148 PRODUCTION OF PUPS BY OVARIAN TRANSFER IN THE SYRIAN HAMSTER

Instead of gametes, ovaries could be used as alternative resources for cryopreservation. In this study, we attempted to produce pups by transplantation of fresh ovaries to foster mothers as a first step to establish a preservation method of hamster strains on the basis of the cryopreservation of ovaries in combination with ovarian transfers. We also checked the possibility of inter-strain transfers of ovaries, since immunological tolerance among hamster strains is suggested by the fact that most Syrian hamsters were derived from only a small number of animals. Fresh ovaries collected from 3-weekold females of HAW (white coat) and APA (albino) strains were transferred into ovarian bursae of 3-week-old recipient females with agouti-coat (Slc:Syrian) under anesthesia with xylazine and ketamine. Halves of ovaries of recipients were removed immediately before the transfers, i.e., both donor and recipient ovaries were present in each ovarian bursa. Successful transplantation of ovaries was checked by the coat color (non-agouti color) of offspring produced by test matings of recipients with Slc:Syrian males after the recipients became mature. Five and six recipients received HAW and APA ovaries, respectively. All 11 recipients tested became pregnant and delivered pups. According to the coat color of the pups, three of five recipients which received HAW ovaries and one of six recipients which received APA ovaries delivered pups derived from transplanted ovaries (two out of eight pups, one out of seven pups, and three out of 11 pups for HAW; one out of five pups for APA). Our results indicate that transplantation of fresh ovaries to foster mothers could be used for production of pups from grafted ovaries in the Syrian hamster. In particular, immunological tolerance for ovarian transfers among at least three strains suggests that recipient strains might not need to be the same as donor strains for practical ovarian transfers in the Syrian hamster. Our results would facilitate the development of a strain preservation system for the Syrian hamster based on ovarian cryopreservation. This work was supported by a grant from the Ministry of Health, Labor, and Welfare of Japan.

Proliferation and adhesion of periodontal ligament cells on synthetic biominerals

OBJECTIVE

Hydroxiapatite (HA) has been suggested as a useful biomaterial to support the regeneration of tissues. In this study, we investigated the adhesion of periodontal ligament (PDL) cells on octacalcium phosphate (OCP) and its hydrolyzed apatitic product (HL), which are known precursors of HA.

METHODS

Rat PDL cells were cultured on OCP or HL-coated dishes. Cell proliferation and adhesion and mRNA expression of collagen I, fibronectin integrin subunits were examined. Cell adhesion inhibition assays were carried out by GRGDSPK (Gly-Arg-Gly-Asp-Ser-Pro-Lys).

RESULTS

In early culture period, the cell number of PDL cells was lower on OCP and HL than that on control without any coating. However, the cell number on OCP or HL caught up with control later period. mRNA expression level of collagen I and fibronectin on OCP and HL were similar among OCP HL and control, although they differed early in the culture period. Integrin subunits were expressed on both OCP and HL as well as on control. Cell adhesion was inhibited by RGD inhibitor peptide.

CONCLUSION

Our findings indicated that rat PDL cells produce collagen I and fibronectin on OCP and HL, and then show increased cell numbers depending on adhesion to the matrices through integrins.

Formation of bone-like apatite enhanced by hydrolysis of octacalcium phosphate crystals deposited in collagen matrix

It has been shown that granules of synthetic octacalcium phosphate (OCP) or the composites with collagen are capable of enhancing bone regeneration, accompanied by a gradual conversion from OCP to apatite with time. The present study was designed to investigate whether formation of bone-like apatite can be accelerated by OCP deposited throughout collagen matrix (OCP collagen complex, OCC) immersed in simulated body fluid (SBF). The formation of bone-like apatite has been suggested to be essential to induce osteoconductivity of various substrates. The formation of OCP in collagen solution was investigated in calcium or phosphate ions in the range between 22.5 and 142.5 mM and pH 6.26 and 8.56. X-ray diffraction, Fourier transform infrared spectroscopy, and scanning electron microscopy (SEM) showed that condition to nucleate OCP was limited to that of a solution with Ca/P 0.43 around pH 7.16 in the presence of collagen. OCP was shown to be formed throughout the collagen matrix by SEM observation. The immersion of OCC in SBF up to 10 days enhanced apatite crystal deposition, probably through OCP-apatite conversion: the apatite formation in OCC took place within only 1 day. The present study indicated that the existence of OCP deposited throughout the collagen matrix promotes bone-like apatite formation under physiological condition.

