Note: practical monitoring system using characteristic impedance measurement during plasma processing.

A method for characteristic impedance monitoring (CIM) is developed for anomaly detection during plasma processing. Advantages of the method include high-sensitivity and real-time monitoring, as well as structural simplicity to install the measurement system in the mass production equipment. To obtain real-time monitoring without time delay, our CIM system consists of a directional coupler and a newly developed vector processing system instead of the conventional high voltage and current probes. The system can measure the time variations of characteristic and load impedances even while the plasma is generated.

A recurrent log-linearized Gaussian mixture network.

Context in time series is one of the most useful and interesting characteristics for machine learning. In some cases, the dynamic characteristic would be the only basis for achieving a possible classification. A novel neural network, which is named "a recurrent log-linearized Gaussian mixture network (R-LLGMN)," is proposed in this paper for classification of time series. The structure of this network is based on a hidden Markov model (HMM), which has been well developed in the area of speech recognition. R-LLGMN can as well be interpreted as an extension of a probabilistic neural network using a log-linearized Gaussian mixture model, in which recurrent connections have been incorporated to make temporal information in use. Some simulation experiments are carried out to compare R-LLGMN with the traditional estimator of HMM as classifiers, and finally, pattern classification experiments for EEG signals are conducted. It is indicated from these experiments that R-LLGMN can successfully classify not only artificial data but real biological data such as EEG signals.

Head injuries in snowboarders compared with head injuries in skiers. A prospective analysis of 1076 patients from 1994 to 1999 in Niigata, Japan.

We investigated snowboarding-related head injury cases and skiing-related head injury cases during five ski seasons at one resort area. There were 634 snowboarding-related head injuries and 442 skiing-related head injuries. The number of snowboarding head injuries increased rapidly over the study period. More male snowboarders than female snowboarders suffered head injuries. For both snowboarders and skiers, head injuries frequently occurred on the easy and middle slopes. Falls were the most frequent causes of injury in both groups. Jumping was a more frequent cause of injury in the snowboarders (30%) than in the skiers (2.5%). Injury to the occipital region predominated in the snowboarders as compared with the skiers. There were 49 organic lesions in 37 snowboarders and 46 organic lesions in 33 skiers. Subdural hematoma was frequent in the snowboarding head injury group, and fracture was frequent in the skiing head injury group compared with the snowboarding group (not significant). Subdural hematoma was likely to be caused by a fall rather than by a collision, and bone fracture was likely to be caused by a collision rather than by a fall. Four snowboarders and one skier died as a result of their head injuries. Our data suggest that snowboarding head injuries may be prevented by protection of the occipital region and refraining from jumping by beginners.

[Hypoglycemic hemiplegia: a report of three cases].

Hemiplegia is a rare complication accompanied with hypoglycemia. We reported three cases of hypoglycemic hemiplegia (HH). Case 1: A 74-year-old female had medication for diabetes mellitus (DM). She had right hemiplegia and aphasia. Case 2: A 72-year-old male had DM, and was admitted to our hospital having loss of consciousness and right hemiplegia. Case 3: An 82-year-old female suffered from consciousness disturbance with tetraplegia, and had left hemiparesis later. She had no DM, but suffered from iatrogenic hypoglycemia. The brain CT of these three cases showed atrophy, and MRI demonstrated multiple infarction. The angiography of case 1 showed the stenosis of bilateral internal carotid artery and the origin of the left vertebral artery. The angiography of case 2 showed severe stenosis of the left internal carotid artery. The cases above had hypoglycemia at admission. The value of the case 1 was 48 mg/dl, case 2 was 35 mg/dl and case 3 was 38 mg/dl. But these symptoms of the three cases disappeared rapidly after glucose infusion. The literature regarding HH was reviewed, and the pathogenesis was discussed. We emphasize the importance of checking blood sugar levels for the emerging patients with hemiplegia, because it is difficult to discriminate by clinical history or neurological findings.

Role of preoperative midsagittal magnetic resonance imaging in endoscopic third ventriculostomy.

