Clinical Outcomes of Coil Embolization for Acutely Ruptured Aneurysm. Comparison with Results of Neck Clipping when Coil Embolization is Considered the First Option.

SUMMARY: The purpose of this prospective study was to evaluate clinical results in patients with acutely ruptured cerebral aneurysm treated by neck clipping (NC) or coil embolization (CE) when CE was considered the first option. Between 1998 and 2003, 280 patients with acutely ruptured cerebral aneurysms excluding intracerebral hematoma were evaluated. Patients were managed prospectively according to the following protocol: primary treatment modality was CE (n=179). NC (n=101) was selected for the patients with aneurysms that were small (less than 2 mm) or an unsuitable shape for CE. Surgical complication rates were 4.5% for CE and 16.8% for NC. Symptomatic vasospasm occurred in 8.4% of CE patients and 29% of NC patients. Good recovery on the Glasgow Outcome Scale was achieved by 71% of CE patients and 50% of NC patients at discharge. Surgical complications and symptomatic vasospasm were significantly reduced in CE compared to NC. Clinical outcome at discharge was also better with CE. Although 18.3% of CE patients showed various degrees of aneurysmal recanalization and 7% of CE patients required additional treatment (re-CE or NC), aneurysmal rebleeding occurred in only one patient during followup (mean, 3.95 years).

Stability of microcatheter for cerebral aneurysm embolization after steam shaping.

SUMMARY: To compare the performance of stability after steam shaping on 4 types of microcatheters, which are commonly used for cerebral aneurysm embolization, an experimental simulation was performed. Distal portion of the microcatheters were shaped into the 90 degree with length of 5 mm with the steam under the instruction of each catheter. In the temperature kept water bath, the change of the angle of the catheter tips were recorded and measured. Several stresses were added to the tips with coaxially passing through the guiding catheter, using guidewire and Guglielmi detachable coil (GDC). The degree of straightening was prominent on braided microcatheters and on the short length of shaping. The degree of recover of the primary shaping was prominent on non-braided catheter. The most influence factor of straightening of shaped catheter tip was the stress from the manipulation of guidewire. The influence from the inserting GDC was less than the guidewire manipulation. It was shown that the decreased angle after large stress was recovered under the situation of without or with small stress. Our study shows that the nonbraided microcatheter was suitable when stability of microcatheter tip after steam shaping was requested for aneurysm coiling.

Preoperative selective internal carotid artery dural branch embolisation for petroclival meningiomas.

We assessed the clinical value of preoperative embolisation of the dural branches of the internal carotid artery (ICA) in cases of petroclival meningioma was evaluated. We carried out preoperative selective embolisation on seven consecutive patients with large petroclival meningiomas, using nonbraided 2 F steam-shaped microcatheters and shapeable hydrophilic microguide-wires to enter the dural branches of the ICA. The embolisations were performed using digital subtraction fluoroscopy with 150-250 microm polyvinyl alcohol particles. The tumours were resected a few days after embolisation. We reviewed angiographic findings before and after endovascular devascularisation, blood loss during tumour resection and clinical outcome. All endovascular procedures were technically successful, and postembolisation angiography showed disappearance of or marked decrease in tumour stain in all cases. Intraoperative bleeding was easily controlled, and intraoperative blood loss was low.

Implementation of a redox microarray: an experimental model for future nanoscale biomolecular computing using integrated circuits.

The possibility of constructing high-density parallel computing architectures using molecular electronics technology is explored. By employing molecular computing devices, new circuitsystem integration could be realised. To clarify the proposed concept, an experimental model of a redox microarray is presented. A first experimental system for a redox microarray consists of a two-dimensional array of platinum microelectrodes to catalyse reversible reactions of redox-active molecules. Experimental results of active wave propagation in the redox microarray are presented to demonstrate the potential of molecular computing devices for creating artificially programmable reaction-diffusion dynamics for specific target applications.

Coil migration, malposition, stretching and retrieval.

SUMMARY: In this educational program for complicated coil placements, we report several cases of coil malposition, migration, and retrieval. We emphasize that a decrease in the expected one-toone motion of the coil is the earliest sign of a possible imminent complication, and the over the core wire technique with a fixed-loop snare (Gooseneck microsnare) is a very effective potential solution for elongated coil retrieval.

