Diagnostic value of spinal MR imaging in spontaneous intracranial hypotension syndrome.

BACKGROUND AND PURPOSE: Spontaneous intracranial hypotension (SIH) presents with orthostatic headache, and the diagnosis is made on the basis of low CSF pressure and brain MR imaging findings characteristic of the disorder. However, a broad spectrum of symptoms and MR imaging findings of SIH is recognized, and some cases have no typical MR imaging abnormalities. SIH is believed to be caused by CSF leakage from the spinal dural sac, whereas the usefulness of MR imaging of the spine remains unclear. Our aim was to elucidate the diagnostic value of brain and spinal MR imaging MATERIALS AND METHODS: The sensitivities for the detection of SIH were retrospectively evaluated in 18 patients with SIH treated in our institutions between January 1998 and August 2007. RESULTS: Brain MR imaging detected abnormalities in 15 of the 18 patients (83%): diffuse pachymeningeal enhancement in 15 (83%), descent of the cerebellar tonsil in 13 (72%), brain stem sagging in 13 (72%), enlargement of the pituitary gland in 12 (67%), and subdural fluid collection in 13 (72%). Spinal MR imaging detected abnormalities in 17 of the 18 patients (94%): distention of the epidural veins in 14 (78%), epidural fluid collection on fat-saturated T2-weighted images in 16 (89%), and abnormal visualization of the nerve root sleeve in only 1 (6%). The sensitivity for SIH was 83% for brain MR imaging and 94% for spinal MR imaging. CONCLUSIONS: Spinal MR imaging is useful for the diagnosis of SIH, especially in the early stage.

Phylogenetic description of immobilized methanogenic community using real-time PCR in a fixed-bed anaerobic digester.

After immobilization of anaerobes on polyurethane foam in a thermophilic, fixed-bed, anaerobic digester supplied with acetate, the results of real-time PCR analysis indicated that the major immobilized methanogenic archaea were Methanosarcina spp., and that the major free-living methanogenic archaea were Methanosarcina and Methanobacterium spp. 16S rRNA gene densities of Methanosarcina spp. and Methanobacterium spp. immobilized on the polyurethane foam were 7.6x10(9) and 2.6x10(8) copies/cm3, respectively. Immobilized methanogenic archaea could be concentrated 1000 times relative to those in the original anaerobically digested sludge from a completely mixed thermophilic digester supplied with cattle waste. On the other hand, immobilized bacteria could be concentrated only 10 times. The cell densities of the immobilized methanogenic archaea and bacteria were higher than those of the free-living methanogenic archaea and bacteria in the reactor. The results of clone analysis indicate that the major methanogenic archaea of the original thermophilic sludge are members of the order Methanomicrobiales, and that the major methanogenic archaea immobilized on the polyurethane foam are Methanosarcina spp., and those of the liquid phase are Methanobacterium spp. The results of the real time PCR analysis approximately agree with those of the clone analysis. These results indicate that real-time PCR analysis is useful for quantitatively describing methanogenic communities.

Early treatment for ruptured cerebral aneurysms. Location of aneurysms and choice of treatments.

SUMMARY: The purpose of this study was to evaluate the effect of endovascular treatment with Guglielmi detachable coils (GDC) on the outcomes of subarachnoid haemorrhage (SAH) patients of poor grades and high ages for each location of aneurysms. Between 1990 and 2003, 529 SAH cases underwent angiograghy as candidates of early aggressive treatment in our hospital. For the 299 cases in 1990-96 (Group 1), treatment options were early and intensively delayed craniotomy surgery and conservative management, while for the 230 cases in 1997-2003 (Group 2), GDG embolization at acute stage was added to these three treatment options. We compared clinical courses and outcomes of the poor grade (Hunt & Kosnik Grade 4-5) patients and high age (>=70 years old) patients between two groups for each location of aneurysms. Introduction of GDC embolization expanded the indication for early treatment in the poor grade patients with anterior communicating artery aneurysm (A-Comm An), the high age patients with internal carotid artery aneurysm (IC An) and all patients with Basilar bifurcation aneurysm (BA-Top An), and has contributed to improvement of their outcomes. To the poor grade patients with middle cerebral artery aneurysm (MCA An), GDC embolization was hardly indicated, because haematoma evacuation concomitantly performed with aneurysm occlusion would be necessary for those patients. In conclusion, results of treatment with GDC embolization at an acute stage are desirable for poor grade patients with A-Comm An, aged patients with IC An and all patients with BA-Top An. The indication of GDC embolization for the patients with MCA An is limited.

