[Surgical treatment for symptomatic arachnoid cysts].

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).

Migration of a lumboperitoneal shunt catheter into the spinal canal--case report.

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.

[A case of intravascular malignant lymphomatosis presenting as cerebral infarction].

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.

[A case of psoriatic arthropathy complicated with spinal fracture and epidural hematoma].

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.

[A case of high flow CCF with congestive hemorrhage].

The authors report a case of high flow CCF with intracerebral hemorrhage during treatment with endovascular coil embolization. A 52-year-old woman had been in good health until a sudden onset of orbital bruit and left orbital tinnitus occurred. Conjunctival chemosis and diplopia caused by left abducens palsy gradually progressed. Left internal carotid arteriography revealed a carotid-cavernous sinus fistula with direct high-flow shunt. The fistula drained into the superior orbital vein, inferior petrosal sinus, intercavernous sinus and sphenoparietal sinus with significant cortical reflux. The attempt at transarterial balloon occlusion failed. Then transvenous coil embolization was performed. During the course of endovascular treatment, follow up CT depicted intracerebral hemorrhage. Intracerebral hemorrhage was asymptomatic and thought to be caused by venous hypertension from cortical reflux. The patient underwent direct occlusion of the left sphenoparietal sinus for prevention of further hemorrhage via craniotomy. Lastly, the cavernous sinus was completely occluded by transvenous coil embolization. The signs and symptoms resolved 3 months after the procedures.

The spinal antinociceptive effect of FR140423 is mediated through kyotorphin receptors.

We investigated the antinociceptive effect of a novel anti-inflammatory and analgesic drug, 3-(difluoromethyl)-1-(4-methoxyphenyl)-5-[4-(methylsulfinyl)phenyl]pyraz ole (FR140423), in the tail-pinch test in mice, and evaluated the mechanism of action of FR140423 using L-leucyl-L-arginine (Leu-Arg), a kyotorphin (endogenous Met-enkephalin releaser) receptor antagonist, L-NG-nitroarginine methylester (L-NAME), an inhibitor of nitric oxide (NO) synthase, and methylene blue (MB), an inhibitor of activation of guanylate cyclase. Oral administration of FR140423, at doses of 5-80 mg/kg, produced a dose-dependent antinociceptive effect with an ED50 value of 18 mg/kg. This antinociception was reversed by intrathecal (i.t.) (10 microg/mouse), but not by intracerebroventricular (i.c.v.) (100 microg/mouse), injection of Leu-Arg. Moreover, the antinociceptive effect of i.t. injection of FR140423 with an ED50 value of 3.7 microg/mouse was completely antagonized by co-administered Leu-Arg 10 microg/mouse. However, L-NAME (2000 mg/kg s.c.) and MB (200 mg/kg s.c.) did not antagonize the antinociception of FR140423. These findings suggest that FR140423 plays a role in nociceptive modulation in the spinal cord, being antinociceptive via the kyotorphin-Met-enkephalin pathway but not via the peripheral NO-cyclic GMP pathway.

Comparative study of intraoperative mitomycin C and beta irradiation in pterygium surgery.

AIMS: To compare the rate of recurrence and complication after surgery for primary pterygium performed by one surgeon using either intraoperative mitomycin C or beta irradiation. METHODS: A retrospective study was performed of 164 eyes in 164 patients who had undergone primary pterygium surgery. After the pterygium was excised, the bare sclera was covered by sliding adjacent superior conjunctiva. 103 eyes received intraoperative mitomycin C (0.04%, 150 seconds) and 61 eyes beta irradiation (total dose 21.6 Gy). The mean follow up period was 20.2 (SD 17.9) months (range 1-66 months). Recurrence was defined as the postoperative regrowth of fibrovascular tissue crossing the corneoscleral limbus. RESULTS: The recurrence rate after mitomycin C and beta irradiation was 8.74% and 23.0% of eyes, respectively, after mean follow up of 17.9 and 31.2 months, respectively. The Kaplan-Meier survival analysis revealed a significantly better outcome for those who had intraoperative mitomycin C (Mantel-Cox log rank analysis, p=0.031). The mean interval to recurrence was not significantly different between the two groups. During the follow up, none of the patients showed side effects or reactions related to mitomycin C or beta irradiation. CONCLUSIONS: The intraoperative administration of 0.04% mitomycin C is more effective than beta irradiation as an adjunctive treatment for pterygium surgery in the patient population examined in this study.

