Cimetidine and Clobenpropit Attenuate Inflammation-Associated Colorectal Carcinogenesis in Male ICR Mice

Histamine and histamine receptors (Hrhs) have been identified as critical molecules during inflammation and carcinogenesis. This study was conducted to determine the effects of Hrh1-Hrh3 antagonists on inflammation-associated colorectal carcinogenesis. Male ICR mice were treated with azoxymethane (AOM, 10 mg/kg bw, i.p.) and 1.5% dextran sodium sulfate (DSS, drinking water for 7 days) to induce colorectal carcinogenesis. The mice were then fed diets containing test chemical (500 ppm terfenadine, 500 ppm cimetidine or 10 ppm clobenpropit) for 15 weeks. At week 18, feeding with the diets containing cimetidine (Hrh2 antagonist) and clobenpropit (Hrh3 antagonist/inverse agonist) significantly lowered the multiplicity of colonic adenocarcinoma. Terfenadine (Hrh1 antagonist) did not affect AOM-DSS-induced colorectal carcinogenesis. Adenocarcinoma cells immunohistochemically expressed Hrh1, Hrh2, Hrh3 and Hrh4 with varied intensities. Because clobenpropit is also known to be a Hrh4 receptor agonist, Hrh2, Hrh3 and Hrh4 may be involved in inflammation-related colorectal carcinogenesis. Additional data, including the mRNA expression of pro-inflammatory cytokines and inducible inflammatory enzymes in the colonic mucosa, are also presented.

[Side Effects of Low Dose Atropine]

PURPOSE

Because highmyopia causes severe visual impairment, it is important to prevent the progression of myopia. Recently, the prevention of myopia progression by low dose atropine was reported from Singapore. We started the study of low dose atropine in Japanese children, with the aim of investigating the side effects of low dose atropine.

SUBJECT AND METHODS

The participants were 16 children between the age of 6 and 12. They receive 0.01% atropine once nightly in both eyes. Refractive error, distant vision, near vision, accommodation and pupil diameter were checked before (baseline) and two weeks after the treatment (second baseline). Also, we checked subjective symptoms and adverse events.

RESULTS

There was no significant change between baseline and second baseline in the refractive error, distant vision, near vision. Accommodation decreased mean 1.5 D (p < 0.01) and the pupil diameter was mean 0.7 mm larger (p < 0.0001), but the subjective symptoms were minimal. Accommodation and pupil diameter showed significant changes. Severe subjective symptoms and adverse events were not found in any of the cases.

CONCLUSION

The side effects of low dose atropine were not severe. The treatment could be continued for the prevention of myopia.

Antimicrobial properties and mechanism of volatile isoamyl acetate, a main flavour component of Japanese sake (Ginjo-shu)

AIMS

To evaluate the antimicrobial properties of the main Ginjo-flavour components of sake, volatile isoamyl acetate and isoamyl alcohol.

METHODS AND RESULTS

Volatile isoamyl acetate and isoamyl alcohol both inhibited growth of the five yeast and 10 bacterial test strains. The minimum inhibitory dose and minimum bactericidal (fungicidal) dose of isoamyl acetate were higher than those of isoamyl alcohol. Escherichia coli and Acetobacter aceti were markedly sensitive to isoamyl acetate and isoamyl alcohol. In E. coli exposed to isoamyl acetate for 5 h, changes in expression were noted in proteins involved in sugar metabolism (MalE, MglB, TalB and PtsI), tricarboxylic acid cycle (AceA, Pfl and AcnB) and protein synthesis (EF-Tu, EF-G, and GlyS). Expression of acid and alcohol stress-response proteins was altered in E. coli exposed to isoamyl acetate. Esterase activity was detected in E. coli, suggesting that isoamyl acetate was hydrolyzed to acetic acid and isoamyl alcohol. Acetic acid and isoamyl alcohol damaged E. coli cell membranes and inactivated membrane proteins, impairing respiration.

CONCLUSIONS

Volatile isoamyl acetate and isoamyl alcohol were effective in inactivating various micro-organisms, and antimicrobial mechanism of volatile isoamyl acetate against E. coli was clarified based on proteome analysis.

SIGNIFICANCE AND IMPACT OF THE STUDY

To the best of our knowledge, this is the first report to examine the antimicrobial mechanism of volatile organic compound using proteome analysis combining two-dimensional difference gel electrophoresis with peptide mass fingerprinting.

Evaluation of the human papillomavirus mRNA test for the detection of cervical lesions in Japan

AIMS

For the screening of cervical abnormalities, human papillomavirus (HPV) DNA testing is widely used along with Papanicolaou (Pap) testing. Although the sensitivity of the HPV DNA testing is good, its specificity is relatively low. In the present study, the authors evaluated the use of the Gen-Probe APTIMA HPV Assay for the detection of HPV mRNA and compared it with HPV DNA testing.

MATERIALS AND METHODS

Liquid cervical Pap specimens collected from 410 women were assessed using the APTIMA test, the Qiagen Hybrid Capture 2 HPV DNA (HC2) Test, and the AMPLICOR HPV Test.

RESULTS

The sensitivity and specificity for the detection of high-risk HPV were 85.6% and 99.2% for the APTIMA test, 94.1% and 98.4% for the HC2 test, and 90.2% and 95.7% for the AMPLICOR test, respectively. As the severity of the cervical lesion progressed, the positive rate of the three tests indicated a similar increase. The clinical sensitivity and specificity for the detection of squamous intraepithelial lesion (SIL) were 91.2% and 84.2% for the APTIMA test, 94.5% and 80.4% for the HC2 test, and 87.9% and 78.2% for the AMPLICOR test, respectively.

CONCLUSION

The APTIMA is sensitive and specific for the detection of high-risk HPV. In the specimens with SIL, the APTIMA test is more specific than the HC2 and the AMPLICOR tests. This indicates that the APTIMA test may improve patient management and reduce the cost of screening.

