The kinetics of VEGF and MCP-1 in the second vitrectomy cases with proliferative diabetic retinopathy.

PurposeTo determine whether the concentrations of vascular endothelial growth factor (VEGF) and monocyte chemoattractant protein (MCP)-1 in the vitreous changed after vitrectomy in patients with proliferative diabetic retinopathy (PDR).ParticipantsTwenty-one eyes of 21 patients who needed a second surgery for PDR were included. The reasons for the second surgery were tractional retinal detachment (TRD), neovascular glaucoma, persistent vitreous hemorrhage, macular pucker, and secondary intraocular lens (IOL) implant.MethodsWe measured the VEGF and MCP-1 levels using sandwich enzyme-linked immunosorbent assays in vitreous samples collected from patients with PDR before pars plana vitrectomy (without IOL implantation), and from the same patients during the second surgery.ResultsThere was not significant change in mean VEGF concentrations when comparing first (0.81±0.88 ng/ml) and second surgeries (1.09±1.51 ng/ml). The MCP-1 level was significantly elevated at the time of second surgery (2.20±2.21 ng/ml) compared with the first vitrectomy (0.72±0.57 ng/ml). The MCP-1 levels of the second surgery cases with TRD (3.18±2.27 ng/ml) increased significantly compared with those with other complications (1.72±2.10 ng/ml).ConclusionsAt the second vitrectomy, VEGF did not change significantly in the vitreous of the patients examined. The MCP-1 concentration was markedly elevated at the second vitrectomy, implying an association between the prolonged inflammation after vitrectomy and complications, especially TRD.

Elastic moduli of thyroid tissues under compression.

The aim of this study was to evaluate the elastic moduli of thyroid tissues under uniaxial compression and to establish the biomechanical fundamentals for accurate interpretation of thyroid elastograms. A total of 67 thyroid samples (24 samples of normal thyroid tissue, 2 samples of thyroid tissue with chronic thyroiditis, 12 samples of adenomatous goiter lesions and 7 samples of follicular adenoma, 19 samples of papillary adenocarcinoma (PAC) and 3 samples of follicular adenocarcinoma (FAC)) obtained from 36 patients who had received thyroid surgery were subjected to biomechanical testing within three hours after surgical resection at precompression strains of 5%, 10% and 20% and applied strains of 1%, 2%, 5% and 10% of sample height. As a result, the mean values of elastic moduli for benign thyroid lesions at all examined precompression levels were significantly higher than those for normal thyroid tissue measured at the same load (p<0.01). At low precompression (5%) and compression (1-2%) levels, benign thyroid nodule samples were 1.7 times harder than normal thyroid tissue. At high precompression (20%) and compression (10%) levels, this difference increased to 2.4 times. Stiffness of PAC samples was significantly higher than those for normal thyroid tissue and benign thyroid tumors measured at the same load (p<0.01). At low precompression (5%) and compression (1-2%) levels, PAC samples were 5.0 times harder than normal thyroid tissue. At high precompression (20%) and compression (10%) levels, this difference increased to 17.7 times. In contrast, samples of FAC were much softer than PAC (p<0.05) and were comparable in stiffness to normal thyroid tissues. The significant differences in the stiffness between normal thyroid tissue and thyroid tumors may provide useful information for accurate interpretation of thyroid elastograms.

Concurrent chemoradiotherapy for oropharyngeal carcinoma.

The clinical results of definitive chemoradiotherapy for oropharyngeal carcinoma were retrospectively analyzed. Thirty-one patients with oropharyngeal carcinoma who received definitive radiation therapy between January 1986 and June 1998 were analyzed. The median age was 61 years. All patients had squamous cell carcinoma. According to the Union International Contre le Cancer 1997 classification system, stage I, II, III, IVA, and IVB were 1,0, 9, 14, and 7, respectively. Regarding the primary site, 23 tumors were in the lateral wall, whereas 2 were in the superior wall, and 3 each were in the anterior and posterior walls. The median total dose was 66 Gy, with a range of 60 Gy to 74.4 Gy. The overall treatment time ranged from 39 days to 113 days, with a median of 50 days. Seven patients underwent hemilateral radical neck dissection. Fourteen patients received concurrent chemotherapy using weekly cisplatin (50 mg/d) at least three times. The 5-year overall and cause-specific survival (CSS) rates were 55% and 62%, respectively. All local recurrences occurred within 2 years. The CSS rate in patients with lateral or superior wall origin was significantly superior to that of patients with anterior or posterior wall origin (p < 0.05). The 3-year CSS rate was 83% for patients treated with concurrent chemoradiotherapy using weekly cisplatin at least 3 times, whereas that was 53% for the remaining patients (p < 0.05). No serious adverse effects were observed. It is concluded that definitive concurrent chemoradiotherapy using weekly cisplatin for oropharyngeal carcinoma appear promising.

