Association Between Cerebral Angiography and Asymmetrical Cortical and Deep/Medullary Vein Signs on T2 Star Magnetic Resonance Imaging in Patients with Hyperacute Horizontal Segment of the Middle Cerebral Artery Occlusion.

BACKGROUND: When treating acute ischemic stroke patients, evaluation of collateral flow to the ischemic area is essential. Blood-oxygen-level-dependent imaging, including T2 star (T2∗), can identify elevated deoxyhemoglobin levels, reflecting an increase in the oxygen extraction fraction. Prominent veins on T2∗ represent increased deoxyhemoglobin and cerebral blood volume. This study compared asymmetrical vein signs (AVSs) on T2∗ and digital subtraction angiography findings during mechanical thrombectomy (MT) in patients with hyperacute middle cerebral artery occlusion. METHODS: Clinical and imaging data of 41 patients with occlusion of the horizontal segment of the middle cerebral artery who underwent MT were collected. Patients were divided into 2 groups based on angiographic occlusion sites as: proximal and distal to the lenticulostriate artery (LSA). AVSs on T2∗ were divided into asymmetrical cortical vein sign (cortical AVS) and asymmetrical deep/medullary vein sign (deep/medullary AVS), and were compared with the findings of intraoperative digital subtraction angiography. RESULTS: Twenty-seven patients had AVSs. Cortical AVS was the only parameter with a significant association with poor angiographic collateral supply. In terms of occlusion site, deep/medullary AVS was the only parameter with a significant association with occlusion proximal to the LSA. CONCLUSIONS: In patients with occlusion of the horizontal segment of the middle cerebral artery, presence of the cortical AVS on T2∗ suggests a poor angiographic collateral supply, while presence of the deep/medullary AVS suggests impaired blood flow to the basal ganglia through LSAs. Both these signs contribute to poor outcomes in patients undergoing MT.

Investigation of the concentration ratios of anthropogenic metal elements in fresh snow at mountain area as a tracer for the discrimination between short- and long-range transport contributions.

Atmospheric deposition of anthropogenic aerosols, which is concerned about several targets of SDGs, was investigated in Japan. Concentrations of trace metal elements (V, Ni, Cd, and Pb), which are index of source for fossil fuel combustion, in winter wet deposition (fresh snow) in mountain area were determined. Average concentrations of snow samples were 0.338 ± 0.289 µg L-1 for V, 0.409 ± 0.724 µg L-1 for Ni, 0.109 ± 0.110 µg L-1 for Cd, and 1.77 ± 1.81 µg L-1 for Pb µg L-1. No significant correlations between V and Ni were found for snow samples at remote mountains. A significant correlation between Cd and Pb was observed when the back trajectories of air mass deriving snowfall passed through Northeast China and Huabei. Significant correlations between V and Pb were found in mountains when the air mass passed through Northeast China and Huabei. Changes in normalized concentrations of trace metal elements in snow at the same snowfall event indicated contributions from short-range transportation in suburb area. The metal element concentration ratios were shown to be useful tracers for discrimination between short- and long-range contributions of anthropogenic elements in snow.

A simplified isolation technique for atherosclerotic aortic arch aneurysms surgery.

The isolation technique is a useful adjunct that prevents atherosclerotic embolism in the brain when the aneurysm is filled with a massive hematoma or 'shaggy aorta'. But the technique is not widespread because of the difficulty in performing the cannulation. We modified this technique by simplifying the cannulation procedure using a puncture method with aortic root cannulas.

Anomalous Origin of the Left Anterior Descending Coronary Artery in an Adult.

An anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart disease. Among the variants, an anomalous origin of the left anterior descending coronary artery from the pulmonary artery (ALADPA) is extremely rare. Here, we report a case of ALADPA in an adult that was treated with coronary artery bypass grafting using the left internal thoracic artery.

[Degenerated Monocusp Valve Complicated with Infective Endocarditis after Total Correction of Tetralogy of Fallot;Report of a Case].

There have been few reports about degenerated monocusp-valve patches, which were used for right ventricular outflow tract( RVOT) reconstruction with complications of infective endocarditis after total correction of tetralogy of Fallot( TOF).A 44-year-old male patient, who had a total correction of TOF using Monocusp Valved Outflow Patch (MVOP) 34 years previous, was admitted for heart failure with aortic regurgitation. An echocardiographic study showed an infective endocarditis with vegetations, attached to the aortic valve and the monocusp-valve outflow patch. The aortic valve was replaced with a mechanical prosthesis and the pulmonary valve was replaced with a biological prosthesis. RVOT was reconstructed using a bovine pericardial patch. The explanted monocusp-valve was deteriorated and heavily calcified. The postoperative course was uneventful. The patient was discharged and returned to his preoperative lifestyle 36 days after the redo surgery.