We measured the distance between the infundibular recess and the tip of the basilar artery (BA) on midsagittal magnetic resonance (MR) images in 217 subjects (mean age, 54.7 years) without intracranial disorders and 8 patients with hydrocephalus treated neuroendoscopically. The mean distance measured in the 217 subjects without intracranial disorders was 10.5 +/- 2.3 mm. There were no significant differences in this distance among age groups. In 28 of these 217 subjects (12.9%), the tip of the BA had shifted anterior to the mamillary bodies on MR images. Twenty-six of these 28 subjects (93%) were 60 years of age or older. The mean distance between the infundibular recess and the tip of the BA was 12 +/- 3.7 mm in 8 patients with hydrocephalus. There was no significant difference between the subjects without intracranial disorders and the patients with hydrocephalus in this distance. In an elderly patient with aqueductal stenosis for whom the distance between the infundibular recess and the tip of the BA was 6 mm, the tip of the BA had shifted anterior to the mamillary bodies and indented the floor of the third ventricle on preoperative midsagittal MR images, and perforation of the floor of the third ventricle therefore had to be carefully performed in order to avoid injury of the BA. Preoperative midsagittal MR images can clearly reveal neurovascular structures beneath the floor of the third ventricle and increase the safety of endoscopic third ventriculostomy.

Successful autotransplantation of microvessel fragments into the rat heart.

We examined whether microvessel fragments (Mvf), autologously transplanted with myofibroblasts (Mf) into the heart, could survive and form connections to the host's coronary microcirculation. Neither achievement has been reported before in the heart. Mvf and Mf were prepared from Sprague-Dawley rat epididymal fat pads. A mixture of Mvf (labeled with the fluorescent probe DiI-acetylated low-density lipoprotein, DiI-Ac-LDL) and Mf was injected into the superficial myocardium under general anesthesia. Rats (n = 5 in each group) were killed on postoperative days 7, 14, 21, 42 and 49, and India ink was perfused through the coronary arteries. Frozen sections of the injected area were examined under fluorescence and light microscopes. Some DiI-Ac-LDL-labeled Mvf survived in each group, and India ink was present in the lumina of microvessels coincident with DiI-Ac-LDL-labeled autotransplanted Mvf. Hematoxylin and eosin staining revealed mild inflammatory reactions followed by some fibrosis at the injection sites. These findings indicate that autotransplanted Mvf can survive for at least 49 days, and that patent microvascular anastomoses can form between them and the host's coronary microvessels. Possibly, autotransplantation of Mvf could lead to the development of a new collateral microcirculation, a phenomenon especially important in the ischemic heart.

Congenital cheek fistula: a report of three cases.

Three cases of the rare condition of congenital cheek fistulae are presented. These differ from preauricular fistulae in terms of their location and the direction in which the fistula is lying. Each cheek fistula seemed to be situated along the line of the junction between the mandibular and maxillary processes of the first branchial arch.

Effect of autotransplantation of microvessel fragments on experimental random-pattern flaps in the rat.

We examined whether autotransplantation of microvessel fragments (Mvf) and/or myofibroblasts (Mf) into an in vivo skin flap model might improve the survival of the ischemic flap. If so, this could improve blood perfusion, increase blood flow, and improve the survival of the flap. A skin flap was raised on the back of each rat (n = 15 in each group). In the control group, the flap was sutured to the original bed. In the other groups (1) phosphate-buffered saline; (2) autotransplanted Mvf, Mf, or Mvf plus Mf, and (3) a homogenized mixture of Mvf plus Mf was injected into the distal part of the flap. In a further group, Mvf labeled with DiI-acetylated low-density lipoprotein were autotransplanted with Mf into the distal part of the flap, and India ink was perfused through the abdominal aorta 7 days postoperatively. The transplanted Mvf plus Mf group showed better flap survival after 7 days than the other groups (p < 0.02). Labeling with DiI-acetylated low-density lipoprotein showed that transplanted Mvf sent arborizations into the nearby tissue. India ink was found in the lumina within such arborizations. Thus, autotransplanted Mvf may improve the survival of ischemic skin flaps by promoting the early formation of patent connections between Mvf and the host's microcirculatory system. This apparently requires the presence of Mf.