Characterization of dentin formed in transplanted rat molars by electron probe microanalysis

The present study was designed to characterize dentin formed in transplanted rat molars by investigating calcium (Ca), phosphorus (P), and magnesium (Mg) concentrations using electron probe microanalysis (EPMA) as well as examining the rate of dentin matrix formation by vital staining. The unerupted immature lower right second molar in 2-week-old rats was transplanted into the upper right first molar socket. Rats were injected with oxytetracycline, calcein, and alizarin intraperitoneally at 1 day before and 1 and 2 weeks after transplantation, respectively, for vital staining. The maxillae and mandibles were fixed 3 weeks after transplantation, resected, and embedded in resin. Undemineralized sections were cut and examined by fluorescent microscopy and EPMA. The thickness of dentin formed in the first week after transplantation was significantly less than that of dentin formed in any other 1-week period in the transplanted tooth and was about one-fifth the thickness of dentin formed in control teeth. Formation of dentin recovered in the third week after transplantation. In the first week after transplantation, EPMA demonstrated a sharp increase in Mg concentration with a slight decrease in Ca concentration. Thereafter, no significant difference was identified among Ca, P, or Mg concentrations or the Ca/P ratio between transplanted and control teeth. These results suggest that disruption of the circulation and innervation by transplantation cause a temporary change in the matrix formation rate and elemental distribution of dentin, which is subsequently restored within 2 weeks after transplantation.

Comparative study on osteoconductivity by synthetic octacalcium phosphate and sintered hydroxyapatite in rabbit bone marrow

Octacalcium phosphate (OCP) is thought to be a precursor of the mineral crystals in biological apatite. Synthetic OCP has been shown to be converted into an apatite structure when implanted in murine calvarial bone, to enhance bone regeneration more than synthetic hydroxyapatite (HA), and to degrade faster than biodegradable beta-tricalcium phosphate. This study was designed to investigate whether OCP implantation enhances the formation and resorption of new bone (remodeling) concomitant with OCP degradation when implanted intramedullary in a rabbit femur for 12 weeks, compared to sintered HA ceramic. Histological and histomorphometric analyses using undecalcified specimens showed that the area of bone apposition was significantly higher on OCP than on HA between 2 and 3 weeks, whereas it subsequently became smaller on OCP than on HA. The area attacked by multinucleated giant cells, including tartrate-resistant acid phosphatase (TRAP)-positive cells, was significantly higher for OCP than for HA at 8 weeks. Radiography revealed resorption of OCP but not of HA. The results disclose some osteoconductive characteristics of synthetic OCP in the bone marrow space: (1) enhancement of bone regeneration at the initial bone apposition stage and (2) stimulation of resorption of the newly formed bone coupled with OCP biodegradation mediated by TRAP-positive osteoclast-like cells. These results suggest that synthetic OCP would be a more useful bone substitute than HA in implant applications where rapid bone formation and concomitant implant resorption are important considerations.

Predicting time of parturition from changing vaginal temperature measured by data-logging apparatus in beef cows with twin fetuses

