Severity analysis of neurovascular contact in patients with trigeminal neuralgia: assessment with the inner view of the 3D MR cisternogram and angiogram fusion imaging.

BACKGROUND AND PURPOSE: Neurovascular contact (NVC) of the trigeminal nerve is not only detected at the affected trigeminal nerve in patients with trigeminal neuralgia (TN) but is also observed at the asymptomatic nerves on the side contralateral to the TN as well as in normal nerves in control subjects. The frequency and severity of the NVC among the affected, contralateral, and normal trigeminal nerves were analyzed by 3D MR cisternogram and angiogram fusion imaging in relation to the cause of TN. MATERIALS AND METHODS: The inner view of the fusion MR imaging projected from inside the trigeminal nerve was used. The severity of the NVC was classified as none, simple, moderate, or severe, according to the nerve circumference in contact with the vessel. The NVC was analyzed in the affected nerves (n = 66) and the contralateral nerves (n = 66). Forty patients underwent microvascular decompression surgery, and 26 were treated medically. The NVC at the normal trigeminal nerves (n = 78) was studied in 39 control subjects without symptoms of TN. RESULTS: The NVC in the affected trigeminal nerve was observed more frequently and much more severely than that at the contralateral and normal trigeminal nerves in controls (P < .01). Additionally, the NVC in the surgical patients was more severe than that in the medically treated patients (P < .01). CONCLUSIONS: Severity analysis of the NVC with the inner view of the fusion MR imaging may provide useful information in the diagnosis of TN and can be a helpful adjunct in treatment planning for patients with TN.

Differential diagnosis of the infundibular dilation and aneurysm of internal carotid artery: assessment with fusion imaging of 3D MR cisternography/angiography.

Fusion imaging of 3D MR cisternography/angiography was used for the assessment of the vascular bulging finding detected by MR angiography from the viewpoint of the outer wall configuration of the corresponding internal carotid artery depicted by MR cisternography. With a fusion image, useful information was obtained to distinguish an infundibular dilation and enlarged origin of the normal posterior communicating artery from an aneurysm. This imaging technique can be a feasible addition to a noninvasive screening of cerebrovascular lesions with MR angiography alone.

Transparent color-coded three-dimensional diffusion-weighted magnetic resonance imaging for the numerical analysis of reversible and irreversible hyperacute ischemic stroke--case report.

Although diffusion-weighted (DW) magnetic resonance (MR) imaging can detect hyperacute ischemic parenchyma with high sensitivity, the ability of DW images to reveal subtle change in abnormal diffusion may be limited by the conventional visual evaluation. To overcome the limitation, we have developed a method of transparent color-coded three-dimensional (3D) DW MR imaging for the computer-aided numerical analysis of hyperacute ischemic stroke. The 3D images were reconstructed from volume data of source DW images by using a parallel volume-rendering algorithm with transluminal imaging technique. By selecting a threshold range from a signal intensity opacity chart of volume-rendering data set, several high signal intensity areas were depicted and assigned to different colors, transparently through contours of the brain. This imaging was applied in a case of a recanalized middle cerebral artery (M2) occlusion with partially reversible ischemic parenchyma accompanied by partial recovery from ischemic neurological deficit. Complex and dynamic change in hyperacute ischemic parenchyma, with regression of subtle high signal intensity areas and progression of ischemic parenchyma, was depicted three-dimensionally. Transparent color-coded 3D DW MR imaging may provide computer-aided numerical analysis of hyperacute ischemic stroke appearing as a high signal intensity area on the source DW images.

Análisis crítico de la realidad: compendio de datos actualizados / x

El libro"Analisis crítico de la realidad", del Padre Gragorio Iriarte, se constituye en un valioso aporte tanto al campo dela salud como al de la economía, la sociología, ecología, politica y otrasáreas de mucha importancia y de interes general; sus datos estadísticos son muy confiables y nos hacen ver la situación real en que vivimos, su análisis político imparcial, nos permite conocer la otra cara de la moneda, el lado oculto que pocos conocen...

