Inhibitory effect of electroacupuncture on murine collagen arthritis and its possible mechanisms.

The influence of electroacupuncture (EA), a traditional Chinese medical treatment, on type II collagen-induced arthritis (CIA) was examined in DBA/IJ mice in vivo. Mice were immunized intradermally twice at a 3-week interval with bovine type II collagen (C II). EA stimulation, begun on day 21 simultaneously with the second immunization, was applied at the acupoint equivalent to GV4 three times a week for 3 weeks. The results showed that EA delayed the onset, attenuated the severity of arthritis, and reduced the anti-collagen antibody level. Furthermore, we investigated the impact of EA on the productions of endogenous interleukin-1 beta (IL-1 beta) and prostaglandin E2 (PGE2), and the levels of IL-1 beta mRNA in splenocytes and synovial tissues from C II immunized mice on day 45 and cyclooxygenase-2 (COX-2) mRNA in lipopolysaccharide (LPS)-stimulated macrophages of normal mice by using reverse transcriptase-polymerase chain reaction (RT-PCR). EA stimulation significantly inhibited the concentrations of splenic endogenous IL-1 beta and serum PGE2. The expression of IL-1 beta mRNA in spleen cells was obviously down-regulated and that in synovial tissues was modestly affected by EA. COX-2 mRNA was highly expressed in cultured peritoneal macrophages when stimulated with LPS. Previous treatment with EA also reduced LPS-stimulated induction of COX-2 mRNA. These data suggest that EA has an inhibitory effect on murine CIA, and the partial mechanism of its therapeutic result may be attributed to inhibiting the productions of IL-1 beta and PGE2 by suppressing the IL-beta and COX-2 gene activations.

[Chemotherapy-resistant CD7-positive stem cell lymphoma presenting with intra-abdominal mass].

We report a case of CD7+ stem cell lymphoma. A 47-year-old man presented with general malaise and lumbago in April 1997. The patient exhibited swollen left cervical lymph-nodes and an intra-abdominal bulky mass. He was referred to us because lymph-node biopsy specimens indicated a diagnosis of diffuse type malignant lymphoma. An abdominal CT scan disclosed large retroperitoneal, para-aortic, and mesenteric root masses. Bone marrow involvement was shown by bone marrow biopsy specimens, though no circulating blasts were detected at presentation. The patient was treated with high-dose CHOP therapy without any benefit. Though ESHAP therapy was performed as salvage chemotherapy, the abdominal masses did not shrink at all. The patient died of tumor progression in November 1997. In the terminal stage, the lymphoma cells emerged in the peripheral blood and thus became available for analysis. The cells expressed CD5, 7, 34, 38, 71, but were negative for CD1, 2, 3, 4, 8, 10, 13, 14, 16, 19, 20, 21, 25, HLA-DR, and EMA. An immunoglobulin heavy chain gene rearrangement band was detected by Southern blot analysis. However, no T cell receptor lambda or beta chain gene rearrangement bands were detected.

[Metastasis of renal cell carcinoma to ipsilateral adrenal residuum and contralateral adrenal gland after radical nephrectomy: a case report].

A 68-year-old woman had undergone radical nephrectomy via a transabdominal approach 4 years earlier for a 8 cm tumor located from the midportion to the upper pole of the right kidney. Pathological diagnosis was renal cell carcinoma (RCC), clear cell subtype, G2, pT2pN0M0. Four years postoperatively, followup computed tomography scan revealed masses in bilateral adrenal region (6 cm in diameter on the left side and 5 cm on the light). Bilateral adrenalectomy confirmed the diagnosis of adrenal metastases from clear cell carcinoma. It was concluded that the tumor had metastasized to the ipsilateral adrenal tissue as the residuum of the previous surgery. She has been treated by oral steroid supplementation without evidence of recurrence for 18 months.

Intraparenchymal meningioma in an infant--case report.

A 1-year and 10-month-old girl presented with an intraparenchymal meningioma in the left frontal lobe manifesting as grand-mal seizures. Computed tomography and magnetic resonance images revealed a round, well-demarcated mass in the left frontal lobe which was homogeneously enhanced. Angiography showed the feeding arteries of the tumor from the middle cerebral artery. The preoperative diagnosis was an intraaxial tumor. At operation, the lesion was totally embedded in the frontal lobe without any connection to the overlying dura or the ventricular system. Some small feeders from the middle cerebral artery were coagulated and the tumor was totally removed. The histological diagnosis was fibroblastic meningioma. Her postoperative course was uneventful. She was doing well 2 years after surgery. Intraparenchymal meningiomas may be seen more frequently than expected in children. Absence of dural attachment is characteristic of pediatric meningiomas.

[A case of effective decompression at the first segment of the vertebral artery for intractable vertigo].