Platelet-activating factor and edema surrounding meningiomas.

OBJECT: The purpose of this study was to evaluate the involvement of platelet-activating factor (PAF) in the formation of edema surrounding meningiomas. METHODS: Volumes of tumor and peritumoral edema were calculated based on three-dimensional reconstructed magnetic resonance images in 31 patients with intracranial meningiomas. The authors measured tumor concentrations of PAF and localized PAF and leukocytes in the tumors by using immunohistochemical studies. A significant positive correlation was found between peritumoral edema and PAF concentration. Both PAF and leukocyte common antigen were localized to the interstitial tissue of the tumor. Edema production was related to the degree of leukocyte infiltration in meningiomas. CONCLUSIONS: It appears that PAF, which may arise from infiltrating leukocytes, is important to the development of peritumoral edema in patients with meningioma.

Changes in hemodynamics in jejunal flaps of rabbits due to ischemia, venous congestion, and reperfusion as measured by means of colored microspheres.

The effect on the jejunal hemodynamics of restoration of blood flow of the jejunal artery or vein in the free jejunal flap has not yet been elucidated. In the present study, a model of ischemia and reperfusion in the jejunal flap of rabbits, and that of venous congestion and reperfusion, were prepared. Jejunal blood flow was measured by means of colored microspheres, and changes in jejunal blood flow were analyzed. Three segmental jejunal flaps were designed on each rabbit (n = 16), with one artery and one vein kept intact. Arterial clamp and venous clamp groups were prepared with a control group in which there was no clamping. After clamping for 5 minutes (n = 7), the jejunal blood flow of the arterial clamp group decreased to 1.6 percent of that of the control group (p = 0.0002), and that of the venous clamp group decreased to 31.2 percent of that of the control group (p = 0.0041). At 5 minutes after release of clamping, the jejunal blood flow of the arterial clamp group recovered to only 74.1 percent of that of the control group, with no consistent tendency; that of the venous clamp group recovered to 45.9 percent of that of the control group (p = 0.0194), with an increase of only 14.7 percent over that of the clamped jejunal blood flow group. Thus, injury of the jejunal hemodynamics in the venous clamp group had already begun in response to clamping for 5 minutes. After clamping for 30 minutes (n = 9), the jejunal blood flow of the arterial clamp group decreased to 4.3 percent of that of the control group (p = 0.0060), and that of venous clamp group decreased to 12.5 percent of that of the control group (p = 0.0106). At 5 minutes after release of clamping, jejunal blood flow of the arterial clamp group recovered to 171.0 percent of that of the control group (p = 0.0295), and that of venous clamp group recovered to 41.7 percent of that of the control group (p = 0.0276). Jejunal blood flow of the arterial clamp group recovered to 409.7 percent of that of the venous clamp group (p < 0.0001). When measurement of jejunal blood flow was repeated twice after changing the color of microspheres, jejunal blood flow of the second measurement was approximately 24 percent greater in mean value than that of the first measurement. The histologic results of the jejunum of the arterial clamp group clamped for 30 minutes showed no injury, which was similar to the results of the control group. The jejunum of the venous clamp group clamped for 5 minutes showed injury with severe hemorrhage in the lamina propria, and irreversible injury 30 minutes thereafter, with massive hemorrhage in all layers of the jejunal wall. In conclusion, as microcirculatory hemodynamics and histologic results of the jejunum demonstrated evidence of injury even by venous congestion for 5 minutes, restoration of blood flow of the free jejunal flap must be started from the jejunal vein.

Intracranial germinoma associated with Down's syndrome. Report of 2 cases.

It is well known that Down's syndrome is sometimes associated with leukemia. However, there have been only a few case reports of a relationship between Down's syndrome and brain tumors. We report 2 cases with histological diagnoses of germinoma. The 1st case was a 10-year-old boy with Down's syndrome complaining of seizure and left hemiparesis. Computed tomographic (CT) scan and magnetic resonance imaging (MRI) showed a mass lesion in the right basal ganglia and thalamus. Histological examination indicated two cell pattern germinomas. The 2nd case was a 20-year-old man with Down's syndrome complaining of headache and vomiting. CT scan and MRI showed a pineal region tumor with marked hydrocephalus. Surgical specimens showed typical germinoma. Only 13 cases of brain tumors associated with Down's syndrome have been reported. A higher incidence of germ cell tumors seems to be related to chromosomal abnormalities.