Small Cell Ovarian Carcinomas - Characterisation of Two Rare Tumor Entities

Objective: Small cell ovarian carcinomas (SCOC) are differentiated into two types: hypercalcaemic (SCOCHT) and pulmonary (SCOCPT). Unfortunately, little is known about pulmonary-type small cell ovarian carcinoma. Study Design: We carried out a systematic analysis of all available reports in the literature on individual cases of SCOCHT and SCOCPT. Results: We found that patients with SCOCPT were significantly older than those with SCOCHT. Vimentin and chromogranin detection by immunohistochemistry allow good differentiation between the two types. Interestingly, SCOCPT but not SCOCHT was found to be associated with other benign and malignant ovarian tumours in about 44 % of cases. Although the percentage of R0/R1 resections was high (~ 74 %), survival was poor; even in patients with disease limited to the ovaries (stage Ia and Ib) the recurrence rate was 40 %. Chemotherapy with etoposide or anthracyclines could be useful. Conclusion: Taking the limitations of our study such as its retrospective nature into account and based on the results from studies of small cell carcinomas originating from other tumour sites, we conclude that treatment of SCOCPT should be based on the therapies used to treat other small cell carcinomas. Surgery is appropriate, especially in very early stages of disease, but chemotherapy should not be omitted. Newer concepts such as treatment with somatostatin analogues could help to control symptoms and stabilise some slow-growing tumours.

Outcomes analysis of ruptured distal anterior cerebral artery aneurysms treated by endosaccular embolization and surgical clipping

Although endovascular surgery is now widely used to treat intracranial aneurysms, no comparative studies of clipping versus endovascular surgery to address distal ACA aneurysms at the same institution are available. We compared the results of these treatment modalities to address distal ACA aneurysms at our institution. We treated 68 patients with ruptured distal ACA aneurysms (endovascular surgery, n=13; clipping surgery, n=55). We performed a retrospective comparison of the treatment outcomes. To study the efficacy of endovascular surgery we classified all our cases into three types: type A were small-necked aneurysms, type B were wide-necked aneurysms on the parent artery, and type C were aneurysms in which the A3 portion of the ACA arose from the aneurysmal dome near the neck. Intraoperative hemorrhage occurred in 7.7% of aneurysms treated by endovascular surgery and in 34.5% treated by clipping surgery. In 7.7% of the endovascularly-treated aneurysms we noted coil migration during embolization surgery; venous infarction due to cortical vein injury occurred in 7.3% of clipped aneurysms. Of the endovascularly-treated aneurysms, 7.7% manifested post-embolization hemorrhage; 23.1% manifested coil compaction. In clipping surgery, postoperative rerupture occurred in 1.8% of the aneurysms; one patient presented with postoperative acute epidural hematoma. Clip dislocation was noted in 1.8% of aneurysms. Angiography was indicative of post-treatment vasospasm in 7.7% of aneurysms treated endovascularly and in 50.9% of the clipped aneurysms. The clinical outcome showed no significant difference between endovascular surgery and clipping surgery.

A case of non-traumatic subgaleal hematoma effectively treated with endovascular surgery

Non-traumatic subgaleal hematoma is very rare. We present a case of refractory non-traumatic subgaleal hematoma occurring in a 15-year-old male patient. The patient was successfully treated by embolization of the superficial temporal artery. This therapeutic approach to refractory non-traumatic subgaleal hematoma is discussed.

Sarcoidal granulomas in the spleen associated with multiple carcinomas

Sarcoid reactions are relatively rare manifestations of epithelioid cell granulomas associated with malignancy; they are especially found in the lymph nodes draining malignant tumors, but rarely found in other organs. We present a case of a 60-year-old female with sarcoid reactions in the spleen identified during the consecutive diagnosis and management of ovarian, breast, and thyroid carcinomas during a period of about 2 years. The symptoms and laboratory data suggestive of systemic sarcoidosis were absent except for a slight mediastinal lymphadenopathy detected only by a computed tomographic scan. The splenic granulomas were accompanied by dendritic cells of mature and immature types, the latter being different from the reported nodal counterparts. To our knowledge, this is the first reported case of splenic sarcoid reactions associated with multiple cancers, and the first reported immunohistochemical detection of dendritic cells in splenic granuloma.

Multiple (18)F-FDG, PET-CT for postoperative monitoring of breast cancer patients

BACKGROUND

Positron emission tomography (PET)-computed tomography (CT) may be useful in the post-treatment follow-up of breast cancer patients.

PURPOSE

To assess the usefulness of (18)F-fluorodeoxyglucose (FDG) PET-CT (PET-CT) for postoperative monitoring of breast cancer patients.

MATERIAL AND METHODS

One hundred twenty-nine PET-CT studies performed on 55 female postoperative breast cancer patients (median age 56 years, range 36-86 years) were analyzed. The median interval between the PET-CT studies was 6 months (range 1-15 months). In order to determine the usefulness of serial PET-CT examinations in the postoperative follow-up of breast cancer patients, the PET-CT findings were compared with the physical findings, findings obtained by other imaging modalities, and the (18)F-FDG-PET (PET) findings.

RESULTS

The PET findings were negative in 4 metastatic bone lesions with a positive bone scan. The PET findings were also negative in 6 of 9 osteogenic bone metastases and one of 64 osteolytic bone lesions. There were 5 cases with false-positive of PET, which were determined to be areas of soft-tissue hyperactivity. All false-positive/-negative findings were corrected by the addition of CT.

CONCLUSION

The results of this study lend support to the clinical role of PET-CT in the postoperative follow-up/monitoring of breast cancer patients.

[Surgical removal of native aortic valve thrombosis associated with acute myocardial infarction and protein C deficiency; report of a case]

Native aortic valve thrombosis is an uncommon event. We describe the case of a 76-year-old man who suffered acute myocardial infarction associated with native aortic valve thrombosis diagnosed by cardiac catheterization. Since the thrombus was localized on the right coronary cusp and occluded right coronary artery, rescue revascularization was performed using perfusion catheter, which was continuously engaged to the right coronary artery. Operation was immediately performed under cardiopulmonary bypass. After incision of ascending aorta, thrombus was removed easily and aortic valve was preserved without degenerative change. Histological study showed a typical thrombus without any specific findings. He had a good clinical course and discharged 9 days after the operation. He had no history of heart valve disease, left heart catheterization or bacterial endocarditis. Since laboratory data showed 41% in protein C antigen and 32% of protein C activity, he was diagnosed of protein C deficiency. Our report emphasize that this thrombus formation may be caused by protein C deficiency.

