[Visual defect due to chiasmic compression by the A1 portion of the anterior cerebral artery]

Unilateral nasal hemianopia is highly difficult to notice with bilateral vision intact, and only a few cases has been reported. There are several reported cases of quadrantic hemianopsia caused by cerebral lesions, but the defects were found bilaterally in all cases. There is only one reported case of which an aneurysm was believed to be the cause. We confronted 3 cases of unilateral nasal quadrantic hemianopia. In either case no ophthalmologic disorders could be found but magnetic resonance imaging revealed the compression of the optic chiasma by the A1 portion of the anterior cerebral artery. All three cases are presently under conservative therapy and receive routine evaluations. Nerve fibers from the upper and lower areas of the retina are routed complicatedly in the optic nerve in the periphery of the optic chiasma. From the presentation of the quadrantic hemianopia and from the radiological findings, we diagnosed that the visual defect was caused by vascular compression of the optic chiasma.

Simple purification method of the antiphospholipid antibody from normal human plasma

We have reported that rabbit serum contains a phospholipid (PL)/ganglioside-binding protein which adsorbs to Sephacryl S-400 gel and agglutinates human red blood cells. A new protein similar to the PL/ganglioside-binding protein was simply purified from normal human plasma using Sephacryl S-400, Sepharose CL-4B and DEAE-Sepharose CL-6B columns. The purified protein was found to agglutinate rabbit red blood cells. The hemagglutination was specifically inhibited by two PL, phosphatidylserine and phosphatidylinositol, but not by any other PL, gangliosides, saccharides or glycoproteins tested. From analyses of the N-terminal amino acid sequence and immunological specificity, the protein was identified to be a human immunoglobulin M.

Systemic lupus erythematosus complicated by disseminated intravascular coagulation: the role of serum soluble cell surface markers

We describe a 31-year-old Japanese female patient with systemic lupus erythematosus (SLE), who developed disseminated intravascular coagulation (DIC), fever, erythema on the hands, and aphthous stomatitis despite the absence of circulating anticoagulant. Since no other cause for DIC besides SLE could be demonstrated, she was treated with prednisolone and anticoagulants, which rapidly corrected the DIC as well as the other manifestations of SLE. During the episode of DIC, elevated serum anti-DNA antibody titers and decreased serum complement concentrations were not observed. In contrast, the serum concentration of soluble CD8 (sCD8) paralleled SLE disease activity. In addition, the concentration of plasma thrombomodulin was also increased. These observations suggest that the serum concentration of sCD8 is related to the clinical aspects of SLE, and that vasculitis might contribute to the development of SLE-associated DIC.

Contribution of tumor necrosis factor alpha and interleukin-1 alpha on the production of macrophage inflammatory protein-2 in response to respiratory syncytial virus infection in a murine macrophage cell line, RAW264.7

The production of several inflammatory cytokines, such as murine macrophage inflammatory protein-2 (MIP-2), tumor necrosis factor (TNF), and interleukin (IL)-1, was investigated in response to respiratory syncytial virus (RSV) infection in a murine macrophage cell line, RAW264.7, with special reference to mutual relation of their productions. The kinetics of MIP-2 production showed a trend for a biphasic pattern, that is, MIP-2 levels became detectable from 2 h postinfection (p.i.) and increased markedly until 8 h p.i. Thereafter, this level fell to the same level until 16 h p.i. and then increased again. TNF alpha was also detectable at 2 h p.i. and then increased sharply until 8 h p.i., when the peak level attained. Compared with the levels of MIP-2 and TNF alpha, that of IL-1 alpha/beta, especially IL-1 beta, was lower (ng versus pg/ml order). The presence of anti-TNF alpha or anti-IL-1 alpha antibody did not influence the early phase of MIP-2 production but significantly inhibited the late phase, suggesting that MIP-2 is induced by the combined effects of RSV infection via direct induction and indirectly after initial induction of TNF alpha and IL-1 alpha productions. Although RSV-infected RAW264.7 cells had no alteration in viability compared with mock-infected control, these data demonstrate that RSV is a potent inducer of inflammatory cytokines by direct induction and indirectly via the initial production of other cytokines.

