Tentorial enhancement on MR images is a sign of cavernous sinus involvement in patients with sellar tumors.

BACKGROUND AND PURPOSE: This study was undertaken to analyze enhancement patterns of the dura around sellar tumors and to compare the results with tumor invasion or compression of the cavernous sinuses. Postoperative enhancement patterns on MR images were compared with preoperative findings. METHODS: Contrast-enhanced coronal and sagittal MR images were examined prospectively in 96 patients with sellar tumors (65 macroadenomas, 15 microadenomas, 14 Rathke cleft cysts, and two chordomas at the sella). All patients underwent surgical treatment, and pre- and postsurgical features on MR images were compared. RESULTS: Presurgical MR images showed dural enhancement in 36.5% of the patients: asymmetric tentorial enhancement in 24 patients, symmetric tentorial enhancement in seven, and sphenoidal ridge or clivus enhancement in four. Asymmetric tentorial enhancement disappeared after surgical decompression in seven patients. For evaluation of cavernous sinus invasion ipsilateral to the enhancement, sensitivity and specificity of the asymmetric tentorial enhancement sign were 81.3% and 86.3%, respectively. Sensitivity and specificity of the sign were 42.9% and 93.6% for cavernous sinus involvement, including compression and invasion. CONCLUSION: Asymmetric tentorial enhancement is a useful sign in the diagnosis of invasion or severe compression of the cavernous sinus by sellar tumor. The sign may represent venous congestion or collateral flow in the tentorium due to obstructed flow in the medial portion of the cavernous sinus.

[Right ventricular outflow tract reconstruction for pulmonary atresia with ventricular septal defect: the possibility of ventriculo-arterial direct anastomosis].

Between September 1997 and December 2000, 29 patients with pulmonary atresia associated with ventricular septal defect were undergone corrective surgery. The age at operation ranged from 24 days to 14.7 years. The 5 patients were younger than 3 months. The body weight at operation ranged from 1.5 kg to 35.8 kg. 10 patients had MAPCAs. 21 patients had been undergone modified Blolock-Taussig shunt and/or uniforcalization of pulmonary artery (PA). We could perform right ventricular outflow tract reconstruction with ventriculo-arterial direct anastomosis in 19 patients (65%) (4/10; patients with MAPCAs, 3/5; younger than 3 months). We performed pulmonary angioplasty on stenotic and/or underdeveloped leasions as a concomitant procedure in 13/19 cases. Our technique is composed of 4 points, (1) fully mobilizing central and distal pulmonary artery (PA), (2) dissecting the PA with connective tissue together, (3) pulmonary arterial wall flap, (4) right ventricular outflow tract reconstruction during cardiac arrest.

Interpeak latency of auditory event-related potentials (P300) in senile depression and dementia of the Alzheimer type.

Most studies on event-related potentials (ERP) in psychiatric illness or dementia have focused on the single-peak latency of ERP components. In the present study, not only peak latencies of ERP components (N1, P2, N2, and P3) but also interpeak latencies (IPL; N1-P2, P2-N2, and N2-P3) were analyzed using the auditory oddball task. Thirty-five senile depressed patients and 34 patients with dementia of the Alzheimer type (DAT) were compared to 39 age-matched healthy volunteers. The mean latencies of P2 and P3 were shorter in patients with senile depression than in controls. In DAT patients, the N2 and P3 latencies were longer. When the IPL was assessed, however, only the mean IPL of N1-P2 was shorter in patients with senile depression, while the P2-N2 IPL were longer in those with DAT. The IPL results suggest that in senile depression the early cognitive process is hastened and in DAT the middle process is disturbed. Based on these results, we conclude that IPL of the auditory ERP might be used to reveal the disturbed steps within the cognitive process.

[5-year follow-up study of brain function in the healthy aged--study of the relationship between environmental factors and results of psychiatric examinations].

In order to investigate the relationship between environmental factors and results of psychiatric examinations, a questionnaire survey studying these factors and neurophysiological examinations (electroncephalography (EEG), somatosensory evoked response (SER) and contingent negative variation (CNV)), as well as clinical neuropsychiatric examinations and intelligence scale (Hasegawa's dementia rating scale (HDRS) and Kohs's blocking design test (KBDT)), were performed on 41 healthy aged (61-80 years old) who were participants in programs of Osaka Prefectural Center for the elderly. Initial examinations were conducted in 1983 and the second in 1988 on the same subjects for the purpose of measuring the aging process over 5 years with regard to brain function. A total of 29 subjects, for a participation rate of 82.9% (excluding deceased and those who moved away from the area), attended the second examination. The results are summarized as follows. 1. When environmental factors were compared for 1983 and 1988, a reduction in participation in social activity was observed in some of the aged in 1988, although differences in their daily living situations were unchanged. 2. The mean scores of HDRS and KBDT were 31.9, 98.6 in 1983 and 30.2, 94.6 in 1988 respectively, with only 2 subjects showing considerable decline of intelligence. 3. With regard to the neurophysiological examinations, the number of subjects with peak latencies of SER that were abnormally prolonged increased in 1988, while there was little difference in their EEGs between 1983 and 1988. 4. From these results, it appears that the relation between declines in brain function and environmental factors, involves multiple factors that will require further study.

