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1.
Biomater Res ; 27(1): 70, 2023 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-37455318

RESUMO

BACKGROUND: Adipose tissue-derived microvascular fragments are functional vessel segments derived from arterioles, capillaries, and veins. Microvascular fragments can be used as vascularization units in regenerative medicine and tissue engineering containing microvascular networks. However, the in vivo therapeutic and vascularization properties of human microvascular fragments have not been investigated. METHODS: In this study, we isolated microvascular fragments, stromal vascular fractions, and mesenchymal stem cells from human lipoaspirate and studied their therapeutic efficacy and in vivo vasculogenic activity in a murine model of hindlimb ischemia. In addition, in vivo angiogenic activity and engraftment of microvascular fragments into blood vessels were measured using Matrigel plug assay. RESULTS: Both microvascular fragments and stromal vascular fractions contain not only mesenchymal stem cells but also endothelial progenitor cells. In a Matrigel plug assay, microvascular fragments increased the number of blood vessels containing red blood cells more than mesenchymal stem cells and stromal vascular fractions did. The engraftment of the microvascular fragments transplanted in blood vessels within the Matrigel plug significantly increased compared to the engraftment of mesenchymal stem cells and stromal vascular fractions. Moreover, intramuscular injection of microvascular fragments markedly increased blood flow in the ischemic hindlimbs and alleviated tissue necrosis compared to that of mesenchymal stem cells or stromal vascular fractions. Furthermore, transplanted microvascular fragments formed new blood vessels in ischemic limbs. CONCLUSIONS: These results suggest that microvascular fragments show improved engraftment efficiency and vasculogenic activity in vivo and are highly useful for treating ischemic diseases and in tissue engineering. Adipose tissue-derived microvascular fragments are vascularization units in regenerative medicine and tissue engineering containing microvascular networks. Intramuscular injection of microvascular fragments markedly increased blood flow in the ischemic hindlimbs and alleviated tissue necrosis. The present study suggests that microvascular fragments show improved engraftment efficiency and vasculogenic activity in vivo and are highly useful for treating ischemic diseases and in tissue engineering.

2.
Childs Nerv Syst ; 26(6): 853-6, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20217097

RESUMO

INTRODUCTION: Endodermal cysts, also known as enterogenous, neurenteric, foregut, epithelial, bronchogenic, or respiratory cysts, are rare benign lesions lined by columnar epithelium of a presumed endodermal origin. Endodermal cysts are rarely intracranial, but when this occurs, the cysts are frequently located in the posterior fossa with the most common locations being anterior to the brainstem and within the fourth ventricle. However, an endodermal cyst located in the medulla oblongata is extremely rare. CASE REPORT: Here, we present a case of a 23-year-old man with an endodermal cyst located in the medulla oblongata. Although rare, clinicians should be aware that this lesion is differentiated from other cystic lesions of the posterior fossa by the absence of a mural nodule. DISCUSSION: Total resection of endodermal cysts in the medulla oblongata is recommended, despite their location and adhesion to surrounding structures, due to its frequent recurrence.


Assuntos
Encefalopatias/diagnóstico , Neoplasias Encefálicas/diagnóstico , Cistos/diagnóstico , Bulbo , Encefalopatias/patologia , Encefalopatias/cirurgia , Neoplasias Encefálicas/patologia , Cistos/patologia , Cistos/cirurgia , Diagnóstico Diferencial , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Bulbo/patologia , Bulbo/cirurgia , Resultado do Tratamento , Adulto Jovem
3.
J Neurosurg ; 110(3): 540-2, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19012483

RESUMO

Vascular complications, including vessel occlusion and hemorrhage, can arise after radiosurgery; however, hemorrhage due to a ruptured de novo aneurysm after Gamma Knife radiosurgery (GKS) for tumor is extremely rare. To the authors' knowledge, only a single case of de novo aneurysm formation after GKS for vestibular schwannoma has been previously reported. In this study, they describe their experience with the treatment of a 74-year-old woman with subarachnoid hemorrhage limited to the cerebellopontine cistern, who had undergone GKS for vestibular schwannoma 5 years earlier. Cerebral angiography demonstrated a left distal anterior inferior cerebellar artery aneurysm; coil embolization was attempted and failed. However, self-resolution of the aneurysm was revealed on follow-up angiography.