Detection of a genetic variant, lysine-->glutamic acid at position 372 of human serum albumin, by capillary electrophoresis and structural identification

A genetic variant of human serum albumin (alloalbumin) is detected by capillary electrophoresis (CE). Two albumin peaks, which were in the ratio of approximately one, were clearly separated. One of the peaks had the same migration time as normal albumin (Alb A) and the other (Alb X) had a longer migration time. SDS-polyacrylamide gel electrophoresis of CNBr fragments (CB) of Alb X indicated that the amino acid substitution was localized in the CB5 fragment (residue 330-446) of the molecule, because of anomalous migration of CB5 in the gel. The CE mapping of the tryptic peptides from the variant CB5 revealed clearly the existence of a new peptide, and the lack of two normal peptides. The sequence analysis of the variant peptide collected by CE micropreparation showed that the N-terminus of the variant peptide corresponded to that of T49 in Alb A. The substitution site, lysine-->glutamic acid at the position 372, was revealed by sequence determination of the variant peptide purified by reversed-phase HPLC.

[Dynamic MR hepatocholangiography with the SIP Fast GRE (saturation inversion projection fast gradient echo) method]

The purpose of this study was to assess the utility of dynamic MR hepatocholangiography with the Gd-EOB-DTPA enhanced SIP Fast GRE sequence in the hepatobiliary system. The SIP Fast GRE sequence was used for sequential imaging of the hepatobiliary system with a frame rate of 3 sec in a 256 x 192 matrix. Dynamic sequential acquisition was performed for 51 min before and after the injection of 30 mu mol/kg of Gd-EOB-DTPA in a rabbit. Dynamic images of the hepatobiliary system were obtained in the rabbit study. Dynamic MR hepatocholangiography provides better functional information than conventional MR cholangiography.

[Two cases of personal identification from dental information]

We describe two cases in which unknown bodies were positively identified from dental information and biochemical examination using tooth materials. In one case, a charred body was positively identified with little effort by comparison of antemortem dental records (dental chart and dental X-ray film) with postmortem data. In the other case, although the unknown individual had dental treatment, the police were unable to obtain the antemortem dental records of the victim. We then conducted biochemical analysis of teeth, facilitating personal identification using DNA analysis and age estimation based on aspartic acid racemization. The mutation obtained from the sequence of mtDNA and the genotypes of HLADQ alpha, HPRTB and ABO blood groups including the data for estimated age supported the kinship between the unknown individual and his mother. The data for maternally inherited mtDNA were of great importance in this case, since it was possible to obtain DNA from the mother. Dental identification in one of the most accurate methods of personal identification if suitable antemortem records are available. In the absence of such records, biochemical analysis of teeth also makes it possible to increase the probability of correct personal identification.

[Trial of analysis of esophageal wall motion using optical flow method on esophagogram]

Several studies have indicated that the analysis of esophageal motion provides a valid means of identifying esophageal diseases. Although this motion can be seen on esophagogram, its quantification leaves much room for improvement. This study presents a computer method to quantify the apparent motion (optical flow) observed on sequences of esophagogram. This method computes at every point of a sequence of digitized images the two-dimensional velocity vector which characterized its motion from one image to the next image. The information on motion of the esophagus can be displayed by superimposing the local velocity vector on the original image.

Assessment of breast cancer with dynamic gadolinium-enhanced MR imaging combined with magnetization transfer contrast using a newly developed breast surface coil for the supine position

To assess the value of dynamic gadolinium-enhanced MR imaging combined with magnetization transfer contrast (MTC) of breast cancer by SPGR sequence, 15 patients with breast cancer were imaged in the supine position with the newly developed breast coil in a 1.5 Tesla imager. Dynamic gadolinium-enhanced MR imaging combined with MTC (10 cases) and conventional dynamic gadolinium-enhanced MR imaging (5 cases) were performed after the administration of Gd-DTPA (0.2 ml/kg). Sagittal images were obtained every 22 seconds during the first 264 seconds. Thus, a total of 15 images were obtained in each lesion. The signal intensity ratio (SIR) of lesion to mammary glarid was calculated for each image as follows: (SI lesion/SI mammary gland)/(SI (pre)lesion/SI (pre)mammary gland). Dynamic gadolinium-enhanced MR imaging with MTC always allowed better SIR at 88 seconds than conventional dynamic gadolinium-enhanced MR imaging after bolus injection (p < 0.01). Dynamic gadolinium-enhanced MR imaging with MTC improved detection of the boundary of the lesion and mammary gland.