Vaginal temperatures (VT) of crossbred (Japanese Black crossed Holstein-Friesian) beef cows (n = 31) were measured by a data-logging apparatus to obtain serial data from days 0 to 6 before parturition. For both single and twin pregnancies, no significant differences were observed in VT during days 3-6 before parturition. Maternal VT was not affected by maternal weight just after parturition, parity, fetal sex, or total fetal litter weight. Average of twin litter weights for two males (MM) and two females (FF) had the strong positive correlations (r = 0.84; P < 0.05) with maternal VT, whereas twin weights of mixed-gender twins (FM) did not correlate with maternal VT (r = -0.26; P = 0.61). Maternal temperature decreased as weights of the female fetus of FM twins became heavier (r = -0.82; P < 0.05). In contrast, maternal VT of FF and MM twins increased as twin weights increased. We defined when the VT began to decrease before parturition by two different methods. One was the "same hours method" where differences in VT between a particular time of day and the corresponding time of the preceding day were compared when the VT was consistently > or =0.3 or > or =0.5 degrees C for more than 3h. The second method was the "maximum-minimum method" where decreased in the maximum or the minimum values of the day over > or =0.3 and > or =0.5 degrees C were compared to values of preceding day. Onset of decreased VT before expulsion was not different between singletons and twins. In an attempt to define the critical condition in predicting parturition, we estimated assumable predicting probability using the 31 cows that were collected VT. When the parturition occurred within 60 h in the "same hours method" and 72 h since VT was > or =0.3 degrees C and in the "maximum-minimum method", the assumable probability was 100%. In verification experiment under these condition, the "same hours method" had a higher probability of predicting the time of parturition than the "maximum-minimum method", and it was possible to detect the onset of decreased VT at the correct time by the minutes. We concluded that "same hours method" was useful for predicting parturition time in cattle with single and twin pregnancies by the serial measurement of vaginal temperature.

Multiple imaging techniques demonstrate the manipulation of surfaces to reduce bacterial contamination and corrosion

Surface imaging techniques were combined to determine appropriate manipulation of technologically important surfaces for commercial applications. The complementarity of the microscopy methods, scanning electron microscopy, electron probe microanalysis and atomic force microscopy assessed and correlated form and function of the surface modifications. Stainless steel disks (1 cm in diameter) were laser-cut from the same sheets of stainless steel and treated by electropolishing or left untreated for controls. Each treatment was analysed separately using each technique. First, the disks were examined by visual inspection and electron probe microanalysis for surface characteristics and elemental composition, respectively. Aliquots of bacterial suspensions (saline rinses of poultry carcasses from a commercial broiler processing plant) were then diluted in broth and monitored for growth by spectrophotometry. Stainless steel disks (1 cm in diameter) were added and the cultures were grown to sufficient density to allow attachment of bacterial cells to test surfaces. Relative differences in the surface morphology shown by atomic force microscopy, including Z ranges, roughness and other measurements, corresponded by treatment with the differences in reduction of bacterial counts shown by scanning electron microscopy. A model of wet-processing conditions tested the effects of corrosive treatment of surfaces. Less bacterial attachment occurred after corrosive treatment on controls and electropolished samples. Electropolishing significantly reduced bacterial numbers and the effects of corrosive action compared to the controls. Thus, the multiple imaging techniques showed that engineered changes on stainless steel surfaces improved the resistance of the surface finish to bacterial attachment, biofilm formation, and corrosive action.

Radiological and pathological changes in the sinus of an experimental arteriovenous fistula of the rat

SUMMARY

The object of this study is to evaluate the radiological and pathological changes in the sinus of an experimental arteriovenous fistula of the rat. Twenty-five male Sprague-Dawley rats, including two control rats, were used for this study. A venous hypertension model in the transverse sinus was induced by means of anastomosis of a common carotid artery (CCA) to the ipsilateral external jugular vein (EJV). Rats were sacrificed 11 to 42 weeks after the procedure, then histopathological and immunohistopathological examinations were performed for the resected transverse sinus. Follow-up angiography was performed two to three weeks after the anastomosis in every case, and five months later in two rats. Patency of the anastomosed portion was confirmed in 12 of the 23 anastomosed rats. An ipsilateral carotid angiogram demonstrated a highflow arteriovenous (AV) shunt from the CCA to the sigmoid-to-transverse sinus and draining into the contralateral juglar vein. A contralateral angiogram displayed a steal phenomenon via the communicating artery. Histopathologically, the vein of the anastomosed portion and the transverse sinus were markedly dilated in with cases. There was a thickening the connecting tissue and a proliferation of fibroblast in four (50%) of the eight cases. Thrombus formation in the transverse sinus was found in one case. VEGF stained strongly in the endothelial hypertrophied area and in fibrous connective tissue around the transverse sinus compared to the control sinuses. Our results from this long-term observation of the radiological and pathological changes in the sinus exposed to hypertension resembled the clinical findings of a dural AV fistula.