Relationship between Focal Inflammation and Symptom Exacerbation after Endovascular Coil Embolization for Symptomatic Intracranial Aneurysms

SUMMARY

As endovascular surgery (EVS) of symptomatic unruptured aneurysms can result in symptom exacerbation due to intra-aneurysmal thrombosis or lump formation by coils, this treatment remains controversial. We present five women ranging in age from 58 to 76 years (mean 65.6 years) who suffered post-EVS symptom exacerbation attributable to local inflammation. The aneurysms measured from 8 to 25 mm (mean 19 mm) and were located at the cavernous portion in four patients and at the origin of the ophthalmic artery in one. All underwent endosaccular embolization under local anesthesia. Immediately after embolization, 24 h anticoagulation therapy was started via the continuous injection of heparin; they also received antiplatelet therapy. At one to three days post-EVS, all five patients manifested worsening of their cranial nerve symptoms. In three other patients the symptoms were improved after EVS. We posit that inflammation induced by coil embolization may worsen cranial nerve symptoms transiently. Our findings suggest that post-EVS followup is necessary and that patients exhibiting aninflammatory reaction be treated with anti-inflammatory drugs.

Efficacy of selective transarterial chemotherapy using a port systemfor angiosarcomas of the face and scalp

SUMMARY

Angiosarcoma is a rare, highly malignant tumor with a poor clinical outcome. From January 2004 to September 2005, we advocated transarterial chemotherapy using a port system for four patients with angiosarcomas of the face and scalp. A heparin coated ANTHRON P-Ucatheter was introduced into the feeding artery. The proximal part of the P-U catheter was connected to the port system and buried in subcutaneous tissue. The amount of chemotherapeutic drug applied using the port system was almost the same as the conventional intravenous dose. Paclitaxel was the standard agent, at 50-100 mg/diluted in 15-30 ml of physiological saline fluid slowly injected over 0.5-1 hour. For immunotherapy where appropriate, r-IL2 was mainly used at a dose of 70.000U/ diluted in 5 ml of physiological saline fluid injected into the port system over 30 seconds. This was continued for two to three weeks (five days/week) until recognition of a disappearance of the tumor. Macroscopic size reduction of the tumor was achieved in three out of the four cases. One case could not be evaluated because of eruptions induced by immunotherapy. Unfortunately two patients died after placement of port system, but the other two are still alive and are enjoying useful lives. Transarterial infusion chemotherapy using such a port system may be particularly effective for angiosarcoma in the early stages because small lesions with limited invasion mean a small territory of blood supply to be covered, and useful life was possible because the port system embedded in subcutaneous tissue allows treatment in an out-patient clinic.

Endovascular surgery for ruptured aneurysms with vasospasm

SUMMARY

With the existence of vasospasm, it is recommended that direct clipping surgery for a ruptured aneurysm be delayed until its disappearance, but this may be associated with aneurysmal re-rupture resulting in a poor outcome for the patients. Indications for endovascular coil embolization in such cases are discussed. Since November in 2003, we have applied endovascular coil embolization in 11 consecutive patients with ruptured aneurysms and apparent vasospasm of the parent artery from two to 17 days (average: eight days) after initial subarachnoid hemorrhage. Three patients had aneurysmal re-rupture before treatment, but the other eight had only experienced the one episode of subarachnoid hemorrhage. With one exception, all endovascular procedures could be successfully performed, resulting in complete occlusion of aneurysms and remarkable dilatation of inserted spastic vessels without technical complications or aneurysmal re-rupture. For the one case of failure because of a tortuous artery, direct clipping surgery was performed after disappearance of vasospasm. Cerebral infarction occurred in four, but only one correlated with the distribution of catheterization, and neurological deficits had completely disappeared three months after the onset. This preliminary report concerning a small number of patients suggests that endovascular coil embolization is not contra-indicated for aneurysms with vasospasm requiring catheterization. A large study for confirmation is now warranted.

Efficacy of endovascular surgery for unruptured internal carotid artery aneurysms presenting with cranial nerve symptoms

SUMMARY

Whether endovascular surgery is able to reduce the mass effects of unruptured aneurysms is still controversial, although some reports have suggested efficacy in cases of internal carotid artery aneurysms with cranial nerve palsy. Here we assessed outcome in a series of cases. Between April 1992 and April 2005, 18 patients with unruptured internal carotid artery aneurysms presenting with cranial nerve palsy were treated by endovascular surgery. The patients were two males and 16 females aged from 19 to 84 (mean 59.6 years). Aneurysms were located in the cavernous portion in 14, at the origin of the ophthalmic artery in one and at the origin of P-com in three. The aneurysms were all embolized using Guglielmi detachable coils, Interlocking detachable coils, Cook's detachable coils or Trufill DSC and detachable Balloons were applied to occlude the proximal parent artery.We analyzed the efficacy of endovascular surgery for such aneurysms retrospectively. The mean aneurysm size was 21.4 mm and the mean follow-up period was 57.7 months. Palsy of II(nd) cranial nerve was evident in three patients, of the III(rd) in eight, of the V(th) and V(th) in one each, and of the VI(th) in nine. Post embolization occlusion was complete in nine patients and neck remnant in the other seven. Regarding complications of endovascular surgery, one case (5.6%) showed TIA after embolization. Overall 11 (46%) cranial nerve symptoms showed complete resolution, eight (33%) showed some improvement, and five (21%) were unchanged. In three cases (12.5%), the symptoms worsened after treatment. The shorter the duration of symptoms was a factor predisposing to resolution of symptoms. In complete resolution cases, the timing of treatment after symptoms appeared and the time of complete resolution were in proportion. These results showed that there is no difference in reduction of mass effects between surgical clipping and endovascular surgery for unruptured internal carotid artery aneurysms.With endovascular surgery, the rapidity of treatment after symptoms is the most important factor for successful results.

New Development of a Dural Arteriovenous Fistula (AVF) of the Superior Sagittal Sinus after Transvenous Embolization of a Left Sigmoid Sinus Dural AVF. Case Report and Review of the Literature

SUMMARY

Transvenous occlusion of an affected sinus has become a standardized curative treatment for dural sinus arteriovenous fistula. A 57-yearold man with a left sigmoid sinus isolated dural AVF was successfully treated with tansarterial followed by transvenous embolization. Followup angiography one year and two months thereafter showed complete disappearance of the dural AVF. However, one year later, superior parasagittal sinus dural arteriovenous fistula had newly developed, for which the etiology and a careful point for follow-up are here discussed.