A case of spindle cell carcinoma of the breast--long survival achieved by multiple surgical treatment.

Spindle cell carcinoma of the breast was formerly called carcinosarcoma, and is relatively rare. We report a case of spindle cell carcinoma of the breast. The patient was treated with multiple surgeries and achieved long-term survival. The patient was a 52-year-old woman, in whom small induration developed at the areola of the nipple of the right breast. The lesion was resected, and benign tumor was diagnosed pathologically. Four years later, she had recurrence at the scar, and a typical mastectomy was performed. A tumor developed again 5 years later; the lesional focus was at the scar of the right chest wall and invasion of the ribs and the sternum was noted. The sternum and the right costal cartilage of ribs 3-9 were dissected together. The right chest wall was reconstructed and adjuvant radiation therapy performed. Four years after this operation, tumor recurred near the scar and chest wall resection including part of the pericardial cavity and the left lung was performed. However, 6 months later, invasion of the mediastinum, heart and lung were noted. The patient died 16 years after the first surgery. Dermatofibrosarcoma protuberance of the breast was diagnosed at the second operation. However, the diagnosis was changed to spindle cell carcinoma of the breast following immunohistochemical studies. Spindle cell carcinoma of the breast is rare, and definitive histopathological diagnosis is often difficult. When spindle cell carcinoma is suspected, comprehensive diagnostic studies including immunohistochemical examinations should be performed. Even in case with multiple recurrences correctly performed operations may contribute to prolongation of survival.

DIC-CT findings of biliary cystadenocarcinoma communicating with the bile duct: a case report.

Among the intrahepatic cystic diseases except Caroli's disease, only biliary cystadenoma/cystadenocarcinoma may communicate with the bile duct. We present a case of biliary cystadenocarcinoma in which drip infusion cholangiographic-computed tomography demonstrated communication between an intrahepatic cyst and the biliary system preoperatively. Drip infusion cholangiographic-computed tomography, a simple and noninvasive examination, is useful for differentiating biliary cystadenoma/cystadenocarcinoma from other intrahepatic cystic lesions.

Treatment of hepatocellular carcinoma occurring after distal splenorenal shunt for esophagogastric varices.

BACKGROUND/AIMS: Whereas endoscopic therapy is hardly effective, distal splenorenal shunt is expected to have permanent hemostatic effects on the esophagogastric varices complicated with hepatocellular carcinoma and to sustain favorable general condition of the patient. In this study, we examined the effects of the shunt in the patients who developed hepatocellular carcinoma during the follow-up of the shunt operation. METHODOLOGY: Among the patients who had undergone distal splenorenal shunt operation for portal hypertension caused by cirrhosis, we selected only those who developed hepatocellular carcinoma during the follow-up, and then we reviewed our treatment of hepatocellular carcinoma. RESULTS: Hepatocellular carcinomas developed postoperatively in 12 out of 59 patients with the shunt operation. At onset of the carcinomas, the varices were well controlled with no risk of bleeding; and the liver function was reasonably maintained and pancytopenia was alleviated, compared to those at shunt operation. We performed hepatectomy in 4 cases and nonoperative therapies in 8 cases. After the therapies, no variceal bleeding occurred. Those therapies caused minor complications but no death. CONCLUSIONS: Distal splenorenal shunt is a useful therapy for postcirrhotic esophagogastric varices as it enables us to safely perform therapies for the hepatocellular carcinomas that develop during the follow-up period.

Surgical closure of the gastrorenal shunt with distal splenorenal shunt operation for portosystemic encephalopathy.

