[A case report of dural sinus thrombosis: direct thrombolytic therapy using endovascular surgery]

Dural sinus thrombosis, a relatively rare disease, is difficult to diagnose because of variable symptomatic manifestations. We successfully treated a case of dural sinus thrombosis by direct thrombolysis using an endovascular technique in combination with postoperative anticoagulant therapy. The patient, a 19-year-old female, developed a headache affecting her whole head on December 13, 1993. She was admitted to our hospital the next day. Neurological examination upon admission revealed no neurological abnormalities, nor was there any abnormality in CT scan, either plain or enhanced, taken on the day of admission. The patient's consciousness deteriorated in the early morning of December 22. MRI and cerebral angiography revealed thrombi from the confluence of the sinuses to the right transverse and sigmoid sinus, with disturbed circulation through deep cerebral veins. Systemic thrombolytics, steroid and mannitol were started, but, on the next day, the third ventricle was compressed by bilateral swelling of the basal ganglia, with hydrocephalus. Since her consciousness deteriorated further despite ventricular drainage and barbiturate therapy, direct thrombolytic therapy was performed on December 25. A catheter was placed in the superior sagittal sinus, and 600,000 units of urokinase was locally injected, followed by postoperative anticoagulant therapy. The patient's condition improved rapidly. On CT scan, the bilateral swelling of the basal ganglia disappeared along with the hydrocephalus. At about 1 month after endovascular surgery, MRI and cerebral angiography revealed recanalization of the deep cerebral veins, straight sinus and confluence of sinuses with improved opacification of the left transverse sinus, although the right transverse sinus was found to be re-occluded.(ABSTRACT TRUNCATED AT 250 WORDS)

Hydrolysis of DNA and RNA through cooperation of two metal ions: a novel mimic of phosphoesterases

The phosphodiester linkages in DNA and RNA are efficiently hydrolyzed through cooperation of the lanthanum(III) ion with the iron(III) or tin(IV) ion, although each of these metal ions exhibits poor activity. The conversion on the hydrolysis of adenylyl(3'-5')adenosine by the lanthanum(III)/iron(III) combination (10 mM each) at pH 7.0 and 50 degrees C for 5 min is 72 mol%, whereas the catalysis by the lanthanum or iron ion alone is only marginal. The activity of their combination in the hydrolysis of thymidyl(3'-5')thymidine is more than 15-fold greater than the sum of the activity of each of the two metal ions.

Simultaneous bleeding from multiple lenticulostriate arteries in hypertensive intracerebral haemorrhage

Angiography within 1 h of the onset of an intracerebral haematoma in a hypertension man showed active bleeding from at least two lenticulostriate arteries. We discuss the pathophysiological significance of this finding.

Angiographic extravasation of contrast medium in acute "spontaneous" subdural hematoma

Acute spontaneous subdural hematoma is very rare. We have encountered four such cases and verified the arterial origin of the bleeding at operation. None of the patients had a history of head trauma, and each had developed sudden onset of headache and other neurologic deficits, which simulate other cerebrovascular diseases. CT directly revealed subdural hematoma but gave no indication as to the source of the bleeding. Cerebral angiography was performed in all cases, with three of them showing localized extravasation of the contrast material into the subdural space. The extravasation was noted usually in the late arterial phase. This is a useful finding for diagnosing this disease and localizing the bleeding point. It is expected that with more routine use of cerebral angiography in cases of acute spontaneous subdural hematoma, extravasation of the contrast medium will be seen more frequently.

[Rebleeding of ruptured intracranial aneurysms in the acute stage]

Among the cases of ruptured aneurysms we have handled, some patients have rebled before surgery was performed. In this study, we examine the factors that contribute to the rerupture of cerebral aneurysms in the acute stage and suggest measures to prevent rerupture prior to surgery. We have encountered 32 cases of rebleeding prior to surgery. The rebleeding occurred within six hours of the initial subarachnoid hemorrhage (SAH) in 26 patients, among whom 21 rebled within three hours. Thirteen patients rebled during bed rest, 10 patients during angiography, 4 patients during CT scan and 5 patients in various other circumstances. Nine of the 10 patients who rebled during angiography had undergone the procedure within three hours of the initial SAH. Overall, the patients' condition deteriorated substantially after rebleeding. Considering these circumstances surrounding aneurysmal rerupture, we suggest the following measures for the prevention of preoperative rerupture in the acute stage: 1) maintenance of lowered blood pressure during the risky period; 2) intentional delay of performance of angiography until at least hours after the initial rupture, and 3) performance of surgery on an emergency basis.

Chronic subdural hematoma associated with middle meningeal arteriovenous fistula treated by a combination of embolization and burr hole drainage

A rare case of chronic subdural hematoma associated with a middle meningeal arteriovenous fistula was treated by a combination of embolization and burr hole drainage. This clinical situation might be missed in this era of computed tomography, when cerebral angiography is seldom indicated for the diagnosis of neuro-traumatic diseases. We should bear in mind the possibility of this clinical situation of a chronic subdural hematoma associated with a linear skull fracture crossing the middle meningeal groove in order to avoid possible hemorrhagic complications during surgery for chronic subdural hematoma.