Successful coil embolization for a "three-hump" internal carotid artery anterior wall aneurysm: a case report

SUMMARY

We describe an unusually shaped aneurysm arising from the anterior wall of the internal carotid artery (ICA) that was treated successfully with Guglielmi detachable coils (GDCs). A 38-year-old woman presented with sudden onset of headache and was transferred to our hospital. Computed tomography revealed thin subarachnoid hemorrhage in the basal cisterns. Three-dimensional rotational angiography clearly showed a "three-hump" anterior wall aneurysm of the ICA. The two distal humps of the aneurysm were successfully obliterated with GDCs, but the proximal hump was too small to treat by coil embolization. The patient was discharged without neurological deficit. Anterior wall (blisterlike) aneurysms of the ICA have a high risk of rupture due to fragility of the wall. These aneurysms are considered difficult to manage by traditional surgical approaches. Our experience suggests that endovascular GDC embolization is a good alternative treatment modality for patients with such an aneurysm.

Blockade of Angiotensin II type-1 receptor reduces oxidative stress in adipose tissue and ameliorates adipocytokine dysregulation

Dysregulated production of adipocytokines may be involved in the development of atherosclerotic cardiovascular disease in metabolic syndrome and chronic kidney disease (CKD) associated with metabolic syndrome. The aim of this study was to determine the effects of treatment with angiotensin II (Ang II) type-1 receptor blocker (ARB) on the regulation of adipocytokines. Olmesartan, an ARB, significantly blunted the age- and body weight-associated falls in plasma adiponectin both in genetically and diet-induced obese mice, without affecting body weight, but had no effect on plasma adiponectin levels in lean mice. Olmesartan also ameliorated dysregulation of adipocytokines in obesity, such as tumor necrosis factor-alpha, plasminogen activator inhibitor-1, monocyte chemotactic protein-1, and serum amyloid A3. Olmesartan significantly reduced reactive oxygen species originating from accumulated fat and attenuated the expression of nicotinamide adenine dinucleotide phospho hydrogenase oxidase subunits in adipose tissue. In cultured adipocytes, olmesartan acted as an antioxidant and improved adipocytokine dysregulation. Our results indicate that blockade of Ang II receptor ameliorates adipocytokine dysregulation and that such action is mediated, at least in part, by targeting oxidative stress in obese adipose tissue. Ang II signaling and subsequent oxidative stress in adipose tissue may be potential targets for the prevention of atherosclerotic cardiovascular disease in metabolic syndrome and also in metabolic syndrome-based CKD.

Expression and mutation of SMAD4 in poorly differentiated carcinoma and signet-ring cell carcinoma of the colorectum

Poorly differentiated adenocarcinoma (Por) and signet-ring cell carcinoma (Sig) are rare but highly malignant types of colorectal cancer. To explore their genetic backgrounds we investigated TGF-beta type II receptor (TGF-beta RII) and SMAD4 in the TGF-beta signaling pathway, and to identify their mutator phenotype we examined microsatellite instability (MSI) status. Loss of SMAD4 expression was significantly more frequent in Por (12 of 38; 31%) and Sig (4 of 5; 80%) tumors than in well (Well) and moderately differentiated (Mod) carcinomas (p = 0.04, 0.003, respectively). Mutation of the SMAD4 gene was detected in 2 of 26 Por tumors. MSI was positive in 14 of the 38 Por tumors and in 1 of the 5 Sig tumors, but in none of the Well or Mod tumors examined. We also found mutation of TGF-beta RII, a putative target of MSI, in 10 of 35 Por tumors (28.6%), but in none of 3 Sig tumors. As a whole, about 50% of the Por tumors and 80% of the Sig tumors showed abnormalities of either TGF-beta RII or SMAD4 expression. This suggests that disruption of the TGF-beta signaling pathway may play a central role in the pathogenesis of Por and Sig tumors of the colorectum.

The platinum ball a new embolic material

SUMMARY

Polyvinyl alcohol (PVA) particles have been widely used as an embolic material for endovascular treatment of vascular enriched tumors, especially for meningiomas. However, there are disadvantages with their use due to the fact that they are radiolucent, with a very irregular shape and a tendency for self-adhesion. With alternative organic liquids there is also a possibility of toxicity. We have therefore developed a new embolic material, platinum balls, which feature radioopacity, a relatively well-defined oval shape, multi-pitted and indented surfaces on electron microscopy and a lower tendency for self-adhesion Based on positive findings in experimental studies, embolization of meningiomas was conducted with platinum balls in 27 patients and the results compared with findings for a matched group previously treated with PVA particles.Total volume of blood transfused during surgery was comparable in the two cases, although a tendency for lower values was noted with the platinum balls, and outcome was equally positive.

Ciliated craniopharyngioma may arise from Rathke cleft cyst

OBJECTIVE

The histogenesis of craniopharyngioma is not fully understood. We encountered a ciliated craniopharyngioma, the details of which may shed light on the histogeny of craniopharyngioma in general.

PATIENT

A 74-year-old man presented with visual disturbance. Computed tomography showed an intra-suprasellar cyst including a solid tumor. Transsphenoidal surgery was performed. During surgery, the cyst was found to contain mucoid milky-white fluid and a solid tumor 1 cm in diameter. Histologically, the tumor was shown to be a papillary type craniopharyngioma with foci of ciliated columnar epithelial cells. Ciliated craniopharyngioma was diagnosed.

CONCLUSION

Our findings in this case together with findings in other reported cases suggest that the basal cells of Rathke cleft cyst transform to papillary type craniopharyngioma after squamous metaplasia, explaining the presence of the cilia and goblet cells.

