Radiologic and Pathologic Features of the Transmantle Sign in Focal Cortical Dysplasia: The T1 Signal Is Useful for Differentiating Subtypes.

BACKGROUND AND PURPOSE: The transmantle sign is a characteristic MR imaging finding often seen in focal cortical dysplasia type IIb. The transmantle sign is typically hyperintense on T2WI and FLAIR and hypointense on T1WI. However, in some cases, it shows T1 high signal. We evaluated the imaging and pathologic findings to identify the causes of the T1 high signal in the transmantle sign. MATERIALS AND METHODS: We retrospectively reviewed the preoperative imaging data of 141 consecutive patients with histologically proved focal cortical dysplasia. We selected 25 patients with focal cortical dysplasia with the transmantle sign and divided them into groups based on the pathologic focal cortical dysplasia subtype and T1 signal of the transmantle sign. We evaluated the clinical, radiologic, and pathologic findings, including the number of balloon cells and dysmorphic neurons and the severity of gliosis or calcifications and compared them among the groups. RESULTS: Nine of the 25 patients had a T1-high-signal transmantle sign; the other 16 patients did not. All 9 patients with a T1-high-signal transmantle sign were diagnosed as type IIb (group A). Of the 16 patients with no T1-high-signal transmantle sign, 13 were diagnosed as having type IIb (group B), and the other 3 patients, as type IIa (group C). The number of balloon cells was significantly higher in group A than in the other groups, but there were no differences regarding dysmorphic neurons, the severity of gliosis, or calcifications. CONCLUSIONS: Approximately 6% (9/141) of this patient series had a T1-high-signal transmantle sign, and all were type IIb. The signal may reflect a rich density of balloon cells. This finding could support the differentiation of subtypes, especially type IIb.

Nonsphericity Index and Size Ratio Identify Morphologic Differences between Growing and Stable Aneurysms in a Longitudinal Study of 93 Cases.

BACKGROUND AND PURPOSE: Recent studies have strongly associated intracranial aneurysm growth with increased risk of rupture. Identifying aneurysms that are likely to grow would be beneficial to plan more effective monitoring and intervention strategies. Our hypothesis is that for unruptured intracranial aneurysms of similar size, morphologic characteristics differ between aneurysms that continue to grow and those that do not. MATERIALS AND METHODS: From aneurysms in our medical center with follow-up imaging dates in 2015, ninety-three intracranial aneurysms (23 growing, 70 stable) were selected. All CTA images for the aneurysm diagnosis and follow-up were collected, a total of 348 3D imaging studies. Aneurysm 3D geometry for each imaging study was reconstructed, and morphologic characteristics, including volume, surface area, nonsphericity index, aspect ratio, and size ratio were calculated. RESULTS: Morphologic characteristics were found to differ between growing and stable groups. For aneurysms of <3 mm, nonsphericity index (P < .001); 3-5 mm, nonsphericity index (P < .001); 5-7 mm, size ratio (P = .003); >7 mm, volume (P < .001); surface area (P < .001); and nonsphericity index (P = .002) were significant. Within the anterior communicating artery, the nonsphericity index (P = .008) and, within the posterior communicating artery, size ratio (P = .004) were significant. The nonsphericity index receiver operating characteristic area under the curve was 0.721 for discriminating growing and stable cases on the basis of initial images. CONCLUSIONS: Among aneurysms with similar sizes, morphologic characteristics appear to differ between those that are growing and those that are stable. The nonsphericity index, in particular, was found to be higher among growing aneurysms. The size ratio was found to be the second most significant parameter associated with growth.

Adenovirus-mediated suicide gene transfer to small cell lung carcinoma using a tumor-specific promoter.

The gastrin-releasing peptide (GRP) is expressed in most types of small cell lung carcinoma (SCLC) and the GRP promoter is thought to be potentially useful for tumor-specific expression of the suicide gene in SCLC. We constructed an adenovirus containing the herpes simplex thymidine kinase suicide gene driven by the GRP promoter (AdGRP-TK) and transfected it into GRP-expressing SCLC cells (SBC5) to confer sensitivity to ganciclovir (GCV). After infection with AdGRP-TK, SBC5 cells became more sensitive to GCV in vitro. In nude mice, a subcutaneously-inoculated tumor of SBC5 cells infected with AdGRP-TK in advance regressed completely after intraperitoneal administration of GCV. These results suggest that adenovirus-mediated gene transfer of the suicide gene followed by pro-drug treatment may be applicable to SCLC.

A novel detection method for 2'-deoxyoxanosine.

2'-Deoxyoxanosine (dOxo) is a novel DNA lesion produced from 2'-deoxyguanosine by the treatment with nitrous acid and nitric oxide. However, there has been no direct evidence on the formation of dOxo in vivo so far. In order to detect dOxo in vivo, we have explored a sensitive detection method specific for dOxo by using a fluorescent labeling reagent and HPLC analysis. An efficient method to detect the dOxo formation in DNA is described.