A 67-year-old woman was admitted to our institution for hepatic encephalopathy. Careful examination revealed a large gastrorenal shunt. On an occlusion test of the gastrorenal shunt using a balloon catheter, portal vein pressure increased to as high as 26 cm H2O from the pretest value of 17.5 cm H2O. From the significant increase of portal vein pressure, it was thought that simple closure of the shunt could cause postoperative formation of an esophageal varix and its rupture. We thus performed shunt closure with distal splenorenal shunt with splenopancreatic and gastric disconnection to prevent the hazard. In treating the encephalopathy caused by a spontaneous shunt, it is one of the options to perform distal splenorenal shunt with splenopancreatic and gastric disconnection in addition to shunt closure if a remarkable increase of portal vein pressure is observed by the shunt occlusion test.

Fibroblast growth factor-induced gene expression and cartilage pattern formation in chick limb bud recombinants.

To clarify the roles of fibroblast growth factors (FGF) in limb cartilage pattern formation, the effects of various FGF on recombinant limbs that were composed of dissociated and reaggregated mesoderm and ectodermal jackets were examined. Fibroblast growth factor-soaked beads were inserted just under the apical ectodermal ridge (AER) of recombinant limbs and the recombinant limbs were grafted and allowed to develop. Control recombinant limbs without FGF beads formed one or two cartilage elements. Recombinants with FGF-4 beads formed up to five cartilage elements, which were aligned along the anteroposterior (AP) axis. Each cartilage element showed digit-like segmentation. In contrast, recombinants with FGF-2 beads showed formation of multiple thick and unsegmented cartilage rods, which elongated inside and outside the AP plane from the distal end of the recombinants. Recombinants with FGF-8 beads formed a truncated cartilage pattern and recombinants with FGF-10 beads formed a cartilage pattern similar to that of the control recombinants. The expression of the Fgf-8, Msx-1 and Hoxa-13 genes in the developing recombinant limbs were examined. FGF-4 induced extension of the length of the Fgf-8-positive epidermis, or AER, along the AP axis 5 days after grafting, at which time the digits are specified. FGF-2 induced expansion of the Msx-1-positive area, first in the proximal direction and then along the dorsoventral axis. The functions of these FGF in recombinant and normal limb patterning are discussed in this paper.

Cell biology of limb patterning.

Of vertebrate organ systems, the developing limb has been especially well characterized. Morphological studies have yielded a wealth of information describing limb outgrowth and have allowed for the identification of a multitude of important factors. In terms of the latter, key signaling pathways are known to control numerous aspects of limb development, including establishment of the early limb field, determination of limb identity, elongation of the limb bud, specification of digit pattern, and sculpting of the digits. Modification of underlying signaling pathways can thus result in dramatic alterations of the limb phenotype, accounting for many of the diverse limb patterns observed in nature. Given this, it is clear that signaling pathways regulate the highly orchestrated and tightly controlled sequence of cellular events necessary for limb outgrowth; however, exactly how molecular signals interface with the cell biology of limb development remains largely a mystery. In this review we first provide an overview of a number of the morphogenetic signaling pathways that have been identified in the developing limb and then review how a subset of these signals are known to modify cell behaviors important for limb outgrowth.

Portal venous dilatation and stenting for bleeding jejunal varices: report of two cases.

We present two patients who underwent a portal stent placement for bleeding jejunal varices of the afferent loop caused by extrahepatic portal venous stenosis. Case 1 involved a 66-year-old woman who developed bleeding jejunal varices due to extrahepatic portal venous stenosis 1 year after a pancreaticoduodenectomy with intraoperative radiation therapy. Percutaneous transhepatic balloon dilatation and stent placement were performed. Since undergoing the procedure, no bleeding has occurred. Case 2 concerned a 44-year-old woman who had a rupture and bleeding of jejunal varices 16 years after a choledocojejunostomy. Stenosis was observed from the right and left branches of the portal vein to its intrahepatic branches. Both balloon dilatation and stent placement were attempted. However, the stent could not be fully inserted into the intrahepatic portal vein. Portal stent placement is less invasive and radical, and therefore should be attempted for the treatment of extrahepatic portal venous stenosis. However, there are limits to its application if the stenosis extends to the intrahepatic branches of the portal vein.

Radical distal pancreatectomy with en bloc resection of the celiac artery, plexus, and ganglions for advanced cancer of the pancreatic body: a preliminary report on perfect pain relief.