Selective hydrolysis of tRNA by ethylenediamine bound to a DNA oligomer

A sequence-selective artificial ribonuclease was prepared by attaching ethylenediamine to the 5'-end of a DNA oligomer as the sequence-recognizing moiety. The hybrid, incorporating a 19-mer DNA which is complementary with the A44-A62 sequence of tRNA(Phe), hydrolyzed the tRNA selectively at the 3'-side of C63.

Lanthanide ions for the first non-enzymatic formation of adenosine 3',5'-cyclic monophosphate from adenosine triphosphate under physiological conditions

Adenosine 3',5'-cyclic monophosphate (cAMP) is formed from adenosine triphosphate at pH 8 and 50 degrees C by use of lanthanide ions. Pr3+ and La3+ are the most active. The cAMP formation is more efficient at higher pH, where the mixture is made homogeneous by the addition of beta-cyclodextrin. The potential functioning of lanthanide ions as the catalytic center of an artificial adenylate cyclase is indicated.

"Kissing aneurysms" of the internal carotid artery

Five patients with kissing aneurysms (adherent internal carotid-posterior communicating artery and ipsilateral internal carotid-anterior choroidal artery aneurysms) are reported. There was female predominance and the subarachnoid hemorrhage was commonly due to rupture of the proximal posterior communicating artery aneurysm. Despite the demonstration of angiographic cleavage, the two aneurysms adhere to each other, which makes surgical dissection difficult. Meticulous dissection of the aneurysmal necks and preservation of the blood flow in the anterior choroidal artery are of vital importance.

Catalytically active species for CeCl3-induced DNA hydrolysis

Cerium(III) chloride efficiently hydrolyzes DNA at pH 7 under aerobic conditions. A titration study showed that Ce(III) is oxidized to Ce(IV) in the reaction mixture and the resultant Ce(IV) is responsible for the DNA hydrolysis.

[Surgical treatment of arteriovenous malformations in the brain stem]

The authors report the surgical removal of four arteriovenous malformations (AVM's) in the brain stem causing hemorrhage. These included two intra-axial and two extra-axial AVM's. Three of the four were situated at the pons, and the remaining one in the posterior medullary velum. Complete surgical removal was obtained in the two extra-axial cases and in one of the intra-axial cases. The patient in whom complete removal was not obtained received partial embolization therapy with the remaining feeder being coagulated surgically. No patient was made permanently worse after surgery. One patient, in a comatose state on admission, died, while the remaining three patients showed useful recovery. These data indicate that surgical therapy with or without endovascular surgery appears to be possible for some AVM's and can be performed at an acceptable risk.

Endovascular treatment of acute thrombotic occlusion of the cervical internal carotid artery associated with embolic occlusion of the middle cerebral artery: case report

A 68-year-old man with acute, total thrombotic occlusion of the right cervical internal carotid artery, associated with embolic occlusion of the ipsilateral middle cerebral artery, was treated by the endovascular approach, i.e., intra-arterial fibrinolysis and balloon angioplasty. Endovascular treatment for a totally occluded internal carotid artery is indicated in the very early stage where there is no thrombus or a short thrombus that can be evacuated. Fibrinolysis of the associated embolus in the middle cerebral artery, if any, can be done in the same session, enabling an early restoration of the blood flow.

Effects of pectenotoxin-1 on liver cells in vitro

The effects of pectenotoxin-1 (PTX1), a nondiarrheagenic toxin from mussels, on liver cells were investigated by fluorescence microscopy. The in vitro application of PTX1 to these cells induced reduction in number and loss in radial arrangement of microtubules. It also induced disruption of stress fibers and accumulation of actin at the cellular peripheries. Further studies are worthwhile to explore the feasibility of using PTX1 as a tool for analyzing the properties of cytoskeletal proteins.

Enhancement of the cleavage rates of DNA-armed hammerhead ribozymes by various divalent metal ions

In order to characterize structure-function relationships, the kinetic behavior of chimeric RNA/DNA ribozyme was compared with that of all RNA ribozyme. Determined kcat values were proven to represent the chemical-cleavage step and not the product-dissociation step. In agreement with the finding by Dahm and Uhlenbeck [Biochemistry 30, 9464-9469 (1991)], various metal ions, including Co2+ and Ca2+ with the ionic radius of 0.65 and 1.0 A, respectively, could support hammerhead cleavage for both types of ribozyme. Measurements of kinetic parameters in the presence of various divalent metal ions revealed that DNA arms always enhanced kcat values. Chemical-probing data using dimethylsulfate indicated that the catalytic-loop structures of all-RNA and chimeric ribozymes were nearly identical with the exception of enhanced termination of primer extension reactions at C3 in the case of the chimeric ribozyme. These observations and others demonstrate that DNA substitution in non-catalytic-loop regions increases chemical-cleavage activity, possibly with an accompanying very subtle change in the structure.

