High expression of interleukin-1beta in the corneal epithelium of MRL/lpr mice is under the control of their genetic background.

MRL/Mp mice bearing the Fas deletion mutant gene, lpr (MRL/lpr), spontaneously develop polyarthritis, sialoadenitis and dacryoadenitis, resembling rheumatoid arthritis (RA), and also corneal involvement such as keratopathy and scleritis, which is a major complication in RA patients. In this study, we found that the expression levels of IL-1beta and MMP-1 mRNAs in cornea were high in both MRL/lpr and MRL/Mp-+/+ strains of mice at an age younger than when they develop any inflammatory lesions. This was not true of other inbred strains, even those bearing the lpr gene, and also not of (NZB x NZW) F1 lupus mice. There was no significant difference in the expression of IL-1alpha and TGFbeta in cornea in these strains. Using crosses between MRL/lpr and C3H/HeJ-lpr/lpr (C3H/lpr) mice, at least the expression of IL-1beta was found to be under the control of the MRL genetic background, likely with a recessive mode of inheritance. Considering that IL-1beta in cornea was detected particularly in the epithelial layer, the high expression of IL-1beta in cornea is most likely involved in the genetic predisposition for corneal involvement and possibly also for arthritis in an MRL strain of mice.

Mazindol administration improved hyperphagia after surgery for craniopharyngioma--case report.

A 54-year-old man presented with visual disturbance and polydipsia. Magnetic resonance imaging disclosed a cystic mass which extended from the intrasellar to the suprasellar region. Bifrontal craniotomy was performed and the tumor was totally removed. Histological findings confirmed the diagnosis of craniopharyngioma. Postoperatively, the patient suffered from transient disorientation. About one month after the operation the patient manifested hyperphagia and he gained 15 kg in one month. Mazindol, a non-amphetaminergic anorectic agent, was administered for 3 weeks. His appetite normalized and his weight fell and stabilized even after mazindol administration was ceased.

Intraaneurysmal Embolization for Wide-necked Aneurysms. Remodeling Technique, Combined Neck-Clipping and Coiling Therapy, Scaffolding Technique.

SUMMARY: We reported the results of the endovascular treatment using Guglielmi detachable coil (GDC) for wide-necked aneurysms. Fourteen aneurysms were treated with remodeling technique. One aneurysm was performed endovascular treatment followed by partial neck clipping. The other was treated with scaffolding technique. All aneurysms could not be performed by conventional GDC treatment initially because of coil protrusion into the parent artery due to wide neck of these aneurysms. These aneurysms sited at anterior circulation system in 10 cases, and at posterior circulation system in 6 cases. Immediately after the procedure, the obliteration rate could be obtained complete occlusion in 3 cases, > 95% occlusion in 7 cases, > 90% occlusion in 3 cases and < 90% occlusion in 3 cases. In 14 patients followup angiography or magnetic resonance image (MRI) was carried out. The angiographic follow-up period is range from 2 to 19 months (mean: 10 months). The results of angiographical follow-up indicated increasing obliteration rate with all aneurysms except for 2 cases. In these 2 cases, the reembolization was needed for recanalization of the aneurysm. The clinical follow-up period is range form one to 26 months (mean: 15 months). There is no evidence of aneurysmal rupture and all cases have been survival without any permanent neurological deficits. The GDC treatment with additional technique (remodeling technique, combined neck-clipping and coiling therapy, scaffolding technique) provides safety and effectiveness, even if there are wide-necked aneurysms.

Coil embolization of a large, wide-necked aneurysm using a double coil-delivered microcatheter technique in combination with a balloon-assisted technique.

The present paper describes a double coil-delivered microcatheter technique used in combination with a balloon-assisted technique to treat a patient with a large, wide-necked basilar tip aneurysm with detachable coil treatment. The aneurysm was completely occluded using this technique. There was no recanalization or any neurological deterioration within 12 months of embolization.

Stenting therapy for extra-cranial carotid stenosis.

We report our initial results of stent placement for extra-cranial carotid stenosis. Fifteen patients aged 54 to 83 years (10 men) with > 60% extra-cranial carotid stenosis were treated with percutaneous stent implantation. Four patients were asymptomatic. The rate of stenosis ranged from 60% to 93% (mean: 74%). Balloon-expandable stents (Palmaz stent: 11, Cordis stent: 1, GFX stent: 2) were placed for fourteen patients and for one patient a self-expandable stent was used (Memotherm biliary stent). The proximal protective balloon technique was used in the most possible cases during predilatation or stent placement. Angiography or ultrasonography was performed as the evaluation of restenosis after stent placement. The definition of restenosis was > 50% stenosis. The mean period of follow-up was 8.5 months (from 1 to 20 months). In all patients, carotid stents were successfully placed. The mean rate of stenosis immediately after the procedure decreased to 0%. The protective balloon technique could be used in ten patients during pre-dilatation, in six during stent placement. One patient suffered a transient ischemic attack immediately after predilatation. The symptoms disappeared completely 15 minutes after onset. There was no patient with relapse or deterioration of neurological deficits after the procedure. There was no restenosis and stent deformation in the follow-up period. In our small series, stent placement for extra-cranial carotid stenosis was performed with a low rate of morbidity and mortality. However, it is necessary to develop more flexible, more controllable stents with increased mesh densities for exclusive neurointervention. In addition, the development of a more reliable protective balloon technique to decrease procedurerelated complications is needed.

Treatment of full-thickness macular holes with autologous serum.

A total of 28 patients (29 eyes) with stage 2-4 idiopathic full-thickness macular holes were treated with the use of autologous serum. Autologous serum (20-30 microL) was placed over each macular hole followed by injection of 16% perfluoropropane gas. Postoperatively, 28 eyes (97%) had flattening of the macular hole, and the hole could not be detected in 27 eyes (93%). Twenty-two eyes (76%) showed visual acuity improvement by at least two lines or more. Preoperative factors such as good visual acuity, earlier stage, and younger age were correlated with postoperative good visual acuity. These results suggest that autologous serum is beneficial in the treatment of full-thickness macular holes.

[Treatment of full-thickness macular holes with autologous serum].

A total of 29 eyes in 28 patients with stage 2 to 4 idiopathic full-thickness macular hole were treated with autologous serum. Autologous serum (20-30 microliters) was placed over the macular hole followed by injection of 16% perfluoropropane gas. Postoperatively, twenty-eight eyes (97%) had flattening of the macular hole, and the hole was invisible in 27 eyes (93%). Twenty-two eyes (76%) showed visual improvement of at least two lines or more. Preoperative factors such as good visual acuity, earlier stage, and younger age were correlated with postoperative good visual acuity. These results suggest the benefit of autologous serum in the treatment of full-thickness macular holes.

Usefulness of two-dimensional time-of-flight MR angiography combined with surface anatomy scanning for convexity lesions.

Thirty-eight patients with convexity lesions were studied prospectively with the two-dimensional time-of-flight (2D-TOF) magnetic resonance angiography (MRA) method. Of these 21 cases had additional surface anatomy scanning (SAS) and 7 cases had three-dimensional phase contrast (3D-PC) MRA. The findings were compared during surgery and the predictability of 2D-TOF evaluated. 2D-TOF was obtained with 2 mm slice thickness after the administration of contrast media for routine magnetic resonance imaging (MRI). Cortical veins were visualized with a good resolution with a scan time of only 5 minutes. The tumor was also visible in the background, due to enhancement, and thus the tumor-vessels relation was shown. Slow-flow vessels were also adequately seen. SAS was done at the same sitting with fast spin echo (FSE) with a scan time of 3 minutes. Once both images were incorporated, information on gyri and their relation to the lesions and vasculature could be obtained from a single image. We found 2D-TOF alone, or at times in combination with SAS, useful for planning of operation for convexity lesions.

Orbital lobe lacrimal ductal cyst.

Lacrimal ductal cysts are rare, especially in the orbit. A case of lacrimal ductal cyst in the orbital lobe, revealed by computed tomography and magnetic resonance imaging, is described in a 16-year-old man who was successfully treated by complete surgical excision. The radiologic and clinical features of this type of lacrimal ductal cyst are discussed.

[Ischemic cerebral symptoms after subarachnoid hemorrhage due to aneurysmal rupture (author's transl)].

Among 169 patients treated at our clinic during past six years there were twenty-four cases (14 per cent) in which cerebral ischemic symptoms gradually developed after full recovery from SAH due to aneurysmal rupture. Duration form the aneurysmal rupture to the onset of ischemic symptoms varied from four days to fourteen days (8 days on average). As the initial symptoms hemiparesis and disturbance of consciousness (18 and 14, respectively) were two major symptoms, and those who showed disturbance of consciousness had more grave prognosis than those with hemiparesis. There were no correlations between the initial symptoms and the sites of aneurysm, but the ICA cases had definitely poor prognosis among those who developed ischemic signs after SAH. Those who became symptomatic within 7 days after SAH had poorer prognosis than those who showed initial symptom more than 8 days after SAH. On angiograms which were done shortly after the onset of symptoms, severe and extensive vasospasm was noted in all cases but four in which degree of vasospasm was not so severe and extensive. Operative treatment, when done within 5 days after the onset of ischemic symptoms had poorer results than when done over 6 days. As a conclusion, it is necessary to watch for possible onset of ischemic symptoms, especially in ICA patients, when seen later than four days after SAH. If ischemic symptoms were present and progressive, the operative treatment should be postponed until clinical course turns uphill by intensive treatments.