An adult female suspected case of herpangina presenting with fever, headache, and oral phlyctenula

　ヘルパンギーナは，発熱と口腔粘膜の水疱性の発疹が特徴の急性のウイルス性咽頭炎で，おもに小児にみられ，夏に流行する．我々は，発熱，頭痛，軟口蓋の小水疱を呈し，ヘルパンギーナが疑われた成人女性の１例を経験したので報告する．患者は25歳，女性．７月に発熱，頭痛，嘔気を主訴に受診し，入院となった．血液検査では，CRP とプロカルシトニンの上昇を認めた．頭部 CT では，出血や占拠性病変は見られなかった．胸腹部 CT では，熱源となる異常所見は見られなかった．抗菌薬投与と対症療法を行い，発熱，頭痛は改善を認めた．口腔内違和感の訴えがあり，口腔内所見で軟口蓋に紅暈を伴う小水疱を数個認め，エンテロウイルス属感染症（ヘルパンギーナ）が疑われた．エンテロウイルス属のウイルス抗体検査では，原因ウイルスは特定できなかった．夏期に発熱，口内炎を呈する場合には，成人でもへルパンギーナを鑑別に挙げる必要があると考える．　Herpangina is an acute viral pharyngitis which presents with fever and oral phlyctenula. It is commonly seen in children, usually during summer. We report an adult female suspected of having developed herpangina because on admission she presented with fever, headache, and oral phlyctenula. The 25-year-old female underwent a medical check at our hospital because of fever, headache, and nausea in July. She was admitted to our hospital. The blood test showed elevation of C-reactive protein and procalcitonin. Brain CT scan showed no bleeding nor any space occupying lesion. Chest and abdominal CT scan showed no lesion of fever origin. Her fever and headache improved after antibiotics and symptomatic treatment. But the patient felt that something was wrong within her oral cavity. Herpangina was suspected because of the presence of phlyctenula with a red halo in the soft palate. Viral antibody test of enteroviruses did not identify viruses that commonly cause herpangina. This case indicates that herpangina should be considered for the differential diagnosis during medical examination of an adult patient who presents with fever and stomatitis during summer

Temporal dispersion in vasculitic neuropathy: its microscopic ultrastructural findings

　症例は35歳男性．32歳のときに右腓腹神経・足底神経支配領域の異常感覚で発症し，その後，左腓腹神経・足底神経領域，両側尺骨神経領域に感覚障害が拡大した．神経伝導検査では，左脛骨神経複合筋活電位において，時間的分散の所見が認められた．腓腹神経生検では，神経上膜にフィブリノイド壊死を伴う壊死性血管炎を認めた．エポン包埋トルイジン青染色では、有髄神経線維の脱落が著明であり，髄鞘の薄い再生軸索が認められた．電子顕微鏡による観察では，脱髄は認められず，軸索の再生が認められたが，髄鞘再生に乏しい thin myelin が特徴的であった．神経伝導検査で，伝導ブロックや時間的分散といった脱髄を疑う所見を呈する血管炎性ニューロパチーについて24例の報告があるが，これまで電子顕微鏡による観察はされていない．血管炎性ニューロパチーによって惹起される時間的分散の出現機序について，微細構造所見を基に考察する．　A previously healthy 35-year-old man developed abnormal sensation in the right sural and medial plantar nerve territory 2 years ago. The sensory impairment gradually spread to the left sural and medial plantar nerve regions, then bilateral ulnar nerve regions. Nerve conduction study showed temporal dispersion in the left tibial nerve. Sural nerve biopsy revealed necrotizing vasculitis with fibrinoid necrosis in the epineurium. Toluidine blue staining of Epon-embedded tissue showed significant loss of myelinated nerve fibers without demyelination, even in the teased nerve fiber preparations. Electron microscopy showed immature regenerated nerve fibers with thin myelin sheaths. Even including 24 reported cases of vasculitic neuropathy with either conduction block, pseudo-conduction block, or temporal dispersion, this is the first case examined by electron microscopy. Herein, we discuss the ultrastructural background of“temporal dispersion”in vasculitic neuropathy

Clinical value of abnormal median-normal sural sensory response pattern for the early diagnosis of acute oropharyngeal palsy: a comparison of recent and previous cases