Aneurysmal rupture during angiography

The aim of the present study was to analyze the clinical data on rebleeding in cerebral aneurysms during angiography and to evaluate the importance of the time interval between the latest rupture and angiography. Fourteen personal cases and 202 patients reported in the literature are reviewed. Rebleeding during angiography occurred most often (78%) on Day O; 89% bled when angiography was performed within 6 hours of the latest rupture. The prognosis in such ruptures was poor, with a mortality of 79%. Intentional delay in angiography of at least 6 hours from the latest rupture is recommended if the associated hematoma is not large.

[Neurological deterioration induced by giant intracranial aneurysms even though these aneurysms had not ruptured; mural hemorrhage and intraluminal thrombosis]

The authors report two cases of intracranial giant aneurysms inducing acute neurological deterioration even though rupture of the aneurysms had not occurred. Neurological aggravation was attributable to the acute swelling of the aneurysmal mass after intramural hemorrhage in one case, and the formation of rapid and massive intraluminal thrombosis in another case. MRI confirmed these mechanisms in both cases. MRI is very useful for demonstrating mural and intraluminal pathologies involving giant aneurysms.

[Hemorrhagic vascular lesions in facial injuries treated by intravascular embolization: report of two cases]

We have encountered 2 cases of hemorrhagic vascular lesion in the external carotid artery system caused by facial injury. In case 1, treatment of epistaxis by nasal packing was unsuccessful. Good result was obtained by intravascular embolization in the internal maxillary artery using polyvinyl alcohol particles and gelatin sponge pieces. In case 2, massive subgaleal hemorrhage due to tearing of the middle meningeal artery caused by a skull base fracture appeared following surgery for open skull fracture. Hemostasis was performed successfully by intravascular embolization in the middle meningeal artery using microcoils and gelatin sponge pieces. In cases of facial injuries with hemorrhagic lesions in the external carotid artery system, hemostasis is generally difficult. Referring to these two cases, we think that the treatment of choice is angiography followed by intravascular embolization.

Mechanism of acute deterioration of the neurological status following rapid and massive intraluminal thrombosis in case of a giant intracavernous carotid artery aneurysm: demonstration by MR imaging

A case is reported of a thrombosed giant aneurysm of the intracavernous carotid artery. Transient neurological deterioration was attributable to the acute swelling of the aneurysmal mass after rapid and massive intraluminal thrombosis. Characteristics on the magnetic resonance imaging of this case are reported and discussed.

[Surgical treatment of ruptured dissecting aneurysms: proximal clipping vs trapping]

The best surgical treatment for ruptured dissecting aneurysms of the vertebral artery is still controversial. Four patients (1 male, 3 female), age ranging from 43 to 62, were operated upon in our department during the last 6 years. Duration from rupture to the operation was 0 to 4 days. In 2 cases, proximal clipping was the primary treatment, while 2 had a trapping. Antiplatelet agents were given to prevent vasospasm in all cases postoperatively. In proximal clipping cases, one patient had suffered from fatal rerupture on the sixth postoperative day. In trapping cases, Wallenberg syndrome developed in one patient. These results suggest that a proximal clipping may not allow the treatment for the vasospasm because of the danger of rebleeding and also a trapped segment of vertebral artery should be as short as possible to avoid compromised perforators.

Extravasation of contrast medium from the lenticulostriate artery following local intracarotid fibrinolysis

Two patients with acute embolic occlusion of the intracranial internal carotid artery and the lenticulostriate arteries were treated by local intraarterial fibrinolysis using tissue plasminogen activator. Although fibrinolysis started within 2.5 hours from the ictus, extravasation of the contrast medium from the lenticulostriate arteries occurred in the region of the basal ganglia. Local intraarterial fibrinolysis for acute embolic occlusion of the internal carotid artery may be a high-risk therapeutic intervention even within the ultra-acute stage, especially when the lenticulostriate arteries are occluded by an embolus.

Pontine hemorrhages presenting as trigeminal neuropathy--report of three cases

Three patients with pontine hemorrhages presenting clinically as trigeminal neuropathy are described. No patient was hypertensive and angiograms were normal. Magnetic resonance (MR) imaging showed heterogeneous lesions, suggesting cavernous malformation, in one patient, but no definite diagnosis could be made in the other two patients. Such cases are rare and should be evaluated using serial MR imaging to differentiate angiographically occult vascular malformation from spontaneous hemorrhage.

