[Ultrasound assessment of gastric content in cesarean delivery patients: an observational study]

BACKGROUND

The aim of this observational study is to examine the benefit of ultrasound assessment of gastric content in cesarean delivery (CD) patients.

METHODS

Thirty-nine patients scheduled for CD were assigned to a scheduled CD group and to an emergency group. Before CD, gastric ultrasonography examinations to calculate CSA (cross sectional area) of gastric antrum were performed to determine if gastric content was residual, and patients in the emergency group were asked what and when they had eaten. They were classified as full stomach when CSA was 2.5 cm2 or more and the sonographic characteristics of the antrum showed mixture with high echogenic particles.

RESULTS

Eight patients were assigned to a scheduled CD group and thirty-one patients to an emergency group, respectively. None of the scheduled CD group should be CSA of 2.5 cm2 or more and eight of the emergency group should be 2.5 cm2 or more, including 3 patients with or without labor showing residual gastric contents after more than 10 hours of ingestion.

CONCLUSIONS

There are some CD patients with the high risk of aspiration with or without labor even 10 hours after the last ingestion.

[Safety of oral rehydration therapy in endoscopic surgery patients]

BACKGROUND

To test safety and efficacy of ORT (oral rehydration therapy), we compared an ORT group with an intravenous infusion (i.v.) group by gastric fluid (volume and pH) obtained by endoscope and gastric ultrasonography examination.

METHODS

Twenty six patients scheduled for endoscopic surgery were assigned to an ORT group or an i.v. group by standardized clinical path. After gastric ultrasonography examinations to calculate CSA (cross sectional area) of gastric antrum, general anesthesia was induced. Immediately after anesthesia induction, gastric fluid was obtained by endoscopy, and its volume and pH were measured.

RESULTS

Fifteen and eleven patients were assigned to ORT group and iv group, respectively. In ORT group, CSA was median 1.9 cm2 (95% CI:1.8-2.6 cm2), gastric volume was median 11 ml (95% CI: 8-18 ml) and pH was median 3.6 (range: 1.2-8.8), and in i.v. group CSA was median 1.8 cm2 (95% CI: 1.6-2.7 cm2), gastric volume was median 4 ml (95% CI: 3-12 ml), and pH was median 3.1 (range: 1.2-7.2). There was no significance between the two groups.

CONCLUSIONS

Gastric volume in ORS group was not smaller compared with that in i.v. group, and there was no significant difference in pH between the groups.

[Effects of magnesium on the onset time of rocuronium in patients for cesarean delivery]

BACKGROUND

Although magnesium can potentially shorten onset time of a muscle relaxant, it is unclear whether it does shorten the onset time of rocuronium for patients in cesarean delivery (CD). Thus the purpose of this study is to compare the onset time of rocuronium in patients with or without preoperative magnesium treatment.

METHODS

In 9 CD patients without magnesium (CD group) and 8 CD patients with magnesium (CD-Mg group), neuromuscular function was continuously assessed with acceleromyography immediately after induction of general anesthesia with intravenous injection of thiopental (4-5 mg x kg(-1)) and rocuronium (0.6 mg x kg(-1)). Onset time of muscle relaxation, defined by the time from rocuronium bolus injection until complete absence of twitch height, was measured.

RESULTS

The onset time of both groups did not significantly differ (50 +/- 10 seconds vs. 51 +/- 11 seconds; P = 0.93, unpaired t-test). Median magnesium concentration, 5.2 mg x dl(-1) (3.8-6.3), and the onset time of CD-Mg group did not correlate magnesium concentrations (P = 0.23, Pearson's correlation coefficient test).

CONCLUSIONS

Magnesium did not shorten the onset time of rocuronium 0.6 mg x kg(-1) in CD patients.

[Reversal of rocuronium-induced neuromuscular blockade with sugammadex in patients for cesarean delivery treated with magnesium sulfate]

BACKGROUND

We investigated whether sugammadex could reverse neuromuscular blockade induced by rocuronium in patients for cesarean delivery treated with magnesium sulfate preoperatively.

