Epicatechin downregulates adipose tissue CCL19 expression and thereby ameliorates diet-induced obesity and insulin resistance.

BACKGROUND AND AIMS: Epicatechin (EC) intake has been suggested to be beneficial for the prevention of cardiovascular disorders, and it is well known that adipose tissue inflammation is one of the major risk factors for coronary heart diseases. The purpose of the present study was to determine the in vitro and in vivo effects of EC on adipose tissue inflammation and obesity. METHODS AND RESULTS: DNA microarray analysis was performed to evaluate the effects of EC on gene expression in adipocytes co-cultured with bacterial endotoxin-stimulated macrophages. To determine the in vivo effects of the catechin, C57BL/6 mice were fed either a high-fat diet (HFD) or HFD combined with EC, and metabolic changes were observed EC suppressed the expression of many inflammatory genes in the adipocytes co-cultured with endotoxin-stimulated macrophages. Specifically, EC markedly suppressed chemokine (CC motif) ligand 19 (CCL19) expression. The target cell of EC appeared to macrophages. The in vivo study indicated that mice fed the EC-supplemented HFD were protected from diet-induced obesity and insulin resistance. Accordingly, the expression levels of genes associated with inflammation in adipose tissue and in the liver were downregulated in this group of mice. CONCLUSIONS: EC exerts beneficial effects for the prevention of adipose tissue inflammation and insulin resistance. Since we previously reported that mice deficient in the CCL19 receptor were protected from diet-induced obesity and insulin resistance, it can be concluded that the beneficial effects of EC could be mediated, at least in part, by marked suppression of CCL19 expression.

Angiographic examination and surgical treatment of bow hunter's stroke.

Anatomically, the vertebral artery courses through six foramina transversaria of the cervical vertebrae, passing through the groove on the surface of the arch of the atlas and then penetrating the dura mater. Because of this anatomical course, the vertebral arteries are often affected by head motion. Stenotic change of the vertebral artery can occur at the atlantoaxial level in head rotation. Such a special type of stroke was named "bow hunter's stroke" by Sorensen. We report three cases of bow hunter's stroke and discuss the angiographic examinations. As surgical treatment, we performed partial transversectomy of the atlas vertebra, with favorable results. The usefulness of this surgical procedure is discussed.

Surgically treated cerebral arterial ectasia with so-called moyamoya vessels.

The case of a 43-year-old woman with multiple intracranial arterial ectasia was reported. The arterial ectasia was accompanied by stenosis of the middle cerebral artery and so-called moyamoya vessels. After extracranial to intracranial bypass surgery, the size and contour of the arterial ectasia decreased. Because the arterial ectasia decreased in size after the extracranial to intracranial bypass surgery, this operation might be useful for space-occupying lesions due to arterial ectasia.

Haemodynamic study of arteriovenous malformations using a hydraulic model.

Despite the accumulation of intraoperative data on arteriovenous malformations (AVMs), details of the haemodynamics have not yet been elucidated. A hydraulic model was constructed from silicone and glass tubes to simulate a high-flow AVM. During stepwise obliteration of the nidus, haemodynamic changes were continuously measured in residual parts of the AVM and in the surrounding brain. The flow in the residual AVM decreased nonlinearly with the advance of obliteration. The feeder pressure increased markedly from 37 mmHg to 94 mmHg, while the drainer pressure decreased gradually. The flow volume in the surrounding brain increased markedly from 40 ml/min to 100 ml/min at an occlusion ratio of 60%, where the pressure gradient across the nidus reached 60 mmHg. In the presence of autoregulation, further obliteration showed no change in the flow volume with the increased pressure gradient to 93.7 mmHg. Under dysautoregulatory conditions the flow volume increased to 122 ml/min, although the pressure gradient was 8.3 mmHg lower than that under autoregulatory conditions. Simulation study is useful in understanding haemodynamic changes during the treatment of AVMs.

[Surgical treatment of cervical spondylotic radiculomyelopathy with abnormal involuntary neck movements. Report of three cases].

