Cerebral hemodynamic benefits after contralateral carotid artery stenting in patients with internal carotid artery occlusion.

CEA contralateral to an ICA occlusion is considered a surgical risk, and CAS may be an alternative for these patients. Our goal was to examine whether CAS improves cerebral hemodynamics on the treated side and on the side of the ICA occlusion, on the basis of measurement of CBF and CVR by using SPECT. The subjects were 8 patients who underwent contralateral CAS. Resting CBF and CVR to acetazolamide were measured by using (123)I-IMP SPECT before and chronically (3-6 months) after CAS. Resting CBF was also measured immediately (<2 hours) after CAS by using (123)I-IMP SPECT. There were no significant differences in resting CBF in both hemispheres immediately after CAS. However, resting CBF and CVR both significantly increased in the chronic period in both hemispheres. Contralateral CAS in patients with ICA occlusion resulted in cerebral hemodynamic improvement on the treated side and on the side of ICA occlusion.

Endovascular treatment of a vertebral artery aneurysm via puncture of the surgically exposed vertebral artery.

We describe a case of subarachnoid hemorrhage due to a ruptured right vertebral artery (VA) aneurysm where endovascular therapy via a trans-femoral route was not feasible. Therefore we surgically exposed the VA and directly punctured it at the C4 level, followed by successful coil embolization. Direct access to the vertebral artery using an anterior surgical approach is an alternative in cases where the proximal side of the artery is occluded.

Development of indirect cavernous dural arteriovenous fistula after trapping for direct carotid cavernous fistula. A case report.

SUMMARY: A 60-year-old man with direct carotid cavernous fistula (CCF) due to a motor vehicle accident underwent internal carotid artery trapping following high-flow external carotid to internal carotid artery bypass (EC-IC bypass). Follow-up angiography revealed ipsilateral complex indirect cavernous arteriovenous fistula. Although the traumatic indirect CCF angioarchitecture differs from cavernous-sinus dural arteriovenous fistula (CS-DAVF), the present indirect fistula was similar to the latter. Complex indirect CCF can occur after treatment of direct CCF caused by severe head injury.

[Total aortic arch replacement for aortic arch aneurysm in a 90-year-old woman; report of a case].

A 90-year-old woman was transferred to our hospital because of severe chest and back pain. Chest computed tomography (CT) scan showed impending rupture of the true aneurysm of the aortic arch. Emergent operation was performed under deep hypothermia and retrograde cerebral perfusion through median sternotomy. Ascending and transverse aorta were totally replaced with arch graft with 4 branches using the arch vessels first technique. Postoperative course was uneventful expect for urinary tract infection. She discharged from our hospital 76 days after the operation and is now doing well.

[Surgical treatment for ruptured aneurysm of a coronary artery to pulmonary artery fistula; report of a case].

We reported a successful operative case of ruptured coronary artery aneurysm associated with coronary artery to pulmonary artery fistula. The patient was a 74-year-old woman who was admitted for syncope and chest oppression. Echocardiogram and chest CT scan revealed cardiac tamponade. Ruptured coronary aneurysm, 3 cm in diameter, was found at emergent operation. After emergent coronary angiography, which demonstrated an aneurysm arising from the left anterior descending coronary artery and draining into the pulmonary artery, orifice of draining artery to the aneurysm was closed and coronary artery fistula was ligated. She recovered smoothly and post operative angiogram revealed disappearance of the aneurysm.

Significance of clinical risk factors of cystic periventricular leukomalacia in infants with different birthweights.

UNLABELLED: Fifteen appropriate-for-date premature low-birthweight infants with cystic periventricular leukomalacia (PVL) were studied. The infants were stratified into three birthweight groups: less than 1000 g, 1000 g and greater but less than 1500 g, and 1500 g or greater. Reported and new risk factors for PVL were compared with control patients for all patients and each birthweight group. Hypocarbia was significantly related to cystic PVL, especially in infants with birthweight 1000 g or greater (p < 0.03). Sensitivity to hypocarbia might be decreased in infants with birthweight less than 1000 g due to therapy or prematurity. In the group with birthweight less than 1000 g, the proportion of cystic PVL infants on continuous intra-arterial blood-pressure monitoring tended to be lower than the controls, with an almost significant difference (p = 0.05). The duration of tocolysis was significantly longer in the cystic PVL infants than in the controls when the birthweight was greater than 1500 g (p < 0.04). For some risk factors, a significant difference or a tendency of difference was demonstrated only after stratifying the birthweight. For others, the difference became insignificant after stratification. Assessing risk factors after stratifying by birthweight or degree of prematurity is therefore useful. CONCLUSION: The results suggest that hypocarbia should be avoided to prevent cystic PVL, especially in infants with birthweight of 1000 g or greater, continuous intra-arterial blood-pressure monitoring may be important in infants with birthweight less than 1000 g, and fetal status should be monitored carefully when the duration of tocolysis is prolonged, especially in infants with birthweight of 1500 g or more.