METHODS

Twenty-three pregnant women received general anesthesia induced with thiopental and rocuronium. They were maintained by nitrous oxide, oxygen and sevoflurane (GOS) before delivery and after delivery by GOS, midazolam, and propofol. After the surgery, the patients with two or more counts of train-of-four (TOF), the moderate block group were classified into Mg (-) M and Mg (+) M, depending whether magnesium sulfate had been injected or not, and sugammadex 2 mg x kg(-1) was administered to both groups. Patients with PTC 2 or more, the profound block group, were classified into Mg (-) P or Mg (+) P and sugammadex 4 mg x kg(-1) was administered to both groups. Recovery time was defined as the time required to reach TOFR 0.9 or more after the injection of sugammadex.

RESULTS

Median recovery times of the Mg (-) M, the Mg (-) P, the Mg (+) M and the Mg (+) P were 63 seconds (range: 26-130, N = 7), 127 seconds (range: 63-228, N = 7), 104 seconds (range: 67-133, N = 5), and 142 seconds (range: 57-209, N = 4), respectively.

CONCLUSIONS

Sugammadex could reverse rocuronium-induced neuromuscular blockade in a dose-response manner even in the patients treated with magnesium sulfate.

[Effects of pregnancy on the onset time of rocuronium]

BACKGROUND

Rapid onset of a muscle relaxant is required for general anesthesia with rapid sequence induction technique. Although a high dose of rocuronium was demonstrated to achieve the rapid onset in non-pregnant persons, it is still unknown whether this is true in women during late pregnancy. The purpose of this study is to compare the onset time of high dose rocuronium between pregnant and non-pregnant women.

METHODS

Ten pregnant women undergoing cesarean delivery and 10 age, height, and body weight-matched non-pregnant women were enrolled in the study. Neuromuscular function was continuously assessed by twitch response with acceleromyography immediately after induction of general anesthesia with intravenous injection of thiopental (4-5 mg x kg(-1)) and rocuronium (0.9 mg x kg(-1)). Onset time of muscle relaxation, defined by the time from rocuronium bolus injection to complete absence of twitch height, was measured.

RESULTS

The onset time of rocuronium in pregnant women was significantly shorter than that in non-pregnant women (42 +/- 9 seconds vs. 56 +/- 10 seconds; P = 0.0039. unpaired t-test).

CONCLUSIONS

The onset time of high dose of rocuronium in pregnant women was significantly shorter than that of non-pregnant women.

[Efficacy of ultrasound imaging of lumbar epidural anesthesia in patients for cesarean delivery: A comparative study between longitudinal and transverse plane imaging]

BACKGROUND

It has been demonstrated that preparatory ultrasound scanning can facilitate lumbar epidural anesthesia. We compared longitudinal with transverse approach of ultrasound imaging to test the precision and the quality of acquired images in cesar ean delivery patients.

METHODS

We enrolled 34 cesarean delivery patients. Measured distances from the skin to dura on each ultrasound view was compared with the actual needle depth. Additionally we measured ultrasound visibility score.

RESULTS

The both distances measured in ultrasound strongly correlated with the actual depth (R2= 0.87 and 95% limits of agreement of -3.07 to 6.45 mm on longitudinal view, R2=0.82 and 95% limits of agreement of -3.50 to 7.74 mm on longitudinal view). The visibility score of the longitudinal view was significantly higher than that of transverse view (P<0.01).

CONCLUSIONS

Both planes provided accurate information about the epidural space and depth, and the longitudinal plane was superior in the imaging quality. It was suggested that both approaches may help identify epidural spaces.

