Renal Oncocytoma Associated With Long-Term Hemodialysis

A 50-year old woman was admitted to our hospital for further evaluation of the right renal tumor. She had been on maintenance hemodialysis for 12 years. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a large right renal tumor. There was no central stellate scar. Angiography showed hypervascularity and tumor staining . With the pre-operative diagnosis of renal cell carcinoma, right nephrectomy was performed. The pathological diagnosis was renal oncocytoma

ショウガクセイ ノ キョウドウタイ カンカク オ ハグクム ガッキュウズクリ ノ トリクミ

本研究は，小学生の共同体感覚を育成することを目的とした学級づくりの実践を報告するものである。共同体感覚を育成することを主眼に置き，教師のかかわりを勇気づけの視点で可視化しフィードバックをする「勇気づけミーティング」，児童のかかわり合いを深めるための「ポジティブメッセージを送ろう」「WONDERFUL GRAND PRIX」という取り組みを実践した。結果，勇気づけのサイクルを意識した教師のかかわりと児童のかかわり合い活動の取り組みが，共同体感覚を育む学級づくりに概ね寄与することが示唆された。The purpose of this study is to examine the effect of the practice of developing children\u27s social interest through classroom creation. “Encouragement Meeting” which focuses on utilizing resources within the classroom where the community sense is fostered, visualizes teacher involvement from encouraging perspective and gives feedback, conducted “Let\u27s send a positive message” and “WONDERFUL GRAND PRIX” to deepen child-to-person relationships.As a result, it was suggested that the involvement of teachers who are aware of the encouragement cycle and the activities of activities to foster involvement of children generally contribute to the creation of classes that foster community sensation

校内研究の推進に関する一考察 ～外部講師の関わり方を中心に～

Lesson practice is often used as the main method for the in-school training programs.However, it is often the case that “Lesson Study” is not a part of in-school training.In otherwords, lesson study is done for the sake of lesson study.If that is the case, “Lesson Study” isfor teachers and not for school children.It is important to make “Lesson Study” work for inschooltraining.We propose three criteria to achieve it:First, we must always do “Lesson Study" with a focus on the study subject.Secondly, children should be the main focus on the “Lesson Study.”Thirdly, we must be prepared to update our “Lesson Study” at any time

