Quantitative analysis of the isolation area after larger-size laser balloon ablation

Background

The visually guided laser balloon ablation is a balloon-based catheter ablation technology used for atrial fibrillation (AF) ablation in recent years. This balloon catheter consists of a compliant balloon that has the capability of real-time endoscopic visualization of the targeted pulmonary vein (PV). The sizeable balloon is usually inflated to obtain optimal PV occlusion. The isolation area after laser balloon (LB) ablation was reported to be smaller than that after cryoballoon ablation. However, when LB is inflated with its maximum pressure, it can visualize wide-area PV antrum. Thereby, we suspected that larger-size LB can create wider isolation area.

Purpose

The aim of this study is to quantitatively evaluate the isolation area after LB ablation at the size larger than appropriate size for ablation in the pulmonary vein carina region.

Methods

We assessed 66 patients with AF who underwent LB ablation at the larger inflation size in our hospital during the period from July 2018 to July 2019. After LB ablation, we created voltage maps with a circular mapping catheter and calculated isolation areas with CARTO system.

Results

Figure shows a larger LB with its maximum pressure. PV antrum isolation was extended to the posterior wall in all patients. The left- and right-sided pulmonary vein antrum isolation area were 15.1±3.9 and 19.4±4.3 cm2, respectively.

Conclusion

LB at the larger inflation size with its maximum pressure can isolate wider-area circumferential PV antrum than previously reported. This method may be a new way of pulmonary vein antrum isolation.

Left atrial voltage mapping after PVI.

Funding Acknowledgement

Type of funding source: None

Intracranial plasma cell granuloma with genetic analysis

BACKGROUND

Plasma cell granuloma of the central nervous system is rare and less than 30 cases have been reported in literature.

METHOD/FINDINGS

A 64-year-old woman complained of headache, and computed tomography (CT) and magnetic resonance (MR) imaging of the brain revealed a tumour at the right anterior-third parasagittal region which led us to diagnose a parasagittal meningioma. We performed total resection of the tumour and the pathological diagnosis was plasma cell granuloma. Polymerase chain reaction (PCR) analysis of immunoglobulin heavy chain (IgH) gene rearrangements produced no monoclonal band. This patient underwent no supplementary treatment and no recurrent tumour was observed for 3 years.

INTERPRETATION

A case of plasma cell granuloma which is diagnosed with genetic analysis is presented. An analysis of the clonality using the PCR procedure would play an important role in supporting the pathological and clinical diagnosis.

[Alexia-agraphia of kanji (Japanese morphogram) after left posterior-inferior temporal lesion]

Several cases of selective alexia with agraphia of kanji have been reported in Japan in this decade. It is well known that the lesion in the posterior inferior temporal lobe of the dominant hemisphere is responsible for this cognitive syndrome. Neuropsychological data in our patient suggest that the postero-inferior region of the temporal lobe of the dominant hemisphere may be the visuo-verbal association area for the analysis of the complex visuo-verbal information. The symptoms caused by the same lesion in western patients might be subangular alexia (alexia without agraphia). Alexia with agraphia of kanji and subangular alexia would appear to be distinct entities, but a dual processing hypothesis of visuo-verbal information and the concept of the visuo-verbal association area might well explain both syndromes.

Large, benign osteoblastoma of the temporal bone--case report

Benign osteoblastoma is a rare tumor of bone, usually confined to the long bones and vertebrae. Its occurrence in the calvaria is extremely rare. The authors report a case of a temporoparietal lesion in a 29-year-old male. Computed tomography revealed a low-density mass, which was irregularly enhanced by contrast medium. Magnetic resonance imaging demonstrated a mass of low intensity on T1- and high intensity on T2-weighted images. Angiography confirmed the presence of a large epidural mass in the left temporal region. The tumor was excised and the pathological diagnosis was benign osteoblastoma.