Application of the liquid coil as an embolic material for arteriovenous malformations

SUMMARY

The purpose of this paper is to clarify advantages and disadvantages of platinum liquid coils as an embolic material for AVMs. During the last eight years, 50 endovascular procedures using liquid coils were conducted in our institute for 19 cases with AVMs, 15 of which were located in the eloquent area. All but one presented with haemorrhage, the exception demonstrating repeated ischemic symptoms. Only liquid coils were used as the embolic material to obliterate the nidus and feeders. In ten of the 15 patients with AVMs located in the eloquent area and one case rejecting surgery, liquid coil embolization was applied one to 11 times (average 3.5 times) to achieve decrease in size and this was then followed by radiosurgery. The remaining eight AVM patients underwent total removal after liquid coil embolization. No complications were encountered during the peri-embolization period. In all cases, the purpose of embolization was to diminish the size to facilitate radiosurgery and decrease bleeding during surgery. The liquid coil has advantages as a material for embolization of AVMs; it is non-toxic and bioinart material; it seldom occludes normal minute vascular channels; when it used in a nidus, it seldom to migrates in the venous direction, and it has good radio-opacity and offers good marking for surgery. Appropriate applications include preoperative embolization or pre-radiosurgical embolization of AVMs, especially when staged embolizations are performed to reduce risk of perfusion pressure breakthrough in patients which are large or located in the eloquent area.

Experimental determination of minimal stimulation current and period for electrical thrombosis in dogs

SUMMARY

Endovascular surgery has been proposed as an alternative treatment for cerebral aneurysms. However, for wide neck and large sized lesions it is very difficult to obtain complete occlusion and tissue organization. The present study was conducted to examine the efficacy of electrical thrombosis for cerebral aneurysms and parent arterial occlusions using Interlocking Detachable Coils (IDCs), focusing on the minimum current volume and stimulation time required for stable electrical thrombosis formation. We used ten mixed-breed adult dogs (in the study body weights 9-12 kg; males: 5, females: 5). Guiding catheter sand microcatheters were introduced into both sides of the distal external carotid artery (ECA) and placed at the same level. To prevent migration, IDCs (4 mm x 12 cm) were placed in the ECA without being detached. After confirming no vessel occlusion, we applied a positive current (2-6 mA) to the coil on one side and performed angiography every ten minutes to observe whether vessel occlusion with electrothrombosis had occurred. It was determined that to achieve complete occlusion of the external carotid arteries in mixedbreed dogs, a minimum stimulation current of 4mA and a minimum stimulation time of ten to 20 minutes are required.

Strategy for the Treatment of Acute Thromboembolic Stroke Involving an Internal Carotid Artery

With the recent improvement of endovascular techniques, intra-arterial local fibrinolytic therapy has become widely available for treatment of acute embolic stroke and there is some evidence that it could be superior to conventional approaches1–6.

However, because of high mortality and morbidity, strokes involving the internal carotid artery (ICA) and featuring acute thromboembolic occlusion remain problematic7.

We have successfully performed intra-arterial local fibrinolytic therapy via the anterior communicating artery through the contra-lateral ICA in two consecutive cases of thromboembolic occlusion of the ICA, anterior cerebral artery (ACA) and middle cerebral artery (MCA), and obtained satisfactory results. We here present details of this new technique applied for the two cases and discuss the efficacy of this method compared with conventional approaches.

Reappraisal of thromboangiitis obliterans--a pathological contribution

Thromboangiitis obliterans (TAO), the Winiwarter-Buerger disease, is a vasoocclusive disease of unknown etiology which typically affects medium-sized extremital vessels of young male smokers. While the diagnosis of TAO is largely based on patients' presentation and clinical criteria, pathological substrates have been poorly defined and repeatedly disputed. Comparing the histology and immunohistochemistry of TAO especially with those of arteriosclerosis obliterans (ASO) and thromboembolism in two larger studies, we recently identified several features with significant meaning for the differential diagnosis. The unique tissue appearance of TAO is in favor of a general disorder of minute vessels indicating periarteritis rather than pure endarteritis, whereas an inflammatory reaction directed to the internal elastic lamina corresponds with the severity of disease. Since TAO or its syndromic equivalent is probably more common than currently diagnosed, the presented pathological criteria may help to identify latent cases, the overlap with ASO, and untypical organ involvement of TAO.

Superselective arterial chemotherapy for inoperable metastases in the dura mater and cranium

SUMMARY

Diffuse metastases to the cranium and dura mater of the bilateral hemisphere do not allow surgical intervention. We describe an excellent case which was treated by intra-arterial chemotherapy using Epirubicine (Farumorbicine). A 58-year-old woman treated for breast cancer ten years ago was admitted to our hospital with headache and frontal mass lesions.Magnetic resonance (MR) imaging on admission revealed a remarkable enhanced lesion of the bilateral dura mater and cranium, and bilateral brain edema in the frontal lobe. Angiography disclosed a vascular rich tumour supplied by bilateral external carotid artery branches.We successfully treated the lesion using superselective intra-arterial chemotherapy with a minimal dose of Epirubicine followed by embolization of bilateral external carotid artery branches. Followup MR imaging two years after the endovascular treatment showed disappearance of the enhanced lesion and remodeling of the skull bone. The patient is neurologically free of symptoms.

The efficacy of coil embolization at the dissection site of ruptured dissecting vertebral aneurysms

SUMMARY

Proximal occlusion of the parent artery has been widely used for treatment of vertebral dissecting ruptured aneurysms, but this does not always completely prevent re-rupture. In this series, the efficacy of occlusion at the dissection site using detachable coils was compared with proximal balloon occlusion. Over a five year period, 25 patients suffering from subarachnoid hemorrhage with dissecting vertebral aneurysms were treated by endovascular surgery. The first three of these 25 patients were treated with proximal balloon occlusion of the parent artery. The remainder underwent platinum coil occlusion at the affected site as early as possible after the diagnosis. In two of the three cases treated with proximal balloon occlusion, clipping or coating surgery were added because of progressive dissection. In all 22 cases of coil embolization, the intervention was successfully performed without complication. In one case with a dissection involving bilateral vertebral arteries, minor rebleeding from a contralateral dissection occurred after embolization. In the other 21 cases, rebleeding was not apparent (clinical follow-up: mean 24 months). Radiological findings showed complete occlusion of the dissection site and patency of the non affected artery (follow-up: mean ten months). We conclude that detachable platinum coil embolization at the dissection site is more effective than proximal occlusion for treatment of ruptured vertebral dissecting aneurysms because of immediate cessation of blood flow to the dissection site. However, in cases with bilateral dissections or hypoplastic contralateral vertebral arteries, preceding bypass surgery or stent treatment to preserve the affected vertebral artery may be needed.