[Study of somatosensory evoked response (SER) in patients with occupational vibration disease. Effect on SER induced by load of hot and cold water, and depressing the brachium].

Somatosensory evoked responses (SERs) to mechanical stimulation were recorded in 5 patients with occupational vibration disease and 10 grader drivers, and the results were compared with those obtained from 48 normal subjects. SERs were recorded at room temperature of 20-23 degrees C and after immersing the hand in hot (40 degrees C) or cold (10 degrees C) water for 5 minutes. SERs were also recorded while depressing the brachium and soon thereafter to examine the effect of ischemia. The following results were obtained. In SERs recorded on the finger of patients with occupational vibration disease, it was observed that some peaks of SERs were absent in 6 out of the 10 cases and that peak latency time was abnormally prolonged in 3 out of them. On the other hand, in SERs recorded on the forearm, abnormality was observed in only 1 out of them. In recording SERs in 6 patients with occupational vibration disease after immersing the hands in hot water, it was observed that abnormal SERs became normal in all 6 cases. However, these normalized SERs became abnormal in 5 out of the 6 cases within 25 minutes after removing the hands from hot water. No appreciable change could be observed in SERs recorded after immersing the hands in cold water. Partial absence of SER peaks could be observed in 2 out of 9 grader drivers while depressing the brachium. On the other hand, all SERs in 7 normal cases did not show any abnormality while depressing the brachium. The results suggest the presence of a close relationship between peripheral vascular dysfunction and peripheral somatosensory disturbance in patients with occupational vibration disease. However, it was observed that peripheral vascular dysfunction could not always trigger peripheral neural dysfunction. These findings have led to the conclusion that SERs to mechanical stimulation are more useful in the diagnosis of dysfunction of the peripheral nerve in patients with occupational vibration disease than SERs to electrical stimulation. The findings suggest that immersion in hot water and cold water and depression of the brachium are useful sensory tests for patients with occupational vibration disease and grader drivers.

[Studies on the occupational maladjustment syndrome (Part 2). In reference to relationship between psychophysiological characters and clinical features].

In a previous report (Natsume et al., Jpn. J. Ind. Health, Vol. 24) on the occupational maladjustment syndrome (O.M.A.S.), on the basis of clinical data, we classified patients with O.M.A.S. into 5 subcategories; core, drop-out, transient reaction, special job maladjustment and other. The core and drop-out types are typical of O.M.A.S. In order to test our hypothesis regarding the clinical and psychophysiological character of patients with O.M.A.S., 39 subjects (25 core type and 14 drop-out type) were studied by polygraphic techniques such as EEG, EMG of facial muscles and electrooculogram, and the results were compared with those of 16 normal subjects. We were specifically interested in their behavior in mental arithmetic and at rest. The results are summarized as follows: At rest, less frequent irregular rapid eye movement (especially "r-type") and smaller amplitudes of the corrugator supercilii muscle characterized the patients compared to the normals. During mental arithmetic these two indicators showed a greater tendency to increase in the core type than in the normals, but they remained unchanged in the drop-out group. In the core type subjects, the increased levels in these indicators persisted briefly after the arithmetic sessions. We discuss the relationship between the clinical character of the two types and the above results. We consider that the psychophysiological character of the two types may play an important role in the pathogenetic mechanism of O.M.A.S.

[An objective technique to examine sensory disturbance in patients with occupational vibration disease. By means of somatosensory evoked response to mechanical stimulation (author's transl)].

Somatosensory evoked responses (SERs) to mechanical (tapping) stimulation were recorded in 24 patients with occupational vibration disease, and they were compared with those recorded in 48 normal subjects. Tapping stimuli were applied on the finger, the palm and the forearm of the bilateral sides. On the other hand, SERs to electrical stimulation were recorded in 5 of the patients, and these were compared with SERs to mechanical stimulation. 1. Some peaks in 32 out of 48 SERs to mechanical stimulation on the finger were absent, and peak latencies in 10 out of the remaining 16 SERs were abnormally prolonged. On the other hand, only 2 out of 27 SERs to mechanical stimulation on the forearm were abnormal. 2. Some peaks in 27 out of 35 SERs recorded in patients with numb sensation in the fingers were absent and peak latencies in the remaining 8 SERs were abnormally prolonged. 3. With respect to the absence of peaks in SERs, P2 and N2 peaks were more frequently absent than N3 and P4 peaks. 4. Peak latencies of the SERs in the patients with occupational vibration disease were abnormally prolonged. The difference of the peak latency between the patients and the controls was statistically significant. 5. Ten SERs to mechanical stimulation and 10 SERs to electrical stimulation were recorded in 5 patients. Nine out of the 10 SERs to mechanical stimulation were abnormal, while only 2 out of the 10 SERs to electrical stimulation were observed. 6. Based on a close relationship between abnormal SERs to mechanical stimulation and the numb sensation in the finger of the patients, it was concluded that sensory disturbances in the occupational vibration disease was due to the lesion in the peripheral nerve. Therefore, SERs to mechanical stimulation can be used for detecting some localized sensory abnormality due to the lesion in the peripheral nerve.