[Case of emergent caesarean delivery in a patient with aplastic anemia complicated with pregnant induced hypertension]

A 32-year-old pregnant woman diagnosed with aplastic anemia was admitted for emergent caesarean delivery of 26th week of the gestation due to PIH (pregnancy-induced hypertension) and NRFS (non-reassuring fetal status). After compensating platelets counts to 5.3x10(4) microl-1, general anesthesia was induced with propofol and rocuronium. Anesthesia was maintained with O2 and sevoflurane until delivery and with modified-NLA after delivery. She was additionally monitored with Vigileo/FloTrac system (Edwards Lifesciences, USA) and TOF-WATCH SX (Nihon Kohden, Tokyo). After 8 minutes of operation her baby was born with the 5-minute Apgar score of 5 and the UA-pH of 7.387. It was only 2 hours and 12 minutes that the baby was born after she was admitted. The baby was tracheally intubated and transferred to NICU. Blood loss during operation was 835 g and two units of RCC was transfused. Circulatory values were kept acceptable and neuromuscular blocking was completely reversed by sugammadex and extubated in the operating room. Bleeding tendency and atonic bleeding were not observed. She survived perioperative period and was to be treated for aplastic anemia. Her baby was discharged neurologically free. We should be ready to respond to anesthetic requirement for urgent cases of aplastic anemia.

[Safe practice of oral rehydration therapy by oral rehydration solution and carbohydrate loading--evaluation by non-invasive gastric echo examination]

Many anesthesiologists are reluctant to depart from their traditional long fasting periods, even though many guidelines recommend that oral intake of clear fluids administered up to 2-3 hours prior to general anesthesia does not adversely affect the gastric contents. It also indicates that the application of these guidelines does not affect the incidence of pulmonary aspiration. One of the reasons why they have not changed their practices is that they wonder whether it is safe to administer clear fluids as recommended in the guidelines. In this review, we emphasize that oral rehydration therapy using clear fluids (such as OS-1, water and carbohydrate-rich beverage) is safe based on the non-invasive gastric echo examinations as many guidelines have already indicated. Oral rehydration therapy should be considered not only as an alternative to intravenous therapy for preoperative fluid and electrolyte management but also as one of the important modalities which can enhance the recovery of surgical patients.

[Safety of preoperative oral rehydration therapy]

BACKGROUND

OS-1 is an oral rehydration solution that conforms with the principles of oral rehydration therapy. It may be useful for preoperative fluid management of surgical patients. While intake of clear fluids 2 hours before surgery is considered safe, it is not known if the same applies to OS-1. We therefore investigated the safety of OS-1 for preoperative patients as compared with clear fluids.

METHODS

First, eight healthy adult volunteers were studied in a crossover manner. Volunteers ingested 500 ml of OS-1 or water (clear fluid). Gastric emptying time was measured using gastric ultrasonography. Gastric antral area as measured by ultrasonography correlates well with gastric volume in a close-to-linear manner. Next, we measured gastric volume of elective surgical patients who had drunk OS-1 until two hours before the induction of anesthesia.

RESULTS

Gastric emptying time did not differ between OS-1 and water. The stomach was emptied 30 minutes after ingestion of both OS-1 and water. The fasting stomach was identified in all patients who had drunk OS-1 before surgery.

CONCLUSIONS

We concluded that allowing elective surgical patients to drink OS-1 until two hours before anesthesia did not affect the volume of gastric contents.

[Hemodynamic changes during pregnancy and cesarean delivery in three cases of triplet pregnancy]

Polypregnancy is one of the major problems to both mothers and fetuses leading to poor prognosis. Even though hemodynamic parameters change greatly during pregnancy and cesarean delivery, it is unclear how blood volume (BV) and cardiac output (CO) increase during triplet pregnancy and how CO goes up and down during cesarean delivery in the cases of triplet pregnancy. We measured BV and CO by dye-densitogram analyzer (DDG-analyzer: Nihon Kohden, Tokyo, Japan) and CO by FlowTrac (Edwards Lifesciences, Irvine, USA) on three cases of triplet pregnancy. BV increased up to about 50% above that of singleton after 20 weeks of gestational age. However, there was no such tendency in CO. When they underwent cesarean delivery under combined spinal-epidural anesthesia (CSEA) or sequential-CSE (S-CSE) receiving a 10 or 12 mg intrathecal isobaric bupivacaine with 20 microg fentanyl, CO decreased in parallel with blood pressure from ten minutes after spinal anesthesia, to the start of operation and just after the birth of third fetus.

