrence and required direct surgery. All 10 cases that required direct surgery were cured without any complications. During the direct surgeries, single draining vein was observed in all 10 cases. The draining vein was located dorsally against the posterior rootlet in 8 cases, ventrally in 1 case, and intraforaminally in 1 case. Vascular tangle was observed on the outer surface of the dura mater in 4 cases, on the inner surface of the dura mater in 3 cases, and on both the inner and outer surfaces in 2 cases. The fistulous point was located around the dural sleeve or the corresponding pedicle in all but 1 case.

  Conclusion : Regarding therapy for T-L dAVF, direct surgery may be more promising than intravascular embolization, although the latter can be performed less invasively. We must remember that cases of T-L dAVF in which the fistulae are located far from the dural root sleeve or corresponding pedicle are rare.

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Ectopic pituitary adenoma of the sphenoid sinus is rarely encountered by general physicians and otolaryngologists. Recently this disease has been identified using CT, MRI, and other imaging examinations. Ectopic pituitary adenomas of the sphenoid sinus are considered to be benign and slow-growing with mild or no symptoms. On the other hand, primary sphenoidal carcinoma is also a rare disease, the chief complaint for which is usually headache or nasal bleeding as a result of invasion around the organs. CT and MRI imaging cannot differentiate sphenoidal carcimona from ectopic pituitary adenomas of the sphenoid sinus. A diagnosis of ectopic pituitary adenoma of the sphenoid sinus may be suspected when a patient has slight complaints such as slight headache, regardless of the findings of imaging examinations. Histological examinations are necessary for the differential diagnosis of the ectopic pituitary adenomas of the sphenoid sinus and sphenoidal carcimona. The prognosis of an ectopic pituitary adenomas of the sphenoid sinus is good if the adenomas are removed by surgery.

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雑草地と牧草地にけい牧した6頭のめん羊 (コリデール種) について, 呼吸数, 心拍数, 直腸温等の生体反応を測定し, 気温, 日射, 食草等の影響について観察した。
夏季日向でけい牧した場合, 環境温度調節室での実験から得た値より, 呼吸数では50～70回/分増, 心拍数では15～35回/分増, 直腸温では0.4～1.1℃高い値を示した。この日射下で食草中の影響を呼吸数の増加から環境調節室内の温度に換算して求めると, 10～17℃高い状態にあたると推定された。
日向で食草中の生体反応は日陰に変わることにより呼吸数は20～60回/分減, 直腸温では0.2～0.3℃降下, 心拍数には変化を認めなかった。この呼吸数の減少は同様に環境調節室の温度に換算すると約4～12℃に見積ることのできるものであった。
牧草地にけい牧すると心拍数の増加と経時的な漸増が特徴であった。心拍数についてはエネルギー代謝や採食量との関係で考察した。
食草中の増加した呼吸は, 高温環境下でみられる浅い呼吸ではなく, やや深めの呼吸型であった。

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日本在来種ヤギ4頭を用いて,採食と運動の負荷に伴う心拍数(HR)と熱産生量(HP)の関係を求めるとともに動静脈血酸素濃度の測定を加え,負荷条件による両者の関係における差異を検討した.1) HRとHPとの関係には,いずれの負荷条件においても高い相関があり,また,HRによるHP推定に伴う誤差(PE,Sy•x/y,%)も5-7%と小さなことを確認した.2) しかし,回帰係数には両負荷区間に明らかな差異が認められ,この違いは,主として運動時の静脈血酸素濃度の低下に伴う動静脈血酸素濃度差の増大によるものであった.3) 相対心拍率(RHR)法を用いて採食区と運動区を統一したヤギのHP推定式を提示するとともに,HP推定式を作成する際の負荷条件等について考察した.

