Embolization of Aneurysms with a Liquid Material: An Experimental Study

The authors evaluated the embolization effects on experimental aneurysm models with a liquid material. This material is a mixture of poly (HEMA-co-MMA), Iopamidol, water and a small amount of ethyl alcohol.

We have satisfactorily treated over 30 cases of AVM with this material. Out of four solutions of different viscosity, we used the solution with the highest viscosity to prevent distal migration of the mixture. Glass models of aneurysms of 5 mm in diameter in pulsatile saline flow were embolized with the mixture under various conditions. When an IDC was placed in the aneurysm models, the mixture obliterated them completely and did not migrate out from the aneurysm models.

In this experimental study, it is suggested that the liquid material appears to be useful in embolizing cerebral aneurysms safely.

[A case of aortic valve replacement 3 years after coronary artery bypass grafting]

A rare case of aortic valve replacement (AVR) with poor left ventricular function, following coronary artery bypass grafting, was reported. The patient was 57-year-old man who received urgent CABG with 2 saphenous vein grafts 3 years ago. At that time, aortic regurgitation (AR) was grade 2. He suffered acute myocardial infarction 1 year after CABG because of the occlusion the saphenous vein graft to the obtuse marginal branch. Percutaneous transluminal angioplasty was successfully performed for occluded graft. Since then, however, AR increased gradually and the left ventricular function decreased. Three years after the initial operation, he was admitted again with congestive heart failure. Heart catheterization revealed grade 3 AR and 17% left ventricular ejection faction (LVEF). AVR was performed through a median sternotomy and 2 saphenous vein grafts were preserved. He showed uneventful postoperative recovery and is now very well with 40% LVEF.

Differential display cloning of a novel rat cDNA (RNB6) that shows high expression in the neonatal brain revealed a member of Ena/VASP family

We have used the differential display method to identify genes that control the neural cell development in CNS. Screening of the differential display bands that showed higher expression at neonate than at adult age enabled us to identify a novel rat cDNA (RNB6) coding for a protein of 393 amino acid residues. Database search revealed this gene as a rat homologue of the murine EVL, a member of Ena/VASP protein family that is implicated to be involved in the control of cell motility through actin filament assembly by their GP5 motifs. Although the precise characterization of EVL was not reported, our Northern blot and immunoblot analyses demonstrated that RNB6 expression in the brain gradually increases during embryonic development, reaches maximum at postnatal day 1 and decreases thereafter. Studies of tissue distribution revealed the expression of RNB6 not only in the brain but also in the spleen, thymus and testis. Histochemical analyses showed that RNB6 protein is mainly expressed in neurons and may be expressed in neural fibers. Our analyses suggest that RNB6 is critically involved in the development of CNS probably through the control of neural cell motility and/or including neuronal fiber extension.

[True "PICA communicating artery" aneurysm: a case report]

We present an unusual case of an aneurysm of the distal posterior inferior cerebellar artery (PICA). A 51-year-old female presented a subarachnoid hemorrhage with mild consciousness disturbance on August 6, 1992. Computed tomography (CT) on admission showed subarachnoid hemorrhage with thick hematoma in the cisterna magna and intraventricular hematoma in the 4th, 3rd and both lateral ventricles. The angiogram on admission revealed no definite vascular anomalies. Repeated angiograms on the 11th day after onset showed an aneurysm on anastomotic branch between the bilateral distal PICAs. The aneurysm was clipped successfully through a suboccipital craniectomy 14 days after the onset. In the literature reviewed, only one such aneurysm, located at an anastomotic vessel of the bilateral PICAs, has been reported by Hlavin et al in 1991. They reported that the aneurysm was associated with a unilateral PICA that supplied both cerebellar hemispheres and arose from an anastomotic vessel in the contralateral circulation. They called the aneurysm as "a PICA communicating artery" aneurysm. We assume that this "PICA communicating artery" is a remnant of a primitive lateral vertebrobasilar anastomosis, which appears in the embryo at the 9 mm stage. It is suggested that the pathogenesis may be not only the hemodynamic factor but also a congenital anomaly.