Treatment strategy for aneurysms of the posterior cerebral artery

SUMMARY

The authors carried out a retrospective review of the records of 12 patients with aneurysms of the posterior cerebral artery (PCA). Four were asymptomatic, 1 presented with a mass effect, and 7 with a subarachnoid haemorrhage (SAH). Of the 7 ruptured aneurysms, 3 were embolized and 2 were clipped. However, 2 patients died from rebleeding before any treatment. Of the 5 unruptured aneurysms, 1 was embolized with coils but the remaining 4 have been conservatively observed. No aneurysms have ruptured during the follow-up period, and 3 have thrombosed spontaneously. According to our results, the PCA aneurysms should be treated aggressively in the early phase. Although the preservation of the anatomical integrity of the PCA should naturally be one of the prime objectives, PCA occlusion may sometimes be inevitable when treating large or fusiform aneurysms. On the other hand, conservative therapy is one of the options for the treatment of incidentally encountered unruptured ones, because these have the possibility of spontaneous thrombosis.

Occurrence of Podosphaera xanthii Race 2 on Cucumis melo in Brazil

Powdery mildew is an important disease of melons (Cucumis melo L.) cultivated in greenhouses in Brazil. Currently, there are 5 races of Podosphaera xanthii (formerly known as Sphaerotheca fuliginea) and 2 races of Golovinomyces cichoracearum (formerly known as Erysiphe cichoracearum) described on melons worldwide, but only race 1 of P. xanthii has been reported in Brazil (1). However, typical whitish powdery fungal growth was observed on an experimental hybrid yellow melon resistant to race 1 of P. xanthii during the summer of 2000 in a greenhouse in Bragança Paulista, State of São Paulo. Conidia collected from diseased leaves were spread onto 0.5% water agar medium and maintained at 22°C for 24 h with 12 h of light and 12 h of darkness. Most of the germinated conidia displayed fibrosin inclusion bodies when observed in a solution of 3% potassium hydroxide (KOH), and approximately 1 of 50 also displayed forked germ tubes. These features allowed us to identify P. xanthii as the causal agent. Conidia raised on the susceptible yellow melon 'Amarelo CAC' were used to inoculate cotyledons of the differential melon lines (2) 'Hale's Best Jumbo' (susceptible to races 1, 2, and 3 of P. xanthii), 'PMR-45' (resistant to race 1 and susceptible to races 2 and 3), and 'PMR-6' (resistant to races 1 and 2 and susceptible to race 3). Inoculations were performed on 10 plants of each differential line and replicated four times. The presence or absence of symptoms was evaluated 18 days after inoculation. 'Hale's Best Jumbo' and 'PMR-45' were rated as susceptible while 'PMR-6' was rated as resistant, thus indicating the presence of race 2 of P. xanthii in Brazil. During field surveys from 2001 to 2003, this race was found on squash (Cucurbita moschata), summer squash (C. pepo), and melons in São Paulo. References: (1) F. J. B. Reifschneider et al. Plant Dis. 69:1069, 1985. (2) C. E. Thomas et al. Cucurbit Genet. Coop. 7:126, 1984.