Nonlinear digital hearing aid with near-instantaneous amplitude compression.

We designed a new type of nonlinear digital hearing aid (TD-1) with near-instantaneous amplitude compression for sensorineural hearing-impaired people. The amplification method utilized by the TD-1 normalizes the signal waveforms within a time window bounded by two adjacent positive going zero-crossing points. The signals within this window are amplified so that the maximum amplitude reaches a preset value, thus allowing a consistent peak amplitude to be maintained. To test this, we examined the efficacy of the TD-1 device in 31 patients with sensorineural hearing loss. When tested for recognition of Japanese sentences in a quiet environment, 7 of 25 (28.0%) subjects wearing the TD-1 showed a 20% or greater increase in the maximum intelligibility score than that obtained when wearing their own linear hearing aids. In addition, 7 of 31 (22.6%) subjects showed the same increase with the TD-1 relative to that obtained when they wore HA70 or HA73 devices (Rion Co., Ltd., Tokyo, Japan), which are conventional analogue hearing aids. These results indicate that TD-1 can be effective for patients with sensorineural hearing loss.

Partial seizures in leukoencephalopathy with swelling and a discrepantly mild clinical course.

We report a patient with 'Leukoencephalopathy with swelling and a discrepantly mild clinical course', an entity of leukoencephalopathy recently clarified. Our patient presented with complex partial seizures in addition to characteristic radiological findings and clinical course. A review of the literature revealed that this new neurodegenerative disease complicates epilepsy in more than half of the patients, and that partial components in the seizure symptomatology are not infrequent.

Magnetic resonance imaging distinguishes progressive supranuclear palsy from multiple system atrophy.

To establish diagnostic magnetic resonance imaging (MRI) criteria for differentiating progressive supranuclear palsy (PSP) from multiple system atrophy (MSA), magnetic resonance images from eight patients with probable PSP, 30 with probable MSA (nine striatonigral degeneration (MSA-P) and 21 olivopontocerebellar atrophy (MSA-C)), and ten age-matched controls were retrospectively studied. Anteroposterior diameters in the midline sagittal T1-weighted image of the rostral (RMT) and caudal midbrain tegmentum (CMT), caudal pons and medulla were measured. Divergence of the red nuclei (RN) in the axial T2-weighted image was judged. All PSP images had a smaller RMT diameter than the lower limit of the normal range, showed RN divergence, and had a pontine diameter within the normal range. All MSA images had a CMT diameter within the normal range; no MSA images showed divergence of RN. Forty-four percent (4/9) of MSA-P and 76% (16/21) of MSA-C images had a pontine diameter smaller than the lower limit of the normal range. On basis of the results, we propose MRI diagnostic criteria for differentiating PSP from MSA.

A fast way to visualize the brain surface with volume rendering of MRI data.

The preprocessing of 3-dimensional (3D) MRI data constitutes a bottleneck in the process of visualizing the brain surface with volume rendering. As a fast way to achieve this preprocessing, the authors propose a simple pipeline based on an algorithm of seed-growing type, for approximate segmentation of the intradural space in T1-weighted 3D MRI data. Except for the setting of a seed and four parameters, this pipeline proceeds in an unsupervised manner; no interactive intermediate step is involved. It was tested with 15 datasets from normal adults. The result was reproducible in that as long as the seed was located within the cerebral white matter, identical segmentation was achieved for each dataset. Although the pipeline ran with gross segmentation error along the floor of the cranial cavity, it performed well along the cranial vault so that subsequent volume rendering permitted the observation of the sulco-gyral pattern over cerebral convexities. Use of this pipeline followed by volume rendering is a handy approach to the visualization of the brain surface from 3D MRI data.

Vibratory analysis of the neoglottis after surgical intervention of cricopharyngeal myotomy and implantation of tracheal cartilage.

OBJECTIVE: To examine the effect of a new surgical intervention, consisting of cricopharyngeal myotomy and tracheal cartilaginous implantation on the anterior wall of the esophagus, for tracheoesophageal shunt and esophageal phonation. DESIGN: We examined the vibration of the neoglottis of tracheoesophageal shunt and esophageal speakers after total laryngectomy using a high-speed video camera (frame rate, 1000 per second). PATIENTS: Twenty-one alaryngeal patients were involved: 13 who had undergone the present procedure and 8 who had not. RESULTS: The regularity of neoglottal vibration and the degree of neoglottal closure were significantly (P<.01) better in patients who had undergone the procedure than in those who had not. These effects on neoglottal vibration induced easier phonation. CONCLUSIONS: Cricopharyngeal myotomy was useful for avoiding reconstructed esophageal spasm, and tracheal cartilaginous implantation was effective for maintaining a wide subneoglottal space. This combination of procedures is useful for obtaining optimal vibration of the neoglottis in tracheoesophageal shunt and esophageal speakers.

