Possible association of body-fat distribution with preeclampsia

OBJECTIVE

To investigate whether preeclampsia is associated with body-fat distribution.

METHODS

Twenty-two patients with preeclampsia (mean age: 31.9 +/- 6.0 years) and 126 controls without preeclampsia (mean age: 30.9 +/- 5.2 years) were enrolled in this study. We compared baseline characteristics and 4 body-fat indices measured by DEXA on Day 5 postpartum. The possible correlation between the variables and the development of preeclampsia was evaluated by multivariate analysis.

RESULTS

The body-fat ratio, the upper-half body-fat amount, upper-half-body body-fat amount ratio, and upper-/lower-half-body body-fat amounts ratio on Day 5 postpartum were significantly higher in the preeclampsia group. However, the upper-/lower-half-body body-fat amount ratio was best correlated with preeclampsia among variables in multivariate analysis.

CONCLUSION

Upper-body-fat distribution might be associated with the development of preeclampsia.

Immunotherapy with husband's leukocytes to primary habitual aborters and autoantibodies in their sera

OBJECTIVE

This study was performed to determine whether primary habitual aborters have an autoimmunological tendency and whether immunotherapy with leukocytes induces autoantibodies in their sera.

METHODS

We measured the levels of antiphospholipid antibodies (APAs) and antinuclear antibodies (ANAs) in the sera of 65 primary habitual aborters. Among them, 8 primary habitual aborters received immunotherapy with their respective husband's leukocytes; these 8 patients were followed up for autoantibodies in their sera before immunotherapy, at the time of pregnancy permission, during the first trimester of pregnancy, at delivery, and postpartum.

RESULTS

Sixty-nine percent of the 65 primary habitual aborters were positive for IgG or IgM antibodies to at least 1 of 6 phospholipids, and 29% of them were positive for ANAs. Although the pregnancy outcomes of the 8 primary habitual aborters after immunotherapy were good, their APAs and ANAs converted to positive after the immunotherapy.

CONCLUSION

Immunotherapy with leukocytes should be performed after checking and confirming the absence of autoantibodies in the sera of a habitual aborter.

Fibrosarcoma versus cellular fibroma of the ovary: a comparative study of their proliferative activity and chromosome aberrations using MIB-1 immunostaining, DNA flow cytometry, and fluorescence in situ hybridization

We retrospectively analyzed the proliferative activity and the centromeric copy number of chromosomes 8, 12, and 17 in three cases of fibrosarcoma and eight cases of cellular fibroma of the ovary using MIB-1 immunostaining, DNA flow cytometry, and fluorescence in situ hybridization (FISH) on paraffin-embedded tissue specimens. In our study, both the MIB-1 labeling index (LI) and the proliferative index (% of cells in S + G2 + M phase) in fibrosarcomas were higher than those in cellular fibromas. The FISH analysis demonstrated the sole abnormality of a gain of trisomy 12 cells in all eight cases of cellular fibroma. Both a gain of trisomy 12 cells and a gain of tetrasomy 12 cells were observed in one case of fibrosarcoma. A gain of trisomy 8 cells was observed in all two fibrosarcomas in which signals were detected. By contrast, neither a gain of trisomy 8 cells nor a gain of tetrasomy 12 cells was observed in any of the eight cases of cellular fibroma. Chromosome 17 showed disomy in all eleven cases. On the basis of these findings, a gain of trisomy 8 cells is therefore considered to be an adequately effective marker to distinguish between cellular fibroma and fibrosarcoma of the ovary, and it may also be related to the proliferative activity of fibrosarcoma of the ovary.

A phase I and II clinical trial of a newly developed ultrasound hyperthermia system with an improved planar transducer

PURPOSE

The clinical usefulness of a newly developed ultrasound hyperthermia system was evaluated.