16S-23S rDNA spacer of Pectinatus, Selenomonas and Zymophilus reveal new phylogenetic relationships between these genera.

The 16S-23S rDNA spacer regions of two Pectinatus species, two Zymophilus species and one Selenomonas species were cloned after PCR amplification. The results of PCR amplification showed that these species had two types of spacer regions which differ in molecular size (long and short). Only the long spacer regions in these bacteria contained one or two tRNA genes (alanine and/or isoleucine). The spacer regions in these bacteria had a relatively high level of homology. Homology was particularly high for bacteria belonging to the same genus. Interestingly, the order of the two tRNA genes present in the long spacer regions of Pectinatus and Selenomonas was the reverse of that which had been previously reported for other bacteria. The results of spacer homology analysis and the order of the tRNA genes suggest that the taxonomic classification of anaerobic bacteria isolated from the brewing process should be re-examined.

The analgesic effect profile of FR122047, a selective cyclooxygenase-1 inhibitor, in chemical nociceptive models.

The pharmacological profile of the analgesic agent, 1-[(4, 5-bis(4-methoxyphenyl)-2-thiazoyl)carbonyl]-4-methylpiperazine hydrochloride (FR122047), was investigated. In recombinant human cyclooxygenase enzyme assays, the inhibition of prostaglandin E(2) formation by FR122047 was 2300 times more selective for cyclooxygenase-1 than cyclooxygenase-2. Oral administration of FR122047 (3.2-100 mg/kg) dose dependently reduced the phase 2 response (10-60 min) of the formalin test in rats. This effect was 3 times less potent than that of indomethacin. FR122047 (1-32 mg/kg; p. o.) showed a dose-dependent analgesic effect against the acetic acid-induced writhing response in mice. Furthermore, FR122047 (0. 01-10 mg/kg, p.o.) inhibited the increase in 6-keto prostaglandin F(1alpha) level in acetic acid-injected mouse peritoneal cavity. However, a selective cyclooxygenase-2 inhibitor, NS-398, had no effect in these cyclooxygenase-1 sensitive pain models. These results suggest that FR122047, a selective cyclooxygenase-1 inhibitor, shows an analgesic effect in chemical nociceptive models and may be a useful analgesic agent.

Direct clipping of a large basilar trunk aneurysm via the posterior petrosal (extended retrolabyrinthine presigmoid) approach--case report.

A 53-year-old female presented with an unruptured, large basilar trunk aneurysm manifesting only as headache with no neurological deficits, including absence of cranial nerve dysfunction. Cerebral angiography disclosed a large aneurysm with a wide neck arising from the midbasilar artery. We treated the aneurysm surgically via the posterior petrosal approach. Five angled clips were applied sequentially to the aneurysm and the basilar artery was successfully reconstructed. Electrophysiological monitoring was continued during the operation and showed no changes. Following the operation, the patient suffered from transient right abducens nerve palsy, which persisted for 3 months. Postoperative angiography showed that the aneurysm was obliterated, and the patency of the basilar artery was preserved.

In vitro antiplatelet profile of FR171113, a novel non-peptide thrombin receptor antagonist.