Adenocarcinoma of the prostate with ectopic antidiuretic hormone production: a case report.

An 88-year-old patient with a poorly differentiated adenocarcinoma of the prostate gland was found to have all cardinal findings of syndrome of inappropriate antidiuretic hormone secretion (SIADH). Elevated levels of antidiuretic hormone were found in the patient's serum and in the prostatic tumor and the cytoplasms of the tumor was positive for prostate specific antigen and was faintly positive for antidiuretic hormone (ADH). He responded well to combination therapy of androgen blockade with leuprorelin acetate and flutamide, and laboratory findings of SIADH and serum ADH level returned to normal. However, he died of sudden profuse bleeding caused by gastric ulcers 6 months after the therapy. Ten cases of SIADH caused by prostatic cancer have been reported including the present case.

Acute pancreatitis caused by extracorporeal shock wave lithotripsy for bilateral renal pelvic calculi.

An elderly woman with a history of cholecystectomy and a re-operation for postoperative peritonitis underwent extracorporeal shock wave lithotripsy (ESWL) for right and left renal pelvic calculi, 11 x 6 and 12 x 5 mm in size, to which 2400 and 1400 shots at 20 kV were given, respectively, on the same day. During the evening after the operation, the patient started to complain of upper abdominal pain. Laboratory examination on the next day revealed elevations in blood and urine amylase levels and a diagnosis of pancreatitis was made. Conservative treatment, including administration of protease inhibitor, did not improve her symptoms; abdominal distension became marked and she underwent laparotomy. Necrosection and indwelling of several drain tubes in abdomen were performed with an operative diagnosis of acute necrotic pancreatitis. With daily irrigation of drain tubes and treatment for methicillin-resistant Staphyloococcus aureus infection of the lungs and abdominal cavity, septicemia and duodenal fistula, the patient gradually recovered and was discharged on postoperative day 151. It was suggested that ESWL was responsible for the acute pancreatitis. Either an obstruction of the pancreatic duct by fragments of common duct stone, or mechanical injury of the pancreas due to adhesion between the pancreas and surrounding tissue caused by the lapalotomy, was considered as a possible cause of pancreatitis. To our knowledge, there has been no previous report of severe acute pancreatitis and the present case suggests that ESWL may cause severe pancreatic even in cases without stone shadow in the bile, common duct or pancreatic duct.

New method of bladder biopsy using combined aspiration and snare.

A method of multiple random biopsy combined with bladder wall aspiration and snare in bladder cancer is presented. Our method was used on 23 patients with clinically superficial bladder cancer and was found to have advantages in obtaining an adequate amount of tissue with minimal thermal degeneration.

IL-1ra versus IL-1 levels in prostatic fluid from prostatitis patients.

Recent papers reported that the balance between the production of IL-1ra and IL-1 probably influences the regulation of host responses, the severity and prolongation of the inflammatory reaction in some diseases. Therefore, in our continuing investigation to clarify the significance of leukocytosis and its prolongation in prostatic fluid from prostatitis patients, we investigated whether low levels of IL-1ra versus IL-1 beta secreted in prostatic fluid were the cause of prolonged prostatitis, especially nonbacterial prostatitis (NBP). As a result of the present study, we concluded that a low level of IL-1ra in relation to that of IL-1 secreted in prostatic fluid is unlikely to cause prolongation of NBP for the following reasons: (1) IL-1 beta was detected in 5 of 10 cases (50.0%), but was slightly elevated in only 2 cases (20.0%) at 14 and 17 pg/ml; (2) the average IL-1ra level was not statistically low compared with that in prostatic fluid from acute bacterial prostatitis (ABP) patients who were cured promptly with antibiotics, and (3) in 5 cases of NBP in which IL-1 beta was detected, the average IL-1ra/IL-1 beta ratio was 118 which was comparable to or even higher than that in 3 ABP and 14 acute bacterial cystitis cases in which IL-1 beta was detected and the ratios were 40 and 88, respectively.

[Analysis of numerical chromosomal aberrations in bladder cancer detected by fluorescence in situ hybridization].