Dynamics of actin and assembly of connectin (titin) during myofibrillogenesis in embryonic chick cardiac muscle cells in vitro

Immunogold electron microscopy of cardiac myocytes microinjected with biotin-labeled actin showed that gold labeling was first found around the A band level of myofibrils at their proximal parts. This observation suggests that polymerization of actin and/or the addition of newly formed actin filaments occurs preferentially in association with myosin filaments to increase the myofibrillar girth. At the distal portions of developing myofibrils, their terminal ends were initially labeled, suggesting that continued reorganization and/or de novo formation of myofibrils occurs at these locations. Soon, gold particles were seen along the termini of growing myofibrils. This appears to indicate that actin subunits are added at the membrane-associated ends of preexisting actin filaments to increase the length of myofibrils. Adhesion plaque proteins, e.g., vinculin, do not appear to play any role in assembling actin monomers at these sites on the inner surface of the sarcolemma. Immunofluorescence and immunoelectron microscopy of cardiomyocytes double-stained with antibodies against two distant domains of connectin (titin) filaments and other sarcomeric proteins showed that these domains of connectin filaments and myosin were synthesized almost simultaneously on large polyribosomes and/or associated immediately after the synthesis of these molecules. Connectin and myosin bands were formed after alpha-actinin striations (Z bands) were seen on preformed I-Z-I-like structures.(ABSTRACT TRUNCATED AT 250 WORDS)

[MR findings in traumatic cerebrospinal fluid leakage with special reference to indications of the need for dural repair]

Eleven cases of traumatic cerebrospinal fluid (CSF) leakage (8 cases of rhinorrhea and 3 cases of otorrhea) were reviewed to discuss magnetic resonance (MR) findings and surgical indications of the need for dural repair. Five patients had delayed onset of CSF rhinorrhea, 12 to 66 days (mean 28 days) after the trauma, and in the remaining 6 patients (3 rhinorrhea and 3 otorrhea) CSF leakage was noted on admission. MR study was carried out within 7 days after the onset of CSF leakage using a 0.5 tesla imager. In 7 cases of rhinorrhea, MR images demonstrated brain herniation into the ethmoid or frontal sinuses and the dural defects were repaired with the vascularized periosteum flap taken from the frontal bone or the fascia lata. In the operations, brain parenchyma was found to be plugged into the fracture line as MR images showed, and also to adhere to the margin of dural fistula. In the remaining 4 patients (without the MR findings of brain herniation into the paranasal sinuses) spontaneous cessation of CSF leakage occurred and their clinical course was good. Spontaneous cessation of CSF leakage in these cases may suggest the complete healing of the lacerated dura. However, in cases with the brain herniated into the paranasal sinuses CSF leakage may not be observed, and natural healing of the dural defect cannot be expected. Therefore, such brain herniation indicates the absolute need for dural repair even if CSF leakage is not observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Dural arteriovenous fistula: a cause of hypoperfusion-induced intellectual impairment

A 76-year-old, right-handed man developed posttraumatic dural arteriovenous fistula (DAVF) involving the superior sagittal sinus. He developed slow but progressive intellectual deterioration and gait disturbance after a minimal head trauma. Cerebral angiography demonstrated a DAVF of the superior sagittal sinus with sinus thrombosis supplied by branches of the bilateral external carotid arteries, and a DAVF of the right sigmoid sinus supplied by the right occipital artery. Selective embolization was carried out. He showed marked improvement on neuropsychological testing, especially on test items which are supposed to tap functions of the right cerebral hemisphere which showed an improved cerebral blood flow. We concluded that the intellectual impairment of our patient was caused by cerebral hypoperfusion, especially of the right cerebral hemisphere.

Molecular design of artificial hydrolytic nucleases and ribonucleases

Artificial nucleases and ribonucleases, which selectively hydrolyze the specific phosphodiester linkages in DNAs and RNAs, are prepared by the attachment of organic and inorganic catalysts to DNA oligomers as sequence-recognizing moieties. A hybrid of ethylenediamine and a 19-mer DNA selectively hydrolyzes tRNA(Phe) at the 3'-side of C63. Site-selective hydrolysis of DNAs has been accomplished by the lanthanide complexes bound to DNA oligomers. No concurrent oxidative cleavage of the ribose or the deoxyribose takes place.

Significance of gadolinium-enhanced magnetic resonance imaging in differentiating spinal cord radiation myelopathy from tumor. Case report

A young woman with a fourth ventricular ependymoma underwent radiotherapy following tumor excision. Twenty months later she developed a progressive neurological deficit at the C-2 vertebral level. Gadolinium-enhanced magnetic resonance imaging, showed an intramedullary lesion at the C-2 level. Although radiation myelopathy was suspected, tumor recurrence could not be excluded. Re-exploration and histopathology both confirmed a diagnosis of radiation myelopathy. A retrospective review of the case indicated findings favoring radiation myelopathy. The pertinent literature is reviewed and the findings discussed.