[Mitral Valve Repair Using a New Artificial Ring which Enables to Decide the Length of Artificial Chordae].

Recently, mitral valve repair has been the mainstream of the operation for the treatment of mitral valve regurgitation. In particular, chorda reconstruction with artificial chordae is useful for the anterior leaflet. However, there has been no established method determining the length of chordae. In this report, we performed mitral valve repair using Memo 3D ReChord ring which enables to decide the length of chordae more easily. It is based on the concept of folding leaflet technique by Garcia et al. We used this ring in 7 patients (of which 2 were reoperation) in our institution. There was no postoperative death nor complication. Postoperative transthoracic echocardiography showed class 0~ Ⅰ mitral valve regurgitation in each case at discharge. This ring helps to make the repair more reproducible and we consider that it enables to decide the length of chordae more easily even in reoperative cases.

[Aortic Valve Repair for Bicuspid Aortic Valve (BAV) Regurgitation Combined with Stanford Type A Acute Aortic Dissection].

A 44-year-old male developed Stanford type A acute aortic dissection combined with bicuspid aortic valve( BAV) regurgitation. Aortic valve repair was performed by central plication and subcommissural annuloplasty. Additionally, replacement of the ascending aorta and the aortic root were performed with hemi-remodeling technique by replacing the non-coronary sinus. In this procedure, the angle of the 2 commissures were set at 180°. Postoperative transesophageal echocardiography revealed no aortic valve regurgitation. Changing the commissural orientation is considered to be important for the treatment of BAV regurgitation.

Clinical value of abnormal findings on brain magnetic resonance imaging in patients with intravascular large B-cell lymphoma.

To investigate the prevalence and clinical value of abnormal findings detected via brain magnetic resonance imaging (MRI) in patients with intravascular large B-cell lymphoma (IVLBCL), we identified 33 patients with IVLBCL pathologically diagnosed and evaluated with pretreatment brain MRI. Abnormal findings on brain MRI were categorized into four patterns: (1) hyperintense lesion in the pons on T2-weighted imaging (T2WI), (2) nonspecific white matter lesions, (3) infarct-like lesions, and (4) meningeal thickening and/or enhancement. Abnormal cerebral findings were detected in 29 patients (87.9%). Hyperintense lesion in the pons was the most common finding (n = 19 (57.6%) patients), followed by nonspecific white matter lesions (n = 14 (42.4%) patients), infarct-like lesions (n = 8 (24.2%) patients), and meningeal thickening and/or enhancement (n = 4 (12.1%) patients). Impaired consciousness was seen in most of the patients with infarct-like lesions (87.5%) but less frequently in patients with hyperintense lesion in the pons (47.4%). We reviewed brain MRI findings in 39 patients with diffuse large B cell lymphoma with central nervous system (CNS) involvement and/or high-risk extranodal lesions for CNS involvement as a control group. In contrast to the patients with IVLBCL, no patient had hyperintense lesion in the pons in the control group (P < 0.001). Follow-up brain MRI revealed improvement of abnormal findings in most of the patients who responded to chemotherapy. This study highlighted the diagnostic implication of hyperintense lesion in the pons on T2WI and the clinical usefulness of pretreatment brain MRI in IVLBCL even in patients without impaired consciousness.

Sulfur Chemical State and Chemical Composition of Insoluble Substance in Soft Rime, Hard Rime, and Snow Collected in Remote and Rural Areas in Japan Using Wavelength-dispersive X-ray Fluorescence.

Using a commercially available wavelength-dispersive X-ray fluorescence (WDXRF) spectrometer, the chemical composition and S-Kα spectrum of rime and snow samples collected in remote and rural areas of Japan were measured with a membrane filter sample technique to investigate the long-range transport of aerosol from the East Asian continent. Insoluble substances are derived into three categories: 1) conventional mineral origin (crustal substance), 2) urban dust origin (Fe-Zn-Ca) and 3) coal origin (S-As). Assuming that (i) S(VI) was found as a plaster-like substance in hard rime, depending on [Ca], and that (ii) S(-II) was found as non-crustal sulfur compounds, fractions of S(VI) and S(-II) in rime could be calculated as 35 ± 6 and 66 ± 7% by [Ca], which is in agreement with 32 ± 8 and 68 ± 8%, respectively, by the chemical shift of the S-Kα line. During a one-day meteorological event that included the accumulation of both rime and snow, differences to the snow-like content corresponded to characteristics typical of rime since the chemical compositions of rime also includes the composition of the snow. The fractions of 22 ± 12% of S(VI) and 76 ± 12% of S(-II), respectively, were found in rime. The fraction of S(-II) decreased from the Chugoku district towards the Shikoku district. Along the coast of the Japan Sea, the fraction of S(-II) decreased from Chugoku district toward the Northeast Japan. It can be proposed that other analytical techniques of S, Al, and Ca in that are favorable to this fractionation.