[Hypernatremia due to hypothalamic tumor: ADH response to changes in plasma osmolality]

A case of a patient with the syndrome of chronic hypernatremia and hypodispia due to hypothalamic tumor was studied to evaluate the change of ADH response to plasma osmolality during the clinical course. A 23-year-old man was admitted for investigation of anorexia, hypodipsia and gait disturbance. Examination showed memory disturbance and generalized muscle weakness. Investigation showed marked hypernatremia (177 mEq/l) and hypopituitarism. Water loading test showed that ADH was not stimulated by hyperosmolality but continued to be secreted at a more or less constant level approximating normal basal state. CT scan revealed hypothalamic tumor. The tumor was suspected to be germinoma due to its radiosensitivity and high serum hCG level. After irradiation, the tumor lesion disappeared. ADH secretion came to be responsive to changes in osmolality but the response of the system was markedly reduced compared with the normal response, and hypodipsia and hypernatremia still remained. We conclude that the adipsia and complete destruction of the osmoreceptor in the patient caused marked hypernatremia and the destruction of ADH osmostat improved partially after irradiation. We believe it very useful for analyzing the disturbance of osmoregulatory system to evaluate the relationship of plasma ADH to plasma osmolality.

[Pineal metastasis--a case report and a review of literature]

This is a report of a rare case of pineal metastasis from gastric adenocarcinoma. A 75-year-old male with a previous medical history of subtotal gastrectomy for cancer of the cardia was diagnosed as having hydrocephalus 6 months later. After undergoing a V-P shunt operation, he was transferred to Kyoto First Red Cross Hospital. The patient had neurological abnormalities: bilateral paralysis of upward eye movement, and bilateral sluggish reflex to light. Ten days later the patient suddenly fell into a coma due to intratumoral hemorrhage. The patient soon regained consciousness and received Cobalt-therapy. However he died two months later of pulmonary malfunction due to pulmonary metastasis. An autopsy revealed a pineal tumor metastasized from gastric adenocarcinoma. The tumor involved the body of the pineal gland, and was expanded having a sharply defined margin which extended to the posterior portion of the third ventricle and the bilateral basal ganglia.

Analysis of immunoreactive insulins in man in relation to the effects of aging

In order to elucidate the effects of aging on insulin content in human pancreas, the immunoelectrophoretic analysis of insulin was applied. The pancreas of senile humans appears to contain less total immunoreactive insulin, because of the decrement of proinsulin fraction after overnight fasting. The results suggest the involvement of insulin biosynthesis according to the aging process.

Diagnosis and localization of an insulinoma with inappropriate hypoglycemia in relation to the level of immunoreactive insulin using gel chromatographic separation

We evaluated the possibility to diagnose the case of insulinoma using the combination of portal blood sampling and gel filtration techniques. The portal blood sampling showed 52 muU/ml of immunoreactive insulin (IRI) level at the closest splenic vein to the tumor, but the level should not be high enough to reasonalize the being of the tumor. The gel filtration pattern of IRI from the blood at the same point was clearly different from the other samples. Therefore, it could be useful for the diagnosis of insulinoma to combine percutaneous transhepatic portal blood sampling and gel filtration in such a case.

Insulin and C-peptide secretion from B cells in human subjects stimulated with glucose

Two groups of immunoreactive insulin in human sera were reported by Kakita et al. (4), using gel chromatography after acid-alcohol extraction. These analogs were noted not only in circulating human sera but also in incubation medium and incubated human pancreas. The release of these insulin analogs was discussed in a previous report (5). The circulating C-peptide immunoreactivity was separated into two groups on a Bio-Gel column, and the early peak should not be proinsulin but an associated C peptide (6). These analogs of insulin were separated by the methods of ion-exchange chromatography, isoelectric focusing, gel electrophoresis, and gel chromatography. Immunoreactive insulin was also separated into two major bands by standard polyacrylamide gel electrophoresis. The fast migrating band corresponds to the rat insulin II position, and the slower corresponds to rat insulin I, which has one more basic amino acid residue in comparison with rat insulin II. Further studies have been performed in five healthy adults in order to elucidate the physiological relationship between analogs of insulin and C-peptide peak substances in human serum; the results are reported in this paper with a consideration of the mechanism of insulin secretion.