[Usefulness of 99mTc-tetrofosmin myocardial scintigraphy before and after coronary intervention]

Dipyridamole-loading 99mTc-tetrofosmin myocardial scintigraphy was performed for patients with coronary artery disease who underwent percutaneous transluminal coronary angioplasty (PTCA) in order to examine whether SPECT imaging prior to treatment is useful for the determination of prognosis after coronary intervention. Thirty-six patients including 9 with angina pectoris (AP), 22 with old myocardial infarction (OMI) and 5 OMI with AP were underwent dipyridamole-loading 99mTc-tetrofosmin myocardial SPECT before and after coronary intervention. The length of follow-up was 185 +/- 107 days after PTCA. Improvement of myocardial uptake was observed on myocardial SPECT in all cases with AP. Improvement of the myocardial uptake was observed 50% (4/8) of patients with OMI who had no myocardial viability. It was suggested that the improvement of myocardial uptake after PTCA was due to incomplete fill-in in cases with AP and that the presence of fill-in was important for level of fill-in in patients with AP. The improvement of myocardial uptake in the scar tissue in patients with OMI contributed to the hibernating myocardium. We concluded that correct detection of hibernating myocardium was difficult despite the superior imaging capability of 99mTc-tetrofosmin myocardial SPECT.

MR imaging of idiopathic trigeminal neuralgia: correlation with non-surgical therapy

Magnetic resonance (MR) findings in patients with idiopathic trigeminal neuralgia were evaluated and correlated with the effectiveness of non-surgical treatments. Thirty-four patients with idiopathic trigeminal neuralgia (ITN) were examined using T1- and T2-weighted spin-echo (SE) pulse sequence techniques to evaluate their trigeminal root-entry zones and the vessels contacted prior to non-surgical treatment (retrogasserian glycerol injection, peripheral nerve block, or only oral analgesics). Vascular contact at the proximal portion of the preganglionic segment (PGS) of the trigeminal nerve and deformity of the PGS on the affected side were observed in 97% and 47% of the patients, respectively. Non-surgical treatments were curative in 12 (67%) but failed in two (11%) of the 18 patients without deformed PGS. However, among 16 patients with deformed PGS, they were curative in only six (37.5%) and failed in four (25%). Results of this study suggest that MR imaging could be useful in the clinical assessment of trigeminal neuralgia prior to instituting non-surgical treatment.

[Detection of early cardiac dysfunction in patients with transfusion-dependent aplastic anemia and chronic iron overload in childhood. Stress-velocity relation as a sensitive index by echocardiography]

In order to detect early-stage left ventricular dysfunction, we examined a load-independent index, that is, the stress-velocity relation, by echocardiography in 13 patients with aplastic anemia including pure red cell anemia. Even when left ventricular contractility and pump function were within the normal range, its afterload had a tendency to increase in transfusion-dependent patients. The patients who had impairment of cardiac pump function died of congestive heart failure within one year after abnormal findings in stress-velocity relation were detected. Therefore, the stress-velocity relation is a sensitive, useful and noninvasive index for detecting asymptomatic myocardial dysfunction in patients with transfusion-dependency and chronic iron overload. It is necessary for these patients to undergo examinations of echocardiography at regular intervals. In case of abnormally in the stress-velocity relation, treatment for afterload mismatch and more effective chelation should be recommended to reduce the burden on the heart. Thereby, the heart is kept in better condition and the prognosis of these patients will be improved.