Local hyperthermia enhances thrombosis in aneurysms containing platinum coils

SUMMARY

Despite recent technical advances in embolization of cerebral aneurysms with platinum coils, some aneurysms eventually resulted in incomplete packing with remnant neck or dome filling. Such a situation with a remaining inflow zone may pose a risk of rupture and subsequent regrowth. Metals characteristically generate heat under high-frequency alternating magnetic fields (AMF). We used this property to induce local hyperthermia and promote thrombogenesis in incompletely packed aneurysms. Glass model aneurysms packed with coils were subjected to AMF to investigate the correlation between weight of platinum and temperature elevation and the correlation between flow rates of water through the model and temperature elevation. Next, activated coagulation time (ACT) of blood obtained from dogs was studied at various temperatures. Finally, side-wall aneurysms created in the canine carotid artery using a venous patch were packed with platinum coils. Change in temperature and angiographic changes were investigated after AMF application. In the glass model, the weight of platinum was correlated with elevation of temperature, and a negative logarithmic correlation was evident between flow rate and elevation of temperature. Elevation of blood sample temperature tended to shorten ACT. In canine carotid aneurysms, elevation of intra-aneurysmal temperature was confirmed and sufficient elevation of temperature was found to promote angiographically evident thrombogenesis of the remnant space after AMF application. Local hyperthermia may be useful in completing luminal obliteration of aneurysms after coil embolization. It may particularly useful for ruptured aneurysms to prevent the early rerupture.

Comparison of Endovascular and Surgical Treatment for Ruptured Cerebral Aneurysms with respect to Short and Long-Term Outcome

SUMMARY

We compared the treatment for ruptured aneurysms from the clinical and radiological follow-ups after endovascular (GDC) or surgical treatment. There were 142 surgically treated cases and 38 endovascular treated cases from May 1997 to December 2001. In endovascular cases there were four A-com, four MCA, 12 ICA and 18 posterior circulation aneurysms. In surgical cases, there were 53 A-com ACA, 51 MCA, 36 ICA and two posterior circulation aneurysms. The clinical outcomes of endovascular and surgical treatments were correlated with the H & H grades before treatments. At short stage, 71% of endovascular and 78.2% of surgical cases showed a favorable outcome (GOS GR or MD) (p=0.3). Long-term clinical follow ups (14.5 to 58 months) showed 77.7% of endovascular and 87.7% of surgical cases resulted in GR or MD (p=0.17). In endovascular cases, 22.2% showed recurrence during the follow-up period and five of them needed re-treatment. We experienced failed endovascular approach at acute stage in seven cases which changed to surgery. In conclusion, the short and long term clinical results of endovascular treatment were acceptable comparing surgical clipping. High recurrence rate after GDC treatment did not permit future completeness of the treatment. Still the treatment alternative between endovascular or surgical treatment may change depending on the criteria of each institution, attention should be paid to the disadvantages of endovascular treatment as the first choice for ruptured aneurysms.

Nagoya university training system for neuroendovascular therapists

SUMMARY

It is very important to train more neuroendovascular therapists (NETists) in response to Japan's growing social needs. Since the supply of qualified NETists is still insufficient to cover Japanese institutions, therefore some emergency cases with indications for endovascular therapy may be overlooked, untreated or treated by other methods resulting in unfavorable outcomes. Thus, neuroendovascular therapies are situated as one of the important tratment modalities for neurosurgical diseases (1,2). We studied our present states of the endovascular neurosurgery and introduce our training system.