Molecular and biochemical events within the brain subjected to cerebral ischemia (targets for therapeutical intervention)

We review the molecular and biochemical events that occur within the brain during cerebral ischemia, based on recent investigations of focal cerebral ischemia models. Occlusion of the middle cerebral artery in rats produces focal ischemia. In contrast to the core where ischemia is severe and infarction develops rapidly, areas surrounding the core (called the penumbra) show a more moderate decrease of blood flow and can tolerate longer durations of ischemic stress. Reperfusion and pharmacological interventions can help to salvage the penumbra. Ischemic insult alters the genomic properties of the brain cells and selective production of heat shock proteins can be seen. Heat shock proteins are necessary in the repair of cell integrity, and is thought to be induced as a rescue program. Pre-ischemic induction of these proteins is known to cause ischemic tolerance, and methods to manipulate genes into inducing HSPs may be effective in protecting neurons from ischemia. Genes that promote apoptosis are also expressed after ischemia, and may cause secondary expansion of the infarction. Strategies to denote expression of these genes may be effective in reducing ischemic neuronal death. Activation of the inflammatory cells such as neutrophils and macrophages, in the ischemic region, may cause further post-ischemic damage. Investigations on the role and mechanics of inflammatory systems in ischemic neuronal injury may present a new target for therapeutic intervention against stroke.

[Analytical evaluation of compression and displacement of the esophagus and trachea due to right aortic arch with MR imaging]

We studied 12 cases of right aortic arch (RAA) with MRI, and the anatomical relationship between right aortic arch and the esophagus and trachea were analysed. Three of 12 cases showed RAA with mirror-image branching. Nine cases were RAA with aberrant left subclavian artery. The proximal portion of the aberrant left subclavian artery in the retrotracheoesophageal space was expanded just like a pouch. The pouch was the 8th segment dorsal aortic root and the so-called aortic diverticulum. This was one of the causes of symptoms such as wheezing and dysphagia. We divided the configuration of aortic diverticulum into two types, bulging type and saccular type, on the basis of coronal images. Two cases were bulging type, seven saccular type. The axial images in two cases showed compressed esophagus, and in three cases showed displacement of the trachea, narrowing of the space like a triangle surrounded by the aortic arch, aortic diverticulum and aberrant left subclavian artery. We drew lines and measured the angle of the aortic arch with the aberrant left subclavian artery on the axial images of these cases. We found that cases with an angle of less than 60 degrees showed a high correlation with the causes of compression of the esophagus or displacement of the trachea. It was necessary to follow such patients with MRI.

[Clear skeletal visualization on whole body 201Tl-chloride scintigraphy: a case of prostatic cancer with diffuse bone metastases]

A 70-yr-old man who was diagnosed as early gastric cancer showed leukocytopenia after total gastrectomy. Osteosclerotic findings on radiography were not remarkable. 99mTc-HMDP bone scintigraphy showed diffusely increased uptake in the axial skeleton, but visualization of the kidney and urinary bladder was apparent. However, whole body 201Tl-chloride scintigraphy showed diffuse abnormal visualization of axial skeleton. Physical and ultrasonographic examination indicated no abnormality in prostate. Afterward, further investigation, including bone marrow biopsy and immunohistochemical study, confirmed the diagnosis of bone metastasis from prostatic cancer. Microscopically, metastatic tumor cells were located in the intertrabecular space. Furthermore, no osteoclastic bone resorption or new trabecular bone formation was seen in this biopsy specimen. These findings suggest that whole body 201Tl-chloride scintigraphy can be a useful non-invasive diagnostic tool to investigate patients with suspicious malignancy in the bone marrow.

Identification and purification of a novel phospholipid/ganglioside-binding protein in rabbit serum

We have isolated a novel phospholipid/ganglioside-binding protein from rabbit sera or platelet-free plasma. Using an affinity chromatography of a commercial gel (Sephacryl S-series gel, Pharmacia) column and a preparative polyacrylamide gel electrophoresis, the protein can be easily purified. The protein agglutinates human red cells irrespective of the ABO blood types, and its hemagglutination reaction is specifically inhibited by some phospholipids (phosphatidylserine and phosphatidylglycerol) and ganglioside (N-acetylneuraminyl-galactosylglucosyl ceramide, GM3). The hemagglutination and its inhibition reactions are independent on any divalent cations (Ca2+, Mg2+, Mn2+, Ni2+). The protein seems to be assembled as multimers of disulfide-bonded molecular of 86 kDa and 59 kDa subunits.

