[Evaluation of aortic aneurysm and dissection by abdominal echography].

Aortic dissection and aneurysm are related to increased vulnerability of the aortic wall due to arteriosclerosis. Echographic findings of aortic sclerosis include irregularity and strong punctate echoes in the intima and meandering of the aorta. Unruptured abdominal aneurysms are often found incidentally by routine echography. The "maximum diameter" and "increase in the size" of aortic aneurysm on echography are important information closely related to the risk of its rupture. In the evaluation of acute aortic dissection, the flap length indicates the range of dissection. The presence or absence of blood flow in the false lumen must be examined simultaneously using color Doppler echography. Some aortic dissections and aneurysms require emergency treatment on detection, and the evaluation of their images on echography, which is often performed for screening of patients with back or abdominal pain, are important for the determination of the therapeutic approach. In patients who are treated conservatively or observed, echography is very useful for the follow-up. Such patients must also be diagnosed or followed up by combining echography with other imaging techniques depending on the condition and necessary information in each patient.

[Cerebral circulation dynamics following fasudil intravenous infusion: a CT perfusion study].

Using CT perfusion studies we evaluated changes in the cerebral circulation before and after the intravenous administration of fasudil 60 mg in 8 patients 7 to 14 days after a subarachnoid hemorrhage. The mean duration to the peak of the time-density curve and the average peak value did not change. In areas with cerebral blood perfusion (CBP) less than 40 ml/100 g/min, the CBP increased from 34.4 +/- 4.7 ml/100 g/min to 41.0 +/- 8.2 ml/100 g/min (p < 0.01) after fasudil infusion, the cerebral blood volume (CBV) rose from 2.41 +/- 0.53 ml/100 g to 2.55 +/- 0.5 ml/100 g (p < 0.05), and the mean transit time (MTT) decreased from 5.09 +/- 1.13 s to 4.82 +/- 0.89 s (p < 0.05). In areas where the CBP was more than 41 ml/100 g/min, the CBP did not change (from 51.8 +/- 7.6 ml/100 g/min to 50.4 +/- 8.4 ml/100 g/min), the CBV decreased (from 2.75 +/- 0.62 ml/100 g to 2.67 +/- 0.55 ml/100 g, p < 0.05), and the MTT did not change (from 3.80 +/- 0.76 s to 3.77 +/- 0.72 s). These results suggest that intravenous infusion of fasudil 60 mg increases cerebral blood flow and cerebral blood volume and shortens MTT in areas with decreased blood flow due to vasospasm.

[Intra-arterial administration of fasudil hydrochloride: duration of action].

Intra-arterial infusion (IA) of fasudil hydrochloride for cerebral vasospasm is performed in many institutions and is associated with few side effects. Nonetheless, as optimum dose and duration of action remain unknown, the present study aimed to clarify these variables. We performed intra-arterial injection of fasudil hydrochloride for eight patients with cerebral vasospasm 7-13 days after subarachnoid hemorrhage. Fasudil hydrochloride was administered via the internal carotid artery without selective microcatheterization, at a concentration and speed of 30 mg/20 ml/10-15 min, using a total dose of 30-60 mg. Cerebral angiography was used to measure change in blood vessel diameter at 19 points, and perfusion CT was used to detect changes in cerebral blood perfusion (CBP), cerebral blood volume (CBV), and mean transit time (MTT) at 12 hemispheres. Investigations were performed before IA, immediately after IA (post IA), and 4.5 to 6 hours later. For central vessels, (A1, M1) mean change in diameter (cm) measured pre IA, post IA, and 4.5-6 hours later was 1.2 +/- 0.68, 1.5 +/- 0.72, and 1.2 +/- 0.7, respectively. For peripheral vessels (peripheral to A1, M1, and the ophthalmic artery) change in diameter (cm) was 0.65 +/- 0.16, 0.97 +/- 0.24, and 0.71 +/- 0.24, respectively. Average CBP (m/100g/min) in the infused hemisphere at pre IA, post IA, and 4.5-6 hours later was 41.6 +/- 3.56, 46.4 +/- 5.82, 41.6 +/- 7.42, respectively. Average CBV (ml/100g) was 2.72 +/- 0.21, 2.73 +/- 0.21, 2.91 +/- 0.42, respectively and average MTT (sec) was 5.16 +/- 0.38, 4.57 +/- 0.70, 5.55 +/- 1.0, respectively. Changes in peripheral vessel diameter and in MTT were statistically significant. Therefore, when performing intra-arterial administration of fasudil hydrochloride, clinicians should be aware that vasodilator effect is less than 6 hours.