251SEARCH FOR GENES INVOLVED IN DEVELOPMENTAL COMPETENCE IN MOUSE OOCYTES USING SUPPRESSION SUBTRACTIVE HYBRIDIZATION

During the first month after birth, synchronous follicular growth occurs in the ovary of immature mice (first wave). Previously, we showed that mouse oocytes during the first wave were more competent developmentally in older females (Suzuki O et al., 2002 Theriogenology 57, 628 abst), although the numbers of mature oocytes did not differ with female age (17, 18, and 24 days old). In this study, we examined the genetic factors that affect the developmental competence of mouse oocytes during the first wave using suppression subtractive hybridization (SSH). Oocytes collected from 17- and 24-day-old B6D2F1 females (D17 and D24, respectively) without hormonal treatment were matured in Waymouth medium supplemented with pyruvate (0.23mM), antibiotics, bovine fetuin (1mgmL−1), and polyvinylpyrrolidone (3mgmL−1). After 17-h culture at 37°C in an atmosphere of 5% CO2, 5% O2, and 90% N2, total RNA was isolated from oocytes whose germinal vesicles had broken down (mature oocytes), separately, in three independent culture groups per age (each group contained oocytes from four animals) using Cell-to-cDNA Cell Lysis Buffer (Ambion, Austin, TX, USA). Some of the total RNA from each independent group was pooled by age (total of RNA from approximately 100 oocytes per age) and used for SSH. A SMART cDNA Synthesis Kit (Clontech, Palo Alto, CA, USA) was used to reverse-transcribe total RNA to cDNA. SSH was performed with a PCR-Select cDNA Subtraction Kit (Clontech). The subtracted PCR products were cloned into pGEM-T vector (Promega, Madison, WI, USA). Clones from the subtracted library (D24−D17) were sequenced and their identities were examined using the NCBI BLAST search. The differential expression of candidate genes preferentially expressed in mature D24 oocytes suggested by SSH was confirmed with cDNA transcribed separately in the three independent culture groups per age using real-time quantitative PCR with an ABI Prism 7900HT with TaqMan technology (Applied Biosystems, Foster City, CA, USA). Of 513 clones sequenced, the top six preferentially-expressed candidate genes in more developmentally-competent D24 oocytes were spindlin (20 clones), bmi-1 (4 clones), cyclin B1 (4 clones), E330034G19Rik (4 clones), Jagged1 (4 clones), and Ndfip2 (4 clones). The expression of spindlin in mature D24 oocytes (relative threshold cycle: −3.8±0.7, mean±SD) was confirmed to be approximately 11-fold higher than in D17 oocytes (−0.3±1.5) when GAPDH was used as an internal control (P&lt;0.05, t-test). Quantitative analyses of mRNA expression of the remaining genes are now under way. Our results suggest that spindlin is one of the key factors leading to the acquisition of developmental competence in mouse oocytes during folliculogenesis. Supported by JSPS KAKENHI (No.145716000) and MHLW.

New scaffold for recombinant human bone morphogenetic protein-2

A bioactive and resorbable scaffold is necessary to exhibit the osteoinductive potency of recombinant human bone morphogenetic protein-2 (rhBMP-2). In a previous study, we found that synthetic octacalcium phosphate (OCP) enhances bone regeneration and is replaced by newly formed bone after it is resorbed. We hypothesized that OCP may be useful as an effective scaffold for rhBMP-2 to enhance bone regeneration. To test this hypothesis, the present study was designed to investigate whether an OCP/BMP composite implant could more effectively enhance bone regeneration. A critical-sized defect was made in a rat calvarium and 1. 15 mg of OCP combined with 10 microg of rhBMP-2 (OCP/BMP 10 microg), 2. 15 mg of OCP combined with 1 microg of rhBMP-2 (OCP/BMP 1 microg), or 3. OCP (OCP alone) was implanted into the defect and fixed at 4 or 8 weeks after implantation. The percentage of newly formed bone (n-Bone%) in the defect was determined by a histomorphometrical analysis. A statistical analysis showed that n-Bone% with OCP/BMP was significantly higher than that with OCP at both time points, whereas the difference in n-Bone% between OCP/BMP 10 microg and OCP/BMP 1 microg was not significant. The present results suggest that OCP can be used as an effective scaffold for rhBMP-2 and this OCP delivery system may be able to reduce the standard effective dose of rhBMP-2, which would be beneficial because low doses (<100 microg/g OCP) of rhBMP-2 enhance bone regeneration.

Differential response to low temperature of two Delta6 fatty acid desaturases from Mucor circinelloides