[Therapeutic effect of repetitive transcranial magnetic stimulation in Parkinson's disease].

The therapeutic effect of repetitive transcranial magnetic stimulation (r-TMS) on clinical performance was studied in 8 patients with Parkinson's disease (PD). Seven patients were used as controls and underwent sham stimulation. The modified Hoehn and Yahr (H & Y) Staging Scale, Schwab and England Activities of Daily Living (ADL) Scale and Unified Parkinson's Disease Rating Scale (UPDRS) were used to assess changes in clinical performance. Eight patients were assessed prior to and following 3, 6 and 9 months of R-TMS. R-TMS was applied manually 60 times (30 times each side) to the frontal areas using a large circular coil, a pulse intensity of 700 V, and a frequency of 0.2 Hz. Sessions were performed once weekly for 9 months. The 7 control patients showed no differences in clinical symptoms between initial evaluations and evaluations after 3 months of sham R-TMS. In all 8 patients, the modified H & Y staging and UPDRS scores decreased significantly, and the Schwab and England ADL Scale increased significantly after 3, 6 and 9 months of R-TMS therapy. These results suggest that R-TMS is beneficial for the treatment of Parkinsonian symptoms.

[Efficacy and safety of intramuscular imipenem/cilastatin (IPM/CS) for complicated urinary tract infections].

An intramuscular preparation of imipenem/cilastatin (IPM/CS, 500 mg/500 mg) was administered to 59 patients with complicated urinary tract infections (UTI; cystitis and pyelonephritis) to evaluate its efficacy and safety. The obtained results are summarized as follows: In patients with cystitis, evaluations based on daily frequencies of administration were also performed. 1) According to the treating doctors, the drug showed an overall efficacy rate of 80% (45/56 patients). The efficacy rate was 89% in patients with cystitis treated by a u.i.d. regimen. Among patients treated by a b.i.d. regimen, the efficacy rate was 67% for cystitis cases and 84% for pyelonephritis cases. 2) When clinical efficacy was assessed according to the criteria for UTI drug efficacy evaluation, the drug was 'markedly effective' in 14 patients, 'effective' in 23, and ineffective in 11 patients, for an efficacy rate of 77% (37/48 patients). 3) The microbiological eradication rate was 88% (59/67 strains). The rate was 95% (20/21 strains) for Gram-positive bacteria and 85% (39/46 strains) for Gram-negative bacteria. The efficacy for Enterobacter faecalis and Pseudomonas aeruginosa was 100% and 73%, respectively. 4) As side effects, pain at the injection site was reported by one patient and abnormal laboratory test values were observed in 2 patients. All of these reactions were mild and resolved shortly after the completion of treatment. Based on these findings, it is concluded that this intramuscular preparation of IPM/CS is effective for treating complicated urinary tract infections.

[Motor evoked potentials of transcranial magnetic stimulation for Parkinson's disease].

We studied motor evoked potential (MEP) elicited by transcranial magnetic stimulation (TMS) in 37 patients with Parkinson's disease (PD). TMS was used at high energy capacity (800 Volts) in all patients and normal subjects under resting position. MEPs were recorded from the abductor pollicis brevis and the abductor hallucis. Magnetic stimulator equipped with an 8-shaped coil and a flat type coil was used for TMS. The data were statistically evaluated using a paired Student t test. The latency of MEPs were slightly shorter in PD patients than that in normal subjects. There were significant differences between HV. (Healthy volunteers) and group B (Hoehn & Yahr's stage III) (p = 0.012), HV, and group C (Hoehn & Yahr's stage IV.V) (p = 0.002), group A (Hoehn & Yahr's stage I.II) and C (p = 0.005) respectively. The duration of MEPs became longer depending on the severity of PD evaluated by Hoehn & Yahr's disability rating. Significant correlations were found between HV, and group C (p = 0.001), group A and C (p = 0.015). The amplitude of MEPs also increased with the severity on the rating. There were significant differences between HV, and group C (p = 0.0002), group A and B (p = 0.0004), group B and C (p = 0.0009) respectively. These changes of MEP findings indicated the dysfunction of pyramidal motor pathways in PD. Thus, the disability in patients with PD can be well evaluated by MEP measurement.