Imaging characteristics of the postoperative globe: a pictorial essay.

Recognizing imaging characteristics after ophthalmic surgery is necessary for radiologists to prevent misdiagnosis. We review typical appearances of intraorbital implanted devices and materials on CT and MRI with demonstration of the common surgical procedures. EX-PRESS glaucoma filtration devices appear as punctate areas of metal attenuation on CT and are typically placed at the corneoscleral junction. The imaging manifestations after cataract extraction are absence of the native lens of ovoid mass and the intraocular lens with high attenuation on CT and low signal intensity on MRI. The treatment of retinal detachment is achieved with intraocular tamponade or scleral buckling. In intraocular tamponade, the eye is filled with a bubble of gas or silicone oil. Gas results in air attenuation on CT and low signal intensity on MRI in the vitreous cavity. Silicone oil is hyperattenuating on CT and has variable intensity on MRI. In scleral buckling, the eye wall is indented with silicone buckling elements that show high or low attenuation on CT and low T1- and T2-weighted intensity on MRI. Degraded hydrogel buckling elements appear as swollen masses showing low attenuation on CT and high T2-weighted intensity on MRI.

[Cavernous hemangioma of the right cardiac chamber;report of a case].

Cardiac cavernous hemangioma is an extremely rare benign tumor. A 53-year-old female had undergone resection of left breast cancer 9 years before, and her clinical course had been uneventful for nearly 9 years. She then experienced sudden fatigability and palpitations. Pericardial effusion and a tumor-like lesion, pressing the right side of the heart, were detected by echocardiography, computed tomography and magnetic resonance imaging. Though her symptoms were ameliorated with pericardial puncture, she was referred to our department for a definitive diagnosis and, if indicated, tumor resection. At surgery the tumor was poorly demarcated and most of it was resected under extracorporeal circulation. The histopathological examination revealed it was cavernous hemangioma. The patient's postoperative course has been uneventful without recurrence for approximately 2 years.

[Cadiac lipoma of the right atrium;report of a case].

Cardiac lipoma is a rare benign tumor. A 42-year-old male was referred to our hospital to undergo thorough examination and treatment of a space-occupying right atrial lesion, detected incidentally by chest computed tomography(CT). After admission, it was diagnosed as cardiac lipoma by echocardiography, CT, and magnetic resonance imaging. We resected the tumor under cardiopulmonary bypass and reconstructed the right atrium using a bovine pericardial patch. The histopathological examination reveaed that the tumor was lipoma. The postoperative course has been uneventful without recurrence for nearly 2 years.

Fenestrations of the basilar artery demonstrated on magnetic resonance angiograms: an analysis of 212 cases.

Fenestration of the basilar artery (BA) is a rare variant of the intracranial artery, well demonstrated in autopsy and angiographic studies. Some angiographic series show a high incidence of associated aneurysms at the basilar fenestration site. The purpose of this study is to report the incidence of BA fenestration, its configurations, associated aneurysms, and arterial anomalies in a large series of intracranial MR angiograms (MRAs). A total of 16,416 MRAs were retrospectively reviewed to identify the location, size and associated intracranial arterial anomalies of BA fenestrations. All images were obtained with the time-of-flight (TOF) technique. Of the 16,416 MRAs, 215 fenestrations were found in 212 cases (1.29%). Most fenestrations were located in the proximal BA. The average length of the fenestration was 4.6 mm; the largest was 15.6 mm. No aneurysm was found at the site of the fenestration. Thirteen aneurysms were found in nine cases at locations other than the BA: seven in the middle cerebral artery (MCA), one in the anterior cerebral artery (ACA), one in the anterior communicating artery (Acom), one in the vertebral artery (VA), one at the carotid siphon, and two at the internal carotid-posterior communicating artery (IC-PC). Arterial anomalies in other locations were found in 26 cases. BA fenestrations were found in 1.29% of the 16,416 cases studied. There were no aneurysms at the BA fenestration site. Aneurysms at the BA fenestration site may be an exceedingly rare phenomenon.