Effect of single essential amino acid excess during pregnancy on dietary nitrogen utilization and fetal growth in rats.

The effect on pregnant rats of individual amino acids added excessively to the diet or intermittently administered in excess directly with a stomach tube was examined. When methionine was excessively added to the diet at a 5% level, amino acid imbalance in plasma was induced and food intake decreased remarkably to approximately one-fifth of that of control rats. However, when administered directly into the stomach, food intake remained almost normal, except for excess of methionine, tryptophan or threonine, and an adverse effect of excess amino acid was not observed. However, in the case of a decrease in food intake, various adverse effects were observed. This was especially so for the group that was administered methionine and whose food intake was far below that of the control group: decrease in maternal body weight, delayed growth of products of conception, and further, significant decrease in brain and liver cells of the fetus were observed. In addition, the changes in nitrogen balance were well correlated with the changes in bodyweight in all groups. In the methionine group, in particular, nitrogen balance was negative throughout the period because of a decrease in food intake, and utilization of dietary nitrogen was inferior. The majority of the various lesions observed with excess administration of individual amino acids were not due to a direct effect of excess amino acid but were mainly caused by the remarkable decrease in food intake.

Early-childhood progressive myoclonus epilepsy presenting as partial seizures in dentatorubral-pallidoluysian atrophy.

PURPOSE: We explored the characteristics of epileptic seizures of progressive myoclonus epilepsy (PME) in 2 brothers with dentatorubral-pallidoluysian atrophy (DRPLA). METHODS: We obtained the case history of the siblings and ictal and interictal EEGs. Postmortem examination or demonstration of elongated CAG repeat in the gene for DRPLA was used to confirm the diagnosis. RESULTS: Two Japanese siblings developed PME characterized by versive or himiclonic seizures with or without secondarily generalized tonic-clonic convulsions. The elder brother regressed mentally and exhibited increasing spasticity after age 1 year. Myoclonus and seizures developed at age 4 years. The younger brother had shown psychomotor retardation before age 4 years, when he began to deteriorate further neurologically as the elder brother had. He also developed myoclonus and seizures at that age. Seizures in both patients remained partial until their deaths at ages 19 and 15 years, respectively. Ictal EEG verified partial onset of seizure evolving to generalized tonic-clonic seizure (GTCS). Interictal EEGs showed multifocal paroxysmal discharges with little or no diffuse paroxysms. Postmortem examination or genetic study confirmed the diagnosis of DRPLA. CONCLUSIONS: Seizures of patients with DRPLA may present as partial seizures in children with early-onset PME.

Intracranial contour extraction with active contour models.

A novel image processing scheme for extracting the intracranial contours in axial magnetic resonance data sets is proposed. The scheme incorporates the method of active contour models, a recently introduced paradigm for contour extraction. Its performance is nearly ideal for T2-weighted images. Although the performances for proton-density-weighted images and T1-weighted images drop slightly, qualitatively satisfactory extraction still can be obtained for T1-weighted images. Due to high degree of automation, the scheme should help speed up some image processing applications that require the presegmentation of the intracranial cavity.

Congenital bilateral perisylvian syndrome: first report in a Japanese patient.

A Japanese boy with congenital bilateral perisylvian syndrome is described. He had oropharyngoglossal dysfunction and severe dysarthria. Magnetic resonance imaging of the brain disclosed bilateral perisylvian malformations suggesting polymicrogyria. The patient also showed mental retardation, epilepsy, and poor motor skills.

[MRI of the pituitary adenomas with reference to the hormonal activity].

Many studies in Magnetic Resonance Imaging (MRI) of pituitary adenomas are already performed. However, few reports exist about MRI findings of pituitary adenomas with reference to the hormonal activity, therefore, we evaluated this problem on the viewpoint of the signal intensity in MRI and pathological features. Fifteen patients with growth hormone producing adenoma (GH-group), 6 patients with prolactin producing adenoma (PRL-group), 15 patients with endocrinologically non-functioning adenoma (Null-group) and 9 cases with normal pituitary gland (normal control group) were examined. Signal intensity values in adenoma (or anterior lobe in normal control group) and in pons as standard value were measured in each cases, then their rates were calculated as signal intensity ratio (SIR). In 24 cases (14 in GH-group, 3 in PRL-group, 7 in Null-group), cellular density were examined with surgically resected specimens. In the T1-weighted images (T1 WIs), PRL-group and Null-group presented more hypointense tendency than normal control group. In the T2-weighted images (T2 WIs), only Null-group presented more hyperintense tendency than other groups. But significant correlation was not observed between SIR and cellular density.

