[Dissecting aneurysm of the posterior inferior cerebellar artery--studied by serial angiography].

We report the case of a 34-year-old male with cerebellar hemorrhagic infarction caused by a dissecting aneurysm of the left posterior inferior cerebellar artery (PICA). The patient suffered from a headache and vomiting for two days and was transferred to our hospital with sudden deterioration of consciousness. On admission, he was semicomatose. A CT scan revealed hemorrhagic infarction in the left cerebellum and upward herniation. The emergency operation for posterior fossa decompression was performed. Postoperatively, his consciousness level improved promptly and he had no neurological deficits except for slight gait disturbance. The first vertebral angiography was performed on Day 27. It showed a sausage-like dissecting aneurysm of the left distal PICA. We planned conservative therapy with careful observation because of there being no indication for an operation. Serial angiography was performed and demonstrated the regression of the dissecting aneurysm on Day 258. Dissecting aneurysms of the distal PICA are rare and their natural history is not well understood. Conservative therapy for vertebrobasilar dissecting aneurysms has often been reported. We suggest that conservative therapy with serial angiography is the treatment of choice especially for ischemic-type dissecting aneurysms. We review 17 cases of dissecting aneurysm of the distal PICA in this study.

[Immuno-histochemical identification of initial lymphatics: the contour and distribution pattern of initial lymphatics in the human foreskin of the penis].

PURPOSE: There has not been an established method to distinguish initial lymphatics from blood capillaries under the light microscopy. In this study, we examined the usefulness of the immuno-histochemical staining method using a monoclonal anti-desmoplakin antibody in identifying initial lymphatics under the light microscopy. The specificity of this reaction was confirmed by the immuno-electron microscopy. MATERIAL AND METHODS: The cryostat sections of the human foreskin were observed under light microscopy by indirect immunoperoxidase method with the anti-desmoplakin mouse monoclonal antibody, and compared with the hematoxylin and eosin sections. These cryostat sections were also observed under electron microscopy by pre-embedding immunoperoxidase method with the same antibody. RESULTS: Under the light microscopy, the initial lymphatics of the human foreskin were visualized by the method with anti-desmoplakin antibody. These lymphatics were mainly distributed in the dermal layer, on the other hand, rarely seen in dermal papillae. Being usually found in closed shape, the lumens of initial lymphatics were hardly recognized as initial lymphatics by the ordinary hematoxylin and eosin staining. Under the immuno-transmission electron microscopy, the peroxidase-desmoplakin antibody precipitations were located on the surface of the endothelial cells of the vasculature which lacked pericytes and basal lamina, and was composed of endothelial cells alone. By these features of the vascular structures, the vessel reacting with anti-desmoplakin antibody was identified as initial lymphatics. CONCLUSION: This study shows the reliability and specificity of the immuno-histochemical method by anti-desmoplakin antibody in identifying initial lymphatics under light microscopy, and this method will be useful in studying the fine distribution of lymphatic vessels in normal human tissue.

[Long-term follow-up of the f wave amplitude in chronic atrial fibrillation].

Long-term follow-up of the amplitude of fibrillatory waves (f waves) on the standard electrocardiograms 0.6 +/- 3.3 yr, up to 20 yrs) was performed in 45 patients with chronic stable atrial fibrillation (24 men and 21 women, average age 60.2 +/- 11.5 yrs). The patients were divided into three groups on the basis of the underlying heart disease. Seventeen patients with mitral stenosis were classified as the MS group, 11 with hypertensive heart disease, old myocardial infarction, and aortic insufficiency as the HD group, and 17 without apparent heart diseases as the no heart disease (NHD) group. The f wave amplitude was measured at lead V1 according to the technique employed by Peter. The initial f wave amplitudes of the MS group (0.24 +/- 0.12 mV, mean +/- SD) and of the HD group (0.19 +/- 0.08 mV) were significantly larger than that of the NHD group (0.13 +/- 0.08 mV, p less than 0.05). The f wave amplitudes were significantly decreased during the observation period in each group, and the terminal f wave amplitudes (expressed as the percent of the initial f wave amplitude) were 61 +/- 34% in MS group, 59 +/- 26% in the HD group and 67 +/- 34% in the NHD group. In the NHD group, there was no significant difference in the terminal f wave amplitude between the cases with (n = 10) and without (n = 7) maintenance dose of digitalis. These results showed the apparent reduction of the f wave amplitude with perpetuation of this arrhythmia, and suggested that maintenance doses of digitalis had little effect on this process.

Seroconversion to human-cytomegalovirus-specific pre-early nuclear antigens in renal transplant recipients.

Seroconversion to human cytomegalovirus (H-CMV)-specific antigens was observed in 8 out of 9 renal transplant recipients. In 7 of the 8 recipients antibody to "pre-early nuclear antigens" (PENA), which are detectable in human embryonic lung cells within 1 hr of H-CMV infection by anti-complement immunofluorescence staining, developed concomitantly with the increase in other antibodies including anti-early antigens (EA), anti-nuclear inclusions (NI), and complement-fixing (CF) antibody in 1--2 months after transplantation. About 1 year later, anti-PENA and anti-EA titers were concomitantly decreased in 2 recipients, whereas anti-NI and CF antibody titers were maintained at elevated levels in all the seroconverted recipients. These results support the idea that the development of antibody to PENA, like antibody to EA, may represent a current or recent infection with (or reactivation of) H-CMV. In one patient, antibody to PENA did not develop through the observation period despite increases in antibody to EA and other antibodies; this lends support to immunological distinctness of PENA from EA.