A case of Proteus syndrome with severe spinal canal stenosis, scoliosis, and thoracic deformity associated with tethered cord.

Proteus syndrome is a rare, sporadic, hamartomatous disorder manifesting with multifocal overgrowth of tissue. The features seem to develop most often during childhood. Vertebral overgrowth with severe spinal canal stenosis is unusual, although scoliosis with abnormal vertebral bodies is one of the typical features of Proteus syndrome. We report a case of Proteus syndrome with severe spinal canal stenosis, scoliosis, cervical kyphosis, and thoracic deformity with airway obstruction because of asymmetrical overgrowth of vertebrae and ribs associated with a tethered cord, lipomas, strawberry hemangioma, flat nasal bridge, and bilateral hypoplasty of the first metatarsal bones with hyperplasty of soft tissue.

[Subacute thrombosis of drug eluting stent immediately after off-pump coronary artery bypass grafting].

A 70-year-old male underwent the implantation of sirolimus-eluting stent at our hospital for total occlusion of the right coronary artery, which had caused acute myocardial infarction. Off-pump coronary artery bypass grafting (OPCAB) was performed for residual stenosis of the left anterior descending artery and the diagonal branch 10 days later. Though the operation was successfully performed, acute myocardial infarction recurred in the early postoperative period. Emergency coronary angiography showed subacute thrombotic occulusion of the drug eluting stent (DES). Percutaneous catheter intervention restored the stent patency. Attention should be paid to subacute thrombosis (SAT) in cases with the history of DES implantation.

Structures of linear poly(ethylene oxide) compounds and potassium complexes in dichloromethane.

The H-1 NMR spectra of a series of linear poly(ethylene oxides) compounds (POE compounds) were measured in dichloromethane-d2 at 25 degrees C, where the POE compounds (HO-(CH2CH2O-)n-R) were unsubstituted POE, HEOn (R=H, n=3, 4, 6), and alkyl-substituted POE, DEOn (R=C12H25, n=4, 6, 8) and MeEO6 (R=CH3, n=6). All the peaks of H-1 NMR signals were assigned to each methylene proton of POE. The chemical shifts and coupling constant between vicinal protons were evaluated by a complete spin analysis. The spectral changes of POE compounds by the addition of potassium ion were measured at various metal-to-POE ratios. The chemical shift change of each methylene proton by the formation of the complex was evaluated. The downfield shift of methylene protons caused by the complex formation indicates that the ethylene oxide that the ethylene oxide moiety is coordinating to surround the potassium ion in the same manner as the cyclic crown ether complexes. The results of spin lattice relaxation time measurements of DEO6 suggest that all the methylenes of the ethylene oxides are immobilized by the coordination to the metal ion. Thus, it was confirmed that all oxygens of POE are participating in the complex formation.

Epicardial radiofrequency ablation for chronic atrial fibrillation undergoing simultaneous on-pump beating coronary artery bypass grafting.

Off-pump coronary artery bypass grafting has become an attractive surgical alternative for myocardial revascularization because of the advantage of myocardial protection and other benefits of patients. However, it is still regarded as a controversial treatment for the coronary artery disease accompanied by atrial fibrillation (AF). A significant number of patients in need of coronary revascularization have chronic AF. Although the Cox-Maze III procedure is the gold standard for the surgical treatment of AF, few of these patients undergo AF operations at the time of their coronary bypass grafting. We report herein a case of the pulmonary vein isolation to eliminate the AF by means of epicardial radiofrequency ablation combined with 2 vessels coronary artery bypass grafting on the beating heart with the aid of cardiopulmonary bypass.

Large-volume injection electrothermal AAS combined with tungsten-treated pyrolytic graphite furnace: determination of cadmium in tap, snow and river water samples with phosphate modifier.

A large-volume (100 microl) injection-ETAAS with W-treated PG furnace combined with a phosphate modifier was applied to the determination of unpolluted levels of Cd in tap, snow and river-water samples. The limit of detection of 1.1 ng l(-1) was observed for a 4 w/v% NH4H2PO4 modifer. Matrix interference studies were tested for major ion species well found in fresh water. The direct determination of Cd in certified river water (12 +/- 2 ng l(-1)) was carried out and the observed value was in agreement with the certified one. The good recoveries of Cd added to real environmental water samples were also observed. This method was applied to the determination of Cd in unpolluted environmental water samples.