METHODS AND MATERIALS

The hyperthermia system uses a modified planer transducer operated at frequencies of 0.5, 1.0, and 1.5 MHz. The transducer has a nonvibrating part at the center to reduce the central hot spot. Frequency sweeping technique is also used to eliminate the annular hot spot around the center. Thirty-eight tumors in 29 patients were examined in this study. In 35 tumors, hyperthermia was given in conjunction with irradiation and/or chemotherapy, and in the remaining 3 tumors, hyperthermia alone was given. In all, a total of 153 hyperthermia sessions were performed.

RESULTS

The number of hyperthermia sessions per tumor ranged from 1 to 7 (mean, 4.0 +/- 1.3). The number of intratumor thermometry points per session ranged from 1 to 8 (mean, 4.3 +/- 1.5). The average intratumor temperature for tumors with a maximum depth of <3 cm, 3-6 cm, and >6 cm was 42.1 +/- 1.2, 41.7 +/- 1.4, and 39.9 +/- 2.0 degrees C, respectively. The percentage of monitored intratumor points with temperature exceeding 42 degrees C was 56 +/- 31%, 43 +/- 34%, and 21 +/- 24%, respectively. Of the 30 evaluable tumors treated with combined irradiation, 12 showed complete response, 14 partial response, and 4 no change. Observed complications included pain at the treatment site in 13 of the 153 treatment sessions and vesicle formation in 3 of the 38 treatment sites. No serious complication was seen.

CONCLUSIONS

These results indicate that the newly developed ultrasound hyperthermia system is clinically useful for the treatment of localized superficial and subsurface tumors with a maximum tumor depth of no more than 6 cm.

[Palliative radiation therapy for multiple myeloma]

PURPOSE

Radiation therapy is a useful palliative modality for refractory lesions of multiple myeloma. It has been reported that total doses of 10 to 20 Gy are usually adequate to obtain some degree of pain relief. However, there are many patients who need additional doses to obtain sufficient pain relief. In this study, we retrospectively analyzed the records of patients with multiple myeloma irradiated at our department, in an attempt to develop an effective treatment policy for this disease.

MATERIALS AND METHODS

Twenty-nine patients with 53 lesions were treated between 1968 and 1993. Total irradiation doses were 4 to 60 Gy(median 40 Gy) with daily fractions of 2 Gy or less, and 16 to 51 Gy(median 30 Gy) with daily fractions greater than 2 Gy. Evaluated were 59 symptoms, including pain (68%), neurological abnormalities (15%), and masses (28%).

RESULTS

Symptomatic remission was obtained in 33 of 36 (92%) lesions with pain, 6 of 8(75%) with neurological abnormalities, and 13 of 15(87%) mass lesions. Pain was partially relieved at a median TDF of 34, and completely at a median TDF of 66(equivalent to 40-42 Gy with daily fractions of 2 Gy).

CONCLUSIONS

Radiation therapy is an effective and palliative treatment method for symptomatic multiple myeloma. However, the treatment seems to require higher radiation doses than those reported to obtain adequate relief of symptoms.

The selectivity of motion-driven visual attention in infants

The onset of motion was used to study stimulus-driven visual attention in 14-week-olds. The movement of an object did not capture attention reflexively at 14 weeks of age. The attention-getting properties of a moving stimulus depended significantly on its color in combination with the colors of other objects in the visual field. Specifically, detection of a green moving target was masked in the presence of mixed red and green static objects. No such masking was observed when the moving target was red or when the green target moved in a visual field that was populated only with green objects. The same effect was observed to a lesser extent when the green bars were replaced with gray bars. The number of distractors in the visual field exerted an effect on the accuracy of detection only when their appearance in the visual field was coincident with the onset of target motion. Attention to motion at this age is not independent of the structure of the visual field; chromatic preferences play a role in how readily infants attend to a moving object. These effects may be mediated by a difficulty in disengaging attention (from distractors) or in suppressing attention to competing objects once attention is engaged on a target.