Medico-financial Environment on Treatment for Acutely Ruptured Cerebral Aneurysms. GDC Embolization vs Neck Clipping.

SUMMARY: We have been using the Guglielmi detachable coils (GDC) since 1997 as one choice of cerebral aneurysm treatment.We have, at the present time, two effective radical treatment methods for acutely ruptured cerebral aneurysms, GDC embolization and conventional surgical aneurysmal neck clipping. There ensued questions about the cost and efficacy of the two strategies. Retrospective analysis was done on a GDC group and a clipping group, with each twenty consecutive patients. The features of the GDC group patients were higher age, and poorer Hunt and Kosnik grades than the other group. All MCA aneurysms were treated with surgical neck clipping, while all the posterior circulation aneurysms were embolized with GDC. Based on the Japanese Medical Insurance and Payment System, 477,890 points (1 point = yen 10) as a mean was required with the GDC group, and 456,084 points with the neck clipping group, showing no significant difference between the two groups. In the GDC group, the cost of the implanted medical device seemed to raise the total medical expense. At present, the GDC embolization is the preferred choice of strategies in acutely ruptured cerebral aneurysms, and its preference increases in the surgically difficult cases, very old, or poor grade patients, and in various complicated cases. And, the GDC embolization seems to be satisfactory from the medico-financial viewpoint.

Endovascular Treatment for Ruptured VA Dissecting Aneurysm Involving the Origin of PICA.

SUMMARY: Ruptured vertebral artery dissecting aneurysms (VADA) re-bleed frequently especially during first 24 hours, which makes the prognosis of the patients with this disease poor. Recently endovascular trapping with detachable platinum coils at an acute stage has been done for preventing re-bleeding. However, for the cases with dissecting aneurysm involving the origin of the posterior inferior cerebellar artery (PICA), these methods are hardly indicated because of the risk of ischemic complication in the PICA territory. We proposed a simple and effective therapeutic method for these cases. We occluded the affected vertebral artery (VA) near its root intending to introduce collateral blood flow from the deep cervical artery into the VA trunk. The controlled antegrade VA flow and retrograde flow from the contralateral VA make a watershed at the dissecting aneurysm, which promotes thrombosis of pseudolumen with preserving the antegrade blood flow of PICA.We treated two cases with ruptured VADA involving PICA, and in both cases thrombosis of aneurysm was obtained without any ischemic complication. This method would be considered as a treatment of choice to the cases with VADA involving PICA.

Removal of 3-chlorobenzoate using an upflow anaerobic sludge blanket reactor under light conditions.

The possibility of 3-chlorobenzoate removal from water using an upflow anaerobic sludge blanket (UASB) reactor without the addition of any extra dechlorinating culture under light conditions has been studied on a laboratory scale. Benzoate removal was observed in the first three months of operation under light conditions, but the 3-chlorobenzoate removal was not observed. After three months of operation under light conditions, the 3-chlorobenzoate concentration in the UASB reactor effluent gradually decreased to less than 1 mg x h(-1). The 3-chlorobenzoate concentration in the effluent did not increase under dark conditions. The DOC concentration in the effluent decreased according to the removal of the 3-chlorobenzoate by the UASB granules. These results indicated that granules in the UASB reactor provided the 3-chlorobenzoate removability after 80-100 d of adaptation to the 3-chlorobenzoate, and that the UASB reactor is useful for 3-chlorobenzoate removal.