Cervical spondylotic myelopathy usually arises in patients in their late 40s or early 50s, most frequently at the C5/6 and C6/7 levels. Recently, excellent results have been attained with microsurgery in cases of cervical spondylosis. On the other hand, treatment of cervical spondylotic myelopathy in patients with athetoid dystonic cerebral palsy entails several problems. The authors report three cases of such troublesome myelopathy. A 34-year-old male with severe athetoid movement showed cervical spondylotic myelopathy. Myelography and magnetic resonance (MR) imaging demonstrated compression of the spinal cord through the C3-C5 levels. A 47-year-old female with athetoid dystonic cerebral palsy presented myelopathy. Myelography and MR imaging showed instability and spinal cord compression at the C5/6 level. A 34-year-old male with spasmodic torticollis showed C6 radiculopathy due to cervical disc hernia at the C5/6 level. Cervical anterior decompression with interbody fusion brought temporary improvement in all the three patients. However, such problems as slippage of Halo-vest, difficulty in eating during Halo-vest fixation, relapse of neurological deficit, were experienced. Due to postoperative cervical instability, cervical laminectomy is considered to be contraindicated in such patients. Anterior decompression with bone fusion has been reported effective, but, if athetoid dystonia continues, there is a potential for myelopathic deterioration due to spondylotic changes adjacent to the fused vertebrae.

Hemodynamic study of posterior circulation using hydraulic vascular model--critical stenosis of the vertebrobasilar artery and tolerance to occlusion therapy.

A hydraulic vascular model with glass and silicone tubes of the intracranial portion of the vertebro-basilar artery was used to determine the critical stenosis causing vertebrobasilar insufficiency, and the minimum diameter of the posterior communicating arteries (PComAs) necessary to tolerate therapeutic vertebrobasilar occlusion for unclippable aneurysms. The critical stenosis of one vertebral artery (VA) or basilar artery (BA) differed greatly depending upon the anatomical variations of the PComA and the posterior cerebral artery (PCA): 1.14 mm diameter when the artery supplies 80 ml/min to the cerebellum and brainstem only, 1.33 mm when 140 ml/min to these structures and one PCA, and 1.56 mm when 200 ml/min to these structures and both PCAs. The minimum PComA diameter to tolerate therapeutic occlusion depended largely upon the occlusion site: one PComA with 1.54 mm diameter for bilateral VA occlusion and 1.25 mm for BA occlusion distal to the branching of the superior cerebellar arteries. The total volume of collateral flow through both PComAs can be estimated by summing the squares of the diameters. These values cannot be applied rigidly to clinical cases, but are useful standards to evaluate the stenotic lesion or tolerance to occlusion.

[Clinical analysis of ossified thoracic ligaments and thoracic disc hernia].

Thoracic lesions present several clinical problems, particularly in their diagnosis and treatment, compared with cervical or lumbar lesions. Since 1983, 18 cases of thoracic space lesions, excluding spinal tumors or trauma have been experienced: nine cases of ossification of yellow ligament (OYL), five of ossification of posterior longitudinal ligament (OPLL), and four of disc hernia (DH). In these 18 patients, problems of clinical manifestations, neuroradiological examination, and surgical approaches are analyzed and discussed. As clinical manifestations, there was a preponderant occurrence in males in the OYL group, while in the OPLL group all the patients were females. OYL and DH occurred at lower thoracic levels. Thirteen of the 18 patients showed combined lesions either in the cervical or in the lumbar regions, such as cervical OPLL, cervical spondylosis, lumbar DH, and lumbar canal stenosis. In the neuroradiological examinations diagnosis of the upper thoracic lesions was difficult. Computed tomography (CT) scan with intrathecal metrizamide injection seemed essential for examination of ossified thoracic lesions. However, because CT imaging of the entire spine is impractical, efficient use of this examination requires previous localization of the offending vertebral level from either the neurological findings or other neuroradiological examinations such as myelography. Magnetic resonance imaging seemed most useful for ruling out the thoracic compressing lesions. As for surgical approaches, posterior decompression was effective for OYL and the anterior approach was useful for OPLL and DH. In patients with "tandem lesions," neurological and neuroradiological findings played an important role in deciding the responsible site.

[An aneurysm of the distal anterior cerebral artery with a remarkably anomalous configuration].

A case of aneurysm on the distal anterior cerebral artery with a remarkably anomalous configuration was reported. In the present case, the left anterior cerebral artery showed hairpin-like angulation, at the top of which a small saccular aneurysm was noticed. This anomalous anterior cerebral artery seemed to feed the territories of the fronto-orbital artery and the pericallosal artery. Although the incidence of distal anterior cerebral artery aneurysm is low, they are very interesting due to several characteristics. According to the reported cases of distal anterior cerebral artery aneurysms, acute angulation of the parent vessel, at the top of which saccular aneurysm is often noticed, and the hemodynamic stress has been considered to play important roles in aneurysm formation. The findings of the cerebral angiograms and the operation of the present case were demonstrated.