A provocative internal carotid artery balloon occlusion test with 99mTc-HM-PAO CBF mapping--report of three cases

The balloon occlusion test (BOT) of the internal carotid artery (ICA), combined with induced hypotension and cerebral blood flow (CBF) mapping, was carried out in three patients with a large or giant aneurysm of the ICA. Occlusion of the ICA for 10 minutes in the normotensive state was followed by 5 minutes of induced hypotension. During the last 2 minutes of hypotensive occlusion, technetium-99m-hexamethyl-propyleneamine oxime was administered to study the CBF. All patients tolerated the procedure well. One patient with moderate CBF reduction developed ischemic complications 24 hours after permanent ICA occlusion. Another showed no significant change in CBF and tolerated permanent ICA occlusion well, while the third refused permanent occlusion. The provocative BOT combined with CBF mapping is a promising predictor of complications of ICA occlusion secondary to perfusion abnormalities.

Embolization in high-flow arteriovenous malformations of the face

Five patients with arteriovenous malformations of the face (4 males and 1 woman; age range, 11-38 years) were treated by selective embolization through the feeding arteries with polyvinyl alcohol particles. Immediate gross angiographical obliteration was obtained in 4 patients, with pronounced reduction of the arteriovenous shunt in the fifth. Clinical symptoms including bleeding, swelling, pulsations, bruit, and disfigurement improved in all the patients followed up for a period of 6 to 21 months. Polyvinyl alcohol particle embolization, without surgical resection, though palliative could be useful in select patients. The classification and diagnosis of congenital vascular malformations is briefly reviewed and treatment discussed.

[Management of elderly patients with aneurysmal subarachnoid hemorrhage]

Clinical features of 61 elderly patients aged over 70 years with ruptured intracranial aneurysms were compared with those of 328 younger patients aged under 70 years. According to a policy of early operation, elderly patients with Hunt and Kosnik's grade I, II and younger patients with grade I, II, III were operated on in the acute stage. In elderly patients with grade III, IV and younger patients with grade IV, the indication for surgery was determined case by case. Surgery was performed on 29 patients (48%) in the elderly group and 277 patients (86%) in the younger group. Our conclusions are as follows: 1. Regarding cases of grade I, II and III of Hunt and Kosnik's classification, the rate of good outcome in the elderly group was similar to that in the younger group, following early surgery and meticulous post-operative care. 2. In the elderly group, no patient in cases of grade IV obtained good surgical outcome. 3. Symptomatic vasospasm was less frequent in elderly patients (18.8%) than in younger cases (37%). 4. Delayed operation was planned for some patients in the elderly group, but none of them underwent surgery because of rerupture of aneurysms and deterioration of general condition.

[Therapeutic occlusion of unilateral vertebral artery for unclippable aneurysms; special reference to postoperative brainstem ischemia]

Seven cases of unclippable vertebral artery aneurysms (3 dissecting, 1 fusiform, 2 saccular and 1 giant) are reported. Five of these had subarachnoid hemorrhage, one showed mass effect and the other was found incidentally. Trapping of the involved portion of the vertebral artery was performed in 4 cases, proximal clip occlusion in 2 and proximal balloon occlusion in 1. There were no operative deaths and no rebleeding, but brainstem ischemia developed in 4 cases, two being transient and two permanent. The ischemic complications were possibly due to; (a) hypoperfusion in the transient cases and (b) thromboenbolism, from the partially thrombosed giant aneurysm or thrombosis of the cul-de-sac vertebral artery, in the permanent ones. Preoperative temporary vertebral artery occlusion with an inflatable balloon or postoperative anticoagulant therapy should be considered in the management protocol.

Collaborative multicenter field trial of the Draft of ICD-10 in Japan--interdiagnostician reliability and disagreement: a report from the WHO project on "field trials of ICD-10, Chapter V"

The Draft of "ICD-10, Chapter V, Clinical Descriptions and Diagnostic Guidelines" was tested in a multicenter field trial in Japan. We have previously reported good results in suitability, confidence and ease of diagnosis, and adequacy of descriptions of the Draft. In this paper, the interdiagnostician reliability of the Draft is reported. Among the two-character categories, "Schizophrenia, Schizotypal States and Delusional Disorders (F2)" (ICC = .80) and "Mood Disorders (F3)" (ICC = .80) proved reliable. "Neurotic, Stress-Related, and Somatoform Disorders (F4)" was less reliable (ICC = .65). The ICCs of the 17 major categories (three-character code) and the 21 subcategories (four-character code) were also calculated. The finding that in Japan subtyping schizophrenia with ICD-10 was more reliable than that made using DSM-III Diagnostic Criteria supports the need to use a descriptive version of ICD-10 as the basis for several versions serving different purposes. The nature of disagreements with unreliable categories was also investigated. The results are discussed with special reference to the changes in the final Draft of Chapter V, which contained a feedback of the results from field trials from all over the world.