Clearance of Subarachnoid Clots after GDC Embolization for Acutely Ruptured Cerebral Aneurysm. Comparison with Early Direct Surgery.

SUMMARY: It is apparent that subarachnoid clots play an important role in the development of delayed vasospasm that is one of the major causes of mortality and morbidity in patients with acutely ruptured cerebral aneurysm. The purpose of this study is to compare the clearance of subarachnoid clots in the acute stage after the treatment with Guglielmi detachable coils (GDC) and after treatment with direct surgery. Forty-nine patients were treated by GDC embolization within four days of the ictus. After GDC embolization, adjunctive therapies, such as ventricular and/or spinal drainage (67%), intrathecal administration of urokinase (41%), continuous cisternal irrigation (16%), and external decompression (16%), were performed. Seventy-four surgically treated patients were subsequently treated by continuous cisternal irrigation with mock-CSF containing ascorbic acid for ten days. The clearance of subarachnoid clots was assessed by the Hounsfield number serial changes on the CT scans taken on days 0, 4, 7, 10 after subarachnoid hemorrhage. The incidence of symptomatic vasospasm was lower in the GDC group (6%) than in the surgery group (12%). The clearance of subarachnoid clots from both the basal cistern and the Sylvian fissure was more rapid in the GDC cases than in the surgery cases in the first four days. Intrathecal administration of urokinase accelerated the clearance significantly. GDC embolization followed by intrathecal administration of thrombolytic agents accelerates the reduction of subarachnoid clots and favorably acts to prevent delayed vasospasm.

Characterization of lighted upflow anaerobic sludge blanket (LUASB) method under sulfate-rich conditions.

Growth of phototrophic bacteria was induced from granules in a lighted upflow anaerobic sludge blanket (LUASB) reactor supplied with an organic-acid-based medium containing 141.7 mg S.l(-1) of SO4(2-) under light conditions (100 microE.m(-2).s(-1)). We investigated the population dynamics of phototrophic bacteria in the LUASB reactor and the performance of the LUASB reactor for wastewater treatment and poly-beta-hydroxybutyrate (PHB) production under anaerobic light and sulfate-rich conditions. In vivo absorption spectra and a colony count suggested that populations of Rhodopseudomonas palustris and Blastochloris sulfoviridis in the LUASB reactor supplied with a medium containing 574.4 mg S.l(-1) of SO4(2-) under light conditions were lower than those supplied with a medium containing 1.0 or 141.7 mg S.l(-1) of SO4(2-) under parallel conditions. Removal efficiencies of ammonium and phosphate in the LUASB reactor supplied with the medium containing 141.7 mg S.l(-1) of SO4(2-) under light conditions were higher than those under parallel conditions but without illumination. The difference in the results of runs under light or dark conditions suggested that the ammonium and phosphate ion removal efficiencies were improved by increasing the amount of phototrophic bacterial biomass in the LUASB reactor under sulfate-rich conditions. The average PHB production rates of the bacterial cells recovered from the effluent of the LUASB reactor supplied with a medium containing 141.7, 283.5 or 574.4 mg S.l(-1) of SO4(2-) were 1.0-2.9 mg.l(-1)-reactor.d(-1) and the average PHB content based on the dry bacterial biomass was 1.4-3.6%.

Microalgal cultivation in a solution recovered from the low-temperature catalytic gasification of the microalga.

Microalgal cultivation in a solution recovered from the low-temperature catalytic gasification of the microalga itself was studied. The growth of Chlorella vulgaris in 75-300-fold diluted recovered solution containing phosphate, magnesium ions and micro-elements was comparable to that in the standard culture medium. It was suggested that C. vulgaris could use ammonium in the recovered solution as its nitrogen source and at the same time could provide a source of biomass which was recycled via gasification.

Organic acid consumption of phototrophic bacteria in a lighted upflow anaerobic sludge blanket reactor.