[Basilar artery occlusion therapy for giant aneurysm: hemodynamic analysis by hydraulic vascular model].

Therapeutic occlusion of the basilar artery has been one of the alternative treatments for surgically or intravascularly inaccessible basilar bifurcation giant aneurysms. However, several problems have been reported, such as incomplete thrombosis of the aneurysms, their growth or rupture, and cerebral embolism originating from their cavities. Since hemodynamic changes after occlusion therapy are suspected to be responsible for these phenomena, they were investigated by a hydraulic vascular model. A hydraulic vascular model of the vertebrobasilar artery was constructed with silicone and glass tubes. A glass-made sphere of 2.5 cm in diameter was attached to the model and was regarded as a basilar head aneurysm. A 40% glycerol solution at 25 degrees C was found to be of similar viscosity and specific gravity to those of human whole blood at 37 degrees C and was perfused in the model. A device to measure intra-aneurysmal clearance was made from a stable luminous source and a Cds photocell. Good correlation was found between the output and an intra-aneurysmal dye concentration. The dye was injected into the aneurysm and its half-life was calculated from clearance curves. It was then regarded as an index of stagnation in an aneurysmal cavity. The flow volumes were estimated as: 60ml/min to the territory of one posterior cerebral artery (PCA) and 80ml/min to the cerebellum and the brain stem. Half-life was recorded in the following conditions: 120ml/min of flow in the basilar artery (BA) into bilateral PCAs stimulating the condition before BA occlusion, and various flow values (60ml/min to 10ml/min) of P1 segment simulating the conditions after BA occlusion distal to the superior cerebellar artery.(ABSTRACT TRUNCATED AT 250 WORDS)

[Acute interhemispheric subdural hematoma: a case report with good result by small craniotomy during the chronic stage].

A 88-year-old male slipped down and hit his head on the floor on the night of November 27, 1988. He was able to return to bed and fell asleep. Next morning, he noticed gait disturbance and was admitted to our clinic. Neurological examination revealed monoparesis (1/5) and hyperreflexia of the left lower extremity. Computed tomography (CT) demonstrated a semilunar high density area with the base toward the right side of the falx. General anesthesia for craniotomy was judged to be contra-indicated because serious ischemic heart disease was also present. Although his neurological condition proved to be not progressive, and the monoparesis recovered gradually under conservative treatment, he could not walk by himself one month after the accident. Since the hematoma was surmised to be liquidized and, hence, could be aspirated either through a burr hole or by small craniotomy, an operation was performed under local anesthesia on January 4th, 1989. The hematoma was successfully removed, and the muscle power of the extremities improved to the level of 4/5 - 5/5 just after operation. He was discharged on foot. Lately, there seems to be an increase in patients with traumatic intra-cranial hematomas who, because of systemic problems related to advanced age, are regarded as high-risk subjects for craniotomy under general anesthesia. Not a few of these patients have residual neurological deficits, even though they are in a chronic stage. The subject of this case reported here is typical of such patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[Vertebral artery occlusion therapy for a VA-PICA giant aneurysm: hemodynamic analysis by hydraulic vascular model].

Although therapeutic occlusion of the vertebral artery has been an accepted treatment for an inaccessible VA giant aneurysm, several problems have been reported such as incomplete thrombosis, growth or rupture of the aneurysms, and cerebral embolism originating from the aneurysmal cavity. Hemodynamic changes after occlusion therapy are suspected to be responsible for these phenomena. It is usually difficult to solve these problems or to predict them before operation because multiple factors are related in a complex fashion in a living body. One of the effective means is to simulate these hemodynamic conditions by a hydraulic vascular model. To evaluate hemodynamics after gradual therapeutic occlusion of the vertebral artery, a glass sphere of 2.5 cm in diameter was placed in a hydraulic model and regarded as a VA-PICA aneurysm. 40% glycerol solution at 25 degrees C, having similar viscosity and specific gravity to human whole blood at 37 degrees C, was used as a perfusate in this study. The dye was injected into the aneurysm and intensity change of the transmitted light was measured. Half-life of the dye was calculated from the thus-obtained clearance curve and was regarded as an index of intra-aneurysm stagnation. The flow volumes of each arterial site have been estimated in our previous study: 60 ml/min to the territory of one posterior cerebral artery, and 80 ml/min to the cerebellum and the brain stem. Clearance curves were recorded in the following various conditions. The flow value of the PICA was set to be 5, 10, 15, 20, 25, and 30 ml/min.(ABSTRACT TRUNCATED AT 250 WORDS)

[Four cases of cerebral arterial ectasia--its clinical manifestations and surgical treatment].