ACTH-mediated effect of metoclopramide on plasma pregnenolone in man

Five healthy adult men were given metoclopramide (10 mg and 20 mg) iv and the effects of L-dopa and dexamethasone on metoclopramide-induced increases in the plasma pregnenolone concentration were determined. After an injection of 10 mg metoclopramide, the pregnenolone level rose slightly, though not significantly vs a control. After injecting 20 mg metoclopramide, the pregnenolone level rose significantly vs both the control and the basal level. The pregnenolone increase was not inhibited by L-dopa pretreatment, whereas pretreatment with dexamethasone did suppress it significantly. The data suggest that metoclopramide increases pregnenolone secretion through an ACTH-dependent effect and that dopamine does not modulate pregnenolone secretion in man. This means that dopaminergic modulation does not affect the early steps (cholesterol to pregnenolone) of steroid biosynthesis in man.

An in vivo analysis of pancreatic protein and insulin biosynthesis in a rat model for non-insulin-dependent diabetes

The purpose of these experiments was to estimate insulin biosynthesis in vivo in a rat model for non-insulin-dependent diabetes. Insulin biosynthesis rates were determined in 4-wk-old animals that had been injected with 90 mg/kg of streptozotocin 2 d postpartum. Control and diabetic animals did not differ in body weight or fasting plasma glucose. Fed plasma glucose was significantly elevated (186 +/- 13 micrograms/dl vs. 139 +/- 7 mg/dl, P less than 0.05) and pancreatic insulin content was reduced (41 +/- 2 micrograms/g vs. 63 +/- 8 micrograms/g, P less than 0.05) in the diabetic rats. Insulin biosynthesis was estimated in vivo by measuring and comparing [3H]leucine incorporation into proinsulin with that into total pancreatic protein 45 min after injection. Insulin biosynthesis was 0.391 +/- 0.07% of pancreas protein synthesized in control rats and 0.188 +/- 0.015% (P less than 0.05) in diabetic rats. In animals of the same age, the fractional and absolute rate of pancreatic protein synthesis were determined. Total pancreatic protein synthesis was not reduced in streptozotocin treated animals (185.5 +/- 14.1%/d vs. 158.6 +/- 14.9%/d, NS) but was markedly reduced in control rats after a 48-h fast (to 70.8 +/- 5.5%/d, P less than 0.01). Because total pancreatic protein synthesis was not decreased in the diabetic rats, the decrease in the fraction of radiolabel incorporated into insulin seems to represent an absolute decrease in the rate of insulin biosynthesis in this animal model for diabetes. Through RNA blot hybridization with 32P-labeled cloned rat insulin complementary DNA, proinsulin messenger RNA (mRNA) was estimated as the rate of insulin biosynthesis in control and diabetic animals. There was a 61% reduction in proinsulin mRNA at 4 wk and an 85% reduction at 7 wk (P less than 0.001) in the diabetic animals. After streptozotocin injection in neonatal rats, there is marked beta-cell damage and hyperglycemia. Beta-cell regeneration occurs with return to normoglycemia, but with age hyperglycemia develops. The reduction in insulin synthesis and proinsulin mRNA seemed disproportionate with the more modest reduction in beta-cell number. The importance of these observations is that, in this animal model, diabetes is associated with a limited ability to regenerate beta-cell mass and to synthesize insulin. The relationship between the defect in glucose-stimulated insulin release and impaired insulin biosynthesis has yet to be determined.

