[Laparoscopic Gastrectomy for Gastric Adenocarcinoma of the Fundic Gland Type - Report of a Case].

A 69-year-old man underwent esophagogastroduodenoscopy, which showed a slightly depressed lesion at the greater curvature of the gastric body. We diagnosed gastric adenocarcinoma of the fundic gland type(GA-FG)from examination of the biopsy specimen. Endoscopic submucosal dissection(ESD)was performed for curative resection. The pathological examination revealed a positive vertical margin. Consequently, laparoscopic gastrectomy was additionally performed. GA-FG has recently been proposed as a new entity of gastric adenocarcinoma. GA-FG mostly develops without Helicobacter pylori infection and often invades the submucosa, regardless of size. However, GA-FG rarely demonstrates lymphatic and venous invasion despite deep submucosal invasion. Since most GA-FG cases undergo ESD, few reports of surgical resection exist. Here, we report our experience of laparoscopic gastrectomy for GA-FG.

The kinesin-like protein TOP promotes Aurora localisation and induces mitochondrial, chloroplast and nuclear division.

The cell cycle usually refers to the mitotic cycle, but the cell-division cycle in the plant kingdom consists of not only nuclear but also mitochondrial and chloroplast division cycle. However, an integrated control system that initiates division of the three organelles has not been found. We report that a novel C-terminal kinesin-like protein, three-organelle division-inducing protein (TOP), controls nuclear, mitochondrial and chloroplast divisions in the red alga Cyanidioschyzon merolae. A proteomics study revealed that TOP is a member of a complex of mitochondrial-dividing (MD) and plastid-dividing (PD) machineries (MD/PD machinery complex) just prior to constriction. After TOP localizes at the MD/PD machinery complex, mitochondrial and chloroplast divisions occur and the components of the MD/PD machinery complexes are phosphorylated. Furthermore, we found that TOP downregulation impaired both mitochondrial and chloroplast divisions. MD/PD machinery complexes were formed normally at each division site but they were neither phosphorylated nor constricted in these cells. Immunofluorescence signals of Aurora kinase (AUR) were localized around the MD machinery before constriction, whereas AUR was dispersed in the cytosol by TOP downregulation, suggesting that AUR is required for the constriction. Taken together our results suggest that TOP induces phosphorylation of MD/PD machinery components to accomplish mitochondrial and chloroplast divisions prior to nuclear division, by relocalization of AUR. In addition, given the presence of TOP homologs throughout the eukaryotes, and the involvement of TOP in mitochondrial and chloroplast division may illuminate the original function of C-terminal kinesin-like proteins.

Complete mitochondrial and chloroplast DNA sequences of the freshwater green microalga Medakamo hakoo.

We report the complete organellar genome sequences of an ultrasmall green alga, Medakamo hakoo strain M-hakoo 311, which has the smallest known nuclear genome in freshwater green algae. Medakamo hakoo has 90.8-kb chloroplast and 36.5-kb mitochondrial genomes containing 80 and 33 putative protein-coding genes, respectively. The mitochondrial genome is the smallest in the Trebouxiophyceae algae studied so far. The GC content of the nuclear genome is 73%, but those of chloroplast and mitochondrial genomes are 41% and 35%, respectively. Codon usages in the organellar genomes have a different tendency from that in the nuclear genome. The organellar genomes have unique characteristics, such as the biased encoding of mitochondrial genes on a single strand and the absence of operon structures in chloroplast ribosomal genes. Medakamo hakoo will be helpful for understanding the evolution of the organellar genome and the regulation of gene expression in chloroplasts and mitochondria.

Cognitive outcome differences on the side of carotid artery stenting.

