Juvenile Bow Hunter's Stroke without Hemodynamic Changes.

Bow hunter's stroke (BHS) is a cerebrovascular disease caused by occlusion of the vertebral artery (VA) on head rotation. BHS is generally associated with hemodynamic changes, often leading to vertebrobasilar insufficiency symptoms, such as vertigo and faintness. Although artery-to-artery embolism has also been proposed as an underlying mechanism, it remains controversial. This report documents a case of BHS without hemodynamic changes. We describe a 26-year-old male patient who had VA occlusion on head rotation and repetitive infarction of thalami. He had an anomalous bypass of the VA and therefore no symptomatic hemodynamic changes. Thus, non-hemodynamic BHS should be considered in juvenile patients with vertebrobasilar stroke.

Artery-to-artery embolism with a mobile mural thrombus due to rotational vertebral artery occlusion.

Rotational vertebral artery (VA) occlusion can cause ischemic strokes due to hemodynamic insufficiency and possibly artery-to-artery (A-to-A) embolism. The former is known as bow hunter's stroke. The latter has been proposed only from indirect evidence. We have described a 7-year-old boy with cerebral infarction associated with A-to-A embolism due to repetitive rotational VA occlusion. He had a mobile mural thrombus at the VA occlusion site on head rotation. Surgical treatment may effectively prevent recurrences.

Asymmetrical weakness associated with central nervous system involvement in a patient with guillain-barrè syndrome.

Guillain-Barrè syndrome (GBS) is usually associated with symmetrical weakness, and therefore asymmetrical weakness may confuse diagnosis. We report on a patient with GBS subsequent to Campylobacter jejuni enteritis who had asymmetrical weakness with CNS involvement. The patient tested positive for anti-ganglioside antibodies, including anti-GM1 IgM, anti-GD1b IgG, and anti-GT1a IgG. Patients with GBS can manifest asymmetrical signs and symptoms attributable to CNS involvement. Prompt, accurate diagnosis and treatment of post-C. jejuni GBS is especially important because its prognosis is relatively poor.

Metal stent placement for two patients with post-transplantation renal artery stenosis, using intravascular ultrasound imaging.

Post-transplantation renal artery stenosis is recognized at relatively early periods after renal transplantation. We report herein our experience of utilizing transluminal expanded metal stents (Palmaz stent and Wall stent) for post-transplantation renal artery stenosis, and monitoring with intravascular ultrasound (IVUS) imaging. The recipients were a 51-year-old woman (case 1) and a 57-year-old man (case 2), and the grafts were procured from cadaveric donors. Renal function had deteriorated suddenly at 5 months after renal transplantation in case 1 and at 86 months in case 2. The cause of the graft dysfunction was renal arterial stenosis. Color doppler ultrasound imaging and angiography diagnosed post-transplantation renal artery stenosis. The renal artery stenosis was serious, being greater than 90% in both patients. Percutaneous transluminal angioplasty (PTA) was performed, but its effectiveness was not sufficient; therefore, an indwelling endoluminal metallic Palmaz stent and an indwelling Wall stent were placed at the sites of stenosis while monitoring was done with IVUS. No complications were recognized at all. The length and degree of stenosis location became clear by using IVUS, and suitable stents could be selected for the renal artery stenosis. The clinical effect was excellent; the renal function improved to the pre-hospitalization value. We conclude that the Palmaz stent and the Wall stent were useful as a noninvasive strategy for treating post-transplantation renal artery stenosis. This procedure could be performed safely and surely using IVUS.

[A case of vesical paraganglioma with intrapelvic multiplicity].

A 35-year-old woman, who had a past history of hypertension due to paraganglioma of the urinary bladder and in the pelvis, was referred to us 12 years after the initial diagnosis of paraganglioma. Before coming to us and during the follow-up after enucleation of myoma uteri, she was again diagnosed as having a bladder tumor by a gynecologist. Cystoscopy revealed a non-papillary broad-based tumor, measuring 2 cm in diameter, on the trigone of the urinary bladder. Magnetic resonance imaging also showed two solid tumors, each measuring 2 cm in diameter, on the bilateral peri-vesical sides in the pelvis. Endocrinologic examination disclosed increased levels of serum and urinary catecholamines. Histopathologic examination revealed that the bladder tumor specimen obtained by transurethral resection was paraganglioma. She underwent partial cystectomy and resection of these intrapelvic tumors via a retroperitoneal approach. These tumors were histopathologically diagnosed as multiple paragangliomas. She has been followed up for 10 months after operation without any evidence of recurrence. Herein, we report this rare case of vesical paraganglioma and present a brief review of the relevant literature.

Association between pentosidine and arteriosclerosis in patients receiving hemodialysis.