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採食に伴うめん羊のRumen内温, 直腸温, 心拍数, 呼吸数などの生体反応を観察し, 反すう動物の採食に伴う生理変化, 特にRumen発酵との関係について考察を行なった。
Rumen内温と心拍数は, 飼料摂取により上昇増加し, その程度は給与飼料の種類や量により異なるものであった。呼吸数も同様に採食により増加するが, 高温時にその影響は顕著に現われた。
採食に伴うRumen内温の上昇, 心拍数及び呼吸数の増加は, 採食運動や摂取飼料の性質に基づく直接的な影響に加えて反すう動物特有のRumen内発酵に基づく発酵熱発酵産物などによる間接的な影響が, 重要な作用を及ぼしているものと考えられた。
採食と関係するこの反すう動物の生体反応の変化の生理学的意義については, Rumen発酵に伴い嫌気的に産生される発酵熱や, 発酵産物との関係において詳細に検討する必要があろう。

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The aim of cell transplantation is to replace damaged area. But transplanted neural stem/progenitor cells (NSPCs) didn't treat lesion core. We transplanted adult NSPCs modified to secrete GDNF in order to make transplanted NSPCs replace ischemic area more effectively.
NSPCs were harvested from subventricular zone (SVZ) of adult rats and cultured with EGF by using neurosphere technique. Expanded NSPCs were transfected with fiber-mutant F/RGD adenovirus containing GDNF (NSPC-GDNF) or EGFP (NSPC-EGFP) gene. The best transfection efficiency was derived from GDNF ELISA. At first, NSPC-GDNF or NSPC-EGFP cells were transplanted into the ischemic boundary zone of MCAO model of Wistar rats in the acute stage (allogenic transplantation). NSPC-GDNF group had a significantly better result in behavioral test and infarction volume than NSPC-EGFP group. Subsequently, NSPC-GDNF or NSPC-EGFP cells were transplanted into the damaged CAI of global ischemia model of Fischer344 rats in the chronic stage (syngenic transplantation). NSPC-GDNF cells migrated and differentiated into neuron as replacing the damaged CAI of hippocampus partially. Moreover, NSPC-GDNF group had shown the activation of neurogenesis of endogenous NSPCs.
Consequently, we confirm NSPC-GDNF have neuroprotective effect and can replace damaged area. We think this result suggests that NSPC-GDNF cells can bring a good result in autologous-transplantation.

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We report a case of a large aneurysm of left posterior cerebral artery presenting with intraluminal thrombosis or intramural hemorrhage. A 49-year-old female was admitted to our department suffering from severe headache and vomiting. CT scan did not show subarachnoid hemorrhage but demonstrated a round high density mass of 1.5 cm in diameter in the left ambient cistern. MRI demonstrated that the intensity of the inside of the mass was low and that of the outer wall was somewhat high in the both Ti and T2 weighted image. Cerebral angiography showed crescent opacification of supero-lateral part of the aneurysm while medial-inferior part was not visualized, indicating thrombus formation.
We carried out surgery via the left extended subtemporal approach. No evidence of subarachnoid hemorrhage was observed during the operation. The wall was dark-blue colored. The parent artery was clipped at the proximal side of the aneurysm and disappearance of the aneurysm was confirmed by the intraoperative angiography. The postoperative course was uneventful and CT scan showed no abnormal low-density area. PCA aneurysms were overviewed literary, and mechanisms of intraluminal thrombosis and intramural hemorrhage were considered.

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栄養士養成における情報処理教育に資するため, 東京都及び神奈川県のE会の会員名簿から, 標本抽出により961人選び, 郵送により回収された308人を対象に, 職場における栄養士業務のコンピュータの利用実状調査を実施した。
1) 全体での利用率は55.8%で, 施設の種類別内訳は, 産業63.0%, 病院62.7%, 学校51.2%, 行政40.7%, 福祉31.2%であり, 経営形態別内訳は, 委託65.2%, 直営52.0%であった。
2) 利用業務は, 栄養管理, 献立作成に約80%, 文書作成, 発注管理, 食数管理, 管理資料作成に約60%と, 給食管理に利用している施設が多かった。
3) 利用業務は施設の種類別により特徴があり, 病院は利用業務の範囲が広く, 多くの業務の利用率が高いが, 他の施設は利用範囲が一部に集中していた。
4) 施設の種類別における利用しての長所は, いずれも事務処理からの解放を最上位にあげているが, 他の回答は施設の種類により相違があった。
5) 利用しての問題点は, 故障の際の影響 (43.2%) が最も多く, 次いで技術 (37.0%), 経費 (31.5%), ソフト (27.4%) に関してであった。また施設の種類別では, 病院, 産業において有意差がみられた。
6) 情報教育の必要程度は, 施設の業務と関係があり, 施設の種類, 経営形態, 機種やソフトによるものではなかった。現段階では, 理論と基本操作, ワープロ操作, 専用ソフトの活用が利用施設において高回答率であった。