Atherosclerotic change is the main reason for vertebrobasilar insufficiency. However, if clinical symptoms such as vertigo happen transiently and repeatedly with head movement, vascular insufficiency due to mechanical compression of the vertebral artery must be kept in mind as its cause. The patient was a 54-year-old male complaining of recurrent vertigo which occurred during head rotation. He had been treated medically before he came to our hospital. Right compressed vertebral angiogram with head turned to the right and left compressed vertebral angiogram with head turned to the left were obtained at the first segment. Unilateral decompression of the vertebral artery was performed. At surgery it was found that the right vertebral artery was compressed by a stellate ganglion. After cutting of the sympathetic chains, the stellate ganglion was detached from the vertebral artery. The patient's intractable vertigo immediately disappeared after this procedure. It is concluded that if severe vertigo or dizziness is repeated under certain conditions, we must perform a bilateral vertebral angiogram and differentiate whether it is a case of decompression or not and then take measures to bring about decompression effectively.

[Surgical treatment for active infective endocarditis : septic embolization and mycotic aneurysms].

From 1978 through 1995, surgical treatment for active infective endocarditis (native valve) was performed in 17 patients. The indication for operation at the active phase was progressive heart failure in 5 (A-group) and uncontrolled infection in 12 (B-group). Operative findings showed vegetations in all cases, perforations of the valve in 6, rupture of tendon in 2, and annular abscesses in 2. One patient in B-group died 14 days after the operation with postoperative mediastinitis and sepsis. There was no perioperative complications in A-group. In B-group before operations 8 patients (66.7%) has an embolic event before operations. The anatomic sites of embolization were the central nervous system (3 patients), viscera (2 patient) and peripheral arteries (3 patients). And after operation there were 2 mycotic aneurysms of the hepatic artery and the popliteal artery, and 1 pyogenic spondylitis. We conclude that the risk of embolization is high in patients undergoing surgery at active phase of infective endocarditis because of uncontrolled infection ; thus, such patients should be carefully monitored for emboli and mycotic aneurysms.

Magnetic resonance imaging characteristics of choroid plexus papilloma in the fourth ventricle.

The computed tomography (CT) and magnetic resonance (MR) imaging characteristics of two cases of small choroid plexus papilloma within the fourth ventricle are reported. CT showed the tumors as high density areas with postcontrast enhancement. MR imaging showed the tumors as basically isointense areas with marked enhancement by gadolinium-diethylenetriaminepenta-acetic acid. Important MR imaging findings included clear evidence of tumor attachment to the normal choroid plexus, location in the lower part of the fourth ventricle, and separation from the fourth ventricular floor.

Associated injuries and mechanism of atlanto-occipital dislocation caused by trauma.

Injuries associated with traumatic atlanto-occipital dislocation (AOD) leading to death were analyzed in 11 patients, nine injured by traffic accidents, of which five were victims of car-pedestrian accidents. On admission, unconsciousness and respiratory arrest were noted in all patients, and cardiac arrest in nine. Skull and cervical roentgenograms revealed enlargement of the retropharyngeal space due to injury of the vertebral artery or its branches in nine patients, atlanto-axial dislocation (C-1-C-2 separation) in four, and skull fracture in four. Computed tomography demonstrated subarachnoid hemorrhage (SAH) in the upper cervical and posterior fossa in nine patients, fourth ventricular hematoma in seven, and atlas fracture in three. SAH and ventricular hematoma were due to craniocervical injury. Other common injuries were injury of face and head excluding the mandibular region in 10 patients, mandibular fracture in three, severe chest injuries in eight, and intraperitoneal bleeding in two. The overall outcome was poor. Nine patients died within 13 hours of admission, one was diagnosed as brain dead 8 days after the accident, and the other one survived in a persistent vegetative state. Early death is probably caused by associated severe injuries, i.e. chest injuries and intraperitoneal bleeding rather than AOD. Although injury of the mandibular region is known to be associated with AOD, head, breast, and abdominal trauma may also lead to neck hyperextension-flexion in various directions. Whatever the direct cause, a distractive force to the craniocervical joint by hyperextension-flexion appears to be important in the mechanism of AOD.

[Studies on distortion of the optic nerve by the internal carotid artery].

