Asymptomatic hypoesthesia of the maxillary alveolar ridge in complete denture wearers.

This study was carried out to investigate the effect of compression induced by complete dentures on the function of the nerves underlying the dentures. The influence of compression induced by complete dentures on nerve function was analysed using current perception threshold (CPT) in 33 complete denture wearers aged 50-80 at Nihon University School of Dentistry (Matsudo, Japan). Based on the age range of the complete denture group, dentate subjects were selected as a control. Because the group characteristics (such as subject age, gender, body mass index) and oral mucosal thickness were not matched, a multiple regression analysis was used to adjust for the influence of heterogeneous characteristics on the CPT. Statistically significant differences were found between subject groups for the nasopalatine and the greater palatine nerve. The results of the study were that complete denture wearers experience asymptomatic hypoesthesia mainly affecting the nasopalatine and greater palatine nerves, but not the infraorbital nerve.

Successful reconstruction for combined tracheal and bronchial disruption.

After a head-on automobile collision, a 21-year-old man was admitted with respiratory distress and subcutaneous emphysema. Bronchoscopy revealed a disruption of the trachea and a complete transection of the intermediate bronchus. A right posterolateral thoracotomy was performed, and both lesions were reconstructed primarily using absorbable materials.

Brainstem arteriovenous malformation with a pedicle aneurysm treated by endovascular surgery and proton-beam radiosurgery--case report.

A 39-year-old male presented with a small pontine hemorrhage and subarachnoid hemorrhage. Angiography showed a small left pontine arteriovenous malformation (AVM) associated with a small aneurysm on the pedicle feeding the AVM. The pedicle aneurysm was occluded by microcoils. The AVM was then treated by proton-beam radiosurgery. Follow-up angiography 2 years later revealed that the AVM had disappeared completely without neurological deficit. The combination of embolization and proton-beam radiosurgery was curative in this patient with a pontine AVM associated with an aneurysm on the feeding artery, showing that these techniques can be used to treat inoperable vascular lesions safely.

Dose measurement for patients and physicians using a glass dosemeter during endovascular treatment for brain disease.

It has been reported that exposure of patients and physicians to radiation from interventional radiological procedures cannot be disregarded. Direct measurement of patient exposure used to be difficult due to possible interference by the detector with the observation of X ray images. Recently, a dosemeter system consisting of small-sized glass chips and a reader which adopts pulsed UV laser stimulation has been developed. Owing to its small size, radiolucency and physical characteristics, direct monitoring of surface dose has become feasible. Dose measurement for patients and physicians during neurointervention was done using the photoluminescence glass dosemeter system. The dose-response of the dosemeter was almost linear over a broad dose range, but its energy dependency was rather high without a filter, the use of which is recommended by the manufacturer to compensate for energy dependency. Variation of sensitivity of about 20% was observed for effective energies of 45-60 keV which are used in neurointervention. In spite of this shortcoming, the photoluminescence glass dosemeter system was judged to be a convenient means for monitoring dose during neurointervention.

[Demonstration of a vascular lesion by intraoperative portable DSA in a case of intracerebral hematoma with impending herniation].

A nine year old boy with sudden onset of loss of consciousness was brought to the emergency room where he was in deep coma with bilateral decerebrated rigidity, and fixed dilated pupils. Computerized tomographic scan showed an intracerebral hematoma in the left temporal lobe associated with signs of uncal herniation. He was taken to the operating room immediately and craniotomy was started. After aspirating a small amount of hematoma through a burr hole, left carotid angiography was carried out by using a portable digital subtraction angiography (DSA) unit. The procedure took approximately ten minutes, and it showed arteriovenous malformation (AVM) supplied by a temporal branch of the middle cerebral artery. Using this angiogram as a guide, the intracerebral hematoma and the AVM were completely removed. The patient recovered well and returned to school after rehabilitation. This case illustrates a method of treatment for intracerebral hematoma with impending herniation. Although, in general, preoperative angiography is required before the operation of AVM, it could be argued that time spent for angiography may result in irreversible damage to the brain stem in the presence of uncal herniation. We chose to perform intraoperative portable DSA during evacuation of the hematoma instead of wasting time on preoperative angiography. With this method, we were not only able to remove the hematoma without delay, but were also able to extirpate the AVM safely. Whether or not our method can be used in general remains to be seen, and further experience is required.