The cytocidal activity of OK-432-activated mononuclear cells against human glioma cells is partly mediated through the Fas ligand/Fas system

We have been applying an adoptive immunotherapy protocol to patients with malignant brain tumors using OK-432-activated peripheral blood mononuclear cells (OK-MCs). In order to elucidate the mechanism of OK-MCs' cytotoxicity, we examined the expression of Fas ligand mRNA in OK-MCs and the cytocidal activity of these cells against a human glioma cell line, T98G which expresses a high level of Fas. The expression of Fas ligand mRNA was low in non-treated peripheral blood mononuclear cells and was elevated by treatment with OK-432, irrespective of the dose employed. Apoptosis of T98G cells induced by OK-MCs was unequivocally inhibited by the pretreatment of T98 G cells with ZB4 monoclonal antibody, which binds to Fas and blocks the binding of Fas ligand to Fas. These data indicate that the cytotoxic activity of OK-MCs via apoptosis seems to be at least partly mediated by the Fas ligand/Fas system. Adoptive immunotherapy using the Fas ligand/Fas system could be a new treatment modality for human malignant brain tumors.

[Expression of apoptosis-related gene products in human brain tumors and apoptosis-inducing therapy]

To elucidate the mechanism of apoptosis in brain tumors, we analyzed the expression of apoptosis-related gene products in cultured glioma cells and biopsied brain tumor specimens. Fas, Bcl-2 family (Bcl-2, Bcl-x and Bax) and ICE family (ICE, Ich-1) were found to be involved in tumorigenesis of certain brain tumors. It was also clarified that OK-432 activated mononuclear cells could kill T98G glioblastoma cells by apoptotic mechanism through the Fas ligand/Fas system.

[Two cases of breast cancer detected by 99mTc-tetrofosmin myocardial scintigraphy]

Breast cancer ranks the second position among the cancer of women in Japan. We report two cases of breast cancer detected by 99mTc-tetrofosmin. First case was 51 years old female with breast cancer (invasive papillotubular carcinoma) and dextrocardia. She received 99mTc-tetrofosmin myocardial scintigraphy to evaluate dextrocardia and suspicious coronary artery disease. A planar image of 99mTc-tetrofosmin myocardial scintigraphy showed myocardium at the right side, gall bladder at the left lower side and abnormal uptake on the left chest wall. Transaxial images of 99mTc-tetrofosmin myocardial SPECT showed myocardium at the right side and abnormal uptake on the left chest wall. Second case was 78 years old female with breast cancer (intracystic papillary carcinoma) and arrhythmia. 99mTc-tetrofosmin myocardial scintigraphy was performed to evaluate arrhythmia and suspicious coronary artery disease. A planar image of 99mTc-tetrofosmin myocardial scintigraphy shows hot nodule at the lateral side of the myocardium. Transaxial images of 99mTc-tetrofosmin myocardial SPECT showed abnormal uptake at the left lateral side on the chest wall. Both cases appeared illed foci as abnormal uptake with 99mTc-tetrofosmin scintigraphy, although histological diagnosis was different. We conclude that 99mTc-tetrofosmin scintigraphy is helpful for evaluating breast cancer.

[Indication and result of hypothermic fibrillatory arrest in coronary artery bypass grafting]

Currently, cardioplegic arrest is used for almost all coronary artery bypass grafting (CABG). However, there are some cases in which aortic occlusion or the cardioplegic infusion is not desirable. In this paper, we discussed the indications and the usefulness of hypothermic fibrillatory arrest for CABG. From April 1992 to March 1995, CABG with hypothermic fibrillatory arrest was performed in 6 patients (3.9% of total CABG cases). The reasons of employing hypothermic ventricular fibrillation were as follows; calcified ascending aorta in 2 patients, coronary aneurysm associated with Behçet's decrease in 1, revascularization to the totally obstructed branches with poor left ventricular function in 2, and collateral circulation from bronchial artery with total obstruction of left main trunk in 1. The age range was 48 to 68 years with a mean of 59.0 +/- 7.8 years. Five patients had a history of myocardial infarction and 2 of them had a left ventricular ejection function less than 0.25. Surgical procedures consisted of elective ventricular fibrillation without aortic cross-clamp, systemic hypothermia and local pericardial cooling, left atrial or pulmonary artery venting, and local vessel isolation during distal anastomosis. Average number of grafts was 2.0 +/- 0.6, and 5 left internal thoracic arteries, 2 gastroepiploic arteries and 5 saphenous vein were used. Mean duration of ventricular fibrillation was 74.0 +/- 17.5 min. Postoperative angiography confirmed all bypasses patent. Only 1 patient, whose preoperative left ventricular ejection function was 0.20, died of heart failure 5 months after the operation. All other patients survived asymptomatically. Hypothermic fibrillatory arrest is useful and reliable technique in coronary artery bypass grafting when aortic occlusion or cardioplegic arrest is not desirable.