校内研究の推進に関する一考察（ 2 ） ―外部講師の助言のあり方を中心に―

2020年はコロナ禍に始まり、コロナ禍に終わった。2019年度末の混乱も大きかったが、2020年度当初からの休校により、さらに学校は混乱したかに見えた。しかし、休校開けの6 月下旬から学校を訪れると、全く混乱はなく、教職員は粛々と、しかも明るい表情で教育活動を進めていた。そして、何よりも驚いたことは、まだまだコロナ禍の中にある状況なのに、校内研究に対して熱意をもって取り組んでいたことである。稿者が校内研究のために学校を訪れると、やっと校内研究が始まったと言って喜んでくれた教師が何人もいた。実際に学校に訪問できる状況にないために、やむを得ずオンラインで校内研究に参加させていただいたにもかかわらず、こんな状況でも校内研究ができることはうれしいことだと語る教師も多かった。　このように、未曾有の追い込まれた状況の中でも、教師（集団）は、研修・研究に対する義務感や意欲をもっている。そして、稿者たちのような大学教員を外部講師に迎え校内研究ができることを自分と集団の成長の絶好の機会であると考えている。そうであれば、外部講師の果たすべき役割はこれまで以上に大きい。とはいえ、校内研究における外部講師の果たすべき役割は曖昧で、肯定的に言えば個々人に任されているのであり、否定的に言えば無責任に言いたいことを言って帰るということになるだろう。　こういった現状をふまえ、渡辺・石丸（2020）は、校内研究に対する外部講師の関わり方として、①校内研究と授業研究をつながりの中で捉え、常に研究主題を意識したものとする　②校内研究、授業研究の主役は子供たちであり、子供たちに成果が届けられるような研究を目指すものとする　③常に更新を受け入れられる体制づくりをしておくという三点を基本的な姿勢として挙げた。これらは、実際に校内研究に取り組んでいる教師にとっては、当たり前のものではあるが、目の前の授業研究に一生懸命になってしまうと次第に1 時間の授業しか目に入らなくなってしまい、見えなくなってしまうものである。それゆえ、客観的視点を持ちうる外部講師が道筋として示していくことが重要なのである。　ただし、それらは授業研究においては抽象的な概念に近く、そのままでは画餅に過ぎない。そこで、より具体的に校内研究のあり方や進むべき道を示すためには、「助言」という形で分かりやすく教師集団に伝えていく必要がある。しかし、内部、外部を問わず講師の「助言」についても、個々人に任されていてそのあり方が明確になっているとは言いがたい。ほとんどの講師の助言は、授業を評価し、よりよい授業を目指すための方向性を示すものであると言ってよいだろう。しかし、外部講師は、校内研究を推進することの一助となることを求められているのであり、1 時間の授業の評価に終わるのではなく、校内研究を推進するという視点を示すことが「助言」という役割を果たす重要な要素であると考える。　本論では、先に挙げた助言の二つの要素、「授業を評価し、よりよい授業を目指すための方向性を示すこと」と「校内研究を推進するという視点を示すこと」の重要性を明らかにするとともに、どのような形で助言をすれば二つの要素の具体化につながるかを示していく。　研究の進め方としては、まず、先行研究について上記の二つの要素についてどのように捉えているかを考察する。それをふまえて、稿者二人が実際に行っている助言について二つの要素から考察し、その有効性について論じていく

Kissing Aneurysm of the Distal Anterior Cerebral Artery: Preoperative CT Angiography and Surgical Management: A

We describe a patient with mirror-image aneurysms in the bilateral distal anterior cerebral artery (ACA). The larger aneurysm was clearly disclosed with digital subtraction angiography (DSA), but the smaller one could not be definitely identified. The bilateral aneurysms were confirmed with computed tomographic (CT) angiography, which showed the right ACA aneurysm to be hidden behind the left ACA aneurysm, likely buried in the cingulate gyrus. During surgery, the left ACA aneurysm was clipped first. The right ACA aneurysm was exposed by a small subpial resection of the cingulate gyrus, and the right ACA aneurysm, which strongly adhered to the surrounding tissue, was safely dissected. Multiple aneurysms associated with a distal ACA aneurysm are not rare. We conclude that further examination with CT angiography is important when kissing aneurysms are suggested by DSA

Amide proton transfer MRI differentiates between progressive multifocal leukoencephalopathy and malignant brain tumors: a pilot study

Background: Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nerve system caused by the John Cunningham virus. On MRI, PML may sometimes appear similar to primary central nervous system lymphoma (PCNSL) and glioblastoma multiforme (GBM). The purpose of this pilot study was to evaluate the potential of amide proton transfer (APT) imaging for differentiating PML from PCNSL and GBM. Methods: Patients with PML (n = 4; two men; mean age 52.3 ± 6.1 years), PCNSL (n = 7; four women; mean age 74.4 ± 5.8 years), or GBM (n = 11; 6 men; mean age 65.0 ± 15.2 years) who underwent APT-CEST MRI between January 2021 and September 2022 were retrospectively evaluated. Magnetization transfer ratio asymmetry (MTRasym) values were measured on APT imaging using a region of interest within the lesion. Receiver operating characteristics curve analysis was used to determine diagnostic cutoffs for MTRasym. Results: The mean MTRasym values were 0.005 ± 0.005 in the PML group, 0.025 ± 0.005 in the PCNSL group, and 0.025 ± 0.009 in the GBM group. There were significant differences in MTRasym between PML and PCNSL (P = 0.023), and between PML and GBM (P = 0.015). For differentiating PML from PCNSL, an MTRasym threshold of 0.0165 gave diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of 100% (all). For differentiating PML from GBM, an MTRasym threshold of 0.015 gave diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of 100%, 90.9%, 80.0%, and 100%, respectively. Conclusion: MTRasym values obtained from APT imaging allowed patients with PML to be clearly discriminated from patients with PCNSL or GBM

