Neuroradiologic findings in focal cortical dysplasia: histologic correlation with surgically resected specimens.

PURPOSE: We investigated the neuroradiologic characteristics of focal findings of surgically resected specimens obtained from 47 patients with focal cortical dysplasia (FCD). METHODS: Forty cases were detected by magnetic resonance imaging (MRI), and two cases were detected only by single-photon emission computed tomography (SPECT), but five cases could not be detected before operation. RESULTS: MRI revealed abnormal gyri and sulci in 34 patients (pachygyric in 18, polymicrogyric in 10, both in six), and blurring of the gray matter-white matter junction in 29 (72%) patients. Signal abnormalities were found in 36 (90%) patients, in the gray matter in 32, with white matter in 30, and at the gray matter-white matter junction in 13. Moreover, peculiar patterns of abnormal signals in the white matter were recognized, including remarkably abnormal subcortical signals of T2 hyperintensity and T1 hypointensity adjacent to the dysplastic cortex in 15 cases, high radiated T2 signals extending from the ependymal surface of the lateral ventricle to the overlying cortex in 11 cases, and widespread abnormal signals in the white matter with gray matter involvement in four cases. Histologically, these abnormal signals corresponded to various degrees of dyslamination and morphologic abnormalities of neurons and glial cells in the gray matter, and to dysmyelination, ectopic clustering of dysplastic neurons, glial proliferation, and necrotic change in the white matter. Regional cerebral blood flow SPECT showed interictal hypoperfusion in 29 (62%) of the 47 patients, interictal hyperperfusion in two, and ictal hyperperfusion in 28 of the 34 patients associated with FCD. [123I]iomazenil SPECT demonstrating the distribution of central benzodiazepine receptors showed low accumulations localized spatially corresponding to the epileptogenic foci associated with FCD in seven of eight patients. CONCLUSIONS: These results demonstrate that neuroimaging reflects various structural and functional changes closely related to epileptogenesis in FCD.

[Study on pulmonary cryptococcosis disclosed by chest radiographic screening in Nagasaki Prefecture].

We conducted a retrospective investigation of 20 cases of pulmonary cryptococcosis discovered by chest radiographic screening in Nagasaki Prefecture among 2,011,577 persons over a period of 9 years, Apr. 1989-Mar. 1998. Eight males and 12 females between 15 and 72 years of age(mean: 46.6 years) were diagnosed as having pulmonary cryptococcosis. The mean detectability of pulmonary cryptococcosis by screening was 0.99 per 10(5) persons: 1.30 for residents, 0.51 for school children and 0.80 for workers. Chest radiography showed shadows of solitary nodules in 9 patients, multiple nodules in 4, infiltration in 4 and others in 3. Cavities were noted in 7. However, it was difficult to distinguish between pulmonary cryptococcosis from pulmonary tuberculosis and pulmonary cancer based on radiographic data alone. Final diagnoses for 11 and 3 patients, respectively, were made using TBLB or BAL, and lung biopsy. Sixteen patients each underwent an Eiken-Latex agglutination test (serum cryptococcus antigen test) and 15 (93.8%) had positive results. The serum antigen level thus appears to be a useful indicator in the supplementary serological diagnosis of pulmonary cryptococcosis.

[Clinical usefulness of trans-brachial angiography for abdominal diseases].

Trans-brachial angiography for abdominal disease has several advantages for the patient. For example, the patient can walk immediately following angiography and can return home or eat in the sitting position after examination. We performed trans-brachial angiography on 451 cases of abdominal disease from June 1992 to March 1995. The purpose of performing angiography in 215 of these cases was examination only, while that in the remaining 236 cases was embolization of liver tumor. Four hundred and five cases were used for the study of safety and accuracy, and the remaining 46 cases as well as another 51 cases of trans-femoral angiography were used for the study of technical difficulty. Based on these experience, we have concluded that trans-brachial angiography for abdominal disease is highly useful, safe and accurate, and can provide significant advantages for patients requiring abdominal angiography.