Detection of feline herpesvirus 1 DNA by the nested polymerase chain reaction

The thymidine kinase region of feline herpesvirus 1 (FHV 1) genome in ocular/nasal swabs from cats with clinical manifestations of upper respiratory disease was amplified by nested polymerase chain reaction (nested PCR). Two primer pairs were prepared for nested PCR. FHV 1 DNA in ocular/nasal swabs was extracted using instaGene-DNA purification matrix. Nested PCR for the FHV 1 culture supernatants was ten times as sensitive as single PCR. On comparing viral isolation with single PCR and nested PCR for the detection of FHV 1 in ocular/nasal secretions, of 5 samples that yielded infectious virus in cell culture, 3 (60%) were positive in single PCR and 5 (100%) were positive in nested PCR. When 22 ocular/nasal swabs that did not yield FHV 1 were assayed, 3 were negative in both single PCR and nested PCR, 2 were positive in both single and nested PCR and 17 were positive in only nested PCR. Thus, FHV 1 was detected in 19/22 (86.4%) by the nested PCR and in 2/22 (9%) by single PCR. These results show that nested PCR is 4.8 (24 positive samples/5 positive samples) times as sensitive as single PCR.

[Diagnostic value of high N-isopropyl-p-[123I] iodoamphetamine (IMP) uptake in brain tumors]

The diagnostic value of high N-isopropyl-p-[123I] iodoamphetamine (123I-IMP) uptake in histologically proven intracranial tumors was evaluated in 54 patients with both early (15-35 min after injection) and delayed (4 hours) SPECT before treatment. Higher uptake in the tumor compared with normal cerebral cortex was observed in early scans in all of the five patients with primary intracranial malignant lymphoma, in two of 16 meningiomas, two of seven astrocytomas, one of three pituitary adenomas, and one central neurocytoma. Among these 11 cases all the malignant lymphomas showed persistent high uptake in delayed scans, whereas other tumors showed decreased uptake in delayed scans. This persistent high 123I-IMP uptake was characteristic of primary intracranial malignant lymphomas and was useful in the diagnosis of intracranial malignant lymphoma.

Partial Amino Acid Sequences of Peptidyl-Prolyl Isomerases ofFusarium sporotrichioides

Peptidyl-proprylyl cis-trans isomerase (PPIase) activity was observed from crude extract of Fusarium sporotrichioides. Proteins from this fungi were separated by two-dimensional polyacrylamide gel electrophoresis and more than one thousand protein spots were separated. Two cytosolic PPIases were found by the N-terminal sequencing from the two separated spots. The N-terminal 41 residues of the major protein spot showed high sequence identity (63.4%) with PPIase from Neurospora crassa. This protein was designated as PPIase a, having an apparent molecular mass of 20 kD and pI 7.0. The minor other protein spot, having a similar molecular mass but distinguishable pI 6.4, was also sequenced and the N-terminal twenty residues were almost identical to PPIase a and was designated as PPIase b. Copyright 1995 S. Karger AG, Basel

Resolution of Fusarium sporotrichioides Proteins by Two-Dimensional Polyacrylamide Gel Electrophoresis and Identification by Sequence Homology Comparison in Protein Data Base

