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We present a case of late-onset ulcerative colitis (UC) complicated with cytomegalovirus (CMV) pneumonia revealed by autopsy. A 77-year-old woman had a diagnosis of UC, and received high-dose steroids and leukocytapheresis. Then she received ganciclovir because CMV-pp65 antigenemia test revealed positive which suggested systemic or colonic CMV infection. But ganciclovir was discontinued because of thrombocytopenia and liver dysfunction. After that she had interstitial pneumonia and died of a respiratory failure. Autopsy revealed CMV colitis based on UC, and CMV pneumonia with diffuse alveolar damage. Evaluation of CMV infection in patients with steroid-refractory UC should be considered before proceeding with immunosuppressive therapy or surgery, especially in elderly patients.

We herein present the first known case of common hepatic artery aneurysm involving the proper hepatic artery treated with in situ bypass by using right gastroepiploic artery. A 55-year-old man was hospitalized after the incidental discovery of a low-echogenic mass with blood flow in the hepatic artery. Selective visceral arteriography demonstrated a hepatic artery aneurysm that filled via the superior mesenteric artery. The most proximal part of the common hepatic artery was occluded. A resection of aneurysm was performed, and the arterial blood flow was restored to the liver by mobilizing the right gastroepiploic artery and anastomosing the proper hepatic artery. This technique is preferable to grafting in that only one anastomosis is necessary and predicts that the results may be at least as good as with vein or prosthetic grafts.

An 81-year-old male appealed against a feeling of dyspnea, and consulted the hospital. The giant tumor discovered in the thorax and it was enlarging gradually for 7 years. The tumor shadow with a diameter of about 15 cm was noted in right lower lung field on the chest X-ray. A definite diagnosis was not obtained by the needle biopsy. The tumor was found to exist between upper lobe and lower lobe and pressed lower lobe at surgery. The tumor was completely excised with partial resection of the collapsed lower lobe. The tumor was 1,050 g in weight and 18 cm in maximum diameter. Pathological examination showed the irregular and plan-like arrangement of the spindle-shape cell. Immunohistochemical study revealed positive findings for bcl-2 and CD34, negative findings for desmin, ketatin, and alpha-actin. The tumor was diagnosed as malignant solitary fibrous tumor of the pleura due to highly atypical nuclear finding with an abundant nuclear fission or histology.

Right-sided aortic arch accompanied by an aberrant origin of the left subclavian artery is rare and seen in 0.05% approximately 0.1% of the population. A 73-year-old woman with this anomaly was admitted to our institution because of the enlargement of the distal aortic arch aneurysm. She also had mild dysphagia. The size of the aneurysm was 70 mm in diameter and she underwent total arch replacement using selective cerebral perfusion through a median sternotomy. Additional right thoracotomy was not required and four cervical vessels were reconstructed. The postoperative course was uneventful. This case report shows median sternotomy alone may provide sufficient access for this pathology.

We detected anti-triosephosphate isomerase antibodies (anti-TPI) in cerebrospinal fluid (CSF) in 5 of 12 neuropsychiatric lupus patients (41.6%) by Western blotting. C3d index was significantly higher in anti-TPI-positive patient (n=5, median 0.446) than in anti-TPI-negative patient (n=7, median 0.098) (p=0.019) CSF samples. TPI was detected from immune complexes (IC) isolated from CSF in 2 of 2 anti-TPI-positive patients tested and was not detected from IC in 5 of 5 anti-TPI-negative patients tested. Our results suggest that anti-TPI form IC in CSF and contribute to the pathogenesis of neuropsychiatric lupus by activating the complement system.

A 46-year-old woman was diagnosed with palmoplantar pustulosis (PPP) at the Department of Dermatology, Fukushima Medical University Hospital in 2000, and was treated with ointment. However, because liver dysfunction developed in 2003, she was referred to our department, where primary biliary cirrhosis (PBC) was also diagnosed on the basis of clinical findings. One year later, at the age of 49, she developed manifestations of Behçet's disease (BD), including erythema nodosum in the lower extremities. Because she had a history of uveitis, recurrent oral ulceration was present, and the HLA typing was positive for B51, BD was additionally diagnosed. Liver function normalized within three months of the start of treatment with ursodesoxycholic acid (UDCA). This is the first case of PBC associated with BD and PPP.

Objective: (123)I-metaiodobenzylguanidine (MIBG) has been developed as a functional analog of the neurotransmitter norepinephrine. The success of MIBG as an imaging agent for neural crest tumors is derived from its chemical similarities to norepinephrine. The present study aimed to explore a potential of (123)I-MIBG to differentiate embryonal tumors from other types of brain tumors., Methods: Sixteen patients with brain tumors including three medulloblastomas, one neuroblastoma, six gliomas, and six meningiomas were examined with single-photon emission computerized tomography (SPECT) using (123)I-MIBG. The (123)I-MIBG uptake of tumors was defined as the ratios of tumor/nontumor (early and delayed T/NT) on SPECT images scanned 30 min and 6 h after intravenous injection of the tracer, respectively. Retention index was calculated as (delayed T/NT - early T/NT)/early T/NT., Results: The T/NT ratios on the early images for embryonal tumors (medulloblastomas and neuroblastoma), gliomas, and meningiomas were 3.2+/-1.7 (mean+/-SD), 1.4+/-0.3, and 1.6+/-0.5, respectively. The early uptake was significantly higher in the embryonal tumors than in gliomas (P<0.05). Delayed T/NT ratios for embryonal tumors were increased compared to the early T/NT ratios, while in contrast delayed T/NT ratios for the other tumors remained low (1.2-1.7). The high retention indices of the embryonal tumors indicate specific uptake of (123)I-MIBG in the tumors., Conclusion: Early high accumulation and high retention on delayed imaging may indicate a possibility of (123)I-MIBG SPECT in differentiating embryonal brain tumors from gliomas and meningiomas.