Clinical usefulness of determining the rate of thermal clearance within heated tumors

Between June 1987 and June 1988, 28 patients (28 tumors) with liver, retroperitoneal, intrapelvic, or superficial tumors were treated with hyperthermia combined with radiotherapy and/or chemotherapy. Hyperthermia was administered once or twice a week for 30-60 min per session, up to a total of 2-11 sessions, with an 8-MHz RF capacitive heating device. Blood flow in the tumors was evaluated from the rate of thermal clearance (TCR) using the bio-heat transfer equation. The TCR was measured in the middle of the first heating session and at the end of the last heating session by turning off the output power of the heating device. For 9 patients, contrast-enhanced CT scans were taken and CT numbers at the centers of tumors were measured before and after the entire course of hyperthermia. Changes in TCR were closely related to average tumor center temperature, changes in CT number, and tumor response. When smaller and more superficial tumors were treated by hyperthermia combined with radiotherapy and/or chemotherapy that consisted of many heating sessions and during which a high average tumor center temperature was achieved, a better tumor response was obtained. The better the tumor response, the higher the local control rate became. The cause-specific survival rate of patients who achieved good tumor responses was higher than that of patients who showed poor tumor responses. Changes in TCR and CT number in heated tumors were useful and important indicators of tumor response to hyperthermia.

Metastatic testicular choriocarcinoma of the skin. Report and review of the literature

Choriocarcinoma is a malignant growth of trophoblastic cells characterized by secretion of human chorionic gonadotropin. Choriocarcinoma usually arises from fetal trophoblasts and rarely arises from germ cells in the testis or ovary or derives from dedifferentiation of other carcinomas. Skin metastasis of choriocarcinoma is rare: only seven cases have been reported in the English and Japanese literature. We report the case of a 22-year-old Japanese man with pure choriocarcinoma of the testis who developed skin metastases that presented as multiple reddish nodules. Microscopic examination of both the primary lesion of the testis and the cutaneous metastasis demonstrated the typical histologic features of pure choriocarcinoma. The patient died 3 months after the initial onset of skin metastasis. Review of the literature indicates that skin metastasis of choriocarcinoma usually occurs as a nodular lesion with the histologically typical feature of the primary disease and signals of poor prognosis.

CD8+ T lymphocytes in cytomegalovirus retinitis in a patient with AIDS

Images

Targeted hyperthermia using dextran magnetite complex: a new treatment modality for liver tumors

BACKGROUND/AIMS

Dextran magnetite complex (DM) is a colloidal suspension of subdomain magnetite particles ('magnetic fluid'). It has been reported that DM generates a great amount of heat in an AC magnetic field.

MATERIAL AND METHODS

In this experimental study on Japanese white rabbits, a new treatment modality for liver tumors was examined in which the tumor is selectively heated with an intravascularly administered DM-containing embolic material followed by external application of an AC magnetic field.

RESULTS

The heat generation of DM in vitro was found to be more than 3-fold greater than that with magnetite particles of 40-micron diameter. As a DM-containing embolic material, we developed a DM/Lipiodol emulsion. When DM/Lipiodol emulsion was injected into the hepatic arteries of the rabbits following VX2 tumor transplantation into the liver, embolization of the artery and selective heating of the embolized liver were successfully attained following exposure to a 100-kHz AC magnetic field of approximately 15000 A/m. Histological examination of the embolized liver disclosed that DM had accumulated in the hypervascular, viable part of the tumor.

CONCLUSION

These results demonstrate the potential feasibility of using a DM-containing embolic material for targeted hyperthermia of liver tumors.