[Simulation of obstetrical disseminated intravascular coagulation (DIC) by scoring algorithm criteria established by the Japanese Association for Acute Medicine, the revised Japanese Ministry of Health and Welfare criteria and the International Society on Thrombosis and Haemostasis criteria]

BACKGROUND

Although obstetric disease is one of the major causes of disseminated intravascular coagulation (DIC), no gold standard exists. Three current criteria, the Japanese Association for Acute Medicine (JAAM) -DIC criteria, the revised Japanese Ministry of Health and Welfare (JMHW) criteria and the International Society on Thrombosis and Haemostasis (ISTH) criteria, do not clarify the usefulness in obstetric DIC. We therefore conducted a retrospective study by simulation.

METHODS

We enrolled 89 cases of emergent caesarean section when platelet count decreased to below 150,000 x 10(9) x mm(-3) during 7 days from 3 days before operation to 3 days after operation from April 2004 to March 2007. We applied them and compared diagnostic rates and investigated characteristics of obstetric DIC.

RESULTS

After excluding 21 cases, 68 cases were examined. The number of patients diagnosed with DIC by JAAM-DIC criteria, JMHW criteria and ISTH criteria were 15 (22.1%), 5 (7.4%) and 3 (4.4%), respectively. Fifteen patients who fulfilled JAAM-DIC criteria included all 5 patients for whom DIC was diagnosed by JMHW criteria, and those 5 patients included all 3 patients for whom DIC was diagnosed by ISTH criteria.

CONCLUSIONS

The current study indicates that JAAM-DIC criteria can be useful but may overdiagnose the DIC.

Myelin-associated glycoprotein inhibits microtubule assembly by a Rho-kinase-dependent mechanism

Myelin-associated glycoprotein (MAG) and Nogo are potent inhibitors of neurite outgrowth from a variety of neurons, and they have been identified as possible components of the central nervous system myelin that prevents axonal regeneration in the adult vertebrate central nervous system. The activation of RhoA and Rho-kinase is reported to be an essential part of the signaling mechanism of these proteins. Here, we report that the collapsing response mediator protein-2 (CRMP-2) is phosphorylated by a Rho-kinase-dependent mechanism downstream of MAG or Nogo-66. The overexpression of the nonphosphorylated form of CRMP-2 at threonine 555, which is the phosphorylation site for Rho-kinase, counteracts the inhibitory effect of MAG on the postnatal cerebellar neurons. Additionally, the expression of the dominant negative form of CRMP-2 or knockdown of the gene using small interference RNA (siRNA) mimics the effect of MAG in vitro. Consistent with the function of CRMP-2, which promotes microtubule assembly, microtubule levels are down-regulated in the cerebellar neurons that are stimulated with MAG in vitro. Reduction in the density of microtubules is also observed in the injured axons following the spinal cord injury, and this effect depends on the Rho-kinase activity. Our data suggest the important roles of CRMP-2 and microtubules in the inhibition of the axon regeneration by the myelin-derived inhibitors.

Wallerian Degeneration Involves Rho/Rho-kinase Signaling

Local axon degeneration is a common pathological feature of many neurodegenerative diseases, whereas the underlying molecular mechanisms are largely unknown. In this study, we used the degeneration of transected axons, termed "Wallerian degeneration," as a model to examine the possible involvement of Rho. Nogo-66, a myelin-derived inhibitor of axon regeneration, significantly accelerated axon degeneration of the dorsal root ganglion explant in vitro, whereas inhibiting Rho-kinase activity abolished the effect. Rho activation was observed in the distal part of the injured axons after spinal cord injury. We demonstrate that degeneration of the injured cortico-spinal axons was significantly retarded by a Rho-kinase inhibitor in vivo. Our findings suggest that inhibiting the signaling pathway may retard axon degeneration in pathological conditions.

Diverse functions of the p75 neurotrophin receptor

The pan-neurotrophin receptor p75NTR belongs to a large family of receptors, which includes tumor necrosis factor receptors, Fas and approximately 25 other members. The p75NTR is the first receptor to be cloned molecularly. Recent years have seen the emergence of a consensus regarding the signaling pathways activated by p75NTR and its potential biological function, although receptor characterization had not been targeted for some years. We now know that p75NTR has surprisingly diverse effects, ranging from cell death to regulation of axon elongation. This diversity can be explained by the complex formation of p75NTR with other receptors and multiple signaling molecules that interact with the intracellular domain of p75NTR.