[Usefulness of the 24-hour delayed film of upper gastrointestinal series for the diagnosis of sigmoidovesical fistula: report of 3 cases].

Recently, sigmoidovesical fistula is not a rare disease as a result of the change of our food style and increase in the age ratio. However, in general, the preoperative image diagnosis is difficult. We have experienced three cases of sigmoidovesical fistula, examined by barium enema, cystography, upper gastrointestinal series, cystoscopy, colonic fiberscopy and computed tomography. The fistulas were identified preoperatively by the 24-hour delayed film of upper gastrointestinal series. By this method, the regions of sigmoidovesical fistula were identified, and the patients were operated. We concluded that the 24-hour delayed film in upper gastrointestinal series might be useful to diagnose the sigmoidovesical fistula.

Benign intracerebellar cyst without epithelial lining.

A case of benign intracerebellar cyst is reported in a 61-year-old woman who presented progressive neurological deficits. MRI and operative findings could not reveal any evidence of neoplastic growth. The biopsied cyst wall revealed normal cerebellar tissue. The simple cyst of the cerebellum is rare, thus we discuss the clinical features and etiology of this rare entity.

[Percutaneous Bacillus Calmette-Guerin perfusion of the upper urinary tract for carcinoma in situ].

We performed percutaneous perfusion of the upper urinary tract with Bacillus Calmette-Guerin (BCG) in 3 patients. Two of them had undergone unilateral nephrectoureterectomy for ureter carcinoma in situ and one had undergone radical cystectomy with bilateral ureterocutaneostomy for invasive bladder carcinoma. However, they suffered recurrent upper urinary tract carcinoma in situ within 2 years after their operation. Under ultrasound control a percutaneous nephrostomy tube was placed in the patient. Before BCG perfusion unobstructed flow from the renal pelvis to the bladder was confirmed and pyelovenous or pyelolymphatic back flow was excluded under fluoroscopy. A dose of 240 mg BCG was dissolved in 150 ml 0.9% saline. The flask was placed 20 cm above the kidney of the resting patient. A continuous flow of approximately 1 ml per minute was maintained. The perfusion was stopped after 2 hours and the nephrostomy tube was closed. Therapy was repeated at weekly intervals for a total of 6 perfusions (1 treatment course). In each of them urine cytology results became negative after 1 treatment course. No severe side effects were observed. Further investigation is also needed to determine whether BCG perfusion of the upper urinary tract could become a conservative treatment for carcinoma in situ of the upper urinary tract.

[Postoperative adjuvant M-VAC chemotherapy for invasive bladder cancer].

Between 1986 and 1989, 14 patients undergoing cystectomy for bladder cancer, in pathological stage high risk pT2 group, pT3-4 and/or with N+ disease, received postoperative adjuvant methotrexate, vinblastine, doxorubicin and cisplatin (M-VAC) chemotherapy. Of the 14 patients 10 were alive with no evidence of disease for an average of 41 months. Tumor recurrence was seen in 4 patients (bone in 2, lungs in 1, brain in 1 patient). Of the 4 patients, 3 patients died of cancer progression at an average of 26 months and 1 patient was alive with tumor for 30 months. Their actual survival rate at 64 months was 70%, which was significantly higher than that of the historical control groups (1974-1981: 18%, 1982-1985: 46%). Although postoperative adjuvant M-VAC chemotherapy for invasive bladder cancer seemed effective in this study, a controlled randomized study will be necessary to conclude if it could be of real benefit for these patients.

Transforming growth factor beta-like activity in human hydrocele fluid.

In this study transforming growth factor beta (TGF-beta)-like activity in human hydrocele fluid was investigated. Inhibition of DNA synthesis of adult rat hepatocytes in primary culture and stimulation of colony formation of normal rat kidney (NRK) fibroblasts, clone 49F in soft agar were observed in all acidified hydrocele fluids and these activities were neutralized by the specific antibody raised against human native TGF-beta. In samples obtained from recurrent cases of hydrocele, TGF beta-like activity was observed in its active form (without acidification). These results suggest that human hydrocele fluid contains TGF beta-like activity and that the active form of TGF-beta in recurrent hydrocele fluid may be responsible for the recurrence of the disease even after repeated aspiration.