OBJECTIVE: The right and left sides of the brain play different roles in cognition. Therefore, the side of treatment should be taken into consideration when evaluating cognitive outcome following revascularization. Thus, we designed a study to evaluate changes in right hemisphere cognitive function in patients undergoing right carotid artery stentings (CAS) and left hemispheric cognitive function in patients undergoing left CAS. In addition, we studied CAS-related changes in regional cerebral blood flow to determine potential correlations with changes in cognitive function. METHODS: We performed a prospective assessment of 39 CAS patients, all of whom were right-handed. Patients with contralateral stenotic lesions were excluded. Twenty-one patients underwent CAS of the right internal carotid artery (Right CAS group) and 18 underwent CAS of the left internal carotid artery (Left CAS group). Neuropsychological testing was performed preoperatively and 6 months after endovascular treatment. Cerebral blood flow was determined by 123I-labeled N-isopropyl-p-iodoamphetamine single-photon emission computed tomography before and 6 months after CAS. RESULTS: In the Right CAS group, postoperative performance intelligence quotient score (91.1±18.2) was significantly improved compared with the preoperative score (84.9±16.7; P<.001). In the Left CAS group, postoperative verbal intelligence quotient score (104.0±18.8) was significantly higher than that before endovascular treatment (97.9±15.8; P<.005). Postoperative regional cerebral blood flow was not significantly different from that before endovascular treatment in either group. However, regional cerebrovascular reactivity of the treated side showed significant improvement after treatment. CONCLUSIONS: Amelioration of cognitive function may be dependent on the side of revascularization. Performance intelligence quotient improved after CAS in patients with severe carotid artery stenosis on the right side. Verbal intelligence quotient also improved on the left side after endovascular treatment. These effects seemed to involve improvement in regional cerebrovascular reactivity by CAS.

Cerebral hemodynamic benefits after carotid artery stenting in patients with near occlusion.

OBJECTIVE: The natural history and management of patients with near occlusion (NO) of the internal carotid artery are controversial. In particular, it is unclear whether cerebral hemodynamics are compromised in these patients and whether improvement by carotid revascularization leads to the prevention of ischemic stroke. In this study, we measured cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) using single-photon emission computed tomography before and after carotid artery stenting (CAS) for NO to examine the effectiveness of CAS from the perspective of cerebral hemodynamics. METHODS: CAS was performed in 15 patients with NO and in 78 with severe stenosis (≥70%) but without NO at our institution. Resting CBF and CVR to acetazolamide were measured using N-isopropyl-p-[I-123] iodoamphetamine single-photon emission computed tomography before and at 3 to 6 months after CAS. We also measured CBF using the same method for healthy individuals and compared the results among the three groups. RESULTS: CAS was successfully performed in all patients. Before CAS, the mean resting CBF was 26.68 ± 4.23 mL/100 g/min, and the mean CVR was -0.8% ± 15.1% in the patients with NO, both of which were significantly lower than in patients with severe stenosis without NO and in healthy individuals. After CAS, the mean resting CBF and mean CVR in patients with NO increased significantly to 30.07 ± 5.67 mL/100 g/min and 37.0% ± 21.4%, respectively, and there were no significant differences among the three groups. CONCLUSIONS: Before CAS, patients with NO were more hemodynamically compromised than those with severe stenosis without NO. After CAS, significant cerebral hemodynamic improvement and normalization occurred long-term. Thus, from a hemodynamic perspective, CAS was effective in patients with NO.

Genomic analysis of an ultrasmall freshwater green alga, Medakamo hakoo.

Ultrasmall algae have attracted the attention of biologists investigating the basic mechanisms underlying living systems. Their potential as effective organisms for producing useful substances is also of interest in bioindustry. Although genomic information is indispensable for elucidating metabolism and promoting molecular breeding, many ultrasmall algae remain genetically uncharacterized. Here, we present the nuclear genome sequence of an ultrasmall green alga of freshwater habitats, Medakamo hakoo. Evolutionary analyses suggest that this species belongs to a new genus within the class Trebouxiophyceae. Sequencing analyses revealed that its genome, comprising 15.8 Mbp and 7629 genes, is among the smallest known genomes in the Viridiplantae. Its genome has relatively few genes associated with genetic information processing, basal transcription factors, and RNA transport. Comparative analyses revealed that 1263 orthogroups were shared among 15 ultrasmall algae from distinct phylogenetic lineages. The shared gene sets will enable identification of genes essential for algal metabolism and cellular functions.