It was previously suggested that a population of phototrophic bacteria, Rhodopseudomonas palustris strain RN1 and Blastochloris sulfoviridis strain GN1 could be induced from granules in a lighted upflow anaerobic sludge blanket (LUASB) reactor. The present study showed that both strains RN1 and GN1 could use acetate, propionate, butyrate, and lactate as electron donors under anaerobic light conditions. The composition of organic acids in the effluent from the LUASB reactor was studied to investigate competitive consumption between acetogenic bacteria, methanogens, and phototrophic bacteria in the reactor. When acetate, propionate and lactate were supplied to the reactor, a small amount of acetate and propionate was observed in the effluent under light conditions. The concentrations of acetate and propionate increased under dark conditions compared with those under light conditions using organic acid and peptone media as the influent. When starch was supplied to the reactor, the concentrations of formate, acetate, propionate, butyrate, and lactate in the effluent were less than 0.5 mg C.l(-1) during operation under light and dark conditions. The concentrations of ammonium and phosphate in the effluent under dark conditions were higher than those under light conditions. These results suggested that phototrophic bacteria in the LUASB reactor consumed acetate and propionate as well as ammonium and phosphate in competition with methanogens and acetogenic bacteria.

Statistical analysis of factors affecting the outcome of patients with ruptured distal anterior cerebral artery aneurysms.

The clinical factors affecting the outcome of patients with ruptured distal anterior cerebral artery (ACA) aneurysms were analyzed using multiple logistic regression analysis. The medical records were reviewed of 52 patients (57 aneurysms) with ruptured distal ACA aneurysms operated on by the same neurosurgeon over 25 years. The standard policy was early surgery for patients in Hunt and Kosnik grades I to IV. Age, sex, Hunt and Kosnik grade, timing of operation, size of aneurysms, number of aneurysms, association of intracerebral haemorrhage (ICH), intraventricular haemorrhage, and azygos ACA, use of temporary clipping, occurrence of premature rupture, and presence of psychiatric change were investigated. Univariant analysis disclosed that clinical grade (P = 0.0006), size of aneurysm (P = 0.005), and size of ICH (P = 0.012) affected the outcome of patients. Multiple logistic regression analysis found that Hunt and Kosnik grade (P = 0.010) and timing of operation (P = 0.033) affected the outcome. There was no significant relationship between long-term outcome and clinical factors, although a close relationship was found with Hunt and Kosnik grade (P = 0.071). Clinical grade and timing of the operation affected the outcome of patients with ruptured distal ACA aneurysms. Patients harboring ICH of over 3 cm diameter in poor grades should also be carefully treated.

Endovascular Treatment with GDC for Severe Acute SAH: Comparison with Early Direct Surgery.

SUMMARY: The purpose of this study was to evaluate the effect of endovascular treatment with Guglielmi detachable coils (GDC) on the outcome of severe subarachnoid hemorrhage (SAH) caused by acute rupture of a cerebral aneurysm and on the incidence of symptomatic vasospasm. Thirty- five patients with aneurysmal SAH were treated in the acute stage using GDC. Fifteen out of 17 patients in Hunt & Kosnik grades I, II, and III showed good recovery (GR) at discharge, while one was moderately disabled (MD) and one was severely disabled (SD). Among 16 patients in poor neurological condition (GCS was

Serial angiography and endovascular treatment of dissecting aneurysms of the anterior cerebral and vertebral arteries. Case report.

This 47-year-old man was admitted to the hospital with disturbance of consciousness due to subarachnoid hemorrhage caused by a ruptured dissecting aneurysm of the left anterior cerebral artery (ACA). Conservative treatment resulted in improvement in the patient's consciousness; however, repeated rupture occurred during the chronic stage. Endovascular coil embolization of the parent artery was successful. Serial angiography demonstrated all stages in the development of the aneurysm. Follow-up angiography demonstrated an incidental dissecting aneurysm of the right vertebral artery. This aneurysm was also treated by endovascular embolization. No new neurological deficit appeared during or after the treatment. Multiple dissecting aneurysms are rare, especially those involving both supra- and infratentorial regions. A ruptured dissecting aneurysm of the ACA is also an uncommon vascular disorder. This case shows that rebleeding may occur, even during the chronic stage, and thus appropriate treatment for the prevention of subsequent bleeding is essential. Incidental dissecting aneurysms can be treated using the endovascular technique, but further study is necessary.