OBJECTIVE: The purpose of this study was to report the effect of radical distal pancreatectomy with en bloc resection of the celiac artery, plexus, and ganglions for locally advanced cancer of the pancreatic body on intractable abdominal and/or back pain and to explore the histopathologic mechanism of this pain. PATIENTS: Five patients with pancreatic body cancer involving the celiac and/or common hepatic artery underwent this radical surgery intended to cure the cancer. DESIGN: A retrospective analysis was performed. MAIN OUTCOME MEASURES: Surgical magnitude, postoperative pain control, postoperative outcome, and histopathologic findings were studied. RESULTS: Arterial reconstruction, gastrointestinal reconstruction, and blood transfusions were unnecessary. The organ deficit was limited to the distal pancreas, spleen and left adrenal gland. There was no postoperative mortality. Postoperative complications occurred in four patients, who were successfully managed with medical treatment. This led to prolonged hospital stays. The intractable preoperative abdominal and/or back pain was completely relieved immediately after surgery in all patients. Perfect pain control has been maintained from surgery to the last follow-up. Histopathologic examination of the surgical specimens revealed cancer invasion of the celiac plexus in all patients. CONCLUSIONS: This operation offers not only disease radicality but also perfect pain relief. The survival benefit has not yet been fully defined.

Preoperative embolization of the common hepatic artery in preparation for radical pancreatectomy for pancreas body cancer.

BACKGROUND/AIMS: To assess preliminary results of preoperative embolization of the common hepatic artery in preparation for distal pancreatectomy with en bloc resection of the celiac and common hepatic arteries for carcinoma of the body of the pancreas involving these arteries. METHODOLOGY: Four patients underwent the embolization with coils 1-7 (median: 5) days before surgery. A detachable coil was used to obtain the best position of the first coil as an anchor in 3 patients. RESULTS: Immediately after embolization, collateral pathways developed from the superior mesenteric artery via the pancreatoduodenal arcades to the proper hepatic and gastroduodenal arteries in all 4 patients; however, they were relatively poor in one patient. There were no complications after embolization. The pulsation of the proper hepatic and gastroduodenal arteries was well palpable during surgery, although it had been compromised sometimes in previous cases without embolization. There were no ischemia-related complications in the 2 patients who underwent radical surgery. CONCLUSIONS: Preoperative embolization of the common hepatic artery is a safe technique and has the potential to enlarge the collateral pathways by the time of distal pancreatectomy with en bloc resection of the celiac artery and prevent postoperative fatal ischemia-related complications.

Nonfunctioning endocrine tumor of the pancreas with extrapancreatic growth and cyst formation: report of a case.

We report a case of nonfunctioning endocrine tumor of the pancreas with extrapancreatic growth and cyst formation. A 48-year-old woman was admitted to our hospital with an upper abdominal mass, which was detected during a routine medical checkup. The preoperative diagnosis was a solid cystic tumor of the pancreas. The tumor, which measured about 7cm in diameter, arose from the head of the pancreas and had a thin stalk, measuring about 1 cm in diameter. The histopathological diagnosis was a malignant nonfunctioning endocrine tumor of the pancreas. Cyst formation occurred in 67% of the reported cases with extrapancreatic growth in Japan. It is speculated that the cyst formation in this disease is related to the large size of the tumor and to the extrapancreatic growth.

Role of chondrogenic tissue in programmed cell death and BMP expression in chick limb buds.