Proteins from Fusarium sporotrichioides M-1-1, a T2-toxin-producing strain, were separated by two-dimensional polyacrylamide gel electrophoresis. One thousand two hundred and forty-four protein spots were resolved and 103 protein spots were subjected to N-terminal sequencing. Fifty-eight protein spots were sequenced and 48 proteins were observed to have blocked N termini. Forty out of 58 sequenced proteins were identified by homology search against the PIR protein sequence data base and protein superfamily data base, while the residual 18 sequences were not identified. Twenty-seven of the N-terminal-blocked proteins were subjected to mild anhydrous hydrazine vapor deblocking. Twenty-four spots were not deblocked indicating the presence of acyl groups at the N termini, while 3 proteins were deblocked showing the blocked group to be pyrroglutamyl carboxylic acid residues. The results can provide a more global view of cellular genetic expression than any other technique. The created data may offer a unique opportunity to link information with DNA sequence data. Copyright 1995 S. Karger AG, Basel

[Clinical usefulness of dipyridamole loading 99mTc-tetrofosmin myocardial scintigraphy]

This study performed to establish the most suitable method in one-day protocol and to evaluate clinical usefulness of 99mTc-tetrofosmin myocardial scintigraphy after dipyridamole infusion. Image quality and liver overlapping of the myocardial SPECT were evaluated in 107 patients with old myocardial infarction (42 cases), angina pectoris (53 cases) and others (12 cases). Left ventricular wall motion and coronary artery stenosis were compared to myocardial uptake score in 55 patients who received cardiac catheterization. The suitable image quality was acquired in early SPECT images using 259 MBq of 99mTc-tetrofosmin. The overlapping between inferior wall and liver uptake was able to minimize over 45 minutes interval from injection of 99mTc-tetrofosmin to data acquisition. The segments of normal wall motion had no perfusion defect of the myocardial SPECT in all cases (100% (148/148)). The segments of abnormal wall motion had decreased myocardial uptake of the myocardial SPECT (77% (24/31)). The agreement between coronary artery stenosis and decreased myocardial uptake was 96% (24/25) in right coronary artery, 87% (26/30) in left anterior descending coronary artery and 83% (19/23) in left circumflex coronary artery. These data suggests that image quality of dipyridamole loading 99mTc-tetrofosmin myocardial scintigraphy. Myocardial perfusion in the 99mTc-tetrofosmin myocardial scintigraphy is good correlation to both left ventricular wall motion and coronary artery stenosis.

Detection of DNA strand breaks associated with apoptosis in human brain tumors

Apoptosis occurs spontaneously in a wide variety of neoplasms. However, it is difficult to detect apoptotic cells in routine histological sections because the cells undergoing apoptosis die singly and are then rapidly phagocytosed. Since DNA fragmentation is an important hallmark of apoptosis, visualization of DNA strand breaks in tissue sections provides the means for readily identifying apoptotic cells in situ. We have applied an in situ DNA strand break staining procedure for the quantitative estimation of apoptotic cells in surgical specimens of 62 different brain tumours. Positively stained apoptotic cells were observed in 25 (40.3%) cases and their percentage (apoptotic index) ranged from 0.1 to 8.9. Both fragmented and condensed nuclei of apoptotic cells and apoptotic bodies were stained. In addition, we assessed the proliferative activity of each specimen by immunostaining with the MIB-1 antibody (MIB-1 index) which detects the cell cycle phase-dependent Ki-67 antigen. Brain tumours with higher MIB-1 indices showed a tendency to higher apoptotic indices. The results of this study indicate that apoptosis occurs spontaneously in various brain tumours.