Somatostatin-like immunoreactivity in mammalian thyroid glands: contents and partial characterization

Somatostatin (SRIF)-like immunoreactivity (SLI) in the thyroid glands of human and several animal species were compared, and the SLI peptides were characterized chromatographically and immunologically. All specimens were extracted with 2 M acetic acid, and the SLI content determined by RIA. The SLI concentrations in guinea pigs [34.3 +/- (SE) 4.8 ng/mg protein] and rabbits (9.4 +/- 0.8 ng/mg protein) were much greater than those in other mammals: dogs, rats, mice, and humans. On gel filtration of extracts of the guinea pig, rabbit and dog thyroids, the major peak of SLI (1.6 K SLI) coeluted with synthetic SRIF-14 (S-14). Two other forms of SLI ("big" SLI and 3 K SLI) were also detected, although their relative proportions to total SLI were small (2.3 to 8.2%). The 3 K SLI and 1.6 K SLI from guinea pig and rabbit thyroids contained peptides coeluting with synthetic SRIF-28 (S-28) and S-14, respectively, on reverse-phase high performance liquid chromatography. The dilution curves of the two molecular forms of SLI, i.e. 3 K SLI and 1.6 K SLI, were parallel to the displacement curves of S-28 and S-14 in the SRIF RIA. It is concluded 1) that the thyroid contents of SLI varied greatly from species to species, with the highest content being found in guinea pig thyroids; 2) that in guinea pigs, rabbits, and dogs, the predominant form of thyroid SLI is 1.6 K SLI; and 3) that the 3 K SLI and 1.6 K SLI peptides from guinea pig and rabbit thyroids are immunologically and chromatographically indistinguishable from S-28 and S-14, respectively.

Adrenocorticotropin-mediated effect of metoclopramide on plasma aldosterone in man

Five healthy adult men were given metoclopramide (10 and 20 mg) iv and the effects of L-dopa and dexamethasone on metoclopramide-induced increases in plasma aldosterone concentration were determined. Plasma PRL, ACTH, and cortisol levels were also measured and the results reported in a previous study. After an injection of 10 mg metoclopramide, aldosterone levels increased significantly. The aldosterone rise was inhibited by L-dopa, but not by dexamethasone. After injecting 20 mg metoclopramide, aldosterone levels increased significantly vs. both the control and the basal level. The aldosterone increase was not inhibited by L-dopa pretreatment, whereas pretreatment with dexamethasone did suppress it. The data suggest that metoclopramide increased aldosterone secretion through an ACTH-dependent (stress mediated) effect in addition to its antidopaminergic adrenal action, simultaneously. There were no significant differences between the ACTH-dependent and dopamine antagonist-mediated aldosterone increases in either the 10- or 20-mg tests. However, the ACTH-dependent aldosterone increase was statistically greater in the 20-mg test than in the 10-mg test, whereas there was only a slight and not statistically significant difference in the dopamine antagonist-mediated aldosterone increase between the tests. This means that the ACTH-dependent component of the aldosterone secretion is affected by the doubling of the metoclopramide dose, whereas the dopamine antagonist-mediated component is not.

Insulin gene expression in the developing rat pancreas

In the developing rat pancreas from about day 15 until birth there is a marked increase in the concentration of insulin. The present experiments were designed to determine whether enhanced insulin biosynthesis is accompanied by a coordinate increment in proinsulin mRNA. Using a sensitive RNA filter hybridization technique and a cloned rat proinsulin 32P-cDNA as a hybridizing probe, the concentration of proinsulin mRNA was measured. A greater than 900-fold accumulation of proinsulin mRNA was found, which closely paralleled that of immunoreactive insulin. Proinsulin mRNA and immunoreactive insulin were highest 1–2 days after birth, more than eightfold higher than that in adult pancreas.

The patterns of digestion by a number of restriction endonucleases of the two nonallelic insulin genes were identical in adult and fetal DNA and in DNA from an insulinoma. We found no evidence of major gene rearrangement during embryogenesis as a prerequisite to insulin gene expression.

Glucose stimulated insulin biosynthesis at the earliest time examined (day 15 of gestation). Insulin biosynthesis was enhanced almost fourfold while proinsulin mRNA differed by less than 20% during a 2-h incubation. This suggested that the short-term effect of glucose on insulin biosynthesis in the developing rat pancreas occurs at the level of translation of existing mRNA, similar to that noted in adult pancreatic islets. These data taken together suggest that the same controls for insulin biosynthesis in the adult exist at these early times in pancreatic development and that the controls for insulin biosynthesis appear coordinately with the appearance of increased insulin during endocrine pancreatic differentiation.