Spatial relationship of nebulin relative to other myofibrillar proteins during myogenesis in embryonic chick skeletal muscle cells in vitro

The developmental expression of nebulin was studied in embryonic chick skeletal muscle cells in vitro by means of immunofluorescence microscopy. Initially nebulin appeared homogeneously or in a punctate form in the cytoplasm, and then it was assembled into I-Z-I-like complexes containing actin and alpha-actinin but not myosin and connectin (titin). Striated patterns of nebulin ('singlets') in myofibrils appeared simultaneously with those of alpha-actinin (Z-bands), myosin (A-bands) and connectin ('doublets'), but earlier than those of actin. After actin striations were formed as myofibrils matured, each nebulin band started to exhibit 'droplets'. The delayed development of nebulin compared to the I-Z-I brush formation and the myofibril maturation seems to indicate that this giant myofibrillar protein is unnecessary for both the initial (formation of I-Z-I-like structures) and the subsequent (regular alignment of myofibrils) phases of myofibrillogenesis.

MRI of spontaneous spinal cord infarction: serial changes in gadolinium-DTPA enhancement

Spinal cord infarcts are rare. We report serial MRI studies of a patient with a clinically diagnosed spontaneous spinal cord infarct. The usefulness of gadolinium diethylenetriaminepentaacetic acid-dimeglumine (Gd-DTPA) enhancement is also discussed. Serial MRI with Gd-DTPA is useful to diagnose the spinal cord infarction.

[A case of a right-sided sigmoid colon]

During dissecting practice by students at Chiba University in 1991, a rare anomaly was found in a cadaver of a 50-year-old Japanese male. The distal part of the colon, including the sigmoid colon, was excessively long and formed a loop behind the ascending colon. This anomalous colon consisted of four parts. The first part began in the left iliac fossa and passed across the lower posterior abdominal wall into the right iliac fossa; the second turned upward and ascended along the posterior surface of the ascending colon to the inferior surface of the right lobe of the liver; the third turned backward and descended to the right iliac fossa and was in contact with the posterior abdominal wall; the fourth curved medially and downward and ended in the rectum at the median line. Only the anterior surface of the anomalous colon was covered with the peritoneum, and its mesocolon was not found. The inferior mesenteric artery gave off four branches toward the distal three-fourths of the excessively long colon and the superior rectal artery to the upper part of the rectum. Since it did not directly give off any branches toward the descending colon and the first part of the anomalous colon (these portions were supplied by a marginal artery), the branch supplying the second part was considered to be equivalent to the left colic artery. Thus, the proximal half of the long colon (parts 1 and 2) can be regarded as a part of the descending colon, and the distal half as the sigmoid colon.(ABSTRACT TRUNCATED AT 250 WORDS)

Computed tomographic evaluation of bleeding sites in primary pontine hemorrhages

BACKGROUND

With the aim of identifying common bleeding sites and probable parent vessels in "small" primary pontine hemorrhages, we reviewed computerized tomographic scans of 20 patients with hematomas less than 2.5 cm in diameter.

SUMMARY OF REPORT

We used scans depicting the upper and lower pons and plotted the centers of the hematomas, assuming them to be a probable source of bleeding. No predilection sites were found on the axial plane.

CONCLUSIONS

Both the paramedian and the long and short circumferential arteries were probable sources of hemorrhage in the present series.

Traumatic carotid-cavernous sinus fistula associated with an intradural pseudoaneurysm: a case report

A case of traumatic carotid-cavernous sinus fistula (CCF) associated with an intradural pseudoaneurysm is reported. A 42-year-old man developed traumatic CCF after severe head trauma. Cerebral angiography demonstrated a direct CCF associated with an intradural pseudoaneurysm at the C2 portion. Transarterial balloon embolization of the CCF caused severe subarachnoid hemorrhage. A CCF with an intradural pseudoaneurysm is life-threatening and requires emergency treatment. However, balloon occlusion in such cases is contraindicated because of possible rupture of a pseudoaneurysm. Trapping or a direct surgical approach is the treatment of choice.

Assembly of connectin (titin) in relation to myosin and alpha-actinin in cultured cardiac myocytes