Delayed data acquisition for optimal PET activation studies with oxygen-15-water in cerebral arteriovenous malformation.

UNLABELLED: In the clinical application of activation PET studies with 15O-water, optimal PET images are required when the high activity of a nearby lesion might affect the activated area. METHODS: To determine the optimal time for data acquisition of PET images, we performed serial dynamic PET measurements in five patients with cerebral arteriovenous malformation (AVM). All AVMs were closest to the motor cortices, and the activation task was opponent finger movement contralateral to the AVM. Activation PET and MR images were coregisterated for localization of activated foci. RESULTS: Time-activity curves of the nidus and normal cortex from the dynamic PET data demonstrated a discrepancy in peak time and significant radioactivity increase in the nidus during the early phase. Elimination of the initial PET data provided better contrast in activated foci without affecting the calculated cerebral blood flow of other areas. CONCLUSION: Delayed data acquisition can avoid interference of the AVM nidus with the activated area.

Corpus callosum atrophy in amyotrophic lateral sclerosis.

Recent studies have suggested widespread involvement of the cerebral regions other than the primary motor cortex in amyotrophic lateral sclerosis. To investigate atrophy of the corpus callosum as a measure of cerebral pathology, we studied 25 right-handed patients with sporadic amyotrophic lateral sclerosis using magnetic resonance imaging. Five patients had cognitive decline or emotional and personality changes. The ratios of mid-sagittal corpus callosum areas to the midline internal skull surface area on T1-weighted images were analysed. Compared with 25 age- and sex-matched right-handed control subjects, the patients had significantly decreased callosal/skull area ratio, with anterior predominance of the degree of atrophy. The patients with cognitive decline or psychiatric symptoms had substantial atrophy of the anterior fourth of the corpus callosum. These findings suggest that atrophy of the corpus callosum, especially in the anterior half, is present in amyotrophic lateral sclerosis, and that severe atrophy in the anterior fourth is associated with cognitive decline and psychiatric symptoms. Callosal atrophy may reflect the widespread distribution of pathological changes in the cerebral cortex, which are accentuated in the frontal cortex.

A case of achondroplasia with downward displacement of the brain stem.

We report a case of achondroplasia with downward displacement of the brain stem. Although upward displacement and anterior angulation deformity of the brain stem are common findings in achondroplasia, they were not observed in this case, because of a coexistent Chiari malformation.

123I-IMP SPECT findings in mitochondrial encephalomyopathies.

We performed N-isopropyl-[123I]p-iodoamphetamine (IMP) single photon emission computed tomography (SPECT) in three patients with Leigh syndrome, two patients with mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS), and two siblings with progressive external ophthalmoplegia (PEO). The SPECT images were compared with the findings on magnetic resonance imaging (MRI) and computed tomography (CT). All Leigh syndrome patients showed low accumulation areas (LAA) bilaterally in the frontal lobes and the basal ganglia. The frontal lobe LAA was seen even in an area without abnormalities on CT/MRI. Each MELAS patient showed a focal LAA. SPECT could also detect an old stroke-like lesion that was no longer shown by CT/MRI. However, SPECT did not show LAA in the basal ganglia, which showed calcification on CT or abnormal signal intensity on MRI. MRI in the 2 PEO patients showed lesions bilaterally in the basal ganglia in one, and in the internal capsules in the other. SPECT showed LAA not only in corresponding areas, but also in the occipital lobes, where no lesions were revealed by MRI. Thus, 123I-IMP SPECT was more sensitive than CT/MRI for detecting stroke-like lesions in MELAS patients, although it did not detect small lesions in the basal ganglia. LAA in the frontal lobes and occipital lobes may be SPECT findings characteristic of Leigh syndrome and PEO, respectively.

Epidural venous system (meningorachidian venous plexus) in juvenile amyotrophy of distal upper extremity: assessment with GD-DTPA enhanced volumetric MR study.

The epidural venous system (meningorachidian venous plexus) was analyzed utilizing gadolinium-diethylenetriamine pentaacetic acid (DTPA) (Gd-DTPA) enhanced volumetric magnetic resonance (MR) images in 11 patients with focal cervical spinal cord atrophy, clinically consistent with juvenile amyotrophy of distal upper extremity. In our series, all of the patients showed unusual posterior epidural venous enhancement at the C5-6 level, suggesting posterior epidural venous dilatation. Three patients also showed prominent dilatation of cervico-thoracic epidural veins surrounding the thecal sac. These MR findings were also demonstrated by spinal phlebography. Gd-DTPA enhanced MR images, especially high resolutional volumetric MR images, were efficient for evaluating these vessels. The observation of meningorachidian venous plexus along the disease course should be necessary for searching the pathogenesis of this disease.