Oculomotor nerve palsy after surgery for upper basilar artery aneurysms.

OBJECTIVE: The goals of this study were to evaluate the relationship between postoperative oculomotor nerve palsy and other clinical factors and to improve preoperative estimations of the risk. Such an evaluation has not been previously described in the literature. METHODS: Patient records for 77 basilar tip aneurysm cases and 28 basilar superior cerebellar artery aneurysm cases treated between 1981 and 1997 were reviewed. Clinical and radiological parameters were separately analyzed using the chi2 test, and then multiple-regression analysis was used. RESULTS: Postoperative oculomotor palsy occurred in 25 (32%) patients with basilar tip aneurysms and 11 (39%) patients with basilar superior cerebellar artery aneurysms, in addition to 2 patients with basilar tip aneurysms and 3 patients with basilar superior cerebellar artery aneurysms who exhibited oculomotor palsy before surgery. For both type of aneurysms, the size and direction of the aneurysms were closely related to oculomotor nerve palsy. The complication also tended to occur in early surgery cases, in younger patients, and in patients of poor-clinical grade status. CONCLUSION: In this study, some clinical and radiological factors were found to be associated with postoperative oculomotor nerve palsy.

Lighted upflow anaerobic sludge blanket.

The upflow anaerobic sludge blanket (UASB) method has been developed as an efficient anaerobic wastewater treatment process; however, the performance of this process in the removal nitrogenous compounds and phosphate is not high. Here, we present the water treatment performance of a lighted upflow anaerobic sludge blanket (LUASB) reactor and propose a novel LUASB concept. A population of phototrophic bacteria was induced from UASB granules under light conditions (100 microE x m(-2) x s(-1)). The ammonium and phosphate ion removal efficiencies of the LUASB reactor were higher than those of a UASB reactor. The difference in the results from runs under light and dark conditions suggests that the efficiencies of ammonium and phosphate ion removal were improved by an increase in the phototrophic bacteria in the LUASB reactor. The UASB granule can decompose a variety of organic substances; therefore, the LUASB method could also be effective for producing phototrophic bacterial biomass and polyhydroxyalkanoates (PHAs) from various wastewaters.

Treatment of liquid fraction separated from liquidized food waste in an upflow anaerobic sludge blanket reactor.

Thermochemical liquidization as a pretreatment for anaerobic digestion of food waste was studied using a laboratory-scale upflow anaerobic sludge blanket (UASB) reactor for a period of 82 d. Model food waste (approximately 90 wt% moisture content) was thermochemically liquidized at 175 degrees C for 1 h. The liquidized food waste was separated into a solid phase (6-10 wt%) and a liquid phase (85-89 wt%). The diluted liquid phase was continuously treated by anaerobic digestion using a UASB reactor at 35 degrees C. The volumetric loading rate was increased stepwise to 6.4-7.2 g total organic carbon (TOC)/l-reactor/d. Methane production was found to be approximately 0.35-0.61 l/g-TOC removed. The range of TOC removal efficiencies was 67-69% at an influent TOC concentration of 10.1-11.1 g/l and a volumetric loading rate of 4.8-5.3 g-TOC/l-reactor/d. This treatment process using an UASB reactor could be suitable for resource recovery from food waste.

Wastewater treatment and poly-beta-hydroxybutyrate production using lighted upflow anaerobic sludge blanket method.