Three-dimensional display of pulmonary nodules using helical CT

To evaluate the clinical usefulness of three-dimensional (3D) images of pulmonary nodules acquired using helical CT, 3D reconstructions were performed in 32 patients using a CEMAX VIPstation. The CT scanner employed was the Toshiba Xforce. Helical CT data were acquired using up to 20 continuous 1.5-sec rotations with an X-ray beam width of 5 mm and a couchtop movement speed of 5 mm/1.5 sec. Axial images were reconstructed at a section interval of 2 mm. The optimal lower and upper threshold CT values for 3D images were as follows: 1) solid pulmonary nodule (-700--400/-100 HU), 2) tumor invading pleura or chest wall (-700--400/-200 HU), 3) pulmonary nodule with cavity (-700--400/50 HU), 4) small pulmonary nodule (< 10 mm) (-750--650/-100 HU), and 5) arteriovenous malformation (180/500 HU). In all cases, it was possible not only to demonstrate abnormal findings three-dimensionally but also to grasp anatomical relationships among the pulmonary nodule, bronchi, vessels, and chest wall.

Aneurysm of a persistent primitive olfactory artery. Case report

A ruptured anterior cerebral artery (ACA) aneurysm is reported in a patient in whom an anomalous ACA arose from the internal carotid artery at the bifurcation. The aberrant artery coursed anteriorly along the ipsilateral olfactory tract and made a hairpin turn posterior to the olfactory bulb, supplying the circulation of the ACA. Persistence of the primitive olfactory artery is suggested as an embryological origin of this vascular anomaly.

Solitary spinal epidural cavernous haemangioma presenting as acute epidural haematoma

This report describes a case of solitary spinal epidural cavernous haemangioma presenting as an acute epiduralhaematoma. The patient is a 50 year old diabetic female with right brachalgia and hemiparesis. Magnetic resonance imaging (MRI) demonstrated the presence of a cervical spinal epidural haematoma. The patient underwent laminectomy and total removal of the haematoma and the accompanying vascular tissue. The diagnosis of cavernous haernangioma was proven by histological examination. Because the source of bleeding in most cases of spontaneous spinal epidural haematoma is usually obscure, the authors emphasise the possibility that a small cavernous haemangioma can be one of the bleeding sources in some of these cases.

Phenotypic and genetic diversity of chlorine-resistant Methylobacterium strains isolated from various environments

Strains of pink-pigmented facultative methylotrophs which were isolated previously from various environments and assigned tentatively to the genus Methylobacterium were characterized in comparison with authentic strains of previously known species of this genus. Most of the isolates derived from chlorinated water supplies exhibited resistance to chlorine, whereas 29 to 40% of the isolates from air, natural aquatic environments, and clinical materials were chlorine resistant. None of the tested authentic strains of Methylobacterium species obtained from culture collections exhibited chlorine resistance. Numerical analysis of phenotypic profiles showed that the test organisms tested were separated from each other except M. organophilum and M. rhodesianum. The chlorine-resistant isolates were randomly distributed among all clusters. The 16S ribosomal DNA (rDNA) sequence-based phylogenetic analyses showed that representatives of the isolates together with known Methylobacterium species formed a line of descent distinct from that of members of related genera in the alpha-2 subclass of the Proteobacteria and were divided into three subclusters within the Methylobacterium group. These results demonstrate that there is phenotypic and genetic diversity among chlorine-resistant Methylobacterium strains within the genus.

Three-dimensional display of the bronchi using helical CT

The purpose of this study was to evaluate the clinical usefulness of three-dimensional (3D) images of the bronchi obtained using helical CT. Thirteen patients with lung cancer, one with tracheal diverticulum, and one with bronchial amyloidosis were examined. The CT scanner employed was the Toshiba Xforce. The helical CT scan cycle consisted of 20 continuous rotations, each requiring 1.5 sec, for a total scanning time of 30 sec. Scans were obtained using a 5-mm X-ray beam width, a 5-mm/1.5 sec couchtop sliding speed, and a 2-mm reconstruction interval. 3D images were reconstructed using a CEMAX VIPstation. The optimal lower and upper threshold CT values for 3D images of the bronchi were -650 and -100 HU, respectively, and 3D images clearly depicted endobronchial lesions. Cartilage crescents were also demonstrated, but longitudinal and circular mucosal folds could not be visualized. In conclusion, 3D images of the bronchi acquired using helical CT were useful in evaluating endobronchial lesions.