[Serial angiographical changes of a ruptured dissecting vertebral aneurysm].

A 54-year-old woman presented a subarachnoid hemorrhage from a ruptured dissecting aneurysm on the right vertebral artery. A right vertebral angiogram revealed a fusiform dilatation distal to the right posterior inferior cerebellar artery and "pseudo lumen" was observed in a delayed arterial phase. Conservative treatment was carried out, and the patient condition gradually improved. An angiographical examination for planned endovascular treatment 46 days after the onset, revealed the normalization of the formerly dilated caliber of the right vertebral artery with only a minor luminal irregularity. However, 83 days after the onset, right vertebral angiogram showed reappearance of the fusiform dilatation. The right vertebral angiogram obtained 204 days after the onset showed that the dilated segment of the dissecting aneurysm had become normalized to a slight degree. The serial angiographical changes of the dissecting site might have been due to regression and organization following transient thrombosis of intramural hematoma. Such drastic changes within a short period have not been reported yet. In conclusion, careful repeated follow-up is recommended in monitoring aneurysmal formation during the early to chronic phase after rupture of a dissecting aneurysm. The repetition of angiography is important, because later, if angiography has been performed only once, aneurysmal dilatation may be overlooked. One has to be aware of such changes, because such changes may alter the clinician's decision about treatment, as they did in our case.

[A case of asymptomatic Dandy-Walker syndrome with cerebellar hemorrhage].

A case of asymptomatic Dandy-Walker syndrome (DWS) complicated by cerebellar hemorrhage is reported. A 65 year-old man was hospitalized for investigation and treatment of disturbance of consciousness. CT scan and MRI showed a large hematoma in the posterior fossa cyst. Postoperative CT scan and MRI revealed the DWS and cerebellar hemorrhage on the left side. This patient had no symptom until 65 years of age, in spite of having DWS. There has been no such case reported in the literature to our knowledge. Derangement of secretion and absorption of cerebrospinal fluid seem to have been the cause of late-onset symptoms after a long well balanced symptom-free period.

[Transient cortical blindness and convulsion mimicking a hemorrhagic complication during embolization of the cerebellar AVM].

We report a case of transient cortical blindness and convulsions during embolization of the cerebellar AVM. A 29-year-old man was admitted to our hospital with subarachnoid hemorrhage. Cerebral angiography showed the right cerebellar AVM fed by the right superior cerebellar artery. Preoperative embolization of the AVM was performed. During embolization, the patient lost consciousness suddenly and appeared to be in a decerebrate posture. About 15 minutes later, the patient came around and complained of total blindness. Cerebral angiography revealed the disappearance of the aneurysm and AVM. There were no abnormal findings in the vertebrobasilar system. Computed tomography obtained just after the procedure, showed considerable contrast enhancement of the occipital lobes. Two hours later, a repeat computed tomography showed clearance of contrast enhancement. Magnetic resonance imaging obtained 12 hours after the procedure, showed no evidence of infarction in the occipital lobes. Two days after, the patient's sight gradually returned. Seven days after the procedure, the patient recovered completely. We speculated that these clinical features might be convulsions due to contrast material. In the reported cases, convulsions and transient cortical blindness due to non-ionic low osmolar contrast materials is a rare complication. This case suggested disruption of the blood-brain barrier demonstrated by the computed tomography appearance of contrast enhancement in the occipital lobes.

[Bilateral traumatic hemorrhage in the basal ganglia: report of two cases].

