Association of baseline plasma des-acyl ghrelin level with the response to rikkunshito in patients with functional dyspepsia.

BACKGROUND AND AIM: We recently conducted a randomized placebo-controlled trial on the efficacy and safety of rikkunshito, a standardized Japanese herbal medicine, for the treatment of functional dyspepsia (FD). The present post-hoc study aimed to evaluate the differences in clinical characteristics between responders and non-responders among FD patients who received rikkunshito for 8 weeks. METHODS: Rikkunshito responders were defined by using a global patient assessment. Candidate predictors included age, gender, smoking, alcohol consumption, body mass index, comorbidity, Helicobacter pylori infection, plasma levels of acyl ghrelin and des-acyl ghrelin, severity of dyspeptic symptoms, FD subgroup, previous medication, and the type of recruiting institution (clinic or hospital). We calculated hazard ratios (HRs) by using Cox regression analysis with the factors that were indicated to be associated with responders. RESULTS: We assigned 83 and 42 patients to responder and non-responder categories, respectively. Lack of alcohol consumption (HR, 2.04; 95% confidence interval, 1.08-3.88) and low plasma des-acyl ghrelin levels (< 177 fmol/mL; HR, 2.42; 95% confidence interval, 1.24-4.73) were significantly associated with the efficacy of rikkunshito. Lack of alcohol consumption was associated with the efficacy of rikkunshito especially among H. pylori-infected participants. On the other hand, the low plasma des-acyl ghrelin was associated with the efficacy of rikkunshito especially among H. pylori-negative participants. CONCLUSIONS: A low baseline level of plasma des-acyl ghrelin was associated with an increased treatment efficacy of rikkunshito against FD. Lack of alcohol consumption was also clinically useful for predicting the response to rikkunshito.

Treatment of ruptured cerebral aneurysms - clip and coil, not clip versus coil.

BACKGROUND AND AIMS: Recent advances in neurosurgery and interventional neuroradiology have brought us a new aspect in the treatment of cerebral aneurysms. The present single-surgeon series provides a balanced overview of the treatment of ruptured aneurysms in surgical clipping and coil embolization. CLINICAL MATERIALS AND METHODS: One hundred consecutive patients with ruptured cerebral aneurysms underwent surgical clipping or endovascular coil embolization between January 2005 and December 2007. All patients underwent clipping or coil embolization of at least one ruptured cerebral aneurysm by a single neurosurgeon (YK) who performed both the surgical clipping and endovascular coiling. RESULTS: Of the 48 surgically treated patients, 37 (77.1%) achieved a favorable outcome. Of the 52 patients who underwent endovascular embolization, 37 (71.2%) achieved a favorable outcome. No significant difference was observed regarding the proportion of favorable outcomes between the two treatment modalities. Five patients (9.6%) who underwent endovascular embolization needed re-treatments, while no re-treatment was necessary in the surgically treated patients. The rates of symptomatic vasospasm and shunt dependent hydrocephalus were 18.8% and 14.6%, respectively, in the clipped patients, and 19.2% and 21.2%, respectively, in the coiled patients. Endovascular coiling of ruptured aneurysms has a tendency towards a higher risk of developing shunt dependent hydrocephalus. CONCLUSION: A combined microsurgical-endovascular approach can achieve the best outcomes for patients with ruptured cerebral aneurysms. Our findings support the policy of "Clip and Coil, not Clip versus Coil."

Follow-up study on in-stent thrombosis after carotid stenting using multidetector CT angiography.