Stress-mediated effect of metoclopramide on cortisol secretion in man

Five healthy adult men were given metoclopramide (10 and 20 mg) iv, and in repeated tests almost always developed transient restlessness lasting from 10-30 min. The effects of L-dopa and dexamethasone on metoclopramide-induced increases in cortisol concentration were determined. These response values were compared with those of a control. After an injection of 10 mg metoclopramide, the cortisol level increased significantly only at 40 min; the ACTH level did not change. The cortisol rise was suppressed by dexamethasone pretreatment. Pretreatment with 0.5 g L-dopa resulted in a decrease in the PRL level from -20 min to 20 min, and the increase in cortisol seen at 40 min was cancelled. The ACTH level did not change. After injecting 20 mg metoclopramide, the ACTH level increased significantly from 20 min to 60 min and the cortisol level showed a significant increase from 20 min to 120 min. Pretreatment with dexamethasone resulted in a decrease in these hormones. The L-dopa pretreatment did not reduce even the rise in the PRL level which resulted from the administration of 20 mg metoclopramide. These findings suggest that the ACTH and cortisol response to metoclopramide is a stress-mediated effect. Plasma cortisol responses to 20 mg metoclopramide and insulin-induced hypoglycemia were studied and compared in seven volunteers and found to be similar.

Pancreatic content of insulins I and II in laboratory rodents. Analysis by immunoelectrophoresis

The purpose of these experiments was to determine the relative proportion of insulins I and II in the pancreas of inbred strains of mice and rats, and whether this proportion would be altered by conditions known to affect insulin biosynthesis. Rapid analysis of multiple samples was accomplished by an immunoelectrophoretic method in which insulin can be detected in crude pancreatic extracts without further purification. Insulin I was found to account for 65–76% of total pancreatic content in C3H/HeJ, C57BL/6J, and CD2F1 mice. Glucose injection produced a significant increase in insulin content, which was completely accounted for by insulin I, although fasting for 2 days had no effect. In all three strains there was either no change or a decrease in content of insulin II, while insulin I increased 77–83% (P < 0.05) of the total pancreatic insulin.

To determine the effects of chronic hyperglycemia, the content of insulins I and II was measured in the pancreas of obese hyperglycemic mice and compared with that of lean littermates. Insulin content in pregnant rats was also evaluated, since pregnancy is characterized by insulin resistance and hyperinsulinemia. The results of these studies indicate that insulin I predominates in the pancreas of a variety of strains of rats and mice. More important is the observation that conditions that increase insulin production preferentially increase insulin I relative to II, suggesting independent regulation of the two genes.

Immunodetection of insulin after transfer from gels to nitrocellulose filters. A method of analysis in tissue extracts

This report describes the development of a rapid method for detection of nanogram quantities of insulin in tissue extracts after electrophoresis. Following electrophoresis the proteins are transferred to nitro-cellulose filters and treated with a photoreactive crosslinking agent. Filter bound insulin is detected by antiinsulin antibody and 125I-protein A, followed by autoradiography. The photoaffinity crosslinking is simple, rapid, and stable, and does not require reactive binding sites on derivatized paper. Under these conditions insulin maintains its immunoreactivity yet can be washed extensively to reduce nonspecific background; as little as 10 ng can be visualized. The method has proven to be useful for rapid analysis of qualitative as well as quantitative differences in immunoreactive insulin in tissue extracts.