Quantitative Chemical Exchange Saturation Transfer Imaging of Amide Proton Transfer Differentiates between Cerebellopontine Angle Schwannoma and Meningioma: Preliminary Results

Vestibular schwannomas are the most common tumor at the common cerebellopontine angle, followed by meningiomas. Differentiation of these tumors is critical because of the different surgical approaches required for treatment. Recent studies have demonstrated the utility of amide proton transfer (APT)-chemical exchange saturation transfer (CEST) imaging in evaluating malignant brain tumors. However, APT imaging has not been applied in benign tumors. Here, we explored the potential of APT in differentiating between schwannomas and meningiomas at the cerebellopontine angle. We retrospectively evaluated nine patients with schwannoma and nine patients with meningioma who underwent APT-CEST MRI from November 2020 to April 2022 pre-operation. All 18 tumors were histologically diagnosed. There was a significant difference in magnetization transfer ratio asymmetry (MTRasym) values (0.033 ± 0.012 vs. 0.021 ± 0.004; p = 0.007) between the schwannoma and meningioma groups. Receiver operative curve analysis showed that MTRasym values clearly differentiated between the schwannoma and meningioma groups. At an MTRasym value threshold of 0.024, the diagnostic sensitivity, specificity, positive predictive value, and negative predictive values for MTRasym were 88.9%, 77.8%, 80.0%, and 87.5%, respectively. Our results demonstrated the ability of MTRasym values on APT-CEST imaging to discriminate patients with schwannomas from patients with meningiomas

Three-Dimensional Anisotropy Contrast MRI and Functional MRI of the Human Brain: Clinical Application to Assess Pyramidal Tract in Patients with Brain Tumor and Infarction

We describe and evaluate the findings of three-dimensional anisotropy contrast MR axonography (3DAC MRX) and functional MRI (fMRI) in brain tumor and infarction. We obtained diffusion-weighted images (DWI) in 28 patients including 23 brain tumors and 15 acute infarctions located in or near pyramidal tract. Three anisotropic DWIs were transformed into graduations color-coded as red, green or blue, and then composed to form a combined color 3DAC MRX. We also performed functional MRI in 7 of the 28 patients and compared with cortical mapping of 3DAC MRX. 3DAC MRX with 23 brain tumors showed that the ipsilateral pyramidal tract was either discontinuous due to impaired anisotropy (n=8) or compressed due to mass effect (n=15). In 10 patients of acute infarction with motor impairment, pyramidal tract involvement was visually more conspicuous on 3DAC MRX compared to standard DWI. On functional MRI, hand motor activation was observed between blue vertical directional colors of pre- and post central gyrus. In conclusion, 3DAC MRX is a new noninvasive approach for visualization of the white matter neuronal tract and provides the information concerning pyramidal tract involvement

Percutaneous Direct Puncture of Retropancreatic Splenic Vein and Portal Thrombectomy in a Patient With Liver Transplantation and Simultaneous Splenectomy

Portal vein thrombosis following liver transplantation is generally managed by endovascular treatment. Although several techniques are available for portal venous access, trans-splenic access is of interest because it avoids damage to the liver graft. However, the spleen cannot be punctured to access the portal vein after splenectomy. We herein report a case of portal vein thrombosis following living donor liver transplantation with simultaneous splenectomy successfully treated by percutaneous intervention with direct puncture of the retropancreatic splenic vein. The splenic vein was punctured under computed tomography guidance in the prone position. Portal venography revealed a contrast defect due to a thrombus in the extrahepatic to intrahepatic portal vein. The portal vein was reopened after thrombectomy, and the portal vein thrombosis did not recur for 2 y. The technique and advantages of our approach are described