(Nakamura et al., 1965a,b;Crompton et al., 1966), coma vigile (Gerstenbrand, 1967), parasomnia (Jefferson, 1944), akinetic mutism (Cairns et al., 1941), and apallic syndrome (Kretschmer, 1940). Recently, Jennett and Plum (1972) We arbitrarily designed the following criteria in order to study such patients: (1) defect of verbal and behavioural communication; (2) loss of expression of intention; (3) absence, or at least reduction of emotional expression; (4) urinary and faecal incontinence; (5) complete loss of selfsupportability; (6) continuation of above conditions for more than three months, regardless of causative disease. Patients and methodsIn response to simple inquiries to 269 hospitals in 16 prefectures of western Japan on 1 June 1973, 193 potentially suitable cases were reported from 189 hospitals; we then visited each hospital and examined each patient. Based on the above criteria, 110 patients were included in our study.Although we were unable to assess the incidence of vegetative patients for all districts responding to our inquiry our survey did cover all hospitals within Yamaguchi prefecture, a population of approximately 1.5 million. We found 37 vegetative patients, an incidence of 0.0025%.We examined the behaviour, response to various stimuli, and neurological signs of the 110 patients in our sample. Analyses were also made of the results of ancillary examinations, methods of management of the patients, and effectiveness of treatment given. In order to assess the level of 876

Materials and methodsCriteria for selection of the patients and method of survey have been described in the previous paper. We continued to keep contact with attending physicians in each hospital as to outcome of the patients once a year, and we examined surviving patients at the end of the five-year folloNv-up period (May 1978

Background Reduced field‐of‐view diffusion‐weighted imaging (rDWI) with tilted two‐dimensional radiofrequency (RF) excitation planes has not yet been applied to the imaging of the pancreas although the utility of this technique which allows the acquisition of high‐quality images without aliasing artifacts in the phase‐encoding direction has been evaluated for brain and spinal cord imaging. Purpose To evaluate the visual image quality of the pancreas by tilting the excitation plane (tilted rDWI) in comparison to conventional DWI (cDWI) and rDWI without using the tilted excitation plane. Study type Retrospective. Population Thirty‐two patients evaluated for suspected pancreatobiliary diseases. Field Strength/Sequence Echo‐planar imaging DWI (cDWI, rDWI, and tilted rDWI) acquired at 3 T. Assessment Images from each DWI sequence were analyzed by five radiologists to compare image quality (conspicuity of pancreatic edges, interslice signal homogeneity, overall image quality, and conspicuity of focal pancreatic lesions) and artifacts (presence of blurring or ghosting artifacts, susceptibility artifacts, and aliasing artifact). Statistical Tests Shapiro–Wilk test was performed to assess whether data were normally distributed. Friedman test followed by Bonferroni‐adjusted Wilcoxon signed‐rank test for post hoc analysis was performed to compare image quality and artifact scores. Results The mean scores for conspicuity of pancreatic edges (3.36 vs. 2.37), interslice signal homogeneity (3.14 vs. 2.81), presence of ghosting artifacts (3.32 vs. 2.66), susceptibility artifacts (3.06 vs. 2.30), and aliasing artifacts (3.90 vs. 2.34), and overall image quality (3.49 vs. 2.36) were significantly higher in the tilted rDWI than in the rDWI (P < 0.017 for all parameters). The conspicuity score for focal pancreatic lesions tended to be higher in tilted rDWI than in rDWI (2.44 vs. 2.00, P = 0.07). Data Conclusion Tilted rDWI had better image quality and reduced artifacts relative to cDWI and rDWI techniques in the pancreas. Level of Evidence 4 Technical Efficacy Stage 2

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A case of Proteus syndrome in a 13-year-old boy with macrodactyly, hemihypertrophy, exostosis of the skull, epidermal naevi, palmar and plantar masses, and scoliosis is reported. Macrodactyly involving the left thumb was treated surgically. The usual findings in macrodactyly, hypertrophy of the digital nerves and proliferation of subcutaneous fat, were not observed in this case. Macrodactyly associated with Proteus syndrome should be distinguished from other forms of macrodactyly because of its poor prognosis and high rate of recurrence.