BACKGROUND: It has been suggested that advanced glycation endproducts (AGEs) accumulate in arteriosclerotic lesions, playing and important role in the development and progression of arteriosclerosis. A chemical quantification method using high-performance liquid chromatography (HPLC) has been established to determine pentosidine levels in these products. Some studies reported that the abdominal aorta calcification index (ACI), obtained by computed tomography (CT), was useful for noninvasively diagnosing arteriosclerosis and determining its severity. In the present study, we measured the ACI and plasma pentosidine in patients receiving maintenance hemodialysis, and investigated the association between arteriosclerosis and pentosidine. METHODS: In 73 patients receiving maintenance hemodialysis (43 men; 30 women), we determined the ACI, and investigated the association of the ACI with plasma total pentosidine, total cholesterol, triglyceride, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, serum creatinine, and parathyroid hormone (PTH), as well as the product of serum calcium and serum phosphorus, duration of dialysis, and age. RESULTS: The ACI did not correlate with total cholesterol, triglyceride, HDL cholesterol, LDL cholesterol, serum creatinine, PTH, or the product of serum calcium and serum phosphorus. Age, duration of dialysis, and plasma total pentosidine correlated with the ACI: (y = -33.12 + 0.913x; r = 0.407; P < 0.01), (y = 13.94 + 0.403x; r = 0.488; P < 0.01), and (y = 14.13 + 0.630x; r = 0.365; P < 0.01), respectively. CONCLUSIONS: It is suggested that pentosidine may be associated with arteriosclerotic development in hemodialysis patients. It has been suggested that advanced glycation endproducts (AGEs) accumulate in arteriosclerotic lesions, playing an important role in the development and progression of arteriosclerosis. A chemical quantification method using high-performance liquid chromatography (HPLC) has been established to determine pentosidine levels in these products. Some studies reported that the abdominal aorta calcification index (ACI), obtained by computed tomography (CT), was useful for noninvasively diagnosing arteriosclerosis and determining its severity. In the present study, we measured the ACI and plasma pentosidine in patients receiving maintenance hemodialysis, and investigated the association between arteriosclerosis and pentosidine.

[A case of inflammatory myofibroblastic tumor of the retroperitoneum].

Here we report a rare case of inflammatory myofibroblastic tumor of the retroperitoneal space. A 46-year-old woman had had microscopic hematuria for 5 years. Ultrasonographic examination for screening revealed two solid tumors adjacent to the right kidney. These tumors were suspected to be malignant fibrous histiocytoma or liposarcoma by computed tomography and magnetic resonance imaging. She underwent resection of these retroperitoneal tumors and additional right nephrectomy because these tumors were adhered to the kidney and liposarcoma was highly suspected on frozen sections. Histopathologic examination finally revealed that the tumors were inflammatory myofibroblastic tumor arising within Gerota's fasia. She has been followed up for 9 months without any evidence of local recurrence.

[A case of long-term survival neuroblastoma with conservative therapy].

We report a case of long-term survival in a patient with neuroblastoma treated with conservative therapy. A 2-year-old female patient who presented with a lower abdominal mass was diagnosed with neuroblastoma. Resection of the tumor was not successful because of adhesion. Histopathological diagnosis of para-aortic lymph node was ganglioneuroblastoma. Postoperatively 50 Gy-radiation and chemotherapy were performed. At age 17, needle biopsy of the tumor was performed, and the histopathological diagnosis was ganglioneuroma.

Serum neopterin monitoring and vitamin E-modified, regenerated hemodialyzer membrane influence on biocompatibility.

The exposure of blood to hemodialysis membranes results in numerous phenomena and/or complications in hemodialyzed patients, which have an influence on the quality of life (QOL) of those patients. A vitamin E-modified regenerated cellulose membrane (E-membrane) was developed to act as a scavenger for reactive oxygen species causing complications in hemodialysis patients. Neopterin (NEOP) is a metabolite derived from guanosine triphosphate with the production and release of NEOP being induced in monocytes and macrophages by cytokines such as interferon-gamma (IFN-gamma). Serum neopterin levels are shown to be a reactive marker of bioincompatibility of dialysis membranes in hemodialysis patients. The following report evaluates the usefulness of serum NEOP as a marker for the biocompatibility of the E-membrane hemodialyzer in a clinical study. In the clinical study, where extracorporeal ultrafiltration strategies with E-membranes were employed, the serum levels of NEOP were lower than those in patients using cellulose triacetate membranes (C-membranes). In the long-term evaluation of the biocompatibility of E- and C-membranes, the increase of serum neopterin levels in the C-membrane was higher than those in the E-membrane. In conclusion, the evaluation of serum neopterin levels during hemodialysis shows that the E-membrane has a good biocompatibility in hemodialyzed patients.

[Erectile dysfunction arising from polyarteritis nodosa: a case report].

A 30-year-old male was referred to our department during the examination and treatment for hypertension, because he had not achieved complete erection since the age of 26 years. After detailed examination, he was diagnosed to be suffering from nodal polyarteritis. Since erectile dysfunction persisted, the patient was hospitalized to investigate the cause of erectile dysfunction. Measurement of the penile brachial index (PBI) and cavernous infusion of papaverine hydrochloride strongly suggested the presence of arterial erectile dysfunction. Internal-pudendal angiography revealed multiple microaneurysms in the bilateral internal pudendal arteries, suggesting that nodal polyarteritis caused arterial erectile dysfunction.