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Subarachnoid hemorrhage (SAH) due to ruptured aneurysm in patients aged 80 years and older has been, until recently, very rare. The number of such cases, however, is growing, and the most appropriate management of cases of elderly patients with SAH is still a matter of controversy.
The cases of 29 patients aged 80 and older with SAH are reported. The outcome was defined according to the Glasgow Outcome Scale at six-months following rupture. Of these, 12 were rated Grade III or better on the Hunt-Kosnik scale, while 17 were rated Grade IV or V. Of the four Grade III or better patients who underwent surgery, two Grade I patients obtained GR and one Grade II patient showed MD, while one Grade III patient is severely disabled due to an intracerebral hemorrhage that developed one week after the operation. The remaining eight Grade III or better patients were treated conservatively. Of the three Grade I patients, one obtained GR but two became D. One Grade II patient showed MD. Of the four Grade III patients, one obtained GR and one became MD, while two showed D.
In our case management policy, surgery is contraindicated for Grade IV and V patients. Accordingly, our 17 patients so rated were treated conservatively. Two deteriorated to a vegetative state, while the remaining 15 died from primary damage or rerupture.
In conclusion because better outcome is obtained with surgery on elderly patients in Grade I cases, and because the outcome of elderly patients with rerupture is very poor, aneurysmal surgery should not be withheld in Grade I patients merely because the patient is 80 years old or older.

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Thrombosis of cerebral aneurysms increases the risk of rupture and may even lead to cerebral infarction due to the dispersion of thrombus. We describe two case reports for patients who underwent surgical treatment for a symptomatic partially thrombosed aneurysm of the middle cerebral artery (MCA).
Case 1 was a 20-year-old man who presented with a headache. Detailed examination revealed a partially thrombosed large cerebral aneurysm along the right MCA, which was enlarged owing to advanced thrombosis. The patient experienced subarachnoid hemorrhage while awaiting planned surgery and underwent emergency neck clipping of the aneurysm.
Case 2 was a 63-year-old woman who developed cerebral infarction following a right MCA aneurysm growth with thrombosis and underwent emergency coil embolization. She presented with a recurrent aneurysm 3 months later, and underwent a second coil embolization. Both cases showed acute transformation secondary to thrombosis. Urgent treatment is warranted when symptoms related to thrombosis are observed. The treatment strategy should be designed carefully to suit individual cases based on varying anatomy/geometrical patterns of aneurysms and varying progression of thrombosis.

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  For the management of large cervical dumbbell-shaped neurinomas, generally, a posterior approach is first employed for the removal of the intraspinal tumor, and removal of the remaining extraspinal tumor is attempted through an anterior approach. However, several anterolateral approaches have attempted to remove some cervical dumbbell-shaped neurinomas by one-stage operation. These approaches are excellently organized to remove intraspinal portion of the tumors as well as extraspinal portion via the route medial to the sternocleidmastoid muscle (SCM).

  We report our experience of 2 cases in which large cervical dumbbell-shaped neurinomas laterally extended between the anterior and middle scalenus muscle to the external jugular vein. We performed surgery through a retro-SCM approach to remove the laterally extending tumors. For safe handling of vertebral arteries, we also used the pre-SCM route to expose the anterior tubercles of the transverse process. The retro-SCM approach along the extension of the tumors provided an excellent surgical corridor for the removal of extraspinal, intraforaminal, and even intraspinal portions of the tumor. Moreover, no obstacle, except for the supraclavicular nerve just on the surface of the tumor, was encountered. We were able to preserve this nerve without intense effort. Although 1 patient complained of transient dysesthesia over the ipsilateral clavicular region after the operation, the other patient had no complaints.

  We believe that this approach is safe and effective for the removal of large cervical dumbbell-shaped neurinomas with lateral extension ; however, the approach needs to be investigated in more cases in the near future.

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