Hematomas of the basal ganglia in head injury have long been recognized by pathologists with an interest in head injury but their mechanism has not been revealed clearly. We report two cases of bilateral traumatic hemorrhage in the basal ganglia. Case #1, a 17-year-old male was admitted to our hospital immediately after a traffic accident. Neurological examination revealed that the patient was comatose and had right hemiparesis. CT scan showed bilateral hemorrhage of the basal ganglia and subarachnoid hemorrhage in the perimesencephalic cistern. MRI showed high signal intensity areas in the bilateral basal ganglia, perimesencephalic cistern, cerebral white matter and corpus callosum. The patient was diagnosed as having diffuse axonal injury coinciding with bilateral hemorrhage of the basal ganglia. Stereotactic aspiration for the hematoma of the left basal ganglia was carried out. Case #2, a 75-year-old male was admitted immediately after falling from the roof of his house. Neurological examination revealed no neurological deficit except for headache and nausea. CT scan on the day of injury revealed no abnormality. But CT scan 12 hours following the injury showed bilateral hemorrhage of the basal ganglia. Blood pressure of the patient was within normal range and he was diagnosed as having traumatic bilateral intracerebral hematoma. Conservative treatment was carried out and the patient was discharged 7 days after injury with no neurological deficit. The mechanism of traumatic hemorrhage of the basal ganglia has not been clear. In case #1, diffuse axonal injury (DAI) may have played an important role in the bilateral hemorrhage. But in case #2, non-DAI factor such as vasoparalysis syndrome may have existed.(ABSTRACT TRUNCATED AT 250 WORDS)

Dose measurement on both patients and operators during neurointerventional procedures using photoluminescence glass dosimeters.

BACKGROUND AND PURPOSE: Although radiation skin injuries associated with interventional radiology have been known as a critical issue, there are few reports mentioning direct measurement of the entrance skin dose (ESD). Thus, the purpose of this study was to clarify the regional distributions of ESDs in neurointervention. MATERIALS AND METHODS: Using photoluminescence glass dosimeters (PLDs), we measured the ESDs in 32 patients with a median age of 61.5 years. Angiographic parameters, including exposure time, dose-area product (DAP), and the number of digital subtraction angiography (DSA) studies and frames, were recorded. The ESDs of operators were analyzed by the same method. RESULTS: The maximum ESD of 28 therapeutic procedures was 1.8 +/- 1.3 Gy. Although the averaged ESD on the right temporo-occipital region was higher than that in other regions, disease-specific patterns were not observed. Statistically positive correlations were found between the maximum ESD and exposure time (r = 0.5283, P = .005), DAP (r = 0.7917, P < .001), the number of DSA studies (r = 0.5636, P = .002), and the number of DSA frames (r = 0.8583, P < .001). As for operators, ESDs to the left upper extremity were significantly higher than those to other regions. However, most of the ESDs were <0.2 mGy. Lead protective garments reduced the exposure doses to approximately one half to one tenth. CONCLUSION: It was shown that the regional ESD could be measured by applying the PLD. This method should contribute to reducing the dose accumulation in patients as well as in operators.

Patient skin dose during neuroembolization by multiple-point measurement using a radiosensitive indicator.

BACKGROUND AND PURPOSE: Although neuroembolization has recently spread quickly, sufficient attention has not been focused on the associated radiation exposure. The purpose of this research was to evaluate the patient's entrance skin dose (ESD) during neuroembolizations in 6 institutions. MATERIALS AND METHODS: This study was approved by all of the 6 institutional review boards, and all of the patients gave informed consent. This study included a total of 103 consecutive neuroembolizations in the 6 institutions. Patient ESDs during the procedures were evaluated by using caps that had 44 radiosensitive indicators adherent to the surface. The patient ESDs were calculated from the color difference of the indicators. To check for effects on the scalp, clinical follow-up was performed at 1-2 days, 2 weeks, and 3 months after the procedure. RESULTS: The averages of total fluoroscopic time, total number of digital subtraction angiography frames, and dose area product were 67.1 +/- 41.6 minutes, 883 +/- 626, and 257 +/- 150 Gy x cm(2), respectively. The average maximum ESD for each patient was 1.9 +/- 1.1 Gy (range, 0.4-5.6 Gy; median, 1.5 Gy). The average maximum ESDs of each institution ranged from 1.0 to 2.4 Gy. Epilation was observed in 6 patients. CONCLUSIONS: The maximum ESDs during neuroembolizations exceed the thresholds for radiation skin injuries in some cases.

A pitfall of fibrinolysis. Aneurysms found after attempted fibrinolytic therapy of occluded arteries.

SUMMARY: Three patients with angiographically invisible aneurysms found after attempted fibrinolytic therapy are presented. One aneurysm bled during the procedure with a tragic result. All of aneurysms were located distal to the occluded arteries. Aneurysms were preexisting and invisible distal to the occluded artery, or they developed rapidly after the fibrinolysis. These aneurysms were at a risk for rupture during and after fibrinolytic therapy.