In the developing chick leg bud, massive programmed cell death occurs in the interdigital region. Previously, we reported the inhibition of cell death by separation of the interdigital region from neighboring digit cartilage. In this study, we examined the relationship between cell death and cartilaginous tissue in vitro. First, cell fate was observed with DiI that was used to examine cell movement in the distal tip of leg bud. Labeled cells in the prospective digital region were distributed only in the distal region as a narrow band, while cells in the prospective interdigital region expanded widely in the interdigit. In coculture of monolayer cells and a cell pellet tending to differentiate into cartilage, monolayer cells migrated into the cell pellet. These results suggested that digit cartilage tends to recruit neighboring cells into the cartilage during limb development. Next, we observed the relationship between cell death and chondrogenesis in monolayer culture. Apoptotic cell death that could be detected by TUNEL occurred in regions between cartilaginous nodules in mesenchymal cell culture. More apoptotic cell death was detected in the cell culture of leg bud mesenchyme of stage 25/26 than that of leg bud mesenchyme of stage 22 or that of stage 28. The most developed cartilaginous nodules were observed in the cell culture of stage 25/26. Finally, we observed Bmp expression in vitro and in vivo. Bmp-2, Bmp-4 and Bmp-7 were detected around the cartilage nodules. When the interdigit was separated from neighboring digit cartilage, Bmp-4 expression disappeared near the cut region but remained near the digit cartilage. This correlation between cell death and cartilaginous region suggests that cartilage tissue can induce apoptotic cell death in the developing chick limb bud due to cell migration accompanying chondrogenesis and Bmp expression.

Hepatectomy for metastases from breast cancer offers the survival benefit similar to that in hepatic metastases from colorectal cancer.

BACKGROUND/AIMS: There have been no reports comparing surgical results of hepatectomy for metastases between breast cancer origin and colorectal cancer origin. The aim of the present study was to compare the both and to clarify the survival benefit brought by hepatectomy for metastases from breast cancer. METHODOLOGY: Between 1990 and 1999, 6 patients with hepatic metastases from breast cancer and 94 patients with those from colorectal cancer underwent hepatectomy with curative intent. All patients in the breast-cancer-origin group received adjuvant chemotherapy following hepatectomy, however, fewer patients (55% of the 94 patients) did in the colorectal-cancer-origin group (P = 0.034). RESULTS: Morbidity and mortality rates after hepatectomy in patients with hepatic metastases from breast cancer were 0% and 0%, respectively, and those in patients with metastases from colorectal cancer were 12% and 1%, respectively. Postoperative survival curves in the both groups were similar. Three- and five-year survival rates in the breast-cancer-origin group were 60% and 40%, respectively, and those in the colorectal-cancer-origin group were 54% and 42%, respectively. CONCLUSIONS: When appropriate adjuvant chemotherapy is performed, hepatectomy for metastases from breast cancer offers the survival benefit similar to that in hepatic metastases from colorectal cancer.

Endocrine cell carcinoma of the gallbladder with anomalous pancreaticobiliary ductal junction.

We experienced a case of endocrine cell carcinoma of the gallbladder with anomalous pancreaticobiliary ductal junction. It is well known that anomalous pancreaticobiliary ductal junction has potentiality to cause gallbladder cancer and that most of the cases are papillary adenocarcinoma or well-differentiated adenocarcinoma. The direct relationship between endocrine cell carcinoma of the gallbladder and anomalous pancreaticobiliary ductal junction has not been elucidated.

Pattern formation in dissociated limb bud mesenchyme in vitro and in vivo.

A fundamental process in limb bud development is the formation of position-dependent cartilage pattern. Cells of the distal mesenchyme maintain positional values as the expression pattern of transcription factors, for example, hox genes, which induce position-related cell differentiation and cell surface differences. Cultured, dissociated limb bud mesenchymal cells segregate from each other, and eventually form cartilage nodules. This sorting out is position-dependent, not cell-type dependent, suggesting that the positional values may be involved. Positional valves were found to be retained in limb bud recombinants. In the chick system, the expression of HoxA13 and HoxD12 was present in the distal half of stage 20 recombinants, whereas these markers were expressed throughout the stages 25 recombinants. In the Xenopus system, multiple digit formation was introduced in limb recombinants, and a position-related relationship between regeneration potency and the multiple digit formation could be established. This determination of multiple digit formation with different stages of limb mesenchyme may be useful in understanding mechanisms of the loss of vertebrate limb regeneration potency.