Evaluation of small ischemic lesions after carotid artery stenting: the usefulness of thin-slice diffusion-weighted MR imaging.

INTRODUCTION: There has been concern regarding the usefulness of diffusion-weighted imaging (DWI) to evaluate the ischemic lesions associated with carotid artery stent placement (CAS). Some small lesions may be detected not by standard DWI but by thin-slice DWI alone, since most of the cerebral lesions are very small in size and clinically silent. The purpose of this study is to compare the detectability of the small ischemic lesions after CAS by standard and thin-slice DWI. METHODS: Both standard DWI with slice thickness of 6 mm and thin-slice DWI with slice thickness of 2 mm were obtained at the same MR examination within 2 to 7 days after 20 procedures of CAS in 17 patients. Number and measured diameter size of the detected lesions on both DWI were compared. RESULTS: All CAS procedures in 17 patients were successfully completed. The focal ischemic lesions were detected in 14 of 20 on thin-slice DWI and seven examinations on standard DWI. The total numbers of hyperintense lesions were 31 on thin-slice DWI and ten on standard DWI (p < 0.001). The sizes of these ten lesions on thin-slice DWI were larger than those of standard DWI, and the mean size of the thin-slice DWI and that of standard DWI were significantly different (p < 0.005). CONCLUSION: Thin-slice DWI was able to detect small cortical lesions better than standard DWI. Thin-slice DWI may be useful to evaluate small silent ischemic lesions after CAS.

Preoperative prediction of outcome in 283 poor-grade patients with subarachnoid hemorrhage: a project of the Chugoku-Shikoku Division of the Japan Neurosurgical Society.

BACKGROUND: The management of patients with poor-grade subarachnoid hemorrhage (SAH) continues to be controversial. The objective of this study was to examine predictors of outcome of poor-grade SAH after surgical obliteration of the aneurysm. METHODS: The study was performed as a retrospective review of 283 patients with poor-grade SAH who underwent surgical obliteration of the aneurysm at multiple centers in Chugoku and Shikoku, Japan. RESULTS: A favorable outcome at discharge was achieved in 97 of the 283 patients (34.3%). Age (p < 0.001), World Federation of Neurosurgical Societies (WFNS) grade V at admission (p = 0.002), improvement in WFNS grade after admission (p = 0.002), Fisher grade (p = 0.039) and a low-density area (LDA) associated with vasospasm on computed tomography (CT; p < 0.001) showed a significant association with outcome. Further analysis of WFNS grades indicated that most patients who only improved to preoperative grade IV from grade V at admission did not have a favorable outcome. Multivariate analysis identified age (especially of > or =65 years; p < 0.001), WFNS grade V (p < 0.001) and LDA associated with vasospasm on CT (p < 0.001) as predictors of a poor outcome, and improvement in WFNS grade (p = 0.001) as a predictor of a favorable outcome after surgical obliteration of the aneurysm. CONCLUSIONS: Advanced age, WFNS grade V, improvement in WFNS grade, and LDA associated with vasospasm on CT were found to be independent predictors of clinical outcome, whereas rebleeding, early aneurysm surgery and treatment modality (surgical clipping or Guglielmi detachable coil embolization) were not independently associated with outcome in patients with poor-grade aneurysm.

Cause of hematic cysts of the orbit: increased fibrinolysis and immunohistologic expression of tissue plasminogen activator.