Four cases of intracranial arterial ectasia are reported. The clinical manifestations of the four cases due to the arterial ectasia were ischemic attack in two patients, subarachnoid hemorrhage in one patient and abducens palsy in one patient. Surgical treatment was performed in three patients. The angiographic findings of the four patients were reported and the pathogenesis and the possibility of the surgical treatment of the arterial ectasia were discussed.

[A case of systemic lupus erythematosus associated with multiple intracranial aneurysms].

The author reports a case of systemic lupus erythematosus (SLE) with multiple intracranial aneurysms and subarachnoid hemorrhage. A 31-year-old woman was admitted to the department of internal medicine of Shizuoka General Hospital for the treatment of nephrotic syndrome due to systemic lupus erythematosus on 1984. She spend an uneventful life until April, 1985 when she suddenly complained of severe headache and nausea. The computed tomographic scan revealed subarachnoid hemorrhage and the cerebral angiography showed multiple intracranial aneurysms and stenotic lesion. A review of the literature was made to clarify the incidence, the pathological change, and the prognosis of systemic lupus erythematosus with subarachnoid hemorrhage. The incidence of subarachnoid hemorrhage in SLE was about two percent in the reported clinical cases. The mechanisms of the subarachnoid hemorrhage and the aneurysmal formation in SLE seemed to be due to angitic changes, which involved the vessels of the whole body systematically. The exact prognosis of SLE with subarachnoid hemorrhage is difficult to say, but it seems to be unfortunately poor due to multiplicity of the lesion and the difficulty of its treatment.

[Transthoracic approaches to the lesions of thoracic cord and thoracic vertebrae].

Experiences of transthoracic approaches to the thoracic cord lesions were reported. Since 1983, we have performed six transthoracic approaches to the thoracic lesions; one thoracic OPLL, one dumbbell-shaped neurinoma, two thoracic soft disc, one epidural metastatic tumor to thoracic vertebrae. From the viewpoint of surgical anatomy, the thoracic vertebrae show a physiological kyphosis and the subarachnoid space of the ventral site is narrower than that of the dorsal site. Due to such anatomical characteristics, the thoracic laminectomy for decompression is not so effective as in the cervical or lumbar region and a relatively small mass lesion can bring a paraplegic state. The lesion of the ventral site of the thoracic cord has been regarded as no man's land because of poor results of posterior approaches. Instead of posterior approaches, anterior or anterolateral approaches with transthoracic route have been adopted. In the present paper, we used transthoracic anterolateral approaches for four patients and anterior sternum-splitting approach for two patients. The operative procedures of the approaches were described in detail. By these approaches, we could treat four patients with favourable results but the result of thoracic OPLL was poor. The cause of this poor result seemed to depend upon the intraoperative compression of the thoracic cord. For the troublesome complication, we described the postoperative cerebrospinal fluid leakage into thoracic cavity with respiratory disturbance. Several devices to prevent such troublesome complication were discussed.

[Two cases of von Recklinghausen's disease with multiple brain and spinal tumors].

The authors reported two cases of von Recklinghausen's disease with multiple brain tumors and multiple spinal tumors. The first case, a 21-year-old man who had a past history of optic gliomas was admitted because of gait disturbance. Computed tomography (CT) and magnetic resonance imaging (MRI) showed calcification of the basal ganglia, bilateral C-P angle tumors, cystic cerebellar tumor and arachnoid cyst in the quadrigeminal cistern. Myelography and MRI revealed multiple spinal tumors. Surgical management was performed and cerebellar tumor was histologically confirmed to be a pilocytic astrocytoma. Spinal tumors were also astrocytomas. The second patient, a 56-year-old woman suffered from right iliac pain, right hemiparesis and motor aphasia. CT revealed two round tumors in the left cerebral hemisphere and bilateral C-P angle tumors. Myelography and MRI demonstrated multiple intradural-extramedullary spinal tumors. Histologically, supratentorial tumors were transitional meningiomas and spinal tumors were neurinomas. It is well known that von Recklinghausen's disease is often associated with brain or spinal tumors. But, in the literature, only 22 cases of von Recklinghausen's disease combined with multiple brain tumors with different histological types and multiple spinal tumors have been reviewed. With our two cases, the average age of these 24 cases was 28.6 years old, nine cases were male and 15 cases were female. All patients had C-P angle tumors and 23 cases were combined with intracranial meningiomas. In this paper, the clinical features and diagnostic aspects were discussed.