Efficacy of ultrasonic mass survey for abdominal cancer.

From August 1983 through March 1995, 204,099 people received ultrasonic mass survey of the abdomen for the first time. Among these examinees, 631 (0.31%) malignant neoplasm cases, such as 201 hepatocellular carcinoma (HCC), 81 gallbladder (GB) cancer, 57 pancreatic cancer, and 169 renal cell carcinoma (RCC), were detected. Three hundred seventy six out of 590 cases (64%), excluding chronic leukemia cases and metastatic liver cancer cases, were surgically resected. The resection rate of HCC, GB cancer, pancreatic cancer, and RCC were 25%, 88%, 49%, and 99%, respectively. The cumulative survival rate of the 376 resected cases was 79.5% at 10 years. The cumulative survival rates of resected cases of HCC, GB cancer, pancreatic cancer and cumulative survival rates of resected cases of HCC, GB cancer, pancreatic cancer and RCC were 34% at ten years, 83% at 10 years, 49% at 7 years, and 99% at 10 years, respectively. Ultrasonic mass survey is dramatically useful for early detection of various kinds of abdominal cancers, especially RCC and GB cancer. From now on, many earlier abdominal cancers will be found by establishing and promoting ultrasonic mass survey systems.

Characterization of monoclonal antibodies against (1R,2R)-cyclohexanediamine platinum(II)-DNA adduct.

Two monoclonal antibodies raised against Pt(II)(1R,2R-cyclohexanediamine)-DNA were prepared, and the specificity of the monoclonal antibodies against Pt(II)(cyclohexanediamine)-DNA derivatives was determined by competitive enzyme-linked immunosorbent assay. The binding affinity of the monoclonal antibodies is apparently influenced by the cyclohexanediamine moiety of Pt(II)(cyclohexanediamine)-DNA adducts, but the monoclonal antibodies can not bind to the low molecular analogue, Pt(II)(1R,2R-cyclohexanediamine)-d(GpG), which is the intrastrand binding model compound of Pt(II)(1R,2R-cyclohexanediamine)-DNA. Therefore, the monoclonal antibodies recognize the macromolecular parts, including DNA duplex, in addition to the cyclohexane moieties of the platinum complexes on Pt(II)(cyclohexanediamine)-DNA adducts.

[Use of a disposable infusion device for continuous epidural block].

We analyzed 130 patients with intractable pain who were treated with continuous epidural block therapy using a disposable microinjector to evaluate its efficacy and utility. The mean treatment period was 4.3 +/- 0.4 weeks. After the treatment, the mean visual analog scale (VAS) improved to 3.3 +/- 0.2, from the pretreatment value of 6.5 +/- 0.1. Among the intractable pain conditions, postherpetic neuralgia (PHN) and pain in the neck, shoulder and upper limbs were relieved markedly, while cancer pain was difficult to reduce. These data show that continuous epidural block therapy using the disposable microinjector is particularly useful in PHN, in which sympathetic nerve block is the essential treatment. The pain in the neck, shoulder and upper limbs was relieved with continuous somatic nerve block.

[Onset of RSD and causalgia].

This study examined the time of onset of RSD and causalgia after injury. Many forms of treatment were tried to relieve the complex and debilitating symptoms in 36 subjects. Burning pain occurred in less than a month in 77.8% of patients.

[Treatment of hemifacial spasm with botulinum toxin].

We injected botulinum toxin to treat hemifacial spasm, and investigated the effects and the patient's impression of this treatment. Average duration of improvement lasted about 3.5 months in both the initial treatment group and the recurrent group. However the patients in the recurrent group received fewer units of botulinum toxin than those in the initial treatment group. Except for local paralysis that disappeared within a month, there were very few complications. Most patient were satisfied with this treatment. We conclude that the treatment of hemifacial spasm with botulinum toxin is both simple and useful.

[A case of intracerebral AVM fed by the anterior ethmoidal artery].

Only 27 cases of dural AVM fed by the anterior ethmoid artery have been reported in the literature. Their nidi were usually in the dura mater. In our case, the nidus was located in the brain parenchyma, although its feeder was the dural artery. A 75-year-old man was admitted to our department because of disturbed consciousness. CT scan showed intracerebral hemorrhage in the left frontal region with ventricular perforation, and subarachnoid hemorrhage in the suprasellar cistern. Left carotid angiography revealed an AVM in the anterior cranial fossa, fed by the anterior ethmoidal artery and drained by a cortical vein, which was dilated with some vascular sacs. A left frontal craniotomy was performed. The subcortical hematoma was removed, and then, after retracing the frontal lobe, two feeders penetrating the dura mater were identified and clipped. The nidus of the AVM with aneurysmal vascular dilatation could be seen on the cortical surface. It was coagulated and removed en-bloc. Histologically, the malformation consisted of thickened dilated veins and distorted small arteries. Postoperative angiography revealed no vascular anomaly. The patient was discharged with mild aphasia and mild right hemiparesis.