A case of the incomplete double aortic arch diagnosed in adulthood by MR imaging

Double aortic arch is a rare vascular anomaly, particularly in adults. Most of patients were infants or children. In this report we describe a case of the incomplete double aortic arch in a 55 years old woman complaining of esophageal symptoms was found by esophagography and examined by MR imaging. This anomaly had double aortic arch with partial atresia of the left arch. The right common carotid artery (RCCA) and the right subclavian artery (RSA) arose from the large right aortic arch (RAA). The left common carotid artery (LCCA) and subclavian artery (LSA) arose from the left aortic arch (LAA). Aortic diverticulum was detected at the interior site of the descending aorta connected with the left subclavian artery (LSA). The mediastinal organs were surrounded by the vascular ring (RAA, LAA, LSA and aortic diverticulum).

Dynamic MRI with slow injection of contrast material for the diagnosis of pituitary adenoma

Magnetic resonance (MR) imaging of pituitary adenoma is usually carried out in dynamic studies with bolus contrast material injections, with the result that few strong images are obtained. Dynamic studies using a slowly injected contrast material were carried out in 14 cases of pituitary adenomas. The examinations were performed with a 1.5 Tesla superconducting MR imaging system using the spin-echo technique. Gd-DTPA (0.1 mmol/kg) was slowly injected (within 90 sec) by hand, providing seven to nine dynamic images during 350 sec from the start of injection. The average time to reach the maximum signal intensity was 170.6 sec in adenoma and 156.2 sec in normal gland tissue. The maximum contrast signal intensity ratio of adenoma to normal gland was 0.527 in the fifth image. The contrast of adenoma to normal gland tissue was calculated by the following formula: ASII (adenoma signal intensity index) = (adenoma signal intensity-tissue signal intensity)/tissue signal intensity. The most remarkable contrast between adenoma and normal tissue was obtained from the fourth to eighth images. In other words, we could obtain the strongest contrast at 144.8 sec to 299.6 sec from the start of contrast injection. Our results with slow injection suggest that stronger images can be obtained a longer period after contrast injection.

Radioimmunodetection of cancer of gastrointestinal tract and liver metastasis with I-131 anti-CEA and I-131 anti-CA19-9 monoclonal antibody cocktail (IMACIS-1)

We evaluated the intravenous infusion of a cocktail of I-131 anti-CEA and anti-CA19-9 monoclonal antibody F(ab')2 (IMACIS-1) in patients with gastrointestinal neoplasm and liver metastases in order to assess its efficacy in detecting the presence of cancer. Seven patients with primary or recurrent gastrointestinal cancer in whom liver metastases were also detected were studied. Accumulation of radioactivity in the primary tumor was seen in only one patient. Visualization of the liver metastases was achieved in all patients. Thus detection of liver metastasis was better than in primary or recurrent tumors. While tumor visualization was most often seen in the 3 day image, optimal visualization of the tumor was seen at 5-7 days. There was no correlation between the serum concentration of CEA or CA19-9 and the visualization of tumors. Serum kinetics of I-131 IMACIS-1 showed biexponential components with a 1st phase T1/2 of 5.0 hours and 2nd phase T1/2 of 34.7 hours. The mean whole body (I-131) half-life determined from the whole-body scans was 1.95 days. The mean urinary excretion of I-131 in 7 days was 85%. This value agreed closely with total radioactivity retention detected by scanning. This series of studies demonstrated the potential utility of a cocktail of antibodies consisting of an anti-CEA and an anti-CA19-9 monoclonal F(ab')2.

[Some problems on the clinical phenotype of Machado-Joseph disease in relation between their ages at onset]

This study proposed that three phenotypes of Machado-Joseph disease (MJD) are closely related to the patients' ages at onset.

MATERIALS

Six patients from two families. Autopsy performed in three of them (case 2, 4, 5). Two patients are a father (case 4) and his son (case 5).