PURPOSE: Hematic cysts of the orbit are relatively uncommon. These cysts expand gradually, leading to progressive orbital symptoms. To clarify the cause of hematic cyst, especially the mechanisms leading to its gradual expansion, we investigated the immunohistologic expression of tissue-type plasminogen activator (tPA), a key enzyme of fibrinolysis, in cases of hematic cysts. DESIGN: Retrospective small case series. PARTICIPANTS: Three patients with hematic cyst of the orbit were studied. METHODS: Three surgically removed hematic cysts were studied from a histologic perspective, including immunohistochemistry for tPA. The cyst content was also analyzed chemically. MAIN OUTCOME MEASURES: The pathologic features of hematic cyst of the orbit, expression of tPA in the cyst wall, and coagulation-fibrinolytic factors in the content of the cyst. RESULTS: The cyst wall was composed of dense collagen fibers lacking an epithelial lining and contained many fine capillary- or venule-like vessels. Hemosiderin-laden macrophages were observed among the collagen fibers. Strong immunoreactivity for tPA was revealed in the endothelial cells of the vessels in the cyst wall. Chemical analysis of the cyst content revealed a marked delay in the activated partial thromboplastin time and prothrombin time, a low fibrinogen concentration, and high concentrations of the D-dimer and tPA-plasminogen activator inhibitor-1 complex. CONCLUSIONS: Our findings indicate that blood coagulation and hemostasis occur first and that fibrinolysis occurs second in hematic cysts. Gradual expansion of the cyst may be due to hyperfibrinolysis resulting from oversecretion of tPA from the endothelial cells in the cyst wall, thus impairing normal hemostasis. Hemorrhage may then recur, resulting in enlargement of the hematic cyst. These mechanisms are similar to those occurring in chronic subdural hematomas. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Benign fibrous histiocytoma of the skull with increased intracranial pressure caused by cerebral venous sinus occlusion.

The authors present a very rare case of benign fibrous histiocytoma of the skull with increased intracranial pressure caused by sinus occlusion. A 33-year-old woman was referred for investigation of a right occipital protrusion with tenderness and double vision. She had only mild divergence insufficiency and bilateral papilledema neurologically. Imaging findings showed that the skull tumor was located at the right occipital bone with bone disruption and a compressed right sigmoid sinus. When planning the resection, caution was required to spare the collateral flow so as to manage the intracranial pressure. Immunohistochemical analysis showed that the tumor was positive for CD68, alpha1-antichymotrypsin, and alpha1-antitrypsin. From these findings, the tumor was diagnosed as a primary benign fibrous histiocytoma of the skull.

The influence of focal brain cooling on neurophysiopathology: validation for clinical application.

OBJECT: Focal brain cooling has been recognized to have a suppressive effect on epileptiform discharges or a protective effect on brain tissue. However, the precise influence of brain cooling on normal brain function and histology has not yet been thoroughly investigated. The aim of this study was to investigate the neurophysiopathological consequences of focal cooling and to detect the threshold temperature that causes irreversible histological change and motor dysfunction. METHODS: The experiments were performed in adult male Sprague-Dawley rats (weighing 250-350 g) after induction of halothane anesthesia. A thermoelectric chip (6 x 6 x 2 mm) was used as a cooling device and was placed on the surface of the sensorimotor cortex after a 10 x 8-mm craniotomy. A thermocouple was placed between the chip and the brain surface. Focal cooling of the cortex was performed at the temperatures of 20, 15, 10, 5, 0, and -5 degrees C for 1 hour (5 rats in each group). Thereafter, the cranial window was repaired. Motor function was evaluated using the beam-walking scale (BWS) every day for 7 days. The rats were killed 7 days after the operation for histological examination with H & E, Klüver-Barrera, glial fibrillary acidic protein, and terminal deoxynucleotidyl transferasemediated deoxyuridine triphosphate nick-end labeling stainings. The authors also euthanized some rats 24 hours after cooling and obtained brain sections by the same methods. RESULTS: The BWS score was decreased on the day after cooling only in the -5 degrees C group (p < 0.05), whereas the score did not change in the other temperature groups. Histologically, the appearance of cryoinjury such as necrosis, apoptosis, loss of neurons, and marked proliferation of astrocytes at the periphery of the lesion was observed only in the -5 degrees C group, while no apparent changes were observed in the other temperature groups. CONCLUSIONS: The present study confirmed that the focal cooling of the cortex for 1 hour above the temperature of 0 degrees C did not induce any irreversible histological change or motor dysfunction. These results suggest that focal brain cooling above 0 degrees C has the potential to be a minimally invasive and valuable modality for the treatment of severe brain injury or to assist in the examination of brain function.