Biosynthesis of rat insulins I and II: evidence for differential expression of the two genes

The purpose of these experiments was to determine the relative content and biosynthetic rate of insulins I and II under various experimental conditions. The two insulins were quantitated by polyacrylamide gel electrophoresis, electrotransfer to nitrocellulose paper, photoaffinity crosslinking, and immunodetection with anti-insulin antibody and 125I-labeled protein A. The ratio (mean +/- SEM) of insulins, I/II, was 1.2 +/- 0.2 in Wistar-Furth rats fasted for 4 days, 1.6 +/- 0.2 in normal rats, and 5.5 +/- 0.8 in growth hormone-tumor-bearing hyperinsulinemic rats (P less than 0.01). The increase in content of rat insulin I compared to II in the growth hormone-tumor-bearing animals was confirmed by radioimmunoassay of gel slices. To determine whether the difference in contents of rat insulins I and II in the hyperinsulinemic rats was due to increased biosynthesis or a different turnover rate, isolated rat islets were incubated in [3H]leucine for 4 hr with 5.5 mM or 16.0 mM glucose in the incubation medium. Glucose stimulated insulin biosynthesis greater than 8-fold. The ratio of synthesis of rat insulin I relative to II was 0.9 +/- 0.1 at 5.5 mM glucose and 9.8 +/- 3.3 (P less than 0.01) at 16.0 mM glucose. Therefore, under conditions that stimulate insulin biosynthesis, there was a marked preferential synthesis of rat insulin I relative to II. These studies suggest that the two rat insulin genes are expressed independently and that, under stimulatory conditions, there is preferential expression of the rat insulin I gene.

Insulin biosynthesis and diabetes mellitus

This review reports the use of recombinant DNA techniques in the study of the structure and regulation of expression of insulin genes in man and experimental animals. Insulin biosynthesis by pancreatic islet cells is predominantly regulated by change in plasma glucose concentration. Using a cell-free protein synthesizing system as an assay of functional proinsulin messenger RNA (mRNA), and hybridization analysis with a cloned DNA complementary to proinsulin mRNA, it has been determined that through changes in proinsulin mRNA levels. Insulin genes of the rat, chicken and human have been isolated and sequenced. The 5' ends of the genes have similar sequences suggesting areas important for regulation of transcription. There are two non-allelic insulin genes in the rat, but only one in chickens and humans. Intervening sequences, areas of DNA transcribed into precursor mRNA but which do not appear in mature mRNA, have been described within insulin genes. The insulin gene resides on chromosome 11 of humans as determined by DNA hybridization analysis of mouse human hybrid cells. The structure of the insulin gene in genomic DNA of humans has been analyzed in diabetics and non-diabetics. Insertions of DNA between 1500 and 3400 base pairs have been detected near the transcription initiation site in 65% of type II diabetics, and 25-30% of non-diabetics (this difference is significant at the p less than 0.001 level). Limitation of these insertions to this potential promotor region of the insulin gene suggests that they may alter gene expression in type II diabetes. These insertions of DNA may prove to be useful genetic markers for diabetes.

Gel chromatographic separation of human C-peptide and proinsulin

The immunoreactivity of circulating C-peptide is separated into two main peaks on a Bio-Gel column; the faster peak should not be proinsulin but an associated C-peptide without a covalent bond. Proinsulin is in fact eluted in the fraction prior to the faster eluting peak of C-peptide immunoreactivity with 1 M acetic acid as the eluting buffer. Therefore the use of gel chromatography to study C-peptide and proinsulin needs to be carefully re-evaluated, although the method has been established as one of the standard methods.

Dexamethasone suppressibility of plasma pregnenolone or dehydroepiandrosterone in gonadectomized patients

The 9 AM dexamethasone suppression test was carried out in gonadectomized patients, and plasma pregnenolone or dehydroepiandrosterone (DHA) was radioimmunoassayed following various amounts of dexamethasone administration. Pregnenolone, as well as the plasma ACTH level, was completely suppressed with 1 mg dexamethasone, whereas 4 mg or 8 mg of dexamethasone was needed to induce a complete DHA suppression. These findings suggest that the gonads alone contribute to the poor dexamethasone suppressibility of pregnenolone in normal subjects, and that adrenal DHA secretion might be also regulated by an unidentified factor other than ACTH, which would be suppressed with large doses of dexamethasone.