RESULTS

1. Clinical features. All cases showed cerebellar ataxia and nystagmus. Progressive nuclear oculomotor palsy was common except for one case who killed himself in the early clinical stage. Pyramidal symptom which is increased deep tendon reflexes, spasticity, and extesor plantar response was common for three patients (case 3, 5, 6) whose ages of onset are under 40 years. One case (case 5) developed dystonia of foot at the age of ten and he developed the symptom of type 1 of MJD. However, the other three patients (case 1, 2, 4) who developed ataxia after the middle of the fifth decade showed hypotonia and decreased or absence of deep tendon reflexes from the beginning. The latter did not revealed spasticity or dystonia. Their clinical symptoms were identical with the type 3 of MJD. In spite of ages at onset, they showed general muscular atrophy and sensory disturbance in the advanced clinical course. 2. Neuropathological findings. 1) cerebellar system: Severe degeneration in the spinocerebellar system and mild to moderate one in the pontocerebellar system and dentate nuclei. The inferior olivary nucleus and the cerebellar cortex were almost preserved. 2) extrapyramidal system: Moderate to severe degeneration in the substantia nigra, globus pallidus (prominent in the internal segment) and subthalamic nucleus. 3) Degeneration in the oculomotor nuclei, motor neurons in the anterior horn and dorsal column of the spinal cord.

CONCLUSION

These clinico-pathological findings indicate the difference of clinical phenotype is not always reflected those of neuropathological findings. The review of our experience and the literature suggests that the clinical features of MJD symptoms are related to the patients' ages at onset and clinical progression of the disease. When the disease begins before the age of ten, dystonia is an initial symptom, followed by pyramidal symptoms and cerebellar ataxia (type 1). In the early adult cases, the onset in which is earlier than forty, cerebellar ataxia and pyramidal symptoms are the initial symptoms, followed by extrapyramidal symptoms such as dystonia or choreoathetoid movements or both (type 2). In both instances however, decreased DTRs, muscular atrophy and sensory disturbance are common clinical manifestations at the advanced clinical stage. In late adult MJD cases with the age at onset after forty, the initial symptom is progressive cerebellar ataxia with hypotonia, followed by muscular atrophy and sensory disturbance (type 3). In spite of a marked degeneration in the extrapyramidal system, few or no extrapyramidal symptoms are detected in the last cases.

Biosynthesis of the blood group P antigen-like GalNAc beta 1-->3Gal beta 1-->4GlcNAc/Glc structure: kinetic evidence for the responsibility of N-acetylglucosaminyl-transferase

Previously we reported the occurrence of UDP-GalNAc:Gal beta 1-->4GlcNAc/Glc beta-1,3-N-acetylgalactosaminyltransferase activity in human plasma. Here, the donor substrate specificity of the enzyme partially purified from blood group O plasma was investigated by means of competition experiments with analogs of donor. The enzyme activity was found to be inhibited most strongly by UDP-GlcNAc among the nucleotide sugars tested, and UDP was the best inhibitor among test nucleotides. UDP-GlcNAc was much more inhibitory than UDP, whereas UDP-GalNAc was much less inhibitory than UDP. These results show that the donor-binding site of enzyme has a high affinity for UDP-GlcNAc, but not UDP-GalNAc, suggesting that the enzyme essentially functions in the transfer of N-acetylglucosamine. Indeed, UDP-GlcNAc:Gal beta 1-->4GlcNAc/Glc beta-1,3-N-acetylglucosaminyltransferase activity is known to occur in human plasma. The ratio of N-acetylgalactosamine to N-acetylglucosamine transferred to lactose with O or B plasma was 1:20 when assayed separately at 1 microM of donor, but increased to 1.2:1 at 5 mM. The nearly identical ratio was obtained with the partially purified enzyme preparation.

[The usefulness of three dimensional imaging of the myocardium using three heads SPECT camera (PRISM-3000)]

The SPECT unit using a 3 heads camera (PRISM-3000) has an advantage over the conventional one head camera SPECT unit because it can complete full circle scans (360 degrees scans) within a short time, and because the non-circular orbit of the camera heads fitting the individual form of the body has improved the spatial resolution. In addition, the high speed data processing has reduced the time for scan, enabling the three dimensional imaging system clinically applicable. In the present study, this modern technique was used to examined the myocardium in patients with ischemic heart disease so as to evaluate it for usefulness and depict problem to be solved. In patients with myocardial infarction, images obtained with a PRISM-3000 machine could provide more objective information on infarcts than conventional images. In patients with angina pectoris, delayed images obtained 3 hours after exercise by the new method were superior to conventional ones in power of demonstrating redistribution. The setting of the threshold for ischemic lesions at 40-50% hampers the assessment of the severity of ischemia. A new program should be introduced to solve this problem.