[The clinical effect of intravenous regional sympathectomy with guanethidine in the management of sympathetically maintained pain].

We treated 25 patients suffering from sympathetically maintained pain with intravenous regional sympathectomy with guanethidine. Of these patients, 18 had reflex sympathetic dystrophy; 5 had causalgia; and 2 had shoulder hand syndrome. The visual analog scale before IRS therapy was 6.1 +/- 0.3, and after therapy, it was 2.3 +/- 0.4. The mean rate of improvement was 54.2% in reflex sympathetic dystrophy and 81.0% in causalgia. The therapy was particularly effective in patients with shoulder hand syndrome. These results suggest that intravenous regional sympathectomy with guanethidine could be effective for sympathetically maintained pain.

[Glomerulopathy associated with glomerular microtubular deposits: a report of a case].

A male aged 58 was admitted to our hospital because of proteinuria, hematuria and bilateral pretibial edema. Laboratory tests showed normocytic, normochromic anemia and moderately impaired renal function. Antinuclear antibodies were negative. Neither M-protein nor Bence-Jones protein were detected. Light microscopic study on the biopsied renal specimen indicated a moderate mesangial proliferation accompanying with the deposition of PAS-positive and Congo red-negative materials in the subendothelial area. C3 accumulated segmentally along the capillary walls, which was clarified by immunofluorescence microscopy. Staining for IgG, IgA, IgM and light chains were negative. Electron microscopy demonstrated the deposition of microtubules in the mesangial, subepithelial and subendothelial areas. The diameter of these microtubules ranged from 40 to 80 nm. Such type of the microtubules have been reported to exist in the glomeruli in the patients with systemic diseases such as amyloidosis, systemic lupus erythematosus, cryoglobulinemia and light chain disease. In our patient, however, any clinical or serological findings suggestive of these systemic diseases were not obtained. On the other hand previous report pointed out that microtubules deposited in the glomeruli in the patients with immunotactoid glomerulopathy or other glomerulopathies. Our patient had the clinical features consistent with these glomerulopathies. However, no depositions of immunoglobulins were observed. This case is an atypical glomerulopathy accompanying with the glomerular microtubular deposits.

[Effect of botulinum A toxin injection in the management of hemifacial spasm].

The present study was carried out on the effect of botulinum A toxin, made in Japan, in the management of 30 hemifacial spasm patients. In almost all cases, alleviation of hemifacial spasm reached its peak in a few days. Availability was 93.3% and its effect lasted about 4 months. Side effects were observed in 12 patients (40%), but no serious complications were observed.

[Significance of the measurement of arterial ketone bodies during abdominal surgery].

Ketone body (3-hydroxy butyric acid) present in the blood was successively examined during surgical operations to ascertain the condition of energy metabolism and its clinical significance. In 10 patients (R group) to whom only the lactated Ringer's solution was infused during the operation, values of 3-hydroxy butyric acid increased remarkably in the 30 minutes after the operation began. In 7 patients (GI group), to whom the lactated Ringer's solution in 5% of glucose was administered, the values also increased in the 30 minutes after the operation was started. However, after the administration of glucose the values decreased, and returned to the normal value with administration of insulin. Furthermore, blood sugar readings which were examined at the same time increased significantly immediately after the beginning of the operation in both groups. Insulin readings showed considerably low values during the operation in R group. The readings of free fatty acid tended to show high values in R group, while they tended to decrease after the dose of glucose in GI group. With regard to epinephrine and norepinephrine readings, both groups showed significantly high values 30 minutes after the start of operation.

[Iontophoretic administration of indomethacin in the treatment of postherpetic neuralgia].

Iontophoretic administration of indomethacin (IND) was applied to investigate its effect in 21 cases of postherpetic neuralgia (PHN), which showed no response to other treatment such as nerve blocks. Iontophoretic therapy of IND was applied for 20 minutes once a week up to 5 time (series 1). When pain relief was unsatisfactory in series 1, the same treatment was given once again (series 2). Long term follow-up results were obtained 3 months after the final treatment in series 1 or 2. We used visual analog scale (VAS) to measure their pain intensity. VAS was reduced clearly at the end of the treatment in each series. The average improvement rate of the VAS in each series was as follows; series 1:60.3 +/- 8.2%, series 2:73.7 +/- 7.0%, long term follow-up results: 73.7 +/- 7.0% (mean +/- S.E.) We concluded from the present results that iontophoretic administration of IND was one of the effective and useful treatments for PHN.