A modulating role of taurine on release of acetylcholine and norepinephrine from neuronal tissues

Effects of taurine (2-aminoethanesulfonic acid) on the uptake and release of 14C-acetylcholine (14C-ACh) and 3H-norepinephrine (3H-NE) in the superior cervical ganglion and cerebral cortex of the rat were studied. Taurine suppressed high potassium evoked release of 14C-ACh and 3H-NE from the rat superior cervical ganglia and cerebral cortical slices, while the drug did not modify per se the uptake and unstimulated (spontaneous) release of 14C-ACh and 3H-NE in these tissues. Furthermore, taurine inhibited the release of 3H-NE from the crude synaptosomal (P2) fraction of the rat brain without affecting the uptake. These results suggest that taurine may act as a modulator of neuronal activity, possibly by stabilizing excitable membrane and by suppressing the release of neurotansmitter at synapses.

[The tentorial meningioma fed by "marginal tentorial artery" arising from the external carotid artery--a case report and review of literature (author's transl)]

It is well known that a Bernasconi-Cassinari artery is an important finding at diagnosis of the abnormality in tentorium. Since Bernasconi and Cassinari reported the artery in 1956, many reports have been presented and showed that the artery arose from the intracavernous portion of the internal carotid artery. We presented a 54-year-old female with tentorial meningioma. In selective external carotid angiography, the artery feeding the tumor was revealed arising from the accessory meningeal artery, which came off the internal maxillary artery and passed into the carnium through the foramen ovale, and took the same course of "Bernasconi-Cassinari artery". This angiographic finding suggests that it is possible for marginal tentorial artery to arise from an external carotid arterial system. It is said in the anatomical studies, when the trunk of primitive maxillary artery which is one of maxillo-carotid anastomotic arteries in fetus regresses, "marginal tentorial artery" usually remains linked to the internal carotid artery. But, if this transition of "the artery" from the external to the internal carotid artery failed, it is easily conceived the artery results in the origin of accessory meningeal artery, a branch of the external carotid artery.

[An infantile skull fracture followed by the enlarging of the fracture line ("enlarging skull fracture") (author's transl)]

We experience sometimes an infantile skull fracture which is followed by the skull fracture line and bulging of the fractured area day by day after the head injury. Since John Howship reported the case of the partial absorption of the right parietal bone, arising from a blow on the head in a child aged 9 month in 1816, this phenomenon was variously described meningocele spuria, traumatic cephalohydrocele, leptomeningeal cyst, fibrosing osteitis, cerebrocranial erosion, traumatic meningocele, die wachsende Schädelfrakture, growing skull fracture, etc. So called "growing skull fracture" has generally the triad of the symptoms which are the parietal skull fracture in infancy or childhood, traumatic dural tears, and subsequent enlargement of the fractures. And it is said that the dural tear is an indispensable condition for the developing of the "growing skull fracture". But we recently had the case of a 14 day old male infant who had neither traumatic dural tear nor subdural hematoma, but the progressive enlarging of the fracture line in the left parietal bone. The authors suggest that there should be the difference between the growing skull fracture (with the dural teat) and the enlarging skull fracture (without the dural tear).

[A trial of surgical management of brain edema in cerebral infarction--a review with our own experiences in 31 cases (author's transl)]

We have analyzed the clinical course of 31 cases with cerebral infarction for 4 years. Of the 31 patients, 6 cases (19%) showed the brain edema on the cerebral angiograms as manifested by the shift of the midline arteries. The patients were divided into two groups, normotensive (15 cases) and hypertensive cerebral infarction (16 cases). The clinical and angiographic findings in the normotensive groups have been differed significantly from those of the hypertensive groups. The findings of brain edema on the angiograms were prominent in the hypertensive groups, and the clinical course was generally good and fair in the normotensive groups. We have reviewed the literatures about brain edema associated with cerebral infarction and have discussed on the mechanisms. From the study of our cases, it was concluded that systemic hypertension could be a facilitatory factor in the occurrence of brain edema in cerebral infarction. Furthermore, the management of massive cerebral infarction should be reduction of increased intracranial pressure and prevention of cerebral herniation. So, it will be necessary to perform a surgical treatment such as internal decompression; removal of the infarcted, necrotized area and excision of herniated tissue, and external decompression; removal of boneflap.