Elevated concentrations of sphingosylphosphorylcholine in cerebrospinal fluid after subarachnoid hemorrhage: a possible role as a spasmogen.

This study investigates the role of sphingosylphosphorylcholine (SPC) in the mechanisms underlying cerebral vasospasm after subarachnoid hemorrhage (SAH). The levels of SPC were measured in cerebrospinal fluid (CSF) of patients with SAH and also in an experimental canine model. CSF samples were collected from 11 patients with SAH, and from dogs that had received an injection of SPC into the cisterna magna to examine SPC kinetics in the CSF. SPC was assayed using solid-phase extraction and triple quadrupole mass spectrometry. The SPC concentrations in SAH patients on days 3, 8, and 14 after the onset of SAH were significantly higher than those in normal CSF. In the canine model, rapid dilution of SPC in CSF was observed. In combination with data from previous studies, these results suggest that SPC is involved in the development of cerebral vasospasm. Rapid dilution of SPC in CSF suggests that SPC is released into CSF at higher concentrations than those measured in the present study.

Cyanidioschyzon merolae aurora kinase phosphorylates evolutionarily conserved sites on its target to regulate mitochondrial division.

The mitochondrion is an organelle that was derived from an endosymbiosis. Although regulation of mitochondrial growth by the host cell is necessary for the maintenance of mitochondria, it is unclear how this regulatory mechanism was acquired. To address this, we studied the primitive unicellular red alga Cyanidioschyzon merolae, which has the simplest eukaryotic genome and a single mitochondrion. Here we show that the C. merolae Aurora kinase ortholog CmAUR regulates mitochondrial division through phosphorylation of mitochondrial division ring components. One of the components, the Drp1 ortholog CmDnm1, has at least four sites phosphorylated by CmAUR. Depletion of the phosphorylation site conserved among eukaryotes induced defects such as mitochondrial distribution on one side of the cell. Taken together with the observation that human Aurora kinase phosphorylates Drp1 in vitro, we suggest that the phosphoregulation is conserved from the simplest eukaryotes to mammals, and was acquired at the primitive stage of endosymbiosis.

Dual microdialysis probe monitoring for patients with traumatic brain injury.

BACKGROUND: In vivo microdialysis can be used to examine the focal metabolism by measuring the extracellular concentration of amino acids and other biochemicals in the focal brain tissue in which the probe is placed. We report two patients with traumatic brain injury who underwent placement of dual microdialysis probes. MATERIALS AND METHODS: One probe was placed in the penumbra zone and another in a region remote to the injury. Multiple measurements of several biochemical's were made. FINDINGS: In the first case, a 54-year-old man with right acute subdural hematoma and right fronto-temporal contusion was monitored. Quantitative analysis of in vivo microdialysis was performed. While the extracellular concentration of lactate and glycerol were higher in the penumbra zone than in the region remote to the injury, glutamate remained lower in the penumbra zone than in the remote region. In the second case, dual microdialysis probes were placed in a 56-year-old woman with left acute subdural hematoma and left fronto-temporal lobe contusion. Also in this case, the extracellular glutamate remained lower in the penumbra zone than in the remote region. CONCLUSIONS: The reason why the extracellular glutamate value remained lower in the penumbra zone than in the remote region is unclear. The position of each microdialysis probe was ensured by CT scan after the operation. It is important to be aware of the limitations of performing microdialysis in brain injured patients with a single probe.