Multiple arteriovenous malformations with hemorrhage

BACKGROUND

A rare case of a left temporal arteriovenous malformation (AVM) with bleeding 10 days after removal of another hemorrhagic AVM in the frontal lobe is reported.

METHOD

A 47-year-old man had an attack of headache and vomiting and was admitted to our hospital. On admission, a CT scan showed subcortical hemorrhage in the left frontal lobe. Left carotid angiography revealed four AVMs and a vertebro-basilar angiogram demonstrated a vascular malformation.

FINDINGS

First, a hemorrhagic AVM was removed with a hematoma. Following the operation, left carotid angiograms continued to show, AVMs, particularly a temporal AVM with increased blood flow, and after 10 days this hemorrhaged. This was surgically resected and the remaining small AVMs were treated by stereotactic radiosurgery.

INTERPRETATION

The patient had a high risk of hemorrhage. Adding hemodynamic stress to this situation, hemorrhage would have been expected to occur at an early time after the initial intervention for hemorrhagic AVM. Considering the risk of hemorrhage, other AVMs should undergo surgery as soon as possible after resection of hemorrhagic AVM.

Rupture of pial arteriovenous malformation associated with early thrombosis of the draining system following stereotactic radiosurgery--case report

A 50-year-old man was treated with stereotactic gamma knife radiosurgery for an incidentally detected small callosal arteriovenous malformation (AVM) with stenosis of the main draining pathway. He suffered two episodes of intraventricular hemorrhage at 4 and 14 weeks after the radiosurgery. Radiological studies demonstrated that the anterior portion of the draining system including a varix, which had been irradiated, was thrombosed before the obliteration of arteriovenous shunts. Stereotactic radiosurgery is an accepted treatment for selected small and medium AVMs, but this procedure may increase the risk of bleeding. Early occlusion of a part of the draining pathway after stereotactic radiosurgery might have induced AVM rupture. An impaired venous outlet, either consisting of one draining vein or with stenosis, present before treatment may be develop thrombosis in response to high-dose irradiation.

Two novel cucurbitacins, neocucurbitacins A and B, from the Brazilian folk medicine "Buchinha" (Luffa operculata) and their effect on PEBP2alphaA and OCIF gene expression in a human osteoblast-like Saos-2 cell line

Two novel cucurbitacins designated as neocucurbitacins A (1), possessing inhibitory activity of polyoma enhancer binding protein 2alphaA (PEBP2alphaA) and osteoclastogenesis-inhibitory factor (OCIF) gene expression in human osteoblast-like cells, and B (2) were isolated from the fruit of Luffa operculata. Their structures have been determined by extensive spectroscopic investigation.

Clinically unidentified dissection of vertebral artery as a cause of cerebellar infarction

BACKGROUND AND PURPOSE

Dissection of vertebral arteries has been reported in association with minor neck movements without signs of trauma on the surface of the neck. In addition, injury of a vertebral artery can cause brain infarctions. However, few cases have been reported in which fatal brain infarction was due to nonocclusive, clinically undetected, traumatic thrombus formation in a vertebral artery.

CASE DESCRIPTION

A 62-year-old man was hit by a car, and a right cerebellar infarction was found the day after the accident. The cause of the infarction could not be detected by angiography. Although the patient recovered favorably after surgical removal of the right lateral hemisphere of the cerebellum, he died suddenly 2 weeks after the accident. An autopsy and a microscopic study revealed pulmonary thromboembolism and organizing traumatic lesions of the right vertebral artery without occlusion or noteworthy stenosis of the artery.

CONCLUSIONS

We concluded that the patient sustained traumatic lesions of the right vertebral artery during the traffic accident 2 weeks before death and that his cerebellar infarction was due to a thrombus resulting from these traumatic lesions.

Optimal management of the axilla in patients with breast cancer

BACKGROUND

Although most surgeons perform some form of axillary lymph node dissection (ALND) as part of locoregional management of operable breast cancer, the extent of dissection remains controversial.

PATIENTS AND METHODS

Observation of the axilla trial (protocol I) and partial dissection trial (protocol I) began in January 1996. Between January 1996 and May 2000, 45 post-menopausal and 207 women with clinically node-negative breast cancer were enrolled into protocol I and protocol II respectively.

RESULTS

The 4-year cumulative incidence rate of axillary recurrence was 7% in patients with untreated the axilla. The 4-year overall survival rate was 98% in patients with untreated the axilla. The 4-year disease-free and overall survival rates were 96% and 98% respectively in patients treated with partial dissection.

CONCLUSION

Total axillary dissection seems to be unnecessary in Japanese breast cancer patients with relatively small tumors.

Prevention of Complications during Endovascular Surgery on the External Carotid Arteries, with Special Reference to Use of Nitropaste and the Lidocaine test

SUMMARY

PURPOSE

To examine all complications of endovascular procedures on the external carotid arteries and to ascertain how to reduce their number.

METHODS

In 93 consecutive patients, 137 endovascular procedures on the external carotid arteries were performed during the last 6 years.

RESULTS

We encountered no neurologic complications in these patients. In eight (9%) of the 93 patients who underwent lidocaine tests of the external carotid branches, nine transient cranial nerve palsies occured, seven of 67 vessels (10%) involving the middle meningeal artery and two of 18 vessels (11%) the ascending pharyngeal artery. However, they soon disappeared and successful embolisations were achieved. Vasospasm that prevented endovascular procedures occurred in only two cases of this series as a result of the application of isosorbide dinitrate.

CONCLUSIONS

The lidocaine test effectively provoked cranial nerve palsies without false negatives. The complication rate of endovascular surgery will decrease as long as awareness of complications such as cranial nerve palsy is maintained.