Assuntos
Doenças Cerebelares/etiologia , Aneurisma Intracraniano/etiologia , Neuroma Acústico/cirurgia , Radiocirurgia/efeitos adversos , Idoso , Feminino , Humanos , Hemorragia Subaracnóidea/etiologia
4.
Acta Neurochir (Wien) ; 151(7): 803-8, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19404570

RESUMO

BACKGROUND: Transsphenoidal surgery has been well established as an effective primary treatment for tumours of the sellar region. During the dural opening, the prominent intercavernous sinus poses limitations for this approach and may contribute to incomplete tumour resections. METHOD: Based on our experience from 940 cases of conventional transsphenoidal surgery, we have developed a stepwise protocol for achieving bleeding control in 72 cases (7.7%) that had prominent anterior intercavernous sinus. FINDINGS: A custom-made 45-degree right- or left-angled bipolar coagulator (38 cases) or Landolt bipolar coagulator (29 cases; Aesculp, Tuttlingen, Germany) was inserted into the small dural opening, and both of the dural layers were coagulated together so that the potential space between the endoosteal layer and meningeal layer could be sealed, and the dural opening could be extended. When the anterior portion of the medial wall of the cavernous sinus was accidentally opened, we then placed a small piece of oxidised regenerated cellulose (Surgicel; Johnson & Johnson, North Yorkshire, UK) at the opening of the medial wall of the cavernous sinus and coagulated both dural layers together starting from the sellar floor side with a custom-made 45-degree angled bipolar coagulator. For the relatively large opening of the cavernous sinus, a microfibrillar collagen haemostat (Avitene; MedChem Products, Woburn, MA) or fleece-coated fibrin glue (TachoComb; Nycomed Austria, Linz, Austria) patch was applied over the opened cavernous sinus with gentle compression and was found to be effective in most cases. Rarely, direct suture of the opened medial wall of the cavernous sinus was necessary in five cases. CONCLUSIONS: We describe a stepwise approach to overcome unusual bleedings from the prominent intercavernous sinus during conventional transsphenoidal surgery. Our surgical experience reveals that these methods can be very effective for the control of sinus bleeding.


Assuntos
Seio Cavernoso/cirurgia , Dura-Máter/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Neoplasias Hipofisárias/cirurgia , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/prevenção & controle , Osso Esfenoide/cirurgia , Adulto , Artéria Carótida Interna/anatomia & histologia , Artéria Carótida Interna/cirurgia , Cauterização/instrumentação , Cauterização/métodos , Seio Cavernoso/anatomia & histologia , Celulose/uso terapêutico , Dura-Máter/anatomia & histologia , Feminino , Adesivo Tecidual de Fibrina/uso terapêutico , Humanos , Complicações Intraoperatórias/prevenção & controle , Masculino , Microcirurgia/efeitos adversos , Microcirurgia/métodos , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Neoplasias Hipofisárias/patologia , Hemorragia Pós-Operatória/fisiopatologia , Sela Túrcica/anatomia & histologia , Sela Túrcica/cirurgia , Osso Esfenoide/anatomia & histologia , Resultado do Tratamento
5.
J Neurosurg ; 108(6): 1142-7, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18518718

RESUMO

OBJECT: Considerable confusion exists in the literature regarding the classification of cerebrovascular malformations and their clinical significance. One example is provided by the atypical developmental venous anomaly (DVA) with arteriovenous shunt, because it remains controversial whether these lesions should be classified as DVAs or as atypical cases of other subtypes of cerebrovascular malformations. The purpose of this study was to clarify the classification of these challenging vascular lesions in an effort to suggest an appropriate diagnosis and management strategy. METHODS: The authors present a series of 15 patients with intracranial vascular malformations that were angiographically classified as atypical DVAs with arteriovenous shunts. This type of vascular malformation shows a fine arterial blush without a distinct nidus and early filling of dilated medullary veins that drain these arterial components during the arterial phase on angiography. Those prominent medullary veins converge toward an enlarged main draining vein, which together form the caput medusae appearance of a typical DVA. RESULTS: Based on clinical, angiographic, surgical, and histological findings, the authors propose classifying these vascular malformations as a subtype of an arteriovenous malformation (AVM), rather than as a variant of DVA or as a combined vascular malformation. CONCLUSIONS: Correct recognition of this AVM subtype is required for its proper management, and its clinical behavior appears to follow that of a typical AVM. Gamma Knife radiosurgery appears to be a good alternative to resection, although long-term follow-up results require verification.


Assuntos
Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/cirurgia , Veias Cerebrais/anormalidades , Malformações Arteriovenosas Intracranianas/diagnóstico , Malformações Arteriovenosas Intracranianas/cirurgia , Adolescente , Adulto , Idoso , Fístula Arteriovenosa/etiologia , Circulação Cerebrovascular/fisiologia , Criança , Estudos de Coortes , Diagnóstico Diferencial , Feminino , Humanos , Malformações Arteriovenosas Intracranianas/classificação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
6.
World J Surg Oncol ; 6: 66, 2008 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-18570669

RESUMO

BACKGROUND: A solitary skull metastasis from hepatocellular carcinoma (HCC) prior to diagnosis of the primary tumor without liver dysfunction is a very rare event. CASE PRESENTATION: A 71-year-old male, without known liver disease, presented to our institution with a palpable occipital scalp mass. On brain magnetic resonance imaging (MRI), a highly enhanced and osteolytic skull tumor was observed. The histological diagnosis obtained from the percutaneous needle biopsy was a cranial metastasis from HCC. The metastatic tumor was removed via occipital craniectomy, and the two primary liver mass lesions were subsequently treated by transarterial chemoembolization. CONCLUSION: An isolated skull metastasis may be the sole initial presentation of HCC. Early diagnosis is essential in order to treat the primary disease. A skull metastasis from HCC should be considered in the differential diagnosis in patients with subcutaneous scalp mass and osteolytic defects on X-ray.


Assuntos
Carcinoma Hepatocelular/patologia , Neoplasias Hepáticas/patologia , Neoplasias Cranianas/diagnóstico , Neoplasias Cranianas/secundário , Crânio/patologia , Idoso , Biópsia por Agulha , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica , Humanos , Neoplasias Hepáticas/terapia , Imageamento por Ressonância Magnética , Masculino , Neoplasias Cranianas/cirurgia , Resultado do Tratamento
7.
J Clin Neurosci ; 15(5): 578-80, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-18313302

RESUMO

We present the first case of ectopic ventricular recurrence of an epidermoid cyst in the middle fossa with confirming histological characteristics. A 51-year-old woman presented with an epidermoid cyst in the middle fossa and underwent complete resection. On the 6-month surgical follow-up MRI, a nodular lesion was detected in the frontal horn of the left lateral ventricle without evidence of recurrence at the primary site. The patient underwent transcortial tumor resection. Results of histological studies confirmed that the lesion was an epidermoid cyst similar to the primary lesion. This is a case report of the cerebrospinal fluid spread of an epidermoid cyst, which strengthens the case for special care at the time of surgery to prevent spread of the lesion.


Assuntos
Cisto Epidérmico/patologia , Ventrículos do Coração/patologia , Neoplasias da Base do Crânio/patologia , Fossa Craniana Média/patologia , Cisto Epidérmico/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Recidiva , Neoplasias da Base do Crânio/cirurgia
8.
J Clin Neurosci ; 15(9): 1058-61, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18644728

RESUMO

''Blister-like'' aneurysms of the supraclinoid segment of the internal carotid artery are usually small and have fragile walls, necessitating special care to prevent rebleeding. These lesions are considered high-risk aneurysms because of the technical difficulties associated with their surgical and endovascular treatment. In this report, we describe the use of stent-assisted, repeated coil embolization in the treatment of a ruptured blister-like aneurysm that experienced rapid growth. Stent-assisted coil embolization is an alternative, but sometimes hazardous, treatment for select blister-like aneurysms. Careful serial follow-up angiography will provide documentation as to the long-term stability of the endovascularly treated blister-like aneurysm described here, but early results are encouraging. Alternatively, placement of telescoped stents or graft-stent devices offers promise for future endovascular therapy.


Assuntos
Dissecação da Artéria Carótida Interna/terapia , Embolização Terapêutica/métodos , Aneurisma Intracraniano/terapia , Stents/normas , Procedimentos Cirúrgicos Vasculares/métodos , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/patologia , Dissecação da Artéria Carótida Interna/diagnóstico por imagem , Dissecação da Artéria Carótida Interna/patologia , Fossa Craniana Média/anatomia & histologia , Fossa Craniana Média/cirurgia , Embolização Terapêutica/instrumentação , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/patologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Osso Esfenoide/anatomia & histologia , Stents/tendências , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/instrumentação
9.
J Neurosurg ; 107(3 Suppl): 251-4, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17918537

RESUMO

Neuromyelitis optica (NMO) is a severe demyelinating syndrome defined principally by its tendency to affect optic nerves and the spinal cord selectively. Asymptomatic brain lesions have recently become a common finding in NMO, and symptomatic brain lesions do not exclude the diagnosis of this entity. The authors describe the case of a 12-year-old girl suffering from an unusually atypical form of NMO in which a brainstem lesion was mistaken for a brainstem glioma. Brainstem involvement in NMO exhibits variable features on neuroimaging and is confused with brainstem glioma in cases of extensive brainstem involvement in childhood. Careful differential diagnosis and proper treatment are vital for a favorable prognosis.


Assuntos
Neoplasias do Tronco Encefálico/patologia , Tronco Encefálico/patologia , Erros de Diagnóstico , Glioma/patologia , Neuromielite Óptica/patologia , Tronco Encefálico/metabolismo , Neoplasias do Tronco Encefálico/metabolismo , Criança , Diagnóstico Diferencial , Feminino , Glioma/metabolismo , Humanos , Imageamento por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Mielite/metabolismo , Mielite/patologia , Neuromielite Óptica/metabolismo , Prognóstico
10.
World J Surg Oncol ; 5: 29, 2007 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-17341319

RESUMO

BACKGROUND: Pleomorphic adenoma of the lacrimal gland is known to undergo malignant transformation when incompletely excised. Even if such a malignant change occurs, intracranial direct invasion and leptomeningeal seeding are seldom encountered. CASE PRESENTATION: A 50-year-old woman presented with malignant transformation associated with both intracranial invasion and multiple intracranial and spinal disseminations in the third recurrence of pleomorphic adenoma of the lacrimal gland, 6 years after initial treatment. MRI demonstrated increased extent of orbital mass, extending to the cavernous sinus. The patient underwent intensity-modulated radiation therapy (IMRT) and Gamma Knife radiosurgery. Follow-up MRI showed multiple leptomeningeal disseminations to the intracranium and spine. CONCLUSION: It is important to recognize that leptomeningeal intracranial and spinal disseminations of pleomorphic adenocarcinoma can occur, although it is extremely rare. To our knowledge, we report the first case of pleomorphic adenocarcinoma of the lacrimal gland presumably metastasizing to the intracranium and spine.


Assuntos
Adenocarcinoma/patologia , Adenoma Pleomorfo/patologia , Neoplasias Oculares/patologia , Aparelho Lacrimal/patologia , Neoplasias Primárias Múltiplas/patologia , Neoplasias Primárias Múltiplas/cirurgia , Adenocarcinoma/terapia , Adenoma Pleomorfo/terapia , Biópsia por Agulha , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/terapia , Progressão da Doença , Neoplasias Oculares/cirurgia , Evolução Fatal , Feminino , Humanos , Imuno-Histoquímica , Aparelho Lacrimal/cirurgia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Radiocirurgia/métodos , Medição de Risco , Neoplasias da Coluna Vertebral/patologia , Neoplasias da Coluna Vertebral/terapia
11.
World J Surg Oncol ; 5: 86, 2007 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-17683562

RESUMO

BACKGROUND: Solitary involvement of the sphenoid sinus has rarely been reported in non-Hodgkin's lymphoma. Isolated oculomotor nerve palsy is uncommon as an initial presentation of malignant tumors of the sphenoid sinus. CASE PRESENTATION: A 53-year-old woman presented with a three-month history of headache and diplopia. Neurological examination revealed complete left oculomotor nerve palsy. Magnetic Resonance Imaging (MRI) demonstrated a homogenous soft-tissue lesion occupying the left sphenoid sinus and invading the left cavernous sinus. The patient underwent transsphenoidal biopsy and the lesion was histologically diagnosed as non-Hodgkin's lymphoma, diffuse large B-cell type. Tumor cells were positive for CD20 and negative for CD3. Following six cycles of chemotherapy, the left oculomotor nerve palsy that had been previously observed was completely resolved. There was no enhancing lesion noted on follow-up MRI. CONCLUSION: It is important to recognize that non-Hodgkin's lymphoma of the sphenoid sinus can present with isolated oculomotor nerve palsy, although it is extremely rare. The cranial nerve deficits can resolve dramatically after chemotherapy.


Assuntos
Linfoma não Hodgkin/complicações , Doenças do Nervo Oculomotor/etiologia , Neoplasias dos Seios Paranasais/complicações , Seio Esfenoidal , Feminino , Humanos , Linfoma não Hodgkin/diagnóstico , Pessoa de Meia-Idade , Neoplasias dos Seios Paranasais/diagnóstico
12.
Yonsei Med J ; 48(2): 201-9, 2007 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-17461517

RESUMO

PURPOSE: Methionine synthase (MTR) and 5,10-methylenetetrahydrofolate reductase (MTHFR) are the main regulatory enzymes for homocysteine metabolism. The present case- control study was conducted to determine whether there is an association between the MTR 2756A > G or MTHFR 677C > T polymorphism and plasma homocysteine concentration in Korean subjects with ischemic stroke. MATERIALS AND METHODS: DNA samples of 237 patients who had an ischemic stroke and 223 age and sex-matched controls were studied. MTR 2756A > G and MTHFR 677C > T genotypes were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). RESULTS: Frequencies of mutant alleles for MTR and MTHFR polymorphisms were not significantly different between the controls and cases. The patient group, however, had significantly higher homocysteine concentrations of the MTR 2756AA and MTHFR 677TT genotypes than the control group (p=0.04 for MTR, p=0.01 for MTHFR). The combined MTR 2756AA and MTHFR 677TT genotype (p= 0.04) and the homocysteine concentrations of the patient group were also higher than those of the controls. In addition, the genotype distribution was significant in the MTHFR 677TT genotype (p=0.008) and combined MTR 2756AA and MTHFR 677TT genotype (p=0.03), which divided the groups into the top 20% and bottom 20% based on their homocysteine levels. CONCLUSION: The results of the present study demonstrate that the MTR 2756A > G and MTHFR 677C > T polymorphisms interact with elevated total homocysteine (tHcy) levels, leading to an increased risk of ischemic stroke.


Assuntos
5-Metiltetra-Hidrofolato-Homocisteína S-Metiltransferase/genética , Homocisteína/sangue , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Polimorfismo de Nucleotídeo Único , Acidente Vascular Cerebral/genética , Idoso , DNA/sangue , DNA/genética , Feminino , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/enzimologia
13.
Neurol Med Chir (Tokyo) ; 47(8): 356-9, 2007 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-17721051

RESUMO

A 55-year-old woman presented with moyamoya disease manifesting as recurrent transient ischemic attacks despite taking aspirin and antihypertensive agent. Angiography showed the characteristic angiographic appearance with bilateral internal carotid artery occlusion and abnormal collateral vessels. Left external carotid angiography demonstrated moderate stenosis of the proximal external carotid artery (ECA). A self-expandable stent was successfully placed in the left ECA to improve ipsilateral cerebral perfusion. The patient had an uneventful outcome after a 1-year follow up. Involvement of the proximal ECA is very unusual in moyamoya disease, and might result from hemodynamic stress or degenerative atherosclerosis. Revascularization procedures for stenoses of proximal ECA may improve cerebral perfusion in patients with moyamoya disease.


Assuntos
Doenças das Artérias Carótidas/etiologia , Doenças das Artérias Carótidas/patologia , Arteriosclerose Intracraniana/etiologia , Arteriosclerose Intracraniana/patologia , Doença de Moyamoya/complicações , Doença de Moyamoya/patologia , Angioplastia com Balão/instrumentação , Angioplastia com Balão/métodos , Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Doenças das Artérias Carótidas/diagnóstico por imagem , Trombose das Artérias Carótidas/diagnóstico por imagem , Trombose das Artérias Carótidas/etiologia , Trombose das Artérias Carótidas/patologia , Artéria Carótida Externa/diagnóstico por imagem , Artéria Carótida Externa/patologia , Angiografia Cerebral , Feminino , Humanos , Arteriosclerose Intracraniana/diagnóstico por imagem , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Doença de Moyamoya/diagnóstico por imagem , Stents , Compostos de Tecnécio , Tomografia Computadorizada de Emissão de Fóton Único , Resultado do Tratamento
14.
Neurol Res ; 28(8): 881-5, 2006 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17288750

RESUMO

Intra-arterial thrombolysis and percutaneous angioplasty is feasible in patients with acute middle cerebral artery (MCA) occlusion limited to 6 hours post-ictus, but there are some limitations such as reocclusion or hemorrhagic complications. In this report, we describe a stent placement in the treatment of a refractory artherothrombotic MCA occlusion beyond 6 hours of symptom onset. A 57-year-old man presented with a progressive left-sided weakness and verbal disturbance resulting from an acute thrombotic occlusion of the right MCA superimposed on severe proximal atheromatous stenosis. Diffusion-perfusion magnetic resonance imaging (MRI) demonstrated the significant diffusion-perfusion mismatch. After chemical and mechanical thrombolysis of the clot, balloon angioplasty of the underlying MCA stenosis was performed 2 days post-attack, without significant angiographic improvement. Percutaneous endovascular deployment of a stent (Driver 2.5 x 12 mm, MTI, Irvine, CA) was subsequently performed, with excellent angiographic results. Follow-up diffusion-perfusion MRI showed improved perfusion in the hypoperfused area. The patient's National Institutes of Health Stroke Scale (NIHSS) score was increased from 12 to 3. Clot thrombolysis and subsequent stenting in patients with refractory proximal MCA occlusion is feasible and allows for a significant reduction in the amount of thrombolytic drug required. In selective patients with acute MCA occlusion, the therapeutic window for recanalization procedures can be safely and effectively extended beyond the 'traditional 6 hours'. Diffusion-perfusion MRI in acute MCA occlusion is important for indication of therapy.


Assuntos
Imagem de Difusão por Ressonância Magnética , Infarto da Artéria Cerebral Média/patologia , Infarto da Artéria Cerebral Média/terapia , Stents , Terapia Trombolítica/métodos , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade
15.
J Clin Neurosci ; 13(8): 872-5, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16931021

RESUMO

Ruptured aneurysms of the distal anterior choroidal artery (AchA) are extremely rare and management is dictated by clinical presentation. This report describes a rare patient with a distal AchA aneurysm and subarachnoid and intraventricular haemorrhage. A 60-year-old woman presented with a sudden onset of severe headache and vomiting. No aneurysms could be found on initial angiograms. A repeat angiogram performed 10 days after admission demonstrated an aneurysm in a branch of the cisternal segment of the left AchA without a definite neck. Surrounding vessels showed multifocal stricture and dilatation. Microsurgical clipping was not performed because the patient died suddenly due to pulmonary failure. The aetiology of the aneurysm in this case and surgical strategy are discussed.


Assuntos
Aneurisma Roto/patologia , Plexo Corióideo/irrigação sanguínea , Plexo Corióideo/patologia , Aneurisma Intracraniano/patologia , Aneurisma Roto/complicações , Antibacterianos/uso terapêutico , Angiografia Cerebral , Evolução Fatal , Feminino , Gentamicinas/uso terapêutico , Humanos , Aneurisma Intracraniano/complicações , Pessoa de Meia-Idade , Penicilinas/uso terapêutico , Pneumonia Aspirativa/complicações , Pneumonia Aspirativa/tratamento farmacológico , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus , Hemorragia Subaracnóidea/etiologia , Tomografia Computadorizada por Raios X , Vancomicina/uso terapêutico
16.
Anticancer Res ; 25(3B): 2249-52, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16158971

RESUMO

BACKGROUND: Methylentetrahydrofolate reductase plays a central role in converting folate to methyl donor for DNA methylation. Genetic variations in folate metabolism are believed to contribute to the risk of acute lymphoblastic leukemia, colon, esophageal and stomach cancer, as well as cardiovascular and cerebrovascular diseases. MTHFR C677T and A1298C polymorphisms are known to be risk factors for gastric cancer in the Chinese population. Therefore, we hypothesized that the MTHFR polymorphisms are associated with the risk of stomach cancer in Korean subjects. PATIENTS AND METHODS: We conducted a Korean population-based case-control study to examine the relationship between genetic polymorphisms in MTHFR and risk of stomach cancer. The study subjects were 133 patients with stomach cancer and 445 population controls, matched according to sex and age. Genomic DNA was extracted from blood samples of the controls and from surgically resected "normal" tissues adjacent to the tumor of stomach cancer patients. MTHFR genotypes at the C677T and A1298C sites were analyzed by PCR-based RFLP methods. RESULTS: We found no evidence for an association between the MTHFR C677T and A1298C polymorphisms and stomach cancer in any of the subjects. The adjusted odds ratios and 95% confidence intervals for MTHFR C677T were 0.924 (0.581-1.469) for 677CT versus 677CC wild-type and 1.147 (0.850-1.549) for 677TT versus 677CC, and for MTHFR A1298C, they were 1.114 (0.695-1.783) for 1298AC versus 1298AA wild-type and 0.834 (0.284-2.450) for 1298CC versus 1298AA. CONCLUSION: These results suggest that the MTHFR C677T and A1298C polymorphisms by themselves do not play an important role in the etiology of stomach cancer in the Korean population.


Assuntos
Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Neoplasias Gástricas/enzimologia , Neoplasias Gástricas/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Alelos , Estudos de Casos e Controles , Feminino , Predisposição Genética para Doença , Genótipo , Humanos , Coreia (Geográfico) , Masculino , Pessoa de Meia-Idade , Polimorfismo Genético , Fatores de Risco
17.
J Clin Neurosci ; 12(6): 691-3, 2005 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16098755

RESUMO

The pineal region is an unusual site for brain metastasis and most metastatic pineal lesions are asymptomatic. Rarely the symptoms of metastatic involvement of the pineal gland precede those of the primary tumor or other metastatic sites. An 83 year-old man presented with gait disturbance and limitation of upward gaze. Brain MRI showed homogeneous enhancement of a solitary mass in the pineal region with obstructive hydrocephalus. A stereotactic biopsy was performed, and small cell carcinoma was diagnosed. A systemic investigation for the primary lesion subsequently revealed small cell carcinoma of the lung. The patient was referred for radiotherapy and chemotherapy. Although rare, metastatic tumor should be considered in the differential diagnosis of pineal region tumors, particularly in elderly patients.


Assuntos
Neoplasias Encefálicas/secundário , Carcinoma de Células Pequenas/patologia , Neoplasias Pulmonares/patologia , Pinealoma/secundário , Idoso de 80 Anos ou mais , Tratamento Farmacológico/métodos , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Radioterapia/métodos , Tomografia Computadorizada por Raios X/métodos
18.
Neurosurgery ; 55(3): 710, 2004 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16933382

RESUMO

OBJECTIVE AND IMPORTANCE: Spontaneous or traumatic dissection of the internal carotid artery with resultant lower cranial nerve palsies is well documented. However, dissection of the external carotid artery with lower cranial palsies has not been reported previously. CLINICAL PRESENTATION: A 42-year-old man experienced an epidural hematoma as the result of a fall and underwent a craniotomy and hematoma removal. Subsequently, he developed dysgeusia and difficulty in swallowing. Brain magnetic resonance imaging showed a dilated linear structure, with isosignal intensity on T1-weighted images and hyperintense signal intensity on T2-weighted images. Strong enhancement was seen on postcontrast T1-weighted images, indicating a dissected internal maxillary artery. This was confirmed on selective angiography of the left common carotid artery. INTERVENTION: Guglielmi detachable coils were introduced into the false lumen of the dissected artery. Subsequently, 0.5 ml of glue mixed with Lipiodol (Lafayette Pharmacal, Lafayette, IN) was packed into the remnant of the false lumen. Repeat angiograms demonstrated complete occlusion of the dissected vessel. The patient's postoperative course was uneventful, and the neurological deficits gradually improved. CONCLUSION: We describe the first reported case of internal maxillary artery dissection and pseudoaneurysm presenting with isolated glossopharyngeal nerve palsy. The association between cranial nerve palsy and dissection of the external carotid artery branch may be the result of a compressive mechanism, as suggested by its anatomic relationships, the characteristics of the dissection, and the good prognosis. Endovascular embolization of the external carotid artery dissection and pseudoaneurysm is suggested as an effective therapeutic method for improving or alleviating neurological deficits produced by mass effect.


Assuntos
Acidentes por Quedas , Dissecção Aórtica/complicações , Dissecção Aórtica/diagnóstico , Doenças do Nervo Glossofaríngeo/complicações , Artéria Maxilar , Paralisia/complicações , Adulto , Dissecção Aórtica/etiologia , Dissecção Aórtica/cirurgia , Angiografia Digital , Encéfalo/patologia , Transtornos de Deglutição/etiologia , Diagnóstico Diferencial , Disgeusia/etiologia , Hematoma Epidural Craniano/etiologia , Hematoma Epidural Craniano/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino
19.
J Clin Neurophysiol ; 21(6): 391-8, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15622124

RESUMO

Foramen ovale electrode (FOE) implantation is usually indicated in patients with mesial temporal lobe (MTL) epilepsy. The authors conducted this study to characterize the electrical discharge patterns obtained using FOE recording and evaluated their clinical significance. Interictal and ictal discharge patterns and their temporal relationships to EEGs were examined in 16 patients who had FOEs implanted bilaterally and had good recovery from surgery. After long-term telemetry recording with FOEs, all patients displayed clear seizure onsets originating in one or both sides of the MTL and underwent an anterior temporal lobectomy. Interictal epileptiform discharges (IEDs) were lateralized to the operated side in 12 patients based on scalp EEGs and in 8 patients based on FOE recordings. Among the various possible IED patterns observed with the FOE recordings, a periodic pattern was dominant in the operated side (P = 0.001), whereas a polyspike pattern was dominant in the nonoperated side (P = 0.002). The number of patients with ictal onsets in the operated side was five based on the scalp EEG and 10 based on FOE recordings. Paroxysmal fast frequency activity, rhythmic spikes (>2 Hz), or sharp waves were dominant over other FOE seizure onset patterns in the operated side. By contrast, delta and theta slowing and positive spikes were prevalent in the nonoperated side. The start-stop-start pattern, previously described using subdural electrodes, was also found in FOE recordings and was concordant with the operated side in all cases. The interhemispheric propagation time recorded with bilateral FOEs was 22.6 +/- 20.0 seconds for ictal discharges initiated in the operated side and 7.0 +/- 8.4 seconds for those in the nonoperated side. Among various IED spreading patterns, the most prevalent progression was FOE --> contralateral FOE --> ipsilateral temporal lobe, or --> contralateral temporal lobe. In this series, FOE implantation caused no serious complications. FOE recording appears to be useful for confirming lateralization in patients with MTL epilepsy previously determined using clinical and neuroimaging methods. A thorough analysis of FOE recordings can provide information that may facilitate the differentiation of primary from secondary (nonepileptogenic) temporal lobes.


Assuntos
Eletrodos Implantados , Eletroencefalografia/métodos , Epilepsia do Lobo Temporal/diagnóstico , Adolescente , Adulto , Epilepsia Parcial Complexa/diagnóstico , Feminino , Lateralidade Funcional , Humanos , Masculino , Estudos Retrospectivos , Osso Esfenoide
20.
J Neurosurg ; 96(3): 585-8, 2002 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-11883845

RESUMO

Idiopathic trigeminal sensory neuropathy is a clinically benign disorder in which the main feature is facial numbness limited to the territory of one or more divisions of the trigeminal nerve; the disorder persists for a few weeks to several years. and no underlying disease can be identified. Magnetic resonance (MR) imaging findings are occasionally consistent with a small trigeminal neuroma of the left gasserian ganglion associated with idiopathic trigeminal sensory neuropathy. The authors report on two patients who were treated using a skull base approach in which the gasserian ganglion was exposed and the lesion was removed. The pathological diagnosis was chronic granulomatous neuritis. The authors conclude that, in patients with MR findings suggestive of a small trigeminal neuroma, benign idiopathic trigeminal sensory neuropathy should also be considered in the differential diagnosis. A conservative approach featuring sequential MR imaging studies may avoid an unnecessary surgical exploration.


Assuntos
Granuloma de Células Gigantes/cirurgia , Neurite (Inflamação)/cirurgia , Doenças do Nervo Trigêmeo/cirurgia , Biópsia , Diagnóstico Diferencial , Face/inervação , Feminino , Lateralidade Funcional/fisiologia , Células Gigantes/patologia , Granuloma de Células Gigantes/diagnóstico , Granuloma de Células Gigantes/patologia , Humanos , Hipestesia/diagnóstico , Hipestesia/patologia , Hipestesia/cirurgia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Necrose , Neurite (Inflamação)/diagnóstico , Neurite (Inflamação)/patologia , Gânglio Trigeminal/patologia , Gânglio Trigeminal/cirurgia , Doenças do Nervo Trigêmeo/diagnóstico , Doenças do Nervo Trigêmeo/patologia
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