[Diffuse cerebral artery vasospasm following total resection of posterior fossa meningioma: a case report].

Diffuse cerebral artery vasospasm following brain tumor resection is a rare complication. The authors reported a case of symptomatic diffuse cerebral artery vasospasm of early phase following resection of a left posterior fossa meningioma. A 50-year-old female patient was admitted to our hospital complaining of headache. No neurological deficits were detected at the time of admission. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a large mass in the left posterior fossa. Cerebral angiography demonstrated mildly diffuse stenosis of the bilateral internal carotid artery. The tumor was resected totally. CT after operation showed a small amount of subarachnoid hematoma in the superior aspect of the cerebellum. Pathological specimen of the tumor showed fibrous meningioma. One day after this radical operation, the patient was found to have weakness in her left leg. Then she developed left hemiparesis, weakness in the right leg and left homonymous hemianopsia. MRI showed ischemic lesions in the bilateral parietal and the occipital lobe. Angiography demonstrated diffuse severe vasospasm throughout the whole cerebral artery. Ten days after the operation, angiographical findings were improved. This case indicates that vasospasm may occur even after resection of brain tumors which are localized outside the suprasellar area.

Direct evidence of a connection between autotransplanted microvessel fragments and the host microvascular system.

There are no reports on the autologous transplantation and patency of microvessels in living tissue. We autotransplanted microvessel fragments (Mvf) labeled with DiI-Ac-LDL into the peritoneum and then observed the peritoneum for 7 days postoperatively with a conventional fluorescence or laser scanning confocal microscope. We illustrated a neomicrovascular network of transplanted Mvf labeled with DiI-Ac-LDL in the peritoneum with both a fluorescence and a laser scanning confocal microscope. Furthermore, we demonstrated not only the existence of erythrocytes in the lumina of transplanted DiI-Ac-LDL-labeled Mvf, but also the presence of India ink perfused through the superior mesenteric artery in the lumina of the labeled Mvf. This evidence directly suggests that transplanted Mvf can survive and proliferate to connect adjacent microvascular branches of the superior mesenteric artery in the very early phase of wound healing. Moreover, these findings imply that implantation of Mvf in the microvascular ischemic circulatory tissue might accelerate angiogenesis to reconstitute a new microvascular network connecting to the nearby host microvascular system, which ultimately improves microcirculation.

[Intracerebral hemorrhage secondary to dissecting aneurysm of the anterior cerebral artery].

A case with intracerebral hemorrhage secondary to dissecting aneurysm of the anterior cerebral artery was reported. A 36-year-old male, known to have hypertension, developed somnolence and paresis of the left leg while skiing. There was no evidence of trauma. A plain head CT on admission revealed a high density in the right frontoparietal lobe. Three days after the admission CT revealed low density in the area supplied by the right anterior cerebral artery. An angiogram disclosed a double lumen, suggesting a pathognomonic sign of dissecting aneurysm at the A2 segment of the anterior cerebral artery. In the literature, 18 cases of dissecting aneurysm of the anterior cerebral artery were reported including this case. Eleven of the 17 cases were idiopathic, and 8 of the 11 cases had hypertension. We briefly discussed the relationship between the etiology of dissecting aneurysm and hypertension. Cerebral dissecting aneurysm is rare cause of intracerebral hemorrhage. It should be considered in diagnosis when young individuals develop intracerebral hemorrhage.

Giant aneurysm in the cavernous sinus causing subarachnoid hemorrhage 13 years after detection: a case report.

A 40-year-old man presented with cavernous sinus syndrome due to a giant aneurysm in the cavernous sinus. After a course of 13 years, he died of a subarachnoid hemorrhage (SAH). The finding in this case suggest that radical operation should be considered for nonruptured giant cavernous sinus aneurysms, depending on the location and development of the lesion.