We investigated the performance of a lighted upflow anaerobic sludge blanket (LUASB) reactor for wastewater treatment and poly-beta-hydroxybutyrate (PHB) production. Phototrophic bacteria were induced from UASB (upflow anaerobic sludge blanket) granules under light conditions (100 microE.m(-2).s(-1)). The ammonium and phosphate ion removal efficiencies of the LUASB reactor were higher than those of the UASB reactor. The difference in the results from runs under light and dark conditions suggested that the ammonium and phosphate ion removal efficiencies were improved by increasing the amount of phototrophic bacteria in the LUASB reactor. The average production rate of PHB from the biomass in the effluent from the LUASB reactor was 6.6-14.0 mg.l(-1)-reactor.d(-1) using acetate-based media and the average PHB content based on the dry bacterial biomass was 15.1-25.3%. The PHB concentration increased by reincubation of the effluent from the LUASB reactor with sodium acetate under light conditions. The UASB granular sludge can decompose a variety of organic substances and in addition the LUASB method can remove ammonium and phosphate ions. The LUASB method thus appears to be appropriate for wastewater treatment and production of phototrophic bacteria and PHB from various wastewaters.

Effects of glucose addition and light on current outputs in photosynthetic electrochemical cells using Synechocystis sp. PCC6714.

The effects of glucose addition and light on the current outputs in electrochemical cells using a cyanobacterium Synechocystis sp. PCC6714 were investigated under photo- and chemoheterotrophical conditions. The addition of glucose to the anode solutions of the electrochemical cells resulted in a rapid increase in the current outputs under both light and dark conditions. Although the coulombic outputs were almost the same between under light and dark conditions, the rate of glucose consumption was faster under illumination than in the dark. The total sugar content in the cells of strain PCC6714 increased with the addition of glucose and the total sugar accumulated remained intact during the discharge under illumination, while it decreased gradually in the dark. When the light was switched off after the addition of glucose, the current output markedly increased. The coulombic outputs obtained after darkening were 10 to 80 times larger than that obtained by the addition of glucose under the continuous light or dark conditions. Synechocystis sp. completely incorporated 0.14 mM and 0.42 mM glucose for 1 h and 3 h, respectively, under illumination. There was no difference in the coulombic outputs between 1 h and 12 h illumination times in the electrochemical cells with 0.14 mM glucose. When the light was switched off after 1 h illumination in the electrochemical cells with 0.42 mM glucose, the coulombic output obtained from the electrochemical cell was lower than that in the electrochemical cell with 12 h illumination. This indicates that the current output was produced with higher efficiency with glucose incorporated under illumination than that in the case of glucose incorporated after darkening. The highest coulombic yield of 54% in this experiment was obtained by darkening in the electrochemical cell with 0.14 mM glucose.

Technical points to improve surgical results in cases with basilar tip aneurysms.

Surgical results in 82 cases with aneurysm (61 ruptured and 21 unruptured) of the bifurcation of the basilar artery were analyzed and the causes of unfavorable outcome and its measures were discussed. Operation was performed in grade I, II, III, or IV of the Hunt and Kosnik's classification for the patients with ruptured aneurysm. Both in ruptured and unruptured cases, patient's age was not considered. As it turned out, 10 elderly (70 years old or older) cases (8 ruptured and 2 unruptured) were included in this study. Unilateral pterional approach was adopted for all but one case, and temporary clip and/or division of the hypoplastic posterior communicating artery was actively used. Surgery was completed with clipping of the aneurysm in all but six cases and overall surgical result consists of 70% of favorable outcomes. The main causes of unfavorable outcome were surgical procedures and primary brain damage due to subarachnoid hemorrhage. And the factors influenced to increase surgical technical damage to the brain were the patient's age, size of the aneurysm, and/or height of the neck from biclinoids line. The outcome of the higher grade (grade III or IV) in elderly cases was miserable, whereas it was not different from anterior circulation aneurysms in younger cases. From the result we concluded that the surgical indication for elderly cases should be limited in cases with lower grade (grade I or II) without large and/or high-positioned aneurysm. To obtain further improvement of the surgical result in younger cases, additional surgical techniques have to be considered to avoid the injury of perforating arteries from P1 and to reduce the pressure of the brain retraction which are the most important hazards for aneurysm surgery in this area.