By using polyclonal and monoclonal antibodies against connectin (titin) which stain the A-I junctional area and the A-band domain (polyclonal anti-connectin and monoclonal 4C9) and the I-band domain (monoclonal SM1), the developmental relationship of this elastic protein with sarcomeric proteins, especially and alpha-actin, was examined in embryonic chick cardiac myocytes in vitro under fluorescence microscopy. During premyofibril stages, I-Z-I proteins were detected first (alpha-actinin dots and diffuse actin [phalloidin and anti-troponin C] staining), and later in these areas connectin and myosin dots appeared with nearly identical distribution. Somewhat later, phalloidin-positive nonstriated fibrils were observed in a straight course. They were always reactive with antibodies against alpha-actinin and troponin C, but unreactive or only weakly reactive with anticonnectin and anti-myosin. Initially, alpha-actinin dots were aligned along these fibrils but did not form striations. As they aggregated to form Z-bands, connectin and myosin started to exhibit typical striation ('doublets' and A-bands, respectively). No difference in the staining pattern was observed with two kinds of monoclonal antibodies against different domains of connectin filaments (4C9 and SM1) at early phases. As myosin staining began to show clear A-bands, connectin epitopes became arranged in polarized positions. We conclude that primitive I-Z-I complexes appear prior to the assembly of connectin and myosin filaments and then connectin filaments, developing intimately and coordinately with myosin, become associated with the alpha-actinin lines. Thus it appears that the putative elastic protein connectin plays some role in integrating myosin filaments with the preexisting I-Z-I brushes. The occasional absence of connectin and A-bands between two Z-bands, beyond both of which clear sarcomeres have been formed, indicates that connectin is not a preformed scaffold of myofibrils on which sarcomeric proteins accumulate.

Dural carotid-cavernous sinus fistula and central retinal vein occlusion: a case report and a review of the literature

A case of dural carotid-cavernous sinus fistula was complicated by hemorrhagic retinopathy due to central retinal vein occlusion. A 57-year-old woman with a dural carotid-cavernous sinus fistula was initially treated by transarterial particulate embolization. Her symptoms subsequently improved, but 4 months later she gradually developed decreased visual acuity due to central retinal vein occlusion. A review of the literature showed that central retinal vein occlusion may be more common than previously thought. Dural carotid-cavernous sinus fistulas should be treated and followed taking into account possible complication by central retinal vein occlusion. Early detection of central retinal vein occlusion by frequent ophthalmologic examinations may prevent deterioration of visual acuity.

Fatal aneurysmal rupture: a survey of 60 grade-5 cases

The purpose of the present study was to describe the clinical course of patients with Grade-5 ruptured aneurysms (WFNS grading). Among 250 consecutive cases of ruptured aneurysms, 60 Grade-5 patients were reviewed retrospectively, consisting of 24 males and 36 females with an average age of 58 years. Thirty-two patients were directly transferred to our clinic, while the remaining 28 were referred from other clinics. Duration from rupture to arrival at our clinic was within 1 hour in 25 cases and within 2 hours in 43 cases. Systolic blood pressure on admission was 186 mmHg on average. Obvious misdiagnoses by primary physicians were made in 7 cases. Ventricular drainage and clipping/trapping of the aneurysms were performed in 7 and 25 cases, respectively. Forty-nine patients died and the remaining 11 survived. One made a good recovery, 1 was moderately disabled, 8 severely disabled, and 1 in a vegetative state. The prognosis for Grade-5 patients is well known as being extremely poor, which also was the case in our series. Early referral and early surgical intervention have not changed this poor prognosis. Possible improvement of the outcome of this group might be expected by 1) public health and primary physician education on aneurysmal subarachnoid haemorrhage, and 2) control of blood pressure during referral.

Magnetic resonance imaging of the cavernous sinus

The magnetic resonance (MR) appearance of the cavernous sinus (CS) was studied in 10 normal and 23 abnormal CSs(11 vascular and 12 neoplastic lesions) using T1-weighted spin echo images with and without Gd-DTPA. In normal CSs, the intracavernous carotid artery (ICA) was disclosed as an area of signal void that was not enhanced with Gd-DTPA. Most venous flow showed low intensity and was markedly enhanced with Gd-DTPA. Venous flow, however, was heterogeneous, which suggested the distribution of flow velocities. In the carotid-cavernous sinus fistulas (CCFs), the ICA and shunted flow were disclosed as areas of signal void and their relationship was clearly shown. Normal venous flow appeared as a low intensity area even with CCFs. In the cavernous aneurysms, thrombosis and patent arterial flow were shown, but in one case it was impossible to differentiate patent arterial flow from calcification. In neoplastic lesions, CS invasion was suspected by encasement or marked dislocation of the ICA, disappearance of venous flow, and extension of extrasellar tumors to the medial wall and extension of sellar tumors to the lateral wall. MR was found to be a promising diagnostic modality for the evaluation of the CS.

MR imaging of dural AV fistulas at the cavernous sinus

The magnetic resonance appearance of dural arteriovenous fistulas (AVFs) at the cavernous sinus (CS) was studied in six angiographically verified cases. Magnetic resonance clearly demonstrated shunted blood as an area of signal void both in the CS and in the superior ophthalmic vein. The relationship between shunted blood, internal carotid artery, and extraocular nerves, as well as proptosis, enlargement of the extraocular muscles, and bulging of the lateral wall of the CS were also depicted in the images. Normal venous flow in the involved CS was shown as a low signal area that enhanced after gadolinium administration. Magnetic resonance is useful for screening and follow-up examinations of dural AVFs at the CS. It is essentially a noninvasive procedure that may be repeated and obviates the need for follow-up angiography. However, it should be noted that a signal void in the CS sometimes represents normal venous flow. A definite diagnosis should rely on angiography, which is essential for therapeutic planning.