Multiple Signals Regulate Axon Regeneration Through the Nogo Receptor Complex

Several myelin-derived proteins have been identified as components of central nervous system (CNS) myelin, which prevents axonal regeneration in the adult vertebrate CNS. The discovery of the receptor for these proteins was a major step toward understanding the failure of axon regeneration. The receptor complex consists of at least three elements: the p75 receptor (p75NTR), the Nogo receptor and LINGO-1. Downstream from the receptor complex, RhoA activation has been shown to be a key element of the signaling mechanism of these proteins. Rho activation arrests axon growth, and blocking Rho activation promotes axon regeneration in vivo. Recent studies have identified conventional protein kinase C as an additional necessary component for axon growth inhibition. Possible crosstalk downstream of these signals should be explored to clarify all the inhibitory signals and may provide an efficient molecular target against injuries to the CNS.

[Pulse wave velocity can predict hemodynamic responses to induction of anesthesia and tracheal intubation]

BACKGROUND

The degree of aortic stiffness can be evaluated by noninvasive measurement of pulse wave velocity (PWV). We investigated hemodynamic responses to induction of anesthesia and tracheal intubation, and hypothesized that preoperative measurement of PWV might predict these responses.

METHODS

PWV was measured before operation by using automatic PWV measurement device. Patients were anesthetized with fentanyl (1 microg x kg(-1)) and propofol (target controlled infusion at 2.5 microg x ml(-1)), and tracheal intubation was facilitated with vecuronium (1.5 mg x kg(-1)). Hemodynamic data were recorded from the start of anesthesia to 5 minutes after the tracheal intubation.

RESULTS

Twenty patients completed the study. There was a significant correlation between PWV and percent changes in systolic blood pressure during anesthesia induction. However, a significant correlation between PWV and percent changes in systolic blood pressure after tracheal intubation was found only in the patients without antihypertensive medications.

CONCLUSIONS

Preoperative PWV measurement was useful to predict hemodynamic responses to induction of anesthesia and tracheal intubation.

Neurilemoma of the renal capsule: MR imaging and pathologic correlation

We report a case of neurilemoma arising from the renal capsule. Renal neurilemoma is an especially rare tumor, with only 15 cases previously reported. We attempted to correlate MR findings with microscopic components of the tumor. On T2-weighted images the solid part of the tumor was heterogeneous hyperintense. The MR signal intensity on T2-weighted images help estimate microscopic components of the renal neurilemoma.

[The role of CT and MR imaging in the diagnosis of lung cancer]

CT and MR imaging can play an important role in the diagnosis of lung cancer. Evaluation of a solitary pulmonary nodule is usually carried out using CT. High-resolution CT is useful in the morphologic diagnosis of a solitary pulmonary nodule. The enhancement characteristics of a pulmonary nodule in contrast-enhancement CT can be a method of distinguishing benign and malignant nodules. MR imaging is superior to CT in contrast resolution and multidirectional imaging capability. Contrast-enhancement MR imaging can describe the enhancement characteristics of the pulmonary lesion better than contrast-enhancement CT. The extent of chest wall and mediastinal invasion of lung cancer can be better shown using MR imaging than CT.

[Three-dimensional reconstruction images of central airway using spiral CT: experimental and clinical studies in the demonstrability of tracheobronchial lesions]

