[Intracerebral hemorrhage in a patient with moyamoya phenomenon caused by tuberculous arteritis: a case report].

A case of intracerebral hemorrhage which probably had been caused by a rupture of abnormal "moyamoya vessels" due to tuberculous arteritis was reported. A 42-year-old female had a history of tuberculous meningitis at the age of 2 years and suffered from a sudden onset of severe headache in January of 1998. CT scan disclosed a medium-sized intracerebral hematoma in the left frontal base and many calcifications in the basal cistern. Subsequent angiography demonstrated high-grade stenosis in the terminal portion of the right internal carotid artery and near-by "moyamoya vessels". No surgery was performed on the patient. A second angiography was carried out two months later and it newly disclosed ophthalmic artery-feeding "moyamoya vessels" in the place where the intracerebral hematoma had been located. This led us to conclude that a rupture of "moyamoya vessels" was the cause of the intracerebral hemorrhage and "moyamoya vessels" were not visible in the first angiograms because they had been compressed by the hematoma. Although cerebral infarction is common in tuberculous arteritis, cerebral hemorrhage is uncommon. The pathogenesis of cerebral hemorrhage due to tuberculous arteritis and its difference from that of hemorrhage caused by moyamoya disease is discussed.

A prospective study on mortality among Japanese coal miners.

We conducted a prospective study to clarify mortality patterns among Japanese coal miners in a former coal mining area. Subjects included 1,796 coal miners and 4,022 non-coal-miners, who were identified by a mail survey between 1987 and 1989, and then followed up from the date of the survey to April 30th, 1994. We applied Cox's proportional hazards model to compare the mortalities between coal miners and non-coal-miners. Among the coal miners, significantly high risk ratios were observed in all causes of death (risk ratio = 1.4, p < 0.05) and all malignant neoplasms (risk ratio = 1.5, p < 0.05). Risk ratios for all causes of death and all malignant neoplasms also rose with the length of experience in coal mining. Analysis of the results for sites of cancer showed that coal miners had high risk ratios for stomach cancer (risk ratio = 1.6), liver cancer (risk ratio = 1.4) and lung cancer (risk ratio = 1.6), though these ratios were not statistically significant. When the risk ratio for lung cancer was analyzed according to the length of experience in coal mining, coal miners with at least 15 years' experience had a significantly high risk ratio (risk ratio = 2.4, p < 0.05), though coal miners with less than 15 years' experience had almost the same risk as non-coal-miners.

Experimental macular edema of commotio retinae: preliminary report.

Experimental macular edema of commotio retinae was studied in rhesus monkeys. Clinically, opacification of the retina in these experimental animals closely resembled commotio retinae of man. No pigment epithelial damage was detected by ophthalmoscopy and fluorescein angiography showed no leakage from the retinal and choroidal circulations in the macular region. Histologically, macular swelling was apparent and was due primarily to changes of the outer plexiform layer. In this layer, swelling of the axons of the photoreceptor cells was prominent. Intracellular edema was also detected in the Müller cell processes in the inner retina and in the pigment epithelial cells. Prominent changes also occurred in the inner and outer segments of the photoreceptor cells. Disruption of the blood-retinal barrier was not found using horseradish peroxidase as a tracer. We concluded that retinal opacification was due to disagreement and intracellular edema of the cellular elements of the retina, perhaps a direct result of movement of intracellular fluid in response to mechanical injury.

Pigmentation associated histopathological variations in sympathetic ophthalmia.

The severity of inflammation in sympathetic ophthalmia is related to the degree of pigmentation, and the granulomatous response seems to be related to pigmentation. Eosinophilia is also associated with pigmentation, but this association appears to be fortuitous and is a result of the association of eosinophilia with severity of the inflammation.

Pathological studies on the intracerebral and retinal arteries in cerebrovascular and noncerebrovascular diseases.

Histological examinations of the intracerebral and retinal arteries were preformed in patients who had cerebrovascular disease and in those cases who did nott. Fibrinoid degeneration, fibrous nodule, and splitting, which are most frequently found in putamen, thalamus and pons, are thought to be the main changes in cerebral hemorrhage and infarction. Fibrous and fibro-hyalinoid thickenings of the retinal arteries were found mainly in the neighboring region of the optic disk, which reflects the changes of the intracerebral arteries. Hyalinoid thickening was found in the ora serrata, which does not reflect the changes of the intracerebral arteries. Our results suggest that patients with these retinal artery changes in the region near the optic disk if moderate to severe have an increased risk of having or incurring cerebral hemorrhage and infarction, but the arterial changes in the ora serrata do not always indicate risk of cerebral hemorrhage and infarction.