Investigations of the Dose of Heparin and Whole Blood Coagulation Time during Endovascular Surgery

SUMMARY

We chronologically determined whole blood coagulation time during continuous heparin administration, and investigated optimal doses of heparin in thirty-seven vascular surgery cases. ACT was determined with Hemochron 401. Heparin (2000 IU) was administered by bolus injection at the beginning of intravascular surgery, which was followed by continuous injection of 20 to 160 IU/kg/h. ACT determined before and 30 minutes after heparin administration were compared. There were no complications. ACT was maintained at a nearly constant level by continuous heparin administration. The dose of heparin required to maintain ACT at a level 1.5 to 2 times the initial level was 20 to 60 IU/kg/h. ACT was prolonged by more than three times in two of the ten subjects who were given heparin at a dose of 70 IU/kg/h or more. Continuous administration of heparin allowed maintenance of ACT at a nearly constant level during intravascular surgery. ACT was maintained within the range which is believed to be effective for prevention of thrombus formation (approximately 1.5 to 2.0 times larger than the initial level) by continuous administration of 20 to 60 IU/kg/h of heparin. ACT was, however, prolonged to more than three times the initial level in some subjects who were given 70 IU/kg/h or higher doses, suggesting the risk of a bleeding tendency. Accordingly, it is ideal to continue heparin administration at appropriate doses, while measuring ACT. The results of our study should serve as a useful standard for meeting this goal.

Protection of the spinal cord with pentobarbital and hypothermia

BACKGROUND

Ischemic spinal cord damage during thoracic aortic operations has not been eliminated despite application of various adjuncts. We experimentally investigated the protective effects of pentobarbital and hypothermia on the spinal cord subjected to ischemia.

METHODS

Among nine groups of 6 rabbits each, groups AI to AIII underwent 20-minute infrarenal aortic occlusion, and groups BI to BVI underwent 40-minute occlusion. Five milligrams per kilogram of pentobarbital was administered to groups AII and BII; 10 mg/kg in groups AIII, BIII, and BVI; 20 mg/kg in group BIV; and none in groups AI, BI, and BV. In groups BV and BVI, hypothermia was induced. Forty-eight hours postoperatively, the motor function of the lower limbs was evaluated.

RESULTS

Statistically significant recovery of motor function was observed in animals in groups AII, AIII, BIII, BIV, BV, and BVI.

CONCLUSIONS

Pentobarbital showed dose-dependent protective effects of the spinal cord. Moderate hypothermia alone also showed protective effects. Combined use of pentobarbital and hypothermia resulted in highly significant recovery of spinal cord function.

Bi-directional single anastomotic technique for the proximal anastomosis of free grafts (the saphenous vein or radial artery) to the ascending aorta in coronary artery bypass grafting surgery

In an operation involving coronary bypass grafting, anastomoses to the ascending aorta with saphenous vein or radial artery grafts may increase the possibility of post-operative strokes by the dislodgement of embolic particles into the arterial vasculature. We report a bi-directional single anastomotic technique to decrease the possibility of intra and postoperative strokes and to allow earlier cardiac perfusion by the graft anastomosed to the ascending aorta, in case of CABG with 2 free grafts from there.

[An autopsy case of primary aortoduodenal fistula complicated by both gastric carcinoma and acute gastric mucosal lesions]

We present an autopsy case of aortoduodenal fistula complicated by both gastric carcinoma and acute gastric mucosal lesions(AGML). A 73-year-old man with a past history of gastric ulcer, myocardial infarction, and arteriosclerosis of the right femoral artery presented to Osaka National Hospital complaining of intermittent claudication of the right lower extremity. After a diagnosis of arteriosclerosis obliterans, percutaneous angioplasty was performed. The postoperative course was initially good. However, two weeks after the angioplasty procedure he suddenly vomited blood. Emergency endoscopy revealed both polypoid gastric carcinoma and AGML, which were considered to be the major cause of his gastrointestinal bleeding. And he died of uncontrollable gastrointestinal bleeding two weeks after this examination. Autopsy showed an atherosclerotic aneurysm of the abdominal aorta that had ruptured into the third part of the duodenum. To our knowledge, there has been no previous autopsy on a primary aortoduodenal fistula from an atherosclerotic abdominal aneurysm complicated by similar hemorrhagic gastric lesions. This case emphasizes the difficulty of making a clinical diagnosis of primary aortoduodenal fistula.

Primary intracerebral malignant melanoma with leptomeningeal spread, extradural extension and lung metastasis

A rare primary intracerebral solitary malignant melanoma with extracranial metastasis is reported. The patient was a 66-year-old man who was revealed to have a tumor in the right temporal lobe by MRI. The tumor was totally resected and the histopathological diagnosis was malignant melanoma. Despite postoperative treatment with chemo-radiotherapy, tumor recurred with multiple subarachnoid dissemination. Complete autopsy showed marked leptomeningeal dissemination of tumor in the cerebro-spinal compartment. In the outside of the central nervous system, a microscopic metastatic nodule was found in the right lung. Metastatic tumor in the spinal cord showed the extradural extension which might have led to hematogenous metastasis to the lung.

Coil embolization for the treatment of ruptured dissecting vertebral aneurysms

BACKGROUND AND PURPOSE

Proximal occlusion of the parent artery has been widely used for treatment of vertebral dissecting ruptured aneurysms, but this does not always completely prevent rerupture. We retrospectively studied 24 consecutive patients for clinical characteristics and/or for efficacy of occlusion with detachable coils at the site of dissection.

METHODS

During a 45-month period, 24 of 242 patients with aneurysms associated with subarachnoid hemorrhage had dissecting vertebral aneurysms identified at angiography. Eighteen of the 24 patients were treated with platinum coil occlusion at the affected site as early as possible after diagnosis, two patients were treated conservatively, and four others were not eligible for treatment owing to intractable elevation of intracerebral pressure and severe brain stem dysfunction.

RESULTS

The rate of aneurysmal rupture in the posterior fossa was high, at 56 (23%) of the 242 aneurysms, including 24 (10%) vertebral dissecting aneurysms. Subsequent rupture occurred in 14 (58%) of the patients, all within 24 hours after the first attack and three during transportation to the hospital. In all 18 patients, coil embolization at the affected site was successful, with no complications. Radiologic findings showed complete occlusion of the dissection site and patency of the unaffected artery (mean follow-up, 9 months). Among the six patients who did not undergo embolization, only one survived with a good outcome, the others died of repeat hemorrhage.

CONCLUSION

A high rate of vertebral artery dissecting aneurysms may be expected in patients with subarachnoid hemorrhage, especially in those with early repeat hemorrhage. Detachable platinum coil embolization may be more effective than proximal occlusion for treatment of ruptured vertebral dissecting aneurysms because of immediate cessation of blood flow to the dissection site; however, in patients with bilateral dissections or hypoplastic contralateral vertebral arteries, prior bypass surgery orstent placement to preserve the artery will be needed.