Fluid shear stress is thought to be important in maintaining the phenotype of endothelial cells (ECs) in vivo. The purpose of the study was to determine the effect of varying levels of laminar shear stress on EC elongation and alignment and the role of p38 mitogen-activated protein kinase (MAPK) on the morphologic change induced by shear stress. Cultured bovine aortic ECs were subjected to 1, 4, 7, 14, or 20 dyne/cm(2) laminar steady shear stress. On morphometric analysis of static ECs, the average orientation angle was 41 degrees , whereas after 24 h shear stress at 1, 4, 7, 14, and 20 dyne/cm(2) the angles were 34 degrees, 33 degrees, 16 degrees, 11 degrees, and 10 degrees, respectively. The shape index of static ECs was 0.76, whereas the indexes of ECs exposed to shear stress were 0.72, 0.72, 0.65, 0.50, and 0.47, respectively. The time and the magnitude of activation of p38 MAPK were dependent on the level of shear stress. The results indicate that a minimum shear stress of 7 to 14 dynes/cm(2) is necessary for cell alignment and elongation and this correlates with activity of p38 MAPK. ECs exposed to shear stress in the presence of the p38 MAPK inhibitor SB-203580 did not orient in any manner and the shape index was similar to the static cells.

We describe a 49-year-old woman who presented in 2002 with pure red cell aplasia (PRCA), systemic lupus erythematosus (SLE), and idiopathic portal hypertension (IPH) that developed following a thymectomy. She underwent a thymectomy at 40 years of age to treat myasthenia gravis. PRCA developed 3 years after the thymectomy and she was successfully treated with cyclosporin. Systemic lupus erythematosus and IPH were diagnosed 6 years later. We conclude that immunological dysfunction resulting from the thymectomy contributed significantly to the subsequent development of PRCA, SLE, and IPH in this patient. This is the first report to describe this extremely rare occurrence.

A 53-year-old woman who had been diagnosed with rheumatoid arthritis was found to have thrombocytopenia, splenomegaly, and gastric varices. She was diagnosed as having idiopathic portal hypertension on the basis of liver biopsy and angiography. Treatment with prednisolone was not sufficiently effective for thrombocytopenia. After transabdominal devascularization with splenectomy, thrombocytopenia subsided and gastric varices disappeared. In this case, the autoimmune mechanism as well as hypersplenism was suspected of being involved in the mechanism of thrombocytopenia.

Three-dimensional imaging with MRI is a useful method for neurosurgical simulations. As in our previous study, we have constructed three-dimensional surface anatomical scanning (3D-SAS) from the data of contrast enhanced 3D fast spoiled gradient recalled acquisition in the steady state (3D-FSPGR) sequence. Using this technique, it is possible to generate 3D images from the data of only one acquisition, without using the fusion function. In our previous study, we did not compare the 3D images with the operative views at surgery. In the present study, two radiologists and one neurosurgeon assessed the 3D images in comparison with the operative views. There were problems in some cases, including unclear cortical sulci owing to brain swelling, lack of depiction of the cortical veins owing to meningeal enhancement, inadequate distinction between pial veins and meningeal veins, and so forth. However, in the majority of cases, 3D-SAS with 3D-FSPGR was able to demonstrate good anatomical conformity with the operative views, indicating the clinical usefulness of this technique.

Objective: Increased levels of homocysteine in the blood are a risk factor for atherosclerosis. The purpose of this study was to examine the effects of homocysteine on smooth muscle cell (SMC) migration and to determine whether p38 was involved in this process., Methods: The effect of 0.5 to 2.0 mmol/L d , l -homocysteine as a chemoattractant for SMCs was assayed with a modified Boyden chamber. To determine the functional role of p38 in SMC chemotaxis induced by d , l -homocysteine, we treated SMCs with a p38 inhibitor, SB203580, before the assay., Results: The number of migrated cells was increased 7.0 +/- 1.2-fold (n = 15; P < .001) by 2.0 mmol/L d , l -homocysteine. SB203580 partially prevented the migration of SMCs toward homocysteine. Preconditioning SMCs with 2.0 mmol/L d , l -homocysteine significantly enhanced chemotaxis toward 10% fetal bovine serum compared with nonconditioned control SMCs (28.9 +/- 3.3-fold vs 15.6 +/- 2.8-fold; P < .05). There was a fourfold p38 activation after exposure of SMCs to 2.0 mmol/L d , l -homocysteine by immunoblot., Conclusions: These results suggest that homocysteine not only is a chemoattractant for SMC but can also enhance SMC chemotactic potential. The mechanism of these effects may involve p38 activation., Clinical Relevance: This study demonstrates that homocysteine can promote chemotaxis of SMCs through a p38-dependent pathway. To our knowledge, this is the first report that homocysteine may influence SMC chemotaxis. It may be an important mechanism for homocysteine-induced atherogenesis, because the migration of SMCs from the media is believed to play a critical role in progressive intimal thickening. Although homocysteine promotes atherogenesis and thrombosis by a variety of mechanisms, the effects of homocysteine on SMC proliferation and migration might be critical elements that may have potential therapeutic implications, because selective blockade of the p38 pathway is feasible.