Indirect carotid-cavernous sinus fistula: transvenous embolization from the external jugular vein using a superior ophthalmic vein approach. A case report

A case of indirect carotid-cavernous sinus fistula treated by combined transarterial and transvenous embolization is described. A 49-year-old woman with a right indirect carotid-cavernous sinus fistula draining solely to the right superior ophthalmic vein was treated first by transarterial embolization with polyvinyl alcohol particles. Then, by approaching through the superior ophthalmic vein from the right external jugular vein, the cavernous sinus was embolized with platinum wire using a tracker microcatheter, which resulted in marked clinical improvement. Transvenous embolization by approaching from the external jugular vein through the superior ophthalmic vein represents a promising alternative when shunted blood drains anteriorly to the superior ophthalmic vein.

[Study on determination of the imaginary axis of the tooth crown in anterior teeth: 1]

1. The state of inclination and the change under various conditions of the imaginary axis of the tooth crown of upper jaw anterior teeth can be determined by the image measuring system and method of this study. 2. The measurement error of this system was not more than 0.3 degree. This value was sufficient for the purpose of this study. 3. The imaginary axis of the tooth crown of anterior teeth was determined on the study cast with 1 to 3 degrees in mesiodistal direction and 2 to 4 degrees in labiopalatal direction as standard deviation. 4. The imaginary axis of the tooth crown of anterior teeth was determined toward labial in the random position and toward patient's right and palatal in Standing Posture. 5. It was confirmed that the determination of the imaginary axis of tooth crown was effected by the position of the patient relative to the operator, limitation or direction of view, and approach direction.

A new microcatheter system for endovascular treatment of cerebral arteriovenous malformations

A new microcatheter system was used for diagnostic and therapeutic purposes in three cases of arteriovenous malformation. This microcatheter is used with a steerable guidewire and provides high selectivity of the target vessels and greater catheter maneuverability than does balloon catheters. Tissue adhesive was safely injected for the therapeutic embolization in two of the cases. With this system, however, the utmost attention is necessary to prevent reflux of the tissue adhesive and to avoid lacerating the feeding vessels with the guidewire. This microcatheter system was found to be very useful for diagnostic and therapeutic procedures in endovascular treatment of cerebral arteriovenous malformations.

Magnetic resonance imaging of intracavernous pathology

To evaluate the usefulness of magnetic resonance (MR) imaging of intracavernous pathology, T1-weighted spin echo images of four vascular lesions and 10 neoplastic lesions with surgically confirmed cavernous sinus (CS) invasion were reviewed retrospectively. In one case of traumatic carotid-cavernous fistula (CCF) and one of dural arteriovenous malformation (AVM), the internal carotid artery (ICA) and rapid shunted flow were depicted as signal voids, and the relationship between the ICA and shunted flow was clearly shown. Normal venous flow appeared as a low-intensity area and was observed even in the presence of the CCF and dural AVM. In two cases of thrombosed aneurysms, the thrombosis was clearly demonstrated, along with patent arterial flow in one case; in the other case, however, it was impossible to differentiate patent arterial flow from calcification. The intensity of all neoplastic lesions was similar to that of the cerebral cortex. The relationship between the ICA and the tumors was clearly demonstrated. The visual pathways were also plainly shown unless they were involved, or markedly compressed, by tumor. CS invasion was strongly associated with four findings: 1) encasement of the ICA by the tumor; 2) marked displacement of the ICA; 3) absence of low intensity, which reflects normal venous flow, in the CS; and 4) extension of extrasellar tumors to the medial wall or of intrasellar tumors to the lateral wall. MR imaging was judged promising in the evaluation of intracavernous pathology.

Structure of self-other reversal in schizophrenic disturbances in sense of self

Disturbances in the sense of self are a fundamental state found in schizophrenia. In these phenomena, it is thought that the self and others become interchanged within the mind of patient. The structure of such reversal of self and others (self-other reversal) has its origin in a duplex state in which the body can perceive with the senses, and at the same time can be perceived. These disturbances can therefore be understood as disturbances of corporeity (Merleau-Ponty, M.) or disturbances in the duplex state of the body, and in this sense, they are contrasted with delusions expressed in words.

Fictionality of schizophrenic delusions

A state in which the phenomena of the surrounding world are transformed into a set of symbols that transmit indefinite meanings is thought to provide the circumstances under which delusions arise. The surrounding world is interpreted as a written text, and when the schizophrenic reads this and attempts to construct a coherent fictional account of it, a process of delusion formation takes place, and this process corresponds symptomatologically to a delusional system. If delusions are considered in comparison with fictions, in particular fantastic fictions, areas are found in the paranoid patient's mental processes where contingency is left out, and for that reason it is not possible for the delusional account to be satisfactorily completed.