[Subacute subdural hematoma associated with moyamoya phenomenon--a case report]

A case of subacute subdural hematoma associated with moyamoya phenomenon is reported. On May 8, 1986, a 61-year-old female was referred to Mito National Hospital for evaluation of a left-sided hemiparesis and headache 8 days after minor head injury. Seventeen years ago she experienced the sudden onset of a left-sided hemiparesis which improved by rehabilitation. CT scans showed a thin high density area on the right cerebral convexity and a small low density area in the right semiovale center. On May 12, she was admitted because of aggravation of her symptoms. A repeat CT scan showed an enlarged right temporoparietal subdural hematoma with significant mass effect. Cerebral angiograms revealed the occlusion of right internal carotid artery. There were so-called moyamoya vessels bilaterally and transdural anastomosis on the right side. Avascular area confirmed subdural hematoma. The hematoma was evacuated via two burr holes with preservation of the middle meningeal and superficial temporal arteries. By the time of discharge two months postoperatively, she was walking well without assistance. We reviewed four cases of acute or subacute subdural hematoma associated with moyamoya phenomenon and emphasized the possibility of occurrence of acute or subacute subdural hematoma due to rupture of vault moyamoya vessels.

Older age onset rheumatoid arthritis with or without osteoarthritis

The clinical features of a group of 79 patients with older age onset rheumatoid arthritis (ORA) were compared with those of a group of 414 patients with younger age onset rheumatoid arthritis. The ORA group contained approximately equal numbers of men and women, were less rheumatoid factor positive, had a raised erythrocyte sedimentation rate, lower HLA-DR4 positivity, and a tendency towards larger joint involvement at the onset of the disease. These features have been reported by many authors except for the lower DR4 positivity. Of these features, the lower prevalence of rheumatoid factor positivity and the tendency towards larger joint involvement at the onset were characteristic of a subset of patients with ORA who had had osteoarthritis before the onset of rheumatoid arthritis. It is suggested that osteoarthritic large joints may be susceptible to the occurrence of rheumatoid synovitis at the onset of the disease, but that the osteoarthritis inducing factor may be negatively related to the progression of rheumatoid arthritis.

Continuous recording of cerebral blood flow by means of a thermal diffusion method using a Peltier stack

The thermal diffusion method is known to be effective for making quantitative measurements of blood flow, but cannot be easily applied to problems concerning quantitative changes in blood flow. Carter et al. found that the thermal diffusion technique using a Peltier stack as the probe produced extremely stable recordings and was suitable for quantitative work. We made a more stable probe containing an air space and having a stainless cap that added weight. A stable recording of blood flow was then possible. For calibration of the probe, we used blood flow values measured by means of an electrolytic technique and the equation proposed by Carter et al. In the present study, we have shown that it is theoretically possible to perform the calibration even without obtaining data on blood flow after cardiac arrest. Experimentally, the validity of such calibration was confirmed. This technique for measuring blood flow should be applicable in various fields and its use in a clinical setting, particularly in the monitoring of blood flow during neurosurgical operations, can be expected.

Crystallization and preliminary X-ray diffraction studies of tobacco necrosis virus

Tobacco necrosis virus is a spherical plant virus consisting of 180 copies of coat protein and a single-stranded RNA. The virus has been crystallized in cubic space group P4(2)32 with a = 338 A. The locations and the orientations of the two virus particles in the unit cell have been determined on the basis of the symmetries of both the particle and the crystal. The crystal diffracts X-rays to at least 2.5 A resolution and is quite stable to X-ray beams (1 A = 0.1 nm).

Histological analysis of lymphocyte subsets infiltrated into mouse tumor tissue exposed to local irradiation

The subsets of lymphocytes infiltrated into mouse tumor tissue exposed to irradiation were analyzed by the avidin-biotin-peroxidase procedure using monoclonal antibodies. The effect of PSK administration was also analyzed. Microscopic observation revealed the intense lymphocytic reactions in the exposed tumor, especially 7 days after irradiation of 20 Gy, which mainly consisted of anti-L3T4 positive cells, whereas the degree of infiltration was lower in the nonexposed tumor. PSK was found to enhance T lymphocyte subset infiltration into the exposed tumor tissue.

Extrahepatic organs metabolism of inhaled trichloroethylene

An extrahepatic circulation system for dogs was developed using a portal vein to right femoral vein bypass procedure. This system maintained nearly normal biochemical and physiological parameters, i.e. arterial blood pressure, heart rate, electrocardiogram, leukocyte and erythrocyte count, hematocrit, alkaline phosphatase, blood urea nitrogen, ammonia and creatinine, for 2 h. Thus, the system appears to be a valid technique for investigating extrahepatic metabolism. Dogs were exposed for 1 h to 500, 700 and 1500 ppm of trichloroethylene. Free-trichloroethanol, trichloroacetic acid and conjugated-trichloroethanol appeared in the blood and urine after 30 min of exposure. The amounts of metabolite formed by dogs with hepatic bypass were less than by similarly exposed dogs without hepatic bypasses, specifically 50-80%, 10% and 10-20% for free-trichloroethanol, trichloroacetic acid and conjugated-trichloroethanol, respectively. In addition, trichloroethylene exposure produced a smaller decrease in leukocyte counts in the hepatic bypass dogs than in the non-bypass dogs. This observation may indicate that the liver itself played some role in the elimination or increment of leukocyte counts in the blood.

Biliary excretion of trichloroethylene and its metabolites in dogs

To examine the biliary excretion of trichloroethylene (TRI) and its metabolites, we carried out various experiments with TRI and its metabolites, i.e., chloral hydrate (CH), free-trichloroethanol (F-TCE) and trichloroacetic acid (TCA), using anesthetized dogs. The amount of biliary excretion was significantly increased with the administration of CH and F-TCE, whereas it remained at control levels with the administration of TRI and TCA. The substances excreted into bile were conducted in the form of conjugated-TCE (Conj-TCE) in over 90% of the CH, F-TCE and TRI administration groups. About 95% of these Conj-TCE were conjugated with glucuronic acid. The cumulative excretion ratios of substances and metabolites to dose were 20% for CH and F-TCE, and about 1% for TCA and TRI 2 h after administration.

[Embolotherapy of hepatomas using ferromagnetic microspheres, its clinical evaluation and the prospect of its use as a vehicle in chemoembolo-hyperthermic therapy]

Ferromagnetic microembolization (FME) was applied to patients with hepatoma, using iron microspheres (30-50 mu), suspended in aqueous polysaccharide solution; dextran 40 (12%), sodium carboxymethyl-cellulose (2%) in saline solution. Hepatic arterial infusion of this agent was performed under external magnetic control to confine iron microspheres within the target organs. The therapeutic effect of this procedure on 44 patients with hepatoma was evaluated in relation to the stages of the disease, showing excellent, improved survival terms; survival rates calculated by Kaplan-Meier's method for patients with stage I to III hepatomas were 80% (1 year), 50% (2 years) and 30% (3 years). In order to extend the therapeutic effect of this procedure further, polysaccharide solution was also utilized as a carrier of anti-cancer agents. Serologic and histologic data in experimental animals showed evidence of prolonged release of Mitomycin from polysaccharide solution admixed, indicating its potential use as a method of chemo-embolization. In addition to this, we have also been developing the induction heating of the magnetic microspheres, introduced into the lesion by means of FME, to heat the lesion selectively. The procedure is still in the experimental phase. However, recent results strongly suggest the possibility of its clinical use. In conclusion, we consider FME to be one of the most reliable and potentially valuable methods for extending the capability of multidisciplinary treatment of hepatoma.