The optic nerve (ON) is sometimes distorted by an atherosclerotic internal carotid artery (IC) which we observe during operations. However the distortion seldom causes visual dysfunction. In this paper, 102 nonoperative cases without severe visual disturbance or marked effect on the visual system were studied, using coronal section of MRI and IC angiography, to ascertion ON distortion by IC. The grading of the distortion was determined by coronal section of MRI. Grade (Gr) 0: No distortion of ON, Gr 1: Distortion of ON without chiasmal dislocation, Gr 2: Distortion of ON with chiasmal dislocation. The rate of Gr 0, Gr 1, and Gr 2 were 62.7, 21.6 and 15.7%, respectively. The age of Gr 0, Gr 1 and Gr 2 were 55.4 +/- 19.6, 63.5 +/- 14.7 and 68.9 +/- 5.0 years old, respectively (Gr 2 was different from Gr 0). The occupying rate was calculated by the following formula. The areas were measured by IC angiography of the optic canal: The area of IC in optic canal/The area of optic anal x 100%. The rate of Gr 0, Gr 1 and Gr 2 were 24.2 +/- 19.8, 76.3 +/- 13.2 and 62.0 +/- 28.2%, respectively (Gr 1 and 2 differed from Gr 0). With a rate of more than 70%, the patient had ON distortion by IC.(ABSTRACT TRUNCATED AT 250 WORDS)

[Four cases of urinary lithiasis associated with chronic inflammatory bowel disease].

We report 4 cases of urinary lithiasis associated with chronic inflammatory bowel disease. All cases were surgically treated and the mode of operation was total colectomy in two cases, ileal resection (1 m) in 1 case and total colectomy and ileal resection (1 m) in 1 case. The composition of the stone was uric acid in 2 cases treated with total colectomy and calcium oxalate in the other 2 cases treated with ileal resection. Low urine volume was observed in 3 cases and acid urine in all cases. Hypocitruria was observed in 3 cases. Two cases with ileal resection showed enteric hyperoxaruia and increased urinary excretion of oxalate was observed on the oxalate loading test.

[A five-year survivor of small cell lung carcinoma stage IIIB treated with surgical resection and an adjuvant chemoradiotherapy--a case report].

A 56-year-old woman was admitted to our hospital with the complaint of cough. She had a rt. supraclavicular lymph node swelling, and her chest X-ray showed masses at the rt. hilum and the mediastinum. On bronchofiberscopy, a tumor was detected at the orifice of the lt. B3b, and the biopsy revealed small cell lung cancer (SCLC). With the peroperative diagnosis of stage IIIB SCLC, a neoadjuvant chemotherapy followed by surgical resection was performed. Because of the presence of malignant cells in the pericardial effusion, the operation turned out to be an absolutely non-curative one. As the recurrence of mediastinal lymph node swelling occurred after the surgery, an intensive chemoradiotherapy was performed successfully. Then the patient has been free from disease for five years. This case indicates the possibility that some of SCLC patients can be long-term survivors by the treatment of an appropriate adjuvant therapy combined with radical resection, even if the clinical stage is advanced. Therefore an extended operative indication for SCLC should be considered.

[Persistent primitive proatlantal intersegmental artery (PPPIA) presenting with cerebral infarction].

A case of persistent primitive proatlantal intersegmental artery (PPPIA) is reported. A 65-year-old male with treated hypertension was admitted to our clinic complaining of dysarthria and hemiparesis of sudden onset two days after the ictus. CT revealed spotty low-density lesions in the left corona radiata and bilateral thalami with bilateral watershed infarction. MRI findings were also compatible with cerebral infarction. Left common carotid angiography demonstrated a large anastomosis between the external carotid artery and the vertebral artery at the proatlantal region. Neither of the vertebral arteries were visualized on digital subtraction aortography. All the blood circulation of the vertebro-basilar system was through this anastomotic artery (PPPIA). A flow study revealed hypoperfusion in the territory of the left middle cerebral artery on 133Xe SPECT. Bone window CT of cervical vertebrae revealed hypoplasia of the left transverse foramen in C2, C3, C4, C5, C6 vertebrae. This case is very suggestive of an anaplasia or hypoplasia of the vertebral arteries. The etiology of his left frontal infarction seemed to be a blood-stealing phenomenon of long standing, from the anterior to the posterior circulation through the PPPIA.

New method of MVD using a vascular tape for neurovascular compression involving the vertebrobasilar artery--report of two cases.

In the treatment of hemifacial spasm and trigeminal neuralgia by microvascular decompression (MVD), lack of improvement or recurrence may occur because of the difficulties in positioning prostheses and the involvement of the large vertebrobasilar arteries, even with use of fenestrated aneurysm clips or adhesives. We have developed a new method of MVD, in which a vascular tape is anchored to the dura mater to transpose the responsible large artery. This method achieved successful results in our two patients with nerve compression involving the vertebrobasilar arteries.

Findings of magnetic resonance imaging in cerebral venous occlusion: difference from hemorrhagic infarction.

A case of cerebral venous occlusion is reported. X-ray computed tomography showed a high-density lesion mimicking an intracerebral hemorrhage. In contrast, magnetic resonance images taken at the early clinical stage revealed a high-intensity lesion in both T1- and T2-weighted images. Follow-up magnetic resonance images at the chronic phase revealed that the intensity of this lesion had changed to low in the T1-weighted image, while still being high in the T2-weighted image. These findings suggest that the lesion might be due to venous congestion produced by cerebral venous occlusion rather than hemorrhage into the cerebral parenchyma.