The recently introduced fluorescence in situ hybridization method (FISH method) is a chromosomal analysis for examining interphase nuclei and seems to be a promising approach for chromosomal analysis of a solid tumor, which is considered hard to deal with by a conventional chromosomal staining method. In the present study, a bladder tumor (transitional cell carcinoma) was evaluated by chromosomal analysis, including interphase nuclei, with this FISH method to examine chromosomal numerical aberration in relation to the grade and stage, expecting successful, accurate determination of reliable prognostic factors based on its relapse and invasive intensity. Tissue specimens obtained from 20 patients with bladder tumor (transitional cell carcinoma) were used. The probe used in this study was specific for chromosome No. 1, 7, and 9, which were frequently indicated as being abnormal by a conventional chromosomal staining method. As a result, a tendency towards polysomy was observed in chromosome No. 1 and 7 of high grade invasive cancer cases, while a tendency towards monosomy was evident in chromosome No. 9 of low grade noninvasive cancer cases. From the results mentioned above and consideration of related literatures, it was suggested that monosomy of chromosome No. 9 is important as an index for knowing changes in the initial developmental stage of bladder tumor and polysomy of chromosome No. 1 and 7 is important as an index for knowing changes in the progressive stage.

[Clinical evaluation on serum osteocalcin in advanced prostate cancer patients].

The clinical significance of osteocalcin as a marker for advanced prostate cancer was examined. Osteocalcin is produced by osteoblasts and is also detected in the blood. Its change is a good index of osteometabolic diseases and especially of the osteoblastic activity. In the present study, we examined the serum osteocalcin concentration of those patients with urogenital tumor, especially prostate cancer, who had been confirmed for multiple bone-metastasis by clinical examination. These patients comprised an untreated group (15 cases) of patients with prostate cancer presenting confirmed bone-metastasis, and a group of patients without bone-metastasis. The respective serum osteocalcin concentrations of these two groups were compared with 51 cases of prostate hypertrophy used as the control group. The findings revealed that the serum osteocalcin concentration demonstrated high values in the first group with a tendency toward lowering during treatment. Neither the latter group nor the control group showed high values. On the other hand, false-positive cases (8%), and false-negative cases (20%) were found. In the case of bone-metastasis, these results suggest that measurement of serum osteocalcin concentration is useful for clinical periodical observation about the activity of the bone metastatic focus.

[A case of advanced prostatic cancer presenting as inguinal mass].

A 71-year-old man visited our hospital complaining of a nodule in the left inguinal region. Pathological and immunohistochemical examination of the prostate and the mass and clinical examination revealed a case of prostatic cancer with lymph node metastasis, stage D. Chemoendocrine therapy (diethylstilbestrol diphosphate, cisplatin, adriamycin and carboquone) was performed and the patient responded well. This case indicated the presence of an unusual prostatic cancer in which large non-regional superficial lymph node metastasis occurred.

Systematic search for suitable two-phase solvent systems for high-speed counter-current chromatography.

We have introduced two series of two-phase solvent systems which facilitate the systematic search for the solvent systems suitable for high-speed counter-current chromatography. The n-hexane-ethyl acetate-n-butanol-methanol-water systems provide a broad range of hydrophobicity, while the chloroform-methanol-water systems are extremely useful for separations of various natural products with moderate hydrophobicity. The practical use of these solvent series was demonstrated with several test samples which include dinitrophenyl amino acids, S-triazine herbicides, indole auxins, and non-ionic organic solvents.

Multilayer coil planet centrifuge for analytical high-speed counter-current chromatography.

A compact portable model of a high-speed counter-current chromatograph enables efficient analytical separations of microgram sample quantities within 10 min. A series of preliminary experiments was conducted to study retention of the stationary phase of various two-phase solvent systems in short coils with different helical diameters. Under the optimal experimental conditions, analytical capability of the apparatus was successfully demonstrated in separation of flavonoids from a crude sea buckthorn ethanol extract in a multilayer coil with a total capacity of 8 ml.

[The relation of various metabolic bone markers in renal hemodialysis patients classified by serum estradiol levels].

The bone metabolic markers showed the significant differences in age and sex of the hemodialysis patients with renal insufficiency. It is likely that the evaluations of bone change and biochemical metabolic markers should be based on serum estradiol level, sex and age of the renal hemodialysis patients.

[Markers of bone pain in hemodialysis patients with renal insufficiency].

The patients receiving maintenance hemodialysis were divided into two groups in the absence and the presence of bone pain and investigated the markers of bone pain in these patients. These results suggested that the duration of receiving hemodialysis, serum concentrations of alkaline phosphatase, osteocalcin and parathyroid hormone became to be the markers of bone pain.