Change in glucose homeostasis in rats by long-term magnesium-deficient diet

It is widely known that hypomagnesemia is one of the symptoms observed in diabetic patients. This study was performed to assess the effect of chronic magnesium (Mg) deficiency on glucose metabolism in rats. Male Sprague-Dawley rats (at the age of four weeks) were given a Mg-deficient diet or a control diet for two to eight weeks. The rats were orally administered sucrose solution (2 g/kg BW) every two weeks, and blood was drawn from a tail vein before and 15 min after sucrose loading to determine the concentrations of blood glucose and plasma insulin. At the same time, other rats in a non-fasted condition were sacrificed by decapitation (rats sacrificed at eight weeks were rats used for sucrose loading). The epididymal fat pads were immediately removed and adipocytes were isolated. The amount of glucose transporter 4 (GLUT4) in the plasma membranes and low-density microsomal membranes prepared from the adipocytes was measured by immunoblotting to estimate the influence of chronic Mg deficiency on glucose metabolism at the cellular level. In addition, plasma biochemical parameters and muscle mineral contents were also evaluated. The glucose concentration in fasted blood was significantly lower in Mg-deficient rats than in control rats throughout the experiment period. The feeding of a Mg-deficient diet also attenuated the response of blood glucose and plasma insulin: the glucose level in blood tended to be lower in Mg-deficient rats at 15 min after oral sucrose administration, and the difference was significant at two and eight weeks. The plasma insulin level in Mg-deficient rats was also lower, reaching a significant difference at two weeks. When animals were sacrificed in a non-fasted condition at 2-week intervals, the plasma glucose level was also significantly decreased in Mg-deficient rats as compared to control rats throughout the experiment period. The plasma insulin level in non-fasted Mg-deficient rats was also significantly decreased at two and six weeks. The Mg-deficient diet increased plasma triglyceride, but the difference was significant only at four weeks, and plasma cholesterol remained unchanged. The plasma Mg level was markedly lower in Mg-deficient rats throughout the experiment period. In Mg-deficient rats, the Mg content in muscle was significantly reduced at two and eight weeks, whereas the calcium and sodium contents were significantly increased throughout the experiment period. In Mg-deficient rats, the degree of translocation of GLUT4 to plasma membranes in the adipocytes stimulated by insulin was reduced only at eight weeks. In conclusion, since fasted and non-fasted blood glucose levels and the response of blood glucose to sucrose loading were decreased in Mg-deficient rats, it is suggested that Mg deficiency induces changes in the glucose metabolism via impaired glucose absorption in the intestine or an altered glucose uptake in the liver and/or peripheral tissues.

A novel developmental stage-specific lectin of the basidiomycete Pleurotus cornucopiae

A novel lectin was isolated from mycelia of the basidiomycete Pleurotus cornucopiae grown on solid medium. The lectin was purified to homogeneity by mucin-Sepharose affinity chromatography. The molecular mass of the lectin was 40 kDa under reducing conditions, but the subunits were polymerized through disulfide bridges under physiological conditions. Hemagglutinating activity of this lectin was completely inhibited by 2-mercaptoethanol, indicating that the multimer is active. The activity was also inhibited by EDTA, and restored by CaCl2. N-Acetyl-D-galactosamine was the most potent hapten inhibitor. N-terminal amino acid sequence analysis revealed that the mycelial lectin was different from the fruit body lectin of this organism. The mycelial lectin appeared prior to fruit body formation and disappeared during the formation of fruit bodies. The lectin was localized on the surface of solid-medium-grown mycelia, and only dikaryotic, and not monokaryotic, mycelia produced the lectin. These results suggest that the appearance of this lectin is associated with fruit body formation.

[Successful second stage operations for bilateral giant bullae with cardiovascular disease by thoracotomy and thoracoscopic surgery: a case report]

A 65-year-old male was admitted to our hospital because of bilateral giant bullae and right side pneumothorax. He had had a myocardial infarction and had been receiving medications. Considering his age, ischemic heart disease and hypertension, we excised the bullae in two operations. The first operation was open chest bullectomy of a giant bulla and small bulla on the right side. After this procedure, his clinical course was uneventful. In the second operation, thoracoscopic excision of the left side giant bulla was performed using only one endoscopic stapler by rotating each side of the bulla and making a clear excision line between the bulla and normal lung. His post operative course was excellent and he was discharged from our hospital on the 15th day after the second operation.