　To evaluate whether nerve conduction study (NCS) findings are useful to make an early diagnosis acute oropharyngeal palsy (AOP). 　We evaluated 2 AOP patients. Patient 1: An 18-year-old male who developed a nasal voice two weeks after common-cold symptoms with no weakness in his extremities. Patient 2: A 16-year-old female who developed a nasal voice two days after diarrhea with no weakness in her extremities. We conducted a routine NCS on these 2 patients and followed up their changes. Both patients had an abnormal median-normal sural (AMNS) sensory response pattern, which improved over time. Both patients were diagnosed with AOP and treated with intravenous immunoglobulin (400 mg/kg/day) with a good prognosis. Anti-GQ1b and/or anti-GT1a IgG antibodies were identified in the serum of both patients a few weeks after their initial diagnoses. 　The AMNS sensory response pattern can be useful for the early diagnosis of AOP

Influence of placement sites of the active recording electrode on CMAP configuration in the trapezius muscle

Objective: We investigated how the active electrode placement site influences compound muscle action potential (CMAP) configuration of the upper trapezius muscle (TM). Methods: A nerve conduction study of the accessory nerve was performed, and the CMAPs obtained with two different placement sites, i.e., placement of the active recording electrode on the belly of the upper TM (CMAP-A) and placement of the electrode 2 cm behind the belly (CMAP-B), were compared. CMAPs were also obtained with the active recording electrode placed in the supraspinous fossa (CMAP-C). Results: All CMAPs were recorded from 21 healthy volunteers. The mean peak-to-peak amplitude of CMAP-B was 3.4 mV higher than that of CMAP-A (11.0 ± 4.0 mV vs. 14.4 ± 4.9 mV; P < 0.01). The mean peak-to-peak amplitude of CMAP-C was 10.3 ± 5.0 mV. Conclusions: CMAP of the upper TM was always higher when the active recording electrode was placed 2 cm behind the belly of the muscle. Significance: When stimulating the accessory nerve, a current spread occurs to the C5 spinal nerve root and another CMAP originating from the supraspinatus muscle occurs in the supraspinous fossa. The volume conduction from the supraspinatus muscle affects the active recording electrode on the TM, resulting in an increase in CMAP amplitude. Keywords: Active recording electrode, Compound muscle action potential, Nerve conduction study, Supraspinatus muscle, Trapezius muscle, Volume conductio

Studies on the Energy Absorbed Efficiency during Microwave Heating

前報において、マイクロ波加熱による高含水率の浸漬米の製造、デンプン性食品の殺菌、ジャガイモのマイクロ波加熱におけるクッキング速度式の設定に関する研究を行った結果について報告した。各種マイクロ波加熱の装置設計を進めていくためには、エネルギー吸収効率ならびにマイクロ波加熱における食品の温度上昇の測定に関する研究を進めていくことが必要となる。これまでに、マイクロ波加熱における回分型容器内の液状試料のエネルギー吸収効率に関する研究を行ってきた。本研究では、電子レンジを使用し、回分型容器内の固体状試料については重量減少測定、また、流通容器内の液状試料については温度上昇測定を行って、簡単な熱収支式を用いて、エネルギー吸収効率を求める研究を行った。電子レンジ内の固体状試料のエネルギー吸収効率は、マイクロ波加熱による重量変化の測定によって求めることができ、試料の供給含水量によって変わった。電子レンジ内に流通型容器を取りつけて液状試料を流通させた場合のエネルギー吸収効率は、電子レンジへの流入出口における温度変化の測定によって求めることができた。流通型容器内の液状試料のエネルギー吸収効率は回分型容器内のそれと同じように大きな値となった。本研究で得られた結果は、食品のクッキング、乾燥などのような各種のマイクロ波加熱処理装置を設計する場合に有用となる。In previous papers, we have studied the soaked rice of high level moisture through microwave-treatment, the pasteurization of starchy foods, and the cooking-rate equations on the microwave heated cooking of potato. In order to design various microwave heating apparatuses, it is necessary to measure the energy sbsorbed efficiency and the increased temperature of microwave heated foodstuffs. Therfore, we have studied the efficiency in liquid samples in batch vessel during microwave heating. In this paper, the values of the decreased weight of solid samples in batch type vessel and of the increased temperature liquid samples in continuous type vessel during microwave heating in an electronic range were observed, and the values of the energy absorbed efficiency were calculated by using simple energy equations. The energy absorbed efficiency of solid samples in the range was measured by observing the changed weight during microwave heating, and the values changed with the water content of samples. The energy absorbed efficiency of liquid samples contained in a flow type vessel through the electronic range was measured by observing the changed temperature during the inner and outer positions of the range. The values of energy absorbed efficiency of liquid samples in the flow type vessel were very large same as a batch type vessel contained samples in the range. These phenomena obseved are very interesting for the design of the various microwave treatment apparatuses such as cooking, drying and so on of foodstuffs