The effect of anemia on skin blood flow in human.

The skin blood flow in the deltoid region was measured in 78 males by the Xenon 133 clearance method. A correlation was then made between age, hematocrit value, hemoglobin value and total protein determined at the time of skin blood flow measurement. From the data obtained, the following conclusions could be drawn: (1) skin blood flow significantly decreased with increasing age and with decreasing hematocrit and hemoglobin values; (2) skin blood flow showed the closest correlation with age (P < 0.001) and a weaker correlation (P < 0.01) with hematocrit and hemoglobin; (3) total protein demonstrated a significant decrease (P < 0.01) with a decrease in hematocrit and hemoglobin values giving rise to hypoproteinemia.

The characteristics of laser-Doppler flowmetry for the measurement of regional cerebral blood flow.

The fundamental characteristics of laser-Doppler flowmetry (LDF), especially the depth of cerebral blood flow (CBF) measurement, have not been widely studied in the brain tissue; however, LDF has been widely used in recent clinical and experimental studies. We investigated the depth of CBF measurement and other characteristics related to the use of LDF in the brain. In an animal experimental study, the distribution of laser light and the depth of CBF measurement of LDF were measured by using modified LDF probes. CBF in various conditions was also measured by the LDF and hydrogen clearance method. Laser light of low output lost directivity and was dispersed into a hemispherical form in the brain tissue. The depth of CBF measurement was approximately 100 to 400 microns, depending on the intensity of the emitted laser light, and was affected by changes of CBF. In the physiological condition, the close correlation between the values of CBF by the LDF and hydrogen clearance method was obtained. After cardiac arrest, the CBF value of LDF did not immediately show a 0 value. LDF has several special characteristics, and the sample volume was very small. It is important to pay attention to the several special characteristics of LDF.

Minor malformation of skin and soft tissue of the columella and philtrum.

We present 3 patients with minor malformation of skin and soft tissue between the unilateral columella and philtrum. The first patient has a number of malformations such as minor cleft nose, notch of the left nostril rim and vermilion, and bifid frenula of the upper lip and right accessory ear, whereas the second patient had a notch of the vermilion and the third patient had minor ocular hypertelorism. The clinical findings observed in these patients suggest that a minor malformation of skin and soft tissue between the unilateral columella and philtrum is a focal fetal dysplasia that developed as a result of embryological failure in the ipsilateral medial nasal process and that these minor malformations are a type of facial cleft.

The correlation of skin blood flow with age, total cholesterol, hematocrit, blood pressure, and hemoglobin.

Normal skin blood flow at the deltoid region in 55 men whose ages ranged from 20 to 72 years was measured by the xenon-133 clearance method. In addition, the correlation of skin blood flow with age, systolic blood pressure, total cholesterol, hematocrit, hemoglobin, and total protein was analyzed by multiple regression analysis. The following results were obtained. Normal skin blood flow was found to decrease with increase in age, total cholesterol, and systolic blood pressure and showed a tendency to increase with elevation in hematocrit and hemoglobin values. Of the six parameters examined in the present study, the parameter that showed the strongest correlation with skin blood flow at the deltoid region was age, followed in decreasing order by total cholesterol, hematocrit, systolic blood pressure, and hemoglobin. It could therefore be concluded that age is the most reliable factor in clinically estimating skin blood flow. Furthermore, inasmuch as total cholesterol, hematocrit, systolic blood pressure and hemoglobin values also were correlated with skin blood flow, these values also should be taken in account in the synthetic evaluation of skin blood flow. It was skin blood flow at the deltoid region that was strongly correlated with age. This was followed by systolic blood pressure, hematocrit, and hemoglobin. Total cholesterol showed a weak correlation with age, but total protein did not demonstrate any correlation with skin blood flow and age. The results of the present study show that skin blood flow would be poor in the elderly and in patients with arteriosclerosis, hypertension, and anemia. Since it is suggested that the wound-healing process is delayed in such patients, utmost care should be exercised in treating their wounds.