[Immediate surgical treatment for the traumatic pulmonary pseudocyst: a case report]

Nonpenetrating blunt trauma causing pulmonary pseudocyst is very rare. A 25-year-old young male suffered from motor vehicle accident. He was transferred to our hospital with severe hemoptysis. Immediately he was intubated and kept under mechanical ventilation. A chest X-ray film and CT-scan revealed a marked cavity lesion surrounded by an extensive infiltrate and alveolar air consolidation. Ordinary, it has benign clinical courses by conservative management. However, he was suffered massive and continuous bleeding from endobronchial tube. Therefore, one lung ventilation using a uni-vent tube blocker was performed. After twelve hours blockade, the cavity lesion was enlarged and trans-bronchial bleeding was continued severely. Emergency right lower lobectomy was carried out successfully.

Radiation therapy for T1,2 glottic carcinoma: impact of overall treatment time on local control

PURPOSE

Local control probabilities of T1,2 glottic laryngeal cancer were evaluated in relation to dose and fractionation of radiation therapy (RT).

MATERIALS AND METHODS

Between 1975 and 1993, 96 T1N0M0 glottic cancers and 32 T2N0M0 glottic cancers were treated with definitive RT. Total RT dose was 60-66 Gy/2 Gy for most of the T1 and T2 tumors, although 10 T2 tumors were treated with hyperfractionation (72-74.4 Gy/1.2 Gy bid). Of the 128 patients, 90 T1 glottic tumors and 30 T2 glottic tumors were followed for > 2 years after treatment. Multivariate analyses using the Cox proportional hazards model and a logistic regression analysis were performed to evaluate the significance of prognostic variables on local control.

RESULTS

The 5-year local control probability for T1 tumors was 85%, whereas that for T2 tumors was 71%. Multivariate analyses demonstrated that only overall treatment time (OTT) was a significant variable for local control. Total RT dose, normalized total doses at a fraction size of 2 Gy, and fraction size were not significant. Local control probability of T1 tumors with an OTT of 42-49 days was significantly higher than that of tumors with an OTT of > 49 days (P < 0.02). Only a 1-week interruption of RT, due to holidays, significantly reduced the 5-year local control probability of T1 glottic tumors from 89 to 74% (P < 0.05).

CONCLUSIONS

These results indicate that OTT is a significant prognostic factor for local control of T1 glottic tumors.

Evaluation of angiogenic inhibitors with an in vivo quantitative angiogenesis method using agarose microencapsulation and mouse hemoglobin enzyme-linked immunosorbent assay

In the present work, using a previously reported in vivo quantitative tumor-angiogenesis model, we attempted to ascertain whether this animal model is suitable for practical use in monitoring inhibitors of tumor angiogenesis. Mouse sarcoma-180 cells, human A431 cells or rat C6 cells microencapsulated in agarose beads were implanted s.c. into C57BL/6 mice. The level of blood vessel induction at the agarose pellet site was evaluated using mouse hemoglobin enzyme-linked immunosorbent assay on day 10 after implantation. Hydrocortisone, tetrahydro-S, medroxyprogesterone acetate, pentosan polysulfate and suramin inhibited blood vessel growth in our in vivo tumor-angiogenesis assay system, and heparin enhanced the antiangiogenic effects of hydrocortisone and tetrahydro-S. These results are almost entirely consistent with those observed in common assay systems, and suggest that this method may be useful for the identification and quantitative evaluation of inhibitors of tumor angiogenesis.