A recently identified Delta6 fatty acid desaturase in Mucor rouxii shows a low sequence homology (approximately 24% at the amino acid level) to that isolated from Mortierella alpina, but is phylogenetically closer to a plant enzyme, suggesting the occurrence of Delta6 desaturase isozymes in Mucorales molds. In the present study, two types of Delta6 desaturases, mcD6-1 ( Mo. alpina type) and mcD6-2 ( M. rouxii type), were cloned from Mucor circinelloides. When the cloned genes were expressed in the yeast Saccharomyces cerevisiae in the presence of a linoleic acid substrate (C18:2Delta9, 12), a newly generated gamma-linolenic acid (C18:3Delta6, 9, 12) was detected in the cells, which confirmed the suspected enzymatic function of the recombinant protein. This is the first report of Delta6 desaturase isozymes present in one organism. Northern analysis demonstrated that the amount of mcD6-2 mRNA was less than half of that of mcD6-1 mRNA in cells grown at 28 degrees C. However, upon cultivation of the cells at 15 degrees C for 0.5-1 h, mcD6-2 mRNA rapidly increased by up to 1.5-fold and then gradually decreased. By contrast, mcD6-1 transcripts levels did not fluctuate significantly for 1 h after the temperature shift, but declined by 75% over the next 2 h. The gamma-linolenic acid content in total fatty acid from M. circinelloides decreased at 28 degrees C, but was maintained at approximately 30% at 15 degrees C. These data suggest that Delta6 desaturase isozymes play physiologically distinct roles in the maintenance of cellular lipids and adaptation to low temperature.

Coil retrieval following embolization of cerebral aneurysms

SUMMARY

Failed coil embolization of cerebral aneurysms may be occasionally followed by direct surgical treatment. We had 5 patients who underwent coil retrieval and surgical clipping after coil embolization because of periprocedural complications. The patients, ranging in age from 40 to 71, had wide-neck aneurysms located at the anterior communicating artery (AcomA) in 3 patients, the middle cerebral artery (MCA) in 1, and the internal carotidophthalmic artery (IC-Ophthalmic) in 1. They were embolized with Guglielmi detachable coils (GDCs), which had to be retrieved within 8 days because of coil protrusion and migration in 3 patients, aneurysm rupture in 1, and increased mass effect due to coil compaction in 1. Coils were successfully removed with aneurysmotomy or arteriotomy under temporary trapping, aneurysms were then clipped or trapped. Three patients had a good outcome, but one suffered permanent visual disturbance and the other had a motor deficit. Our study revealed that a small AcomA aneurysm had a high risk of complication in a case of complex anatomy of the AcomA-A1-A2 complex with its difficult access. In addition, insufficient packing of the inflow zone in a large and symptomatic aneurysm may cause coil compaction and regrow with increasing mass effect. The indication and treatment strategy for these aneurysms should be carefully determined.

Treatment Strategy for Cerebral Aneurysms Based on the Evidence of the Efficacy of GDC Embolization

SUMMARY

The authors reviewed 531 patients with cerebral aneurysms treated with Guglielmi detachable coils (GDCs) over 5 years to clarify both the advantages and disadvantages of embolization based on the evidence of complications by aneurysm profile. There were 52 technical complications, 25 of which resulted in unfavorable patient outcomes. Intraoperative rupture, the most serious complication exacerbating the patient's condition, occurred in 19 patients, 4 of whom expired. All of these aneurysms were very small and were mostly located in the AcomA and PICA portions. Thirteen patients encountered thromboembolic complications, 6 of whom were elderly with acute ruptured aneurysms at MCA and the tip of BA. For large or giant aneurysms manifesting the mass effect, particularly those in the ICA-C2 portion compressing the optic nerve, the saccular packing did little to ameliorate the symptoms, and subsequent surgical or endovascular trapping was needed. Therefore, saccular embolization of endovascularly difficult, very small AcomA aneurysms and large C2 aneurysm with visual symptoms should be used sparingly based on a risk-benefit assessment.

A curious autopsy case of a car crash in which self-strangulation and lung collapse were found: a case report

A curious autopsy case following the car crash of a 20-year-old male, in which self-strangulation and lung collapse were observed, is presented. His motor vehicle had crashed into a restaurant as a result of self-strangulation using an electrical cord wound four times around his neck. At autopsy, we found small rupture holes of spontaneous bullae in both lung apices, which had probably taken place upon collision during driving, petechial hemorrhages in the face skin and the absence of severe injuries. Since it seemed unlikely that the small holes in both lung apices caused fatal pneumothorax instantly, the cause of his death was judged to be asphyxia due to self-strangulation. It is not clear whether the self-strangulation was suicidal or autoerotic, because neither traces of suicidal intent nor circumstances suggesting either of them were disclosed.