Embolisation of branches of the ophthalmic artery.

SUMMARY: Nine patients presenting various orbital and skull base pathologies embolised through the ophthalmic artery are reported. All cases were catheterised beyond the bend around the optic nerve (second portion of the intraorbital ophthalmic artery). Embolisation was carried in all with n-butyl cyano-acrylate without post interventional visual disturbance. Relying on the classic description as well as previous personal work on the ophthalmic artery anatomy and angiographic anatomy, all procedures were performed under general anaesthesia without functional testing. The central retinal artery and the long ciliary arteries arise from the first or second portion of the ophthalmic artery. For embryological reasons no branch to the visual tract can arise from the ophthalmic trunk distal to the origin of the superficial recurrent meningeal artery or the lacrimal artery. Therefore distal catheterisation at least beyond the second portion, (and injection without reflux) makes safe embolisation possible in all variations of internal carotid origin of the ophthalmic stem. Independent from the expected goal of the embolisation, the use of particles in this territory should in our opinion be discouraged.

Angiographic Follow-up of Embolization Using Guglielmi Detachable Coils for Cerebral Aneurysms.

SUMMARY: The purpose of this study is to evaluate the mid or long-term angiographical stability of Guglielmi Detachable Coils (GDC) after embolization for cerebral aneurysms. Between march 1997 and november 2001, 164 aneurysms, including 116 ruptured and 48 unruptured aneurysms, were treated using GDC at Mito National Hospital. Cerebral angiograms over one month after embolization were obtained in 111 aneurysms, including 71 ruptured and 40 unruptured aneurysms.At the time of initial GDC embolization of the 71 ruptured aneurysms, complete occlusion was achieved in 31 aneurysms, neck remnant in 18 aneurysms, and body filling in 22 aneurysms. Morphological changes were observed in 26 aneurysms (37%) in follow-up. Progressive thrombosis was obtained in 12 out of 71 aneurysms, no changes were shown in 45, and recanalizations occurred in 14. In the initial embolization of the 40 unruptured aneurysms, complete occlusion was achieved in 15 aneurysms, neck remnant in five and body filling in 20 aneurysms respectively. Morphological changes were observed in 12 aneurysms (30%), in which 12 aneurysms showed progressive thrombosis and 28 aneurysms were unchanged. There were significant differences of the longterm angiographical stability between ruptured and unruptured aneurysms. Rigorous follow-up angiography is mandatory when complete aneurysm occlusion is not achieved in ruptured aneurysms.

Revascularization Using an Extracorporeal Pump for the Treatment of Cerebral Embolism in the Acute Stage. For Protection of the Brain Tissue from Irreversible Change due to Cerebral Embolism.

SUMMARY: Object. For patients with cerebral embolism, we are using an extracorporeal pump to rev ascularize the more peripheral brain tissues far from the thrombus, proceeding the microcatheter beyond the thrombus, and dissolving the thrombus during a satisfactory time as required. Methods. As the critical cerebral blood flow is thought to be below 30 mlllOOglmin, in the case of middle cerebral artery occlusion at the Ml portion, over 15mllmin. of arterial blood is necessary to protect the brain tissue from irreversible change. One thousand and eight hundred mmHg (about 2 atoms) of pump pressure is necessary to send l5mllmin. of blood through the microcatheter (110 cm, FastTrucker 18, Boston). It was confirmed by laboratory and clinical data that hemolysis of the pump action is not sufficient to aggravate kidney function. Conclusion. This method enables the protection of brain tissues from irreversible change after cerebral embolism, and extends the time sufficiently for thrombolysis.

The embolization of ruptured aneurysms in acute stage.

SUMMARY: We have treated 93 ruptured aneurysms with Guglielmi Detachable Coils (GDC) in acute period. Seventy-three patients (78%) were independent on discharge. Among the patient of Hunt and Hess Grade I, II and III, 59 patients (88%) were independent. Acute re-rupture occurred in two elderly patients with insufficient embolization and two patients experienced rerupture in the follow up period. Symptomatic vasospasm was reported in 17.6% of patients. The permanent morbidity rate is 4.4% and one patient died (1.5%). Although the long-term results remain to be determined, embolization with GDC is a safe and promising treatment for acutely ruptured aneurysms.