INTRODUCTION: The purpose of the present study was to evaluate the role of multidetector three-dimensional computed tomography angiography (3D CTA) for evaluating both the residual arterial lumen and the sequential change in the intraluminal diameter and thrombus formation following carotid artery stenting (CAS). MATERIALS AND METHODS: Twenty consecutive patients consisting of 23 successfully stented carotid arteries were examined by 3D CTA with volume-rendering at 2, 4, 8, 12 weeks and 6, 12 months of follow-up. RESULTS: The eccentric in-stent hypodense area could be detected in ten of 23 (43.5%) carotid arteries at 2 weeks of follow-up, and they then gradually declined until they almost disappeared at 12 weeks. Eccentric in-stent hypodense areas in the acute and subacute phase (up to 12 weeks after CAS) were found in nine out of 16 carotid arteries with longer stents (3 or 4 cm in size) deployed across the carotid bifurcation, whereas no eccentric in-stent hypodense area could be observed in the patients with a short stent (2 cm) deployed only to the internal carotid artery. Seven of the ten observed eccentric hypodense areas presented on the dorsal surface at the carotid bifurcation level. CONCLUSION: Carotid 3D CTA for evaluating residual lumen and in-stent thrombus formation after CAS is considered to be a useful diagnostic method. To avoid stent occlusion, both the acute and subacute phases following CAS (up to 12 weeks) call for the administration of appropriate anti-platelet therapy and careful observations of the patients.

Cerebral aneurysms: conventional microsurgical technique and endovascular method.

Recent advances in neurosurgery and interventional neuroradiology have brought us a new aspect in the treatment of cerebral aneurysms. The present series provides a balanced overview of the treatment of aneurysms in surgical clipping and coil embolization. Between January 2004 and March 2006, a total of 119 consecutive patients with cerebral aneurysms underwent endovascular embolization or surgical clipping. Of these, 79 patients suffered an aneurysmal subarachnoid hemorrhage (SAH), whereas the remaining 40 patients had nonruptured cerebral aneurysms. Of the 32 surgically treated patients, 25 (78.1%) achieved a favorable outcome. Of the 47 patients who underwent endovascular embolization, 38 (80.9%) achieved a favorable outcome. No significant difference was observed regarding the proportion of favorable outcomes between the two treatment modalities. Four patients (5.5%) who underwent endovascular embolization required re-treatments but no re-treatments were needed in the surgically treated patients. Of the 40 cases with nonruptured aneurysms, 12 (30%) were treated using surgical clipping, whereas 28 (70%) underwent endovascular embolization. The complication rates of the two treatment modalities demonstrated no significant difference. A combined microsurgical-endovascular team approach is thus considered to provide the most effective means to achieve favorable outcomes for patients with cerebral aneurysms. A case-by-case evaluation based on the individual characteristics of each aneurysm is therefore considered to be essential.

Prediction of neurologic deterioration in patients with lacunar infarction in the territory of the lenticulostriate artery using perfusion CT.

BACKGROUND AND PURPOSE: A significant proportion of patients with lacunar infarctions experience neurologic deterioration after onset. However, no clinical examination has been established for prediction of the progress of symptoms. To determine the hemodynamic predictors of such progression, we performed perfusion CT to quantitatively assess cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) of patients with lacunar infarctions in the territory of the lenticulostriate artery. METHODS: We performed MR imaging and perfusion CT of 26 patients with lacunar infarction within 24 hr after onset. On the CBF map on perfusion CT scans, a round small region of interest was set at the region, with decreased CBF in the territory of the lenticulostriate artery (region of interest 1). Another region of interest was set in the mirror position to region of interest 1 in the contralateral hemisphere (region of interest 2). Using these two regions of interest, CBF, CBV, and MTT were measured. All patients underwent neurologic and MR imaging follow-up while receiving equivalent medical treatment. RESULTS: Neurologic deterioration after onset was shown in 13 patients (progress group), whereas no neurologic deterioration was shown in the other 13 patients (control group). In the progress group, lacunar infarctions were enlarged on follow-up MR images. The ratio of region of interest 1/region of interest 2 showed significantly lower CBF and higher MTT in the progress group than in the control group. CONCLUSIONS: These results suggest that progressive lacunar infarction in the territory of the lenticulostriate artery could be predicted with a higher MTT ratio (>1.26) and a lower CBF ratio (<0.76) on perfusion CT scans obtained within 24 hr after onset.