Synthetic peptides (5 to 14 amino acids), identical in sequence to the new amino-terminus of the thrombin receptor generated following cleavage by thrombin, act as thrombin receptor agonist peptides. Whilst thrombin receptor antagonist peptides are known, non-peptide thrombin receptor antagonists have yet to be described. In the present study, we compared the antiplatelet effects of 3-(4-chlorophenyl)-2-(2,4-dichlorobenzoylimino)-5-(methoxycarbonyl methylene)-1,3-thiazolidin-4-one (FR171113), a novel non-peptide thrombin receptor antagonist, with the known thrombin receptor antagonist 3-mercapto-propionyl-Phe-Cha-Cha-Arg-Asn-Pro-Asn-Asp-Lys-Tyr-OH (C186-65), and argatroban, a specific protease inhibitor of thrombin. FR171113 and C186-65 inhibited thrombin-induced platelet aggregation (IC(50)=0.29 microM and 15 microM, respectively) and Ser-Phe-Leu-Leu-Arg-Asn-NH(2) [a synthetic thrombin receptor agonist peptide (TRAP-6)] induced platelet aggregation (0.15 microM and 20 microM, respectively) in human washed platelets. Argatroban potently inhibited thrombin-induced platelet aggregation (IC(50)=3.5 nM), but did not inhibit TRAP-6-induced aggregation even at 100 microM. In contrast, these compounds did not show inhibitory effects on ADP- and collagen-induced aggregation in human platelet-rich plasma even at 100 microM. FR171113 caused a parallel shift to the right of the concentration-response curve describing aggregation induced by TRAP-6. The Schild plot of the data had a slope of -0.840 (r=0.98) and the pA(2) was 7.29. In protease activity studies using a chromogenic substrate, argatroban inhibited thrombin protease activity in a dose-dependent manner, whereas FR171113 and C186-65 were inactive, even at 100 microM. Additionally, only argatroban displayed dose-dependent prolongation of thrombin time, activated partial thromboplastin time and prothrombin time. FR171113 and C186-65 showed no effects, even at a concentration of 100 microM. These results suggest that FR171113 has a similar mode of action to C186-65, but with more potent antiplatelet activity. In conclusion, FR171113 is suggested to be the first example of a non-peptide thrombin receptor antagonist.

The profile of FR140423, a novel anti-inflammatory compound, in yeast-induced rat hyperalgesia.

The mechanism of action of FR140423 (3-(difluoromethyl)-1-(4-methoxyphenyl)-5-[4-(methylsulfinyl)phenyl]pyra zole), a novel anti-inflammatory compound, in a rat yeast-induced hyperalgesic model was investigated and compared with those of indomethacin and morphine. We tested the inhibitory effects of FR140423 on the formation of arachidonic acid metabolites, prostaglandin (PG) E2, thromboxane (TX) B2 and leukotriene (LT) B4, in yeast-injected inflamed paws and the effect of the opioid receptor antagonist naloxone on FR140423-induced anti-hyperalgesic effect and inhibition of the formation of arachidonic acid metabolites. Oral administration of FR140423 showed a dose-dependent anti-hyperalgesic effect. This effect was fourfold more potent than that of indomethacin but less potent than that of morphine. Unlike morphine, FR140423 suppressed the levels of PGE2 and TXB2 but not LTB4 in inflamed paws. FR140423 did not inhibit yeast-induced paw edema. The anti-hyperalgesic effect of FR140423 in yeast-injected rat paws was partially blocked by naloxone. However, the inhibitory effects of FR140423 on the formation of PGE2 and TXB2 in yeast-injected rat paws were not antagonized by naloxone. These results suggest that FR140423 shows a potent anti-hyperalgesic effect mediated by inhibition of PGs in inflamed tissue and by activation of opioid receptors.

Ventral T-1 neurinoma removed via hemilaminectomy without costotransversectomy--case report.