[Surgical treatment for intractable epilepsy caused by tuberous sclerosis complex with multiple tubers: case report].

We report a case of intractable epilepsy caused by tuberous sclerosis with multiple tubers that was treated successfully by single resection of a tuber A 2-year-old boy developed tonic spasm-like seizures at the age of 4 months and the frequency of the seizures increased despite therapy with various anticonvulsants. He had no neurological deficits, and his intelligence was normal. MRI showed lesions in the left frontal and the right parietal lobe, and EEG (electroencephalogram) demonstrated sharp waves and spike-and-wave complex bursts over the right parietal region. Subdural electrodes were implanted over these lesions, and ictal low-voltage fast waves were demonstrated on the right parietal lesion. Therefore the right cortical lesion and the epileptogenic cortex were resected. Multiple subpial transaction was also added in the irritative cortex. Histological examination proved that the lesion was a tuberous sclerosis complex (TSC) tuber. Since surgery, the patient has remained seizure-free for 2 years. In patients with multiple TSC tubers in the cortex, we suggest that seizures can be suppressed by single resection of a tuber if the tuber can be identified as epileptogenic before surgery.

Neurotoxic effects of exogenous recombinant tissue-type plasminogen activator on the normal rat brain.

Thrombolytic therapy with intravenous and intra-arterial recombinant tissue-type plasminogen activator (rtPA) has been established for the treatment of acute ischemic stroke. However, tPA has also been suggested to have neurotoxic effects. The purpose of this study was to examine direct neurotoxicity of rtPA in vivo. The animals (Wistar rats) were divided to the following three groups: low-dose (15 micromol/L) rtPA group (n = 6); high-dose (30 micromol/L) rtPA group (n = 6); and control (physiological saline) group (n = 6). The rtPA solution was perfused into the cortex via a microdialysis probe. The volume of the lesion was quantified histologically by image analysis of the lesions. Blood-brain barrier (BBB) disruption was evaluated by intravenous injection of Evans blue, and injury to the basal lamina was evaluated by immunohistochemistry using an anti-laminin antibody. In the rtPA-perfused animals, a pale lesion was produced around the probe, and microscopically, neurons showed necrotic changes. The volume of the lesions increased significantly as the concentration of perfused rtPA was increased. Marked extravasation of Evans blue was observed, and laminin immunoreactivity of blood vessels in the rtPA-induced lesions was lost. These results suggest that rtPA promotes acute direct neurotoxicity and participates in disruption of the microvascular basal lamina to cause BBB disruption, thereby increasing edema formation.

Antitumor effects of vaccination with dendritic cells transfected with modified receptor for hyaluronan-mediated motility mRNA in a mouse glioma model.

OBJECT: The receptor for hyaluronan-mediated motility (RHAMM) is frequently overexpressed in brain tumors and was recently identified as an immunogenic antigen by using serological screening of cDNA expression libraries. In this study, which was conducted using a mouse glioma model, the authors tested the hypothesis that vaccination with dendritic cells transfected with RHAMM mRNA induces strong immunological antitumor effects. METHODS: The authors constructed a plasmid for transduction of the mRNAs transcribed in vitro into dendritic cells, which were then used to transport the intracellular protein RHAMM efficiently into major histocompatibility complex class II compartments by adding a late endosomal-lysosomal sorting signal to the RHAMM gene. The dendritic cells transfected with this RHAMM mRNA were injected intraperitoneally into the mouse glioma model 3 and 10 days after tumor cell implantation. The antitumor effects of the vaccine were estimated by the survival rate, histological analysis, and immunohistochemical findings for immune cells. Mice in the group treated by vaccination therapy with dendritic cells transfected with RHAMM mRNA survived significantly longer than those in the control groups. Immunohistochemical analysis revealed that greater numbers of T lymphocytes containing T cells activated by CD4+, CD8+, and CD25+ were found in the group vaccinated with dendritic cells transfected with RHAMM mRNA. CONCLUSIONS: These results demonstrate the therapeutic potential of vaccination with dendritic cells transfected with RHAMM mRNA for the treatment of malignant glioma.