A case of intraventricular arachnoid cyst. How should it be treated?

A rare case of arachnoid cyst in the trigone of a lateral ventricle is reported. The patient was an 8-year-old boy who had had four episodes of convulsions prior to admission. Computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated a cystic lesion containing fluid resembling cerebrospinal fluid. Although he received a cyst-peritoneal shunt, the lesion did not decrease in size. Direct removal of the cyst was then scheduled. The entire cyst was finally removed, although it was firmly attached to the choroid plexus. The enlarged trigone gradually decreased in postoperative CT. The effectiveness of a cyst-peritoneal shunt is not always satisfactory. We recommend total resection of the cyst without use of a shunt system.

[Tricuspid annuloplasty and right ventricular function in mitral valve disease].

From 1985 to 1987, we examined relationship between the lesion of tricuspid valve and right ventricular function in 31 patients (male: 9, female: 22) with mitral valve disease. The median age at operation was 52 years (range 37-69 years). Group I consisted of 17 patients (MS: 10, MSR: 5, MR: 2) accompanied with tricuspid regurgitation (TR) and Group II 14 patients (MS: 12, MSR: 2) without TR. In all cases of Group I tricuspid annuloplasty (TAP) were performed correctly. De Vega methods were done in 12 cases and Carpentier rings were used in 5 cases. Cardiac catheterization was done before and after operation. And right ventricular volume was measured by right ventricular angiography. In both groups pulmonary capillary wedge pressure, pulmonary artery pressure and cardiac index were improved postoperatively. Pulmonary artery resistance (PAR) and total pulmonary resistance (TPR) in Group I were significantly higher before operation but there were no difference between two groups postoperatively. Right ventricular end-diastolic volume index (RVEDVI) and right ventricular end-systolic volume index (RVESVI) in Group I were significantly improved postoperatively, but in Group II these were within normal range both pre- and postoperatively. Preoperative PAR was correlated inversely with postoperative right ventricular ejection fraction (RVEF). It means that patients with severe pulmonary vascular lesion had postoperative lower right ventricular function. In both groups, RVESVI was in inverse correlation with RVEF pre- and postoperatively. In both groups, there was an inverse correlation between the per cent change of RVESVI and that of RVEF. This means that RVESVI influenced right ventricular pump function.

[Evaluation of the thromboexclusion technique for thoracic aortic aneurysms].

From 1981 to 1987 most of DeBakey III type dissecting aneurysms and a part of descending aortic aneurysms were treated by thromboexclusion technique. The effects of the operation by thromboexclusion technique on the patients were compared with those of the operation by temporary bypass technique. Blood loss during an operation was smaller and blood pressure during an operation was more stable in the thromboexclusion technique group, although the difference was not statistically significant. Furthermore, no paraplegia was observed in the thromboexclusion technique group. The respiratory support period was longer and the number of patients with postoperative myocardial injury was greater in the thromboexclusion technique group, although the difference was not statistically significant. Ten patients treated by thromboexclusion techniques were examined by computed tomography. In 7 out of 10 patients (70%), thrombosis occurred in the false lumen of dissecting aneurysm or in the aneurysmal lumen of descending aortic aneurysm. When only the patients without the leakage of blood into the aneurysm through the permanent aortic clamp were examined, thrombosis was observed in 100% of them. Even though the blood flow was reversed, thromboexclusion technique did not have a bad effect on renal function in the long-term. Postoperatively, however, progressive hypertrophy of the left ventricle was recognized, and furthermore, an injury to the aortic wall caused by permanent aortic clamp was observed at an autopsy. This suggests that further long-term follow-up of patients treated by thromboexclusion technique is necessary.

Holoprosencephaly with Dandy-Walker cyst. Rare coexistence of two major malformations.

A case of holoprosencephaly associated with Dandy-Walker cyst is reported. The patient was a male baby whose mother had normal serum titers for toxoplasma, syphilis, rubella and hepatitis B. She had no history of diabetes mellitus, administration of drugs or irradiation during the pregnancy. At the 8th month of gestation, fetal hydrocephalus was diagnosed by ultrasonic imaging. He was delivered by caesarean section at 34 weeks and 4 days, weighing 2,644 g. His head circumference was 42 cm; the anterior fontanel was not distended and its tension was normal. The chromosomal karyotype was a normal 46 XY. X-ray CT showed a large dorsal sac cyst in the supratentorial space and a hypoplastic cerebellum with a large cyst in the posterior fossa. He received a cyst-peritoneal shunt 24 days after birth. After this procedure, his head enlargement was arrested. We discuss the etiology of this rare coexistence of two major malformations.