The purpose of this study was to evaluate the role of three dimensional reconstruction image using spiral CT (3D image) for demonstrating the tracheobronchial lesions. In the experimental study using originally developed phantom, 3D images of simulated endobronchial protrusions were evaluated at combinations of detector collimation (1, 3 and 5 mm), table speed (1, 2, 3 and 5 mm/sec) and reconstruction pitch (1 and 3 mm). 3D images with 1 mm collimation, 1 mm/sec table speed, and 1 mm reconstruction pitch (1/1/1) could provide the best demonstrability of simulated endobronchial protrusions. But the condition (1/2/1) is not so inferior to 1/1/1. The stair-step artifacts were caused by the effects of rotation and aliasing, which could be reduced with slow table speed and fine reconstruction pitch. In clinical study, 3D images (1/2/1) were applied in 34 patients with hilar lung cancer and these images were compared with bronchoscopic findings. 3D images demonstrated irregular obstructions or stenoses in 15 of 16 cases with mucosal lesions, 5 of 7 cases with submucosal lesions with mucosal invasion. On the other hand, in 4 cases with submucosal lesions without mucosal invasion and 6 of 7 cases with intramural or extramural lesions, smooth stenoses were demonstrated on 3D images. In 30 of 34 cases (88.2%), 3D images corresponded to bronchoscopic findings. In conclusion, 3D images proved useful in demonstrating not only the obstructions or stenoses of central airway, but also mucosal irregularity. 3D-CT could be helpful for determining indication for transbronchial biopsy of hilar lung cancer.

[Assessment by three-dimensional CT of pleural indentation or invasion by peripheral lung cancer]

We evaluated the effectiveness of three-dimensional (3D) CT for pleural indentation or invasion by peripheral lung cancer adjacent to pleura. Pleural indentation was shown in three of nine cases on conventional CT, and six cases were demonstrated three-dimensionally. 3D-CT was superior to conventional CT in demonstrating pleural indentation. Pleural invasion could not be assessed on 3D-CT because the pleura adjacent to the tumor was not visualized.

Chronological observation in early radiation myelopathy of the cervical spinal cord: gadolinium-enhanced MRI findings in two cases

Gd-enhanced MR images of two patients with clinically and histopathologically diagnosed chronic progressive radiation myelitis (CPRM) were observed chronologically. One of them had had nasopharyngeal cancer and received radiotherapy at a dose of 100 Gy to the C1-2 level of the spinal cord. She developed CPRM 25 months after the termination of radiotherapy. The other had had malignant lymphoma originating from the tonsil and received chemoradiotherapy. The dose delivered to her cervical spinal cord was 40 Gy, and she developed CPRM 30 months later. Gd-enhanced MRI in the early phase revealed a small crescent-shaped nidus with or without a very small central nonenhanced area in both cases. Enhancement was not great. At that time, patients noticed only the inability to perceive pain and temperature or paresthsia in the opposite side. In a few months, MRI revealed a much more strongly enhanced and larger nidus with enlargement of a central nonenhanced area accompanied by long segmental cord enlargement. The patients' neurological symptoms had also progressed, with hemiparesis developing, for example.

[Fast MR imaging of liver metastasis using FLASH and FISP--optimal sequences for T1- and T2*-weighted images]

This paper deals with a study to obtain the optimal sequence of gradient echo (GE) for T1- and T2*-weighted images similar to T1- and T2-weighted images of spin echo (SE). Two GE sequences, fast low angle shot (FLASH) and fast imaging with steady-state precession (FISP), were performed in 15 cases of liver metastasis in various combination of flip angle (FA), repetition time (TR), and echo time (TE). The optimal combinations were summarized as follows: 1) T1-weighted FLASH image with FA of 40 degrees, TR of 22 msec and TE of 10 msec, 2) T1-weighted FISP image with FA of 70 degrees, TR of 100 msec, TE of 10 msec, 3) both T2*-weighted FLASH and FISP images with FA of 10 degrees, TR of 100 msec and TE of 30 msec. Not only to provide the adequate T1- and T2*-weighted images but also to enable breath-holding MR imaging, GE sequences can optionally take place SE in cases of deteriorated images caused by moving artifacts. Other applications support the re-examination and further detailing when required, conveniently rather in short time.