A 39-year-old male presented with a spinal neurinoma originating from the T-1 anterior root and located ventral to the spinal cord. The tumor was removed by hemilaminectomy with only partial facetectomy without costotransversectomy. No stabilization was necessary, and no complications secondary to surgery occurred. Costotransversectomy is not necessary for neurinoma ventral to the spinal cord within the spinal canal at T-1 level because the transverse process protrudes more laterally and the spinal canal of the T-1 vertebra is wider than at other thoracic levels.

Antinociceptive properties of FR140423 mediated through spinal delta-, but not mu- and kappa-, opioid receptors.

We investigated the antinociceptive effect of FR140423, 3-(difluoromethyl)-1-(4-methoxyphenyl)-5-[4-(methylsulfinyl)phenyl] pyrazole, in the tail-pinch test in mice, and evaluated the mechanism of action using various opioid receptor antagonists. P.o. and i.t. injection of FR140423 exerted dose-dependent antinociceptive activities with ED50 values of 21 mg/kg and 3.1 microg/mouse, respectively. However, i.c.v. injection of FR140423 did not show an antinociceptive effect. The antinociceptive effects of FR140423 were completely abolished by naloxone and naltrindole but not by naloxonazine, beta-funaltrexamine and nor-binaltorphimine. FR140423 did not affect any opioid receptor binding in mouse spinal membranes at concentrations up to 100 microM in vitro. Naloxone-induced jumping and diarrhea tests for morphine-like physical dependence of FR140423 gave negative results. These results suggest that FR140423 can induce antinociception by acting on the spinal but not the supraspinal site, and that spinal delta-opioid systems indirectly play a role in the antinociception produced by FR140423 in mice.

[Brain surface clear cell ependymoma: case report].

We report a case of brain surface clear cell ependymoma. A 13-year-old boy presented with complaints of right hypesthesia. Computed tomography and magnetic resonance image showed a left fronto-parietal cystic, calcified mass lesion. He underwent total resection of the tumor including cyst wall. The tumor located on the surface of the parietal lobe was sharply demarcated from the surrounding brain tissue and there was no continuity with the ventricular wall. Histological examination of the surgical specimens showed oligodendroglioma-like cells that had round unclei, clear cytoplasm which formed perivascular pseudorosettes, and immunoreactivity for glial fibrillary acidic protein (GFAP). Electromicroscopically, microvilli were seen. The findings were compatible with clear cell ependymoma. The cyst wall was lined with a layer of single cuboidal cells and, immunohistochemically, had no basal membrane. The inner surface of the cyst was positive for EMA, and the cuboidal cells were positive for GFAP. We discuss possible mechanisms for tumor growth in our case and the histogenesis of its cyst.

Possible inhibitory mechanism of FK506 (tacrolimus hydrate) ointment for atopic dermatitis based on animal models.

The effects of FK506 (tacrolimus hydrate) ointment on cutaneous allergic reactions in mice and rats were investigated. FK506 ointment showed significant suppressive effects on delayed allergic reactions in both species, and especially in rats, its inhibitory action was much stronger than that of alclometasone dipropionate, a so-called medium class steroid ointment. On the other hand, FK506 ointment did not inhibit the immediate allergic reaction in rats. FK506 ointment suppressed the delayed allergic reactions in locally passively sensitized mice to the same degree as that in actively sensitized mice. Accordingly, it is speculated that FK506 ointment inhibits the activation of sensitized T lymphocytes (Th1 cells) already accumulated in the dermis.

Anesthetic management for pheochromocytoma resection using spinal cord stimulation and intravenous nicardipine--a case report.

We have used spinal cord stimulation (SCS), diazepam and nitrous oxide for maintenance of general anesthesia. Blood pressure was maintained by bolus administration of nicardipine for the removal of pheochromocytoma. Both SCS and nicardipine reduced systemic vascular resistance and SCS increased cardiac output. However, neither SCS nor nicardipine could inhibit the release of norepinephrine. SCS proved to be useful as one of anesthetic technique during the removal of pheochromocytoma, and also in the management of postoperative pain and the prevention of complications.