Angiogram-negative subarachnoid hemorrhage in the era of three dimensional rotational angiography.

BACKGROUND: Three dimensional rotational angiography (3DRA) is a powerful method for depicting intracranial vascular lesions because of its 3D imaging capability. The purpose of this study was to analyse if 3DRA had reduced the incidence of angiogram-negative subarchnoid haemorrhage (SAH) and which type of aneurysm tended to be overlooked with conventional digital subtraction angiography. METHOD: Angiogram-negative SAH was defined as present in those patients with SAH who had no demonstrable lesion revealed by more than two adequate cerebral angiograms. From January 1, 1992, to December 31, 2004, angiography was performed on 247 patients at the Yamaguchi University Hospital. Digital subtraction angiography (DSA) alone was used for 105 patients (DSA group) from 1992 to 2000. After the technology of 3DRA was introduced to our hospital in 2000, 142 patients were evaluated by 3DRA and DSA together (3DRA group). FINDINGS: The incidence of angiogram-negative SAH was 9/105 (8.6%) in the DSA group and 6/142 (4.2%) in the 3DRA group. 3DRA revealed six aneurysms not depicted by the conventional DSA, including a basilar tip aneurysm, anterior cerebral artery aneurysm and a basilar tip aneurysm originating from a previously clipped aneurysm. CONCLUSION: Three dimensional RA is more sensitive in detecting aneurysms, but in our study still produced a 4.2% rate of angiogram-negative SAH. Three dimensional RA has some advantages for evaluation, especially of complicated sites and previously clipped aneurysms because of its three dimensional imaging capability.

Surgery for spontaneous intracerebral hemorrhage has greater remedial value than conservative therapy.

BACKGROUND: The aim of this study was to compare the efficacy of surgery for spontaneous intracerebral hemorrhage with that of medical treatment, based on data from the Japan Stroke Registry Study. METHODS: From 1999 to 2001, 1010 patients with spontaneous intracerebral hemorrhage were registered in the Japan Standard Stroke Registry Study from 45 stroke center hospitals in Japan. The National Institutes of Health Stroke Scale (NIHSS), Japan Stroke Scale (JSS), and modified Rankin Scale scores were used to compare severity and improvement in patients given surgical and medical treatment. CONCLUSIONS: Surgically treated patients, especially those with cerebellar hemorrhage, had significantly greater improvement in NIHSS or JSS score compared with medically treated patients. Our findings indicated that the patients who underwent surgery appeared to have better outcomes. But, because the study was not randomized, this observation cannot be interpreted as indicating that surgery is advantageous.

Various magnetic resonance imaging patterns of chronic subdural hematomas: indicators of the pathogenesis?

Magnetic resonance (MR) imaging can detect various patterns in chronic subdural hematomas. These patterns were compared to the computed tomography (CT) appearances and chemical analysis of the content in 60 hematomas from 44 patients. The hematomas could be classified into five types on both T(1)- and T(2)-weighted images: low, high, and mixed intensity, isointensity, and layered. Combining the T(1)- and T(2)-weighted images of all 60 hematomas revealed a total of 14 different imaging patterns. Combining the CT and MR imaging findings of 55 hematomas identified 25 different patterns. Analysis of the hematoma contents showed that hemolysis-related parameters, such as potassium, glutamate oxaloacetate transaminase, bilirubin, lactate dehydrogenase, and protein concentration, were markedly higher than in the peripheral blood, and there were significant correlations between these parameters. Mixed intensity hematomas were significantly thicker than the other types, and showed markedly higher values of hemolysis-related parameters. Factors affecting the CT and MR imaging findings, such as fresh bleeding, hemolysis, and hemoglobin changes, coexist in a hematoma to varying degrees, and these factors may interact with the age of the hematoma to produce the different patterns that are observed.