Minimally invasive coronary artery bypass grafting for the left anterior descending coronary artery

OBJECTIVE

A single surgeon conducted One hundred and twelve patients underwent minimally invasive direct coronary artery bypass grafting for the left anterior descending coronary artery 112 patients at Yamato Seiwa Hospital from September 1996 until August 1999.

METHODS

All procedures were performed via left anterior short thoracotomy using a stabilizer during graft anastomosis.

RESULTS

No operative deaths occurred but 3 patients died while hospitalized due to noncardiac events. Graft occlusion was seen in 3 patients early postoperatively. Other angiography graft failure such as stenosis was seen in 11 patients. Occlusive lesions of other coronary arteries occurred in 77 patients (69%) and 53 patients underwent percutaneous transluminal coronary angioplasty the pre/postoperatively for those lesions.

CONCLUSIONS

These results suggest that minimally invasive direct coronary artery bypass grafting is seen by cardiologists as a reasonable form of revascularization in conditioned patients having left anterior descending artery lesion, and that minimally invasive direct coronary artery bypass grafting has a spectrum of candidates different from that of conventional surgical revascularization for the coronary artery.

Purification, characterization, and relation to bikunin of rat urinary trypsin inhibitors

Two forms of urinary trypsin inhibitor (UTI-1 and UTI-2) were purified from pooled urine of normal male rats to apparent homogeneity by salting out, affinity chromatography, gel filtration, and reverse-phase HPLC. UTIs-1 and 2 were shown to be thermostable glycoproteins with the respective molecular weights of 22,000 and 18,000 estimated by SDS-PAGE. These inhibitors combined with bovine trypsin in a 1:1 molar ratio: the Kd values were 2.5 x 10(-10) and 2.3 x 10(-10) M, respectively. Amino acid composition and sequence analysis indicated that UTI-1 corresponded to rat bikunin of which the amino acid sequence was deduced from a rat liver cDNA clone encoding alpha1-microglobulin [Lindqvist et al. (1992), Biochim. Biophys. Acta 1130, 63-67] except that the protein sequence seemed to lack C-terminal serine, and UTI-2 corresponded to UTI-1 lacking N-terminal 21 amino acid residues.

Correlation of magnetic resonance imaging and histological findings in a large basilar tip aneurysm after coil embolization--case report

A 73-year-old female with a large basilar tip aneurysm underwent endovascular coil embolization with interlocking detachable coils (IDCs). The patient subsequently died of pneumonia 25 days after the embolization, and the aneurysm specimen was obtained at autopsy. Histological examination showed that the intraaneurysmal structure consisted of three layers. The outer layer was mildly organized thrombus surrounding the coils, the middle layer was disorganized clot, and the inner layer consisted of fresh blood clot. Gradient-echo magnetic resonance (MR) imaging taken before death had demonstrated a central region of high intensity and a peripheral low intensity region corresponding to the inner and middle-outer layers of the aneurysm, respectively. Intraaneurysmal placement of IDCs leads to the formation of a clot surrounding the coils. However, clot formation may be inadequate where the packing of the IDCs is incomplete. Comparison of the MR imaging and histological findings in this case show that gradient-echo MR imaging can assess thrombus and residual blood flow within the aneurysm.

Dural arteriovenous malformations associated with cerebral aneurysms

Only limited information is available concerning dural arteriovenous malformations (AVMs) found in association with cerebral aneurysms. The present report focuses on six such cases, concentrating attention on clinical characteristics and significance. Of a total of 46 dural AVMs encountered over a given period, six (13%) were linked with cerebral aneurysms. Particularly strong associations were noted for dural AVMs in the anterior cranial fossa (three of four cases) and convexity (all of three cases). With dural AVMs in the anterior cranial fossa, subarachnoid haemorrhage is common, so that where this is encountered the possibility of a complicating aneurysm should be considered in order to select an appropriate treatment.

Off-pump coronary artery bypass grafting for the circumflex coronary artery via the left thoracotomy in redo CABG with the patent left internal thoracic artery graft to the left anterior descending artery

Five patients had undergone off-pump coronary artery bypass grafting (CABG) as redo CABG via the left thoracotomy for the lesions of the left circumflex coronary arteries. In all patients, the internal thoracic artery (ITA) grafts to the LAD were well patent and acting significantly important in coronary circulation, however, ischemia due to the lesion of the LCX was significant. The saphenous vein grafts or the radial artery grafts were used as the materials of the grafts. The proximal ends of these grafts were anastomosed to the descending aorta. The procedures were completed successfully in all the patients and the excellent patency was shown angiographycally even in the long-term period after the surgery. Necessity of graft surgery only for the LCX lesion would be a rare occasion for a surgeon; however, these results suggest that the procedure is simple and less risky, which would encourage the surgeon to perform it in clinical situation.

The effect of encephalo-myo-synangiosis on abnormal collateral vessels in childhood moyamoya disease

Child patients with Moyamoya disease initially present with ischemic symptoms. However, the long-term risk of intracranial hemorrhage for childhood Moyamoya disease is unknown. Hemodynamic overload to the fragile collateral vessels has been considered to cause hemorrhage. We reviewed angiograms to evaluate the effect of encephalo-myo-synangiosis (EMS) on abnormally dilated collateral vessels in 13 child patients with Moyamoya disease. EMS was performed on 24 sides in 13 patients ranging from 5 to 14 years of age. Post-operative angiography (6-88 months after surgery) revealed good revascularizations through EMS (larger than one-third of the middle cerebral artery (MCA) distribution) in 18 sides (75%) and smaller revascularizations in 6 sides (25%). In cases with a good revascularization through EMS, reduction of the abnormal collateral vessels was observed not only in the basal Moyamoya vessels (94% of sides) but also in the medullary arteries derived from the choroidal arteries (62% of sides), which are considered to cause intraventricular hemorrhages in adult patients. It is suggested that EMS may reduce the hemodynamic load on dilated collateral vessels and, subsequently, the long-term risk of intracranial hemorrhage in childhood Moyamoya disease.