[MR imaging of mucocutaneous malignant melanoma in the head and neck]

MR imaging was performed in three patients with mucocutaneous malignant melanoma of the head and neck, and surgical specimens were investigated in MR-pathological correlation. Two of 3 cases were revealed to be melanotic melanoma; one arose in the maxillary sinus, and another in the bulbar conjunctiva. The remaining case was amelanotic melanoma originating in the nasal cavity. Two cases of melanotic melanoma showed different intensity on T1WI according to the melanin concentration; the more the melanin-producing process existed, the higher intensity in the tumor was shown. On T2WI there were also some differences in signal intensity; the case having more concentration of melanin changed lower partially in the areas where very high intensity was noted on T1WI, while another case remained unchanged. These findings are based on the inherent paramagnetic effect mostly compatible with the previous reports. On the other hand, the amelanotic melanoma was demonstrated as an intermediate intensity both on T1- and T2WI. Because of the higher incidence of hemorrhage in/around the tumor, it is an important diagnostic clue to this tumor, as in our case of amelanotic type. On reviewing the three cases, we consider that MR imaging offers a useful adjunct in the diagnosis of malignant melanoma.

[MR imaging of compressive cervical myelopathy after surgery--high signal intensity of the spinal cord on T2 weighted images]

We reviewed the MR images of 32 patients with cervical myelopathy, showing lesions of high signal intensity in the spinal cord on the sagittal T2 weighted images (T2WI) after surgery: 16 with OPLL; 9 with spondylosis; 4 with disc herniation and 3 with trauma. All images were obtained on a superconducting 1.5 Tesla system. The lesions were classified into five groups, according to the shape and grade of signal intensity on the sagittal T2WI: (I) oval-shaped lesion of signal intensity less brighter than CSF with blurred margin, (II) longitudinal linear-shaped lesion of signal intensity similar to CSF, (III) spindle-shaped lesion of signal intensity similar to CSF, (IV) round-shaped lesion of signal intensity similar to CSF and (V) mixed-types lesions which consisted of group I and II. The present study was summarized as follows: 1) Oval-shaped lesions were seen in the cases of disc herniation and spondylosis with relatively short duration of the symptom, presumptively with relatively short duration of the symptom, presumptively indicative of edema. 2) Most cases of OPLL and spondylosis showed linear-shaped lesions, suggesting necrosis and/or cavitations of the central gray matter. 3) One case of spondylosis developed a spindle-shaped lesion, implicating syringomyelia. 4) Round-shaped lesions were seen in the cases of spinal trauma, suggesting posttraumatic cyst. 5) In a case of mixed-typed lesion examined pre- and postoperatively, only an oval-shaped lesion decreased in size after surgery.

[CT of hypersensitivity pneumonitis]

High resolution computed tomography (CT) was applied to seven patients with hypersensitivity pneumonitis clinically confirmed. The CT findings include; (1) granular pattern with acino-centric distribution, (2) increase in density of haziness in the lung fields, (3) multiform high density areas, and (4) "subpleural curvilinear shadow" localized posteriorly. Of these findings, which severally varied degree during clinical course, the haziness showed the most remarkable fluctuation. It was especially of interest that the relapsed haziness distributed quite in the same regions. High resolution CT may be an effective adjuvant tool for hypersensitivity pneumonitis when applied to the opportune evaluation through the clinical course.

Studies on the relationship between intestinal flora and cecal coccidiosis in chicken

The bacteriological and histopathological changes in the ceca of young chickens after being infected with sporulated oocysts of Eimeria tenella were investigated. Lactobacilli and bifidobacteria showed remarkable decrease in number on the 5th day after infection, when shizont and gametocyate came to appear, and destruction of mucosa along with severe haemorrhaging was noticed. Other predominant bacteria like bacteroidaceae, catenabacteria and peptostreptococci showed only moderate and temporal decrease in number during the infection. Clostridium perfringens prolifereated after the 5th day post infection following the decline of lactobacilli and bifidobacteria. Proliferation of clostridia was so intense that the number was almost million times greater than that of the uninfected chicken at its peak on the 7th day after infection. Enterobacteria also showed a moderate but persistent increase in number. Most bacteria came to the normal population on the 10th day after infection. As for lactobacilli, bifidobacteria, clostridia and enterobacteria, the disturbances were still noticeable on the 17th day after injection. Antagonism between proliferated bacteria (clostridia and enterobacteria) and lactic acid bacteria (lactobacilli and bifidobacteria) whose intensity is suppose to be related to the cecal mucosa is suggested during cecal coccidiosis in chickens.