Object: The authors of this study evaluated the efficacy of simultaneous microscopic and endoscopic monitoring during surgery for internal carotid artery (ICA) aneurysms., Methods: The endoscopic technique was applied during microsurgery in 11 patients with 13 aneurysms. Nine of these lesions were located on the posterior communicating artery (PCoA), three in the paraclinoid region, and one on the anterior choroidal artery (AChA). Eight patients had unruptured aneurysms and three had ruptured aneurysms. The endoscope was introduced after first exposing the aneurysm through the microscope and was gripped firmly by an airlocked holding arm fitted with a steering system throughout the entire surgery, including dissection of the perforating arteries and application of the aneurysm clips. Regarding paraclinoid aneurysms, clips were applied through direct visualization of the ophthalmic artery and the proximal neck. In a case involving a superior hypophyseal artery aneurysm in the paraclinoid segment, a ring clip was applied without removing the bone structure around the optic canal. In all aneurysms of the PCoA and the AChA, perforating arteries behind the lesion were identified and dissected using endoscopic control. The aneurysm clip was applied in the best position in a single attempt in 10 of 11 patients. There was no surgical complication related to the endoscopic procedures., Conclusions: Simultaneous monitoring with the microscope and endoscope is extremely useful in applying clips to ICA aneurysms. This combined method allows for direct dissection of the aneurysm, perforating vessels, and the main trunk in an area not visible through the microscope's eyepiece and promises better surgical results.

We reported a rare case of cervical glioblastoma with intracranial dissemination at an early stage of clinical course and reviewed the literature. An 8-year-old girl presented with failure of vision 3 months prior to admission to our hospital. Neurological examination on admission disclosed no definitive abnormalities except for bilateral visual disturbance and optic atrophy. Cranial MR images revealed a homogeneously enhancing tumor in the left sylvian fissure. Multiple spotty T2-hyperintensity lesions without contrast enhancement were also disclosed in bilateral cerebellum. Spinal MR images showed an enhancing tumor at C7 and tiny enhancing lesions on the surface of T11. The patient underwent an uneventful excision of the exophytic tumor at C7. The histological diagnosis was glioblastoma. The enhancing tumor in the left sylvian fissure treated by Linac stereotactic radiotherapy with a marginal dose of 38.4Gy in 12 fractions has diminished, whereas the residual tumor at C7 remained unchanged after radiation of 44Gy. In contrast, the multiple spotty lesions without contrast enhancement dispersedly spread in the cerebellum and infiltrated into brain stem despite 4 courses of chemotherapy using ifosfamide, cisplatin, and etoposide. Stereotactic biopsy of the multiple spotty lesions in the cerebellum was performed. Histological examination revealed anaplastic astrocytoma. The patient died 2 weeks after the biopsy despite additional chemotherapy and focal irradiation to the cerebellum. Early detection and selection of optimal therapeutic strategies are important in management of spinal glioblastoma with subarachnoid dissemination, since neuroradiological findings and therapeutic sensitivity are varied according to differentiation of disseminated tumors.

Amino acid imaging is increasingly being used for assessment of brain tumor malignancy, extent of disease, and prognosis. This study explores the relationship between proliferative activity, amino acid transport, and glucose metabolism in three glioma cell lines (U87, Hs683, C6) at different phases of growth in culture. Growth phase was characterized by direct cell counting, proliferation index determined by flow cytometry, and [(3)H]thymidine (TdR) accumulation, and was compared with the uptake of two non-metabolized amino acids ([(14)C]aminocyclopentane carboxylic acid (ACPC) and [(14)C]aminoisobutyric acid (AIB)), and [(18)F]fluorodeoxyglucose (FDG). Highly significant relationships between cell number (density), proliferation index, and TdR accumulation rate were observed in all cell lines ( r>0.99). Influx ( K(1)) of both ACPC and AIB was directly related to cell density, and inversely related to the proliferation index and TdR accumulation in all cell lines. The volume of distribution ( V(d)) for ACPC and AIB was lowest during rapid growth and highest during the near-plateau growth phase in all cell lines. FDG accumulation in Hs683 and C6 cells was unaffected by proliferation rate, growth phase, and cell density, whereas FDG accumulation was correlated with TdR accumulation, growth phase, and cell density in U87 cells. This study demonstