Asunto(s)
Recurrencia Local de Neoplasia/patología , Neurofibroma Plexiforme/patología , Neurofibroma Plexiforme/cirugía , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/cirugía , Adulto , Proliferación Celular , Femenino , Humanos , Mitosis , Recurrencia Local de Neoplasia/diagnóstico , Neurofibroma Plexiforme/diagnóstico , Neurofibromatosis 1/patología , Neoplasias Cutáneas/diagnósticoRESUMEN
During the period from 1983 to 1999, 12 patients with symptomatic arachnoid cyst were treated. The mean patient age was 20.6 years. The most common location was the middle fossa (10 cases). Initial CT scan revealed associated subdural hygroma in 7 patients and hydrocephalus in one. Clinical symptoms were related to increased intracranial pressure, cranio-megaly and seizure. One infant with a huge arachnoid cyst was treated, using a cystoperitoneal (CP) shunt. Four patients underwent membraectomy. Combination CP shunt and membraectomy was performed in 5 patients. The remaining 2 arachnoid cysts were complicated with subdural hygroma and, initially, they were observed conservatively, but hygroma gradually changed to hematoma. One was treated by irrigation and the other hematoma was spontaneously absorbed. Significant complications included extensive subdural effusion in one patient, contralateral chronic subdural hematoma in two, intracranial hypotension in two, and shunt dependency in one. There were no recurrences during the follow-up period (mean 3.6 years).
Asunto(s)
Quistes Aracnoideos/cirugía , Adolescente , Adulto , Quistes Aracnoideos/diagnóstico , Quistes Aracnoideos/fisiopatología , Niño , Cisterna Magna/diagnóstico por imagen , Femenino , Humanos , Hidrocefalia/complicaciones , Presión Intracraneal , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Radiografía , Efusión Subdural/complicacionesRESUMEN
A 50-year-old female suffered upward migration of a lumboperitoneal (LP) shunt catheter into the spinal canal, manifesting as disturbance of short-term memory. Revision of the shunt confirmed that the tube had migrated into the spinal canal. The tube was pulled back into the peritoneal cavity and attached firmly to the fascia with a new anchoring device. LP shunts have the advantages of technical simplicity and extracranial procedure, but firm fixation is recommended since movements of the spine may cause proximal tube migration.
Asunto(s)
Migración de Cuerpo Extraño/diagnóstico , Canal Medular , Derivación Ventriculoperitoneal/instrumentación , Femenino , Migración de Cuerpo Extraño/cirugía , Humanos , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/cirugía , Reoperación , Canal Medular/cirugíaRESUMEN
A case of intravascular malignant lymphomatosis (IML) presenting as progressive cerebral infarction is reported. A 62-year-old previously healthy male developed progressive dementia. MRI of the brain at the nearest hospital revealed multiple infarcts with unknown etiology. His level of consciousness deteriorated rapidly, and then he was transferred to our hospital for further evaluation. High grade fever, raised serum C reactive protein (CRP), and raised lymphoma markers (serum LDH and soluble IL-2 receptor (sIL-2R)) were observed. Repeated brain MRI disclosed progression of multifocal cerebral infarctions. We considered IML most likely, and we performed muscle biopsy. However muscle biopsy didn't demonstrate any proliferation of neoplastic cells of lymphoid origin within small vessels. Thereafter IML was diagnosed by brain biopsy. The patient underwent chemotherapy, but died of pneumonia due to severe myelosuppression. IML is a rare disease but most commonly shows neurological symptomatology as its clinical manifestation. Dementia is the most common neurological symptom, and progressive multiple infarction is the most common of the MRI findings. Rapidly progressive dementia associated with multiple infarction, when elevated CRP, LDH and sIL-2R are observed in the laboratory data, is suggestive of IML.
Asunto(s)
Infarto Cerebral/etiología , Linfoma de Células B/complicaciones , Neoplasias Vasculares/complicaciones , Biomarcadores de Tumor/sangre , Proteína C-Reactiva/análisis , Demencia por Múltiples Infartos/etiología , Progresión de la Enfermedad , Resultado Fatal , Humanos , L-Lactato Deshidrogenasa/sangre , Linfoma de Células B/diagnóstico , Masculino , Persona de Mediana Edad , Neoplasias Vasculares/diagnósticoRESUMEN
A 78-year-old man with psoriatic arthropathy complicated with traumatic spinal fracture and epidural hematoma is reported. He had fallen down the stairs. On admission one hour after injury, he developed an incomplete C6 quadriparesis. CT revealed a C6-7 fracture and dislocation on sagittal reconstruction. MR imaging disclosed the compression of the spinal cord between the posterior margin of the vertebral body and an epidural hematoma. The patient had had the skin lesion, psoriasis vulgaris, for about 20 years and been previously treated for uveitis. Serological tests for rheumatoid factor and HLA B-27 were negative. Emergent laminectomy and evacuation of the epidural hematoma were carried out because of progressive neurological deterioration. Osteoporotic laminar bone and ossified yellow ligament were observed to have been fractured. Conservative therapy was selected for spinal instability. Although a respiratory complication occurred postoperatively, he was transferred to the rehabilitation facility in an improved neurological condition.
Asunto(s)
Artritis Psoriásica/complicaciones , Hematoma Epidural Craneal/etiología , Fracturas de la Columna Vertebral/etiología , Accidentes por Caídas , Anciano , Hematoma Epidural Craneal/cirugía , Humanos , Masculino , Fracturas de la Columna Vertebral/cirugíaRESUMEN
The basic helix-loop-helix gene Math1, a positive regulator of neuronal differentiation, is specifically expressed in the dorsal part of the developing nervous system. To determine the effects of ectopic expression of Math1, we generated two transgenic mouse lines; One carried the Cre recombinase gene under the control of the nestin promoter and enhancer, which direct expression in neural precursor cells, and the other carried the Math1 gene, the expression of which was regulated by the cytomegalovirus (CMV) promoter but interrupted by the stop cassette flanked by loxP sites. In F1 embryos that carried the two transgenes, the stop cassette was removed by Cre recombinase in the developing nervous system, and Math1 expression was ectopically directed from the CMV promoter. We found that these embryos exhibited abnormal morphology of the brain and extensive cell death in the nervous system. These results suggest that ectopic expression of Math1 is toxic to neurons and leads to apoptosis.
Asunto(s)
Expresión Génica/fisiología , Factores de Transcripción/genética , Factores de Transcripción/fisiología , Proteínas Virales , Animales , Factores de Transcripción con Motivo Hélice-Asa-Hélice Básico , Encéfalo/anomalías , Encéfalo/embriología , Encéfalo/patología , Embrión de Mamíferos/anatomía & histología , Secuencias Hélice-Asa-Hélice/genética , Hibridación Genética , Integrasas/genética , Ratones , Ratones Transgénicos/genética , Distribución Tisular/fisiología , Células Tumorales CultivadasRESUMEN
The association between intracranial aneurysms and arteriovenous malformations (AVMs) is well documented. Recent advances in the understanding of the haemodynamics of this association encourage an aggressive approach to these aneurysms. However, the pathophysiology of these aneurysms is not fully understood and a strategy for their management has not been established. We describe seven patients, with eight aneurysms, on the feeding arteries of AVMs. The aneurysms could be divided into those located 1. proximally on the superficial feeding artery (type I; 4 aneurysms); 2. distally on the superficial feeding artery (type II; 3 aneurysms); and 3. on the deep feeding artery (type III; 1 aneurysm). All aneurysms were treated by the endovascular procedure prior to, or simultaneously with, treatment of the AVM, using detachable coils or liquid embolic material. All aneurysms were obliterated successfully, with no adverse events. Each patient further received treatment of the AVM. None of the patients suffered intracranial haemorrhage after treatment for the aneurysms. Based on our experiences, we discuss the indications for this approach for each type of aneurysm. We believe endovascular treatment could be an important alternative for treatment of aneurysms associated with AVMs, thus reducing the risk of haemorrhage.
Asunto(s)
Embolización Terapéutica , Aneurisma Intracraneal/complicaciones , Aneurisma Intracraneal/terapia , Malformaciones Arteriovenosas Intracraneales/complicaciones , Adulto , Angiografía Cerebral , Embolización Terapéutica/métodos , Femenino , Humanos , Aneurisma Intracraneal/diagnóstico , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Radiografía Intervencional , Tomografía Computarizada por Rayos XRESUMEN
Results of cervical carotid stenting are reported. Twenty-nine lesions in 25 cases were treated by percutaneous transluminal balloon angioplasty combined with stent placement. All the lesions were successfully dilated. There was one embolic complication during the operation that caused deterioration of preoperative symptoms. Stent deformation causing more than 30% luminal narrowing occurred in one case. Instent restenosis with more than 50% luminal narrowing was seen in bilateral lesions in one case. These were satisfactory results as an initial experience, but further improvement in this technique is considered essential especially to avoid embolic complications.
RESUMEN
An immediately electrically detachable coil (IEDC) that we previously developed was modified to enhance the reliability in its detachment system. IEDC is detached by applying a monopolar high-frequency electrical current that heat and disrupt a junction between a platinum coil and a delivery wire. The original IEDC immediately detaches only when the junction is just outside the catheter tip and precise positioning of the junction is required. In the modified IEDC, its delivery wire was insulated with poly tetra fluoroethylene (PTFE) to concentrate electrical current to the junction. The modified IEDC was tested in vitro and in animal experiments. Modified IEDC always detached instantaneously even when the junction was far beyond the catheter tip. Insulated delivery wire enabled the electrical current to be concentrated at the PVA junction and produce appropriate heat to disrupt the junction.
RESUMEN
Hes2 encodes a mammalian basic helix-loop-helix transcriptional repressor homologous to the products of Drosophila hairy and Enhancer of split. Here, we isolated and characterized the mouse Hes2 gene. This gene consists of four exons, and all the introns are located within the protein-coding region at positions homologous to those of other Hes genes. On the inter-specific backcross analyses, mouse Hes2 is mapped to the distal region of Chromosome 4 near the Hes3 and Hes5 loci, which are different from the Hes1 locus on Chromosome 16. Upstream of the transcription initiation site, there are GC-rich regions, but a typical TATA box is not present. Transient transfection analyses demonstrated that, while Hes1 and Hes5 promoter activities are significantly upregulated by the active form of Notch, a key regulator of cellular differentiation, Hes2 and Hes3 promoter activities are not. These results suggest that Hes genes are functionally classified into two groups: those that are regulated by Notch and those that are not.
Asunto(s)
Mapeo Cromosómico , Proteínas de Unión al ADN/genética , Proteínas de Drosophila , Secuencias Hélice-Asa-Hélice , Regiones Promotoras Genéticas , Proteínas Represoras/genética , Secuencia de Aminoácidos , Animales , Secuencia de Bases , Factores de Transcripción con Motivo Hélice-Asa-Hélice Básico , Sitios de Unión , ADN Complementario , Proteínas de Unión al ADN/metabolismo , Femenino , Proteínas de Insectos , Masculino , Proteínas de la Membrana/genética , Proteínas de la Membrana/metabolismo , Ratones , Ratones Endogámicos C57BL , Datos de Secuencia Molecular , Iniciación de la Cadena Peptídica Traduccional , Receptores Notch , Proteínas Represoras/metabolismo , Homología de Secuencia de AminoácidoRESUMEN
A 65-year-old female presented with visual acuity loss. Magnetic resonance imaging confirmed the presence of a partially thrombosed giant aneurysm on the basilar tip. Cerebral angiography showed the opacified lumen of the aneurysm was 25 x 15 mm with a broad-based neck. Using a transfemoral approach, a microcatheter was guided through the vertebral artery and placed directly into the aneurysm under local anesthesia. Interlocking detachable coils were deposited into the patent portion of the aneurysm, resulting in 95% obliteration of the aneurysm and preservation of the parent artery. No complication was observed during or after surgery. Follow-up angiography 2 months later demonstrated the aneurysm was 95% occluded. No coil compaction was observed. Endovascular coil embolization therapy provides a therapeutic option for management of basilar tip aneurysms.
Asunto(s)
Arteria Basilar , Embolización Terapéutica/instrumentación , Aneurisma Intracraneal/terapia , Embolia y Trombosis Intracraneal/terapia , Anciano , Angiografía Cerebral , Diseño de Equipo , Femenino , Estudios de Seguimiento , Humanos , Aneurisma Intracraneal/diagnóstico , Embolia y Trombosis Intracraneal/diagnóstico , Imagen por Resonancia Magnética , Resultado del TratamientoRESUMEN
Cortical venous drainage has been described as one of the major risk factors for dural arteriovenous fistula, which may induce venous hypertension leading to venous ischemia or intracerebral hemorrhage. However, it is rather rare to observe cortical venous drainage manifesting in this way in the cavernous sinus region. We report a case of a 55-year-old gentleman with a right cavernous dural arteriovenous fistula, presenting with conjunctival chemosis, exophthalmus and ocular hypertension on the affected side. Magnetic resonance imaging showed a small intracerebral hemorrhage in the right frontal lobe. Cerebral angiography revealed a dural arteriovenous fistula in the right cavernous sinus draining into the right olfactory vein via the uncal vein, as well as into the superior and inferior ophthalmic veins. This unusual cortical venous reflux was thought to be consistent with the intracerebral hemorrhage found on the magnetic resonance imaging. The patient underwent transvenous embolization for the dural arteriovenous fistula using an inferior petrosal catheterization into the uncal vein was difficult, and the cortical venous reflux through the vein seemed to be slight. However, extravasation of the contrast material occurred in the right frontal lobe after obliteration of the ophthalmic veins during the procedure. The cause of the extravasation was suspected to be the same olfactory vein that had been involved in the previous intracerebral hemorrhage. The obliteration of the dural fistula was continued rapidly, and the fistula disappeared after the embolization. Neurologically, the patient had no noticeable troubles, except for a mild headache. The pretreatment symptoms were alleviated within several days, and the patient was discharged in a week. We emphasize the following points from this rare case in order to facilitate a safer procedure during transvenous embolization for cavernous dural arteriovenous fistula. It is important to obliterate the cortical venous drainage as early as possible, even if the reflux is small or the catheterization is difficult. Repeated, careful sinography is useful for the evaluation of the drainage pattern at certain stages during the transvenous embolization procedure.
Asunto(s)
Fístula Arteriovenosa/terapia , Seno Cavernoso/anomalías , Duramadre/irrigación sanguínea , Embolización Terapéutica , Extravasación de Materiales Terapéuticos y Diagnósticos/etiología , Arterias Meníngeas/anomalías , Fístula Arteriovenosa/complicaciones , Seno Cavernoso/diagnóstico por imagen , Hemorragia Cerebral/etiología , Embolización Terapéutica/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , RadiografíaRESUMEN
SUMMARY: The aneurysmal neck size seems to be an important factor in the endovascular treatment outcome(4,5). The purpose of the present study was to measure aneurysm neck size on angiographic films, and compare the measured value with the extent of intra-aneurysmal occlusion performed with detachable coils. The subjects were 22 patients with intracranial aneurysms treated using detachable coils. The cases were divided into two groups according to the aneurysmal neck size, 4 mm being the discriminating value for small neck. The neck of the aneurysm was successfully occluded in 19 of 22 patients. Ten aneurysms had a small neck and 9 aneurysms had a wide neck. Complete aneurysm occlusion was observed in 70% of small neck aneurysms and 25% of wide neck aneurysms. The results support that the size of the aneurysm neck correlates well with the effectiveness of endovascular treatment.
RESUMEN
It has been shown that mammalian neurogenesis is partly controlled by multiple basic helix-loop-helix (bHLH) genes, as in Drosophila. Recently, mouse homologs of Drosophila atonal, a proneural gene encoding a bHLH protein required for chordotonal organ and photoreceptor development, have been characterized to obtain further insights into the molecular nature of mammalian neurogenesis. Here, to assess their potential involvement in genetic neural disorders, we have determined genetic map positions for four mouse atonal-related genes, Atoh1, Atoh2, Atoh3, and Ndrf, which encode MATH-1, MATH-2, MATH-3, and NDRF, respectively. Interspecific backcross analysis indicated that Atoh1 and Atoh2 were located in separate positions of Chr 6 and that Atoh3 and Ndrf were mapped to Chr 10 and Chr 11, respectively. Thus, these structurally related genes are located separately on multiple chromosomes.