[A new principle and device for radiosurgery using a linear accelerator; its principle, devices and clinical trials]

The authors have developed new devices for stereotactic radiosurgery using a conventional linear accelerator (LINAC). The system of devices consists of a rotatory chair with a base ring holder, a Brown Robert Well's stereotactic apparatus (BRW's apparatus) with a double set of base rings and a number of precise collimators which eliminate penumbra to the greatest extent. A study rotatory chair was manufactured, whose vertical axis of rotation is always set and stable. A strongly built, adjustable holder for the BRW's base ring is attached to the chair. The principle and flow of procedures step by step is as follows; 1). The rotatory chair is carried in under the linear accelerator and the vertical rotatory axis of the chair is precisely adjusted to align with the vertical center of the photon beam from the LINAC. 2) A base ring and a locator of BRW's apparatus are mounted on a patient's head and three coordinates of a target are determined by CT scans. 3) The target indicator of the dummy set of BRW's apparatus is positioned according to X, Y, Z coordinates of the target. The tip of a rod indicator fixed on an instrument bloc on the arc device is precisely adjusted to touch at the tip of the target indicator. 4) The base ring and arc device with rod indicator are transferred together from the BRW's dummy set to the rotatory chair and fixed to the base ring holder. The tip of the rod indicator is precisely adjusted to be positioned at the isocenter of the LINAC. 5) The base ring and arc device are removed and replaced by another base ring mounted on the head of a patient, who is made to sit on the rotatory chair. The target in the brain is now located at the isocenter of the LINAC. Stereotactic radiation is started with rotation of the chair and circular movement of the gantry of the LINAC. The chair is rotated at a speed of 100 degrees per second, and the gantry of the LINAC is moved slowly on a circular trajectory from +115 degrees to -115 degrees. Fourteen cases, including AVM, cavernous angioma, acoustic tumor and glioma have been treated so far. Three cases of large AVM were treated by a combination of artificial embolization and stereotactic radiosurgery.(ABSTRACT TRUNCATED AT 400 WORDS)

[Thin-section computed tomography of the normal minor fissure]

The minor fissure was studied with thin computed tomographic (CT) sections (2 mm thickness, 3 mm interval) in 50 patients. It showed high density line or area in all patients. In nine patients CT sections were not obtained through the all region of the minor fissure. Of other 41 patients the fissure was complete in 12 (29%), slightly incomplete in 18 (44%), half incomplete in 7 (17%), and considerably incomplete in 4 (10%). The upper surface of the middle lobe appeared to be upwardly convex in all 50 patients. The location of the highest portion of the minor fissure was hilar in 12 (24%) of 50 patients, medial 1 (2%), anterior 0 (0%), lateral 8 (16%), posterior 3 (6%), dorsal 10 (20%), central 12 (24%), others 2 (4%), and indeterminate 2 (4%). The minor fissure was higher medially than laterally in 22 (44%) patients, and higher posteriorly than anteriorly in 40 (80%) patients. The lowest portion of the minor fissure was anterior in 20 (40%) patients, lateral in 4 (8%), and posterior 3 (6%). The anterior vein of the anterior segment of the right upper lobe (V3b) came in contact with the minor fissure in 20 (40%) patients. In 18 (90%) of these 20 patients minor fissure medial to V3b was incomplete partially. Three dimensional reconstruction image of the minor fissure improved understanding of the anatomy. Familiarity with the anatomic detail of the minor fissure and with variations in the relationships of the upper and middle lobes is useful in localization or extension of a lesion.

A rare case of desquamative esophagitis occurring during radiotherapy for esophageal carcinoma

With the recent progress and increase in availability of fiberendoscopy, acute esophagitis is now much more frequently detected than before. Desquamative esophagitis is a rare form of esophagitis classified as acute esophagitis, but it has come to be reported more frequently in recent years. However, since desquamation seemed to have occurred in relation with the administration of radiotherapy in the present case, this brings to two the total number of cases with radiological involvement, the other case reported by Itai being the first in the world. This is the second report of desquamative esophagitis occurring during radiotherapy for esophageal carcinoma.