Sonochemical formation of gold particles in aqueous solution

Gold(III) ions in aqueous solutions of NaAuCl4 were reduced to form gold particles by ultrasonic irradiation. The rate of formation of gold particles was accelerated in the presence of certain organic additives such as surfactants, water-soluble polymers and aliphatic alcohols and ketones. The rates of formation of gold particles from 1 mM Au(III) ions in pure water were 3 microM min-1 under argon atmosphere and approximately zero under air, and in solutions containing additive the rates were 9-133 microM min-1 under argon and 8-40 microM min-1 under air. Surfactants stabilized the particles as colloidal state for more than several months. The rates of formation of both hydrogen atoms and hydroxyl radicals were estimated to be equal to 25 microM min-1 in the sonolysis of pure water under argon. Three reaction pathways leading to the reduction of metal ions were proposed: (1) reduction by hydrogen atoms; (2) reduction by reducing radicals formed via reactions of hydroxyl radicals or hydrogen atoms with the additives; (3) reduction by radicals formed from thermal reaction of the additives at the interfacial region between cavitation bubbles and bulk solution and/or in the cavities. The order of the contribution of these three pathways to the reduction of gold ions was (3) > (2) > (1) in most cases. The number averages of the size of gold particles formed in surfactant solutions under argon atmosphere were about 10 nm with a fairly narrow size distribution.

Effects of calcium gluconate on the utilization of magnesium and the nephrocalcinosis in rats fed excess dietary phosphorus and calcium

The effects of calcium gluconate on the utilization of magnesium and nephrocalcinosis in male Wistar rats made magnesium-deficient by adding excess dietary phosphorus (1.195 g of phosphorus/100 g of diet) and calcium (1.04 g of calcium/100 g of diet) were compared with the effects of calcium carbonate. The effects of dietary magnesium concentration on the magnesium status and nephrocalcinosis were also examined. Adding excess dietary phosphorus and calcium decreased the apparent magnesium absorption ratios and the concentrations of magnesium in the serum and femur and increased the deposition of calcium in the kidney, and the low magnesium condition (0.024 g of magnesium/100 g of diet) aggravated the deposition of calcium and the low magnesium status. The apparent magnesium absorption ratios and femur magnesium concentration in the rats fed a calcium gluconate diet (an equimolar mixture of calcium gluconate and calcium carbonate was used as a source of calcium) were significantly higher than in the rats fed a calcium carbonate diet (only calcium carbonate was used as a source of calcium), irrespective of dietary magnesium concentration. Dietary calcium gluconate lessened the accumulation of calcium in the kidney and increased the serum magnesium concentration compared with dietary calcium carbonate, when the rats were fed the normal magnesium diet (0.049 g of magnesium/100 g of diet) but not the low magnesium diet. We speculate that the increased utilization of magnesium by feeding the calcium gluconate diet to a limited extent prevented the low magnesium status and the severity of nephrocalcinosis caused by adding excess dietary phosphorus and calcium.

[Intravitreal injection of ganciclovir in AIDS patients with cytomegalovirus retinitis]

The therapeutic effects and safety of intravitreal ganciclovir injection were evaluated in 16 acquired immunodeficiency syndrome (AIDS) patients with cytomegalovirus (CMV) retinitis. The induction therapy was done in a total of 23 courses, i.e., in 14 eyes of 10 patients. Active lesions of CMV retinitis were suppressed by 3 to 7 injections over 21 to 42 days after the initiation of the induction therapy. Intravitreal injections once a week for maintenance suppressed the reactivation of the lesions for at least 6 weeks in 9 eyes of 7 patients among 10 eyes of 8 patients. As for the safety of intravitreal ganciclovir injections in the 16 AIDS patients with CMV retinitis, a total of 354 injections were given and two serious complications, that is, endophthalmitis and retinal detachment were observed in one eye each. During the course of intravitreal injection, 3 of 7 patients developed CMV retinitis in the contralateral eye and systemic CMV infections were suspected in 3 of 12 patients. Intravitreal injection of ganciclovir is thought to be effective for the treatment of CMV retinitis in AIDS patients, but careful procedure and examinations are needed.

The relation between body-fat distribution and lipid metabolism in postmenopausal women

OBJECTIVE

To evaluate the relationship between body-fat distribution and lipid metabolism in postmenopausal women.

METHODS

Fifty-four women (mean: 61.8 +/- 7.8 years old) showing hyperlipidemia and 63 controls were enrolled in this study. Their baseline characteristics and body-fat indices, as measured by DEXA, were compared. The correlations between the serum-lipid levels and the variables were evaluated.

RESULTS

The amount of upper-half-body fat and the body-fat ratio were significantly higher in the hyperlipidemia group. In single-regression analysis, there were low levels of correlation between the serum TC levels and the amount of upper-half-body fat and the upper-body fat ratio. There was a low level of correlation between the serum TG level and the amount of upper-half-body fat, the upper-lower-half-body-fat ratios, and the upper-half-body-fat ratio. After adjusting for variables, the serum TC and TG levels best correlated with the amount of upper-half-body-fat (r = 0.458, r = 457, respectively).

CONCLUSION

In postmenopausal women, lipid metabolism is reflected in the amount of upper-half-body fat, irrespective of age and the body-mass index (BMI).

Decreased cytochrome c oxidase activity but unchanged superoxide dismutase and glutathione peroxidase activities in the spinal cords of patients with amyotrophic lateral sclerosis

The cause of selective degeneration of motor neurons in the ventral horn of the spinal cord associated with amyotrophic lateral sclerosis (ALS) has still not been elucidated. Recently, so-called oxidative stress has been suggested to be a significant factor in the pathogenesis of this disease. We measured the antioxidant actions of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and cytochrome c oxidase (CO) of the human spinal cord in patients with ALS in comparison with those in control patients. Total SOD activity in spinal cord transections from patients with sporadic ALS was not significantly different from the controls in ventral, lateral, or dorsal regions, although enzymic activity was relatively higher in the ventral compared with the dorsal region. GSH-Px activity in the spinal cord of ALS patients was not very different from that in the control tissue. In contrast, CO activity was significantly reduced in all three regions of the spinal cord in patients with ALS, although the reduction was more marked in the ventral region. These results suggest that reactive oxygen species may attack the mitochondrial respiratory chain, leading eventually to the degeneration of vulnerable motor neurons in the spinal cord, even though no obvious changes in the activity of antioxidant enzymes are detectable.

[The cases of acute spontaneous subdural hematoma]

In this paper, 10 cases of acute spontaneous subdural hematoma (ASSDH) among 149 cases of all acute subdural hematoma (ASDH) were reported with a review of 36 cases in the literature. The age of the patients with ASSDH ranged from 48 to 90 years (mean age of 71.9 years), and the average age of ASDH patients was 52.4 years. The male to female ratio of ASSDH and ASDH was 3:7 and 5:2, respectively. ASSDH patients were older than ASDH patients, and ASSDH patient tended to be female. Four cases of ASSDH patients had the past history of dementia. The outcome of 5 cases of ASSDH with general complications was fatal. During operation in all cases except one, spurting arterial rupture from a branch of the cortical artery adjacent to the Sylvian fissure was observed. It was presumed in the literature that the mechanism of the arterial rupture is gliding movement of the brain, tearing an arterial twig with dural attachment, or the existence of the junction of an arterial twig as an anatomically weak point. Hypertension, alcoholism, dementia, past history of subdural hematoma or subarachnoid hemorrhage may be important influencing factors in this mechanism.

Development of an MR simulator: experimental verification of geometric distortion and clinical application

PURPOSE

To evaluate the geometric distortion on magnetic resonance (MR) images obtained with a permanent magnet system and determine the usefulness of MR imaging-assisted x-ray simulation in radiation therapy treatment planning (RTTP).

MATERIALS AND METHODS

The authors measured the distortion on MR images of grid-pattern phantoms. MR imaging-assisted x-ray simulation was performed with skin markers in 14 patients with bone tumors. Treatment planning had already been performed with a conventional system.

RESULTS

On phantom images, most of the positional displacements within a 120-mm radius from the center of the static magnetic field were less than 2 mm; larger displacements were observed in the peripheral region of the images. MR imaging was useful in the RTTP of all patients. The original radiation field was modified after MR examination in six patients.

CONCLUSION

The amount of image distortion within the practical area is acceptable for RTTP. MR imaging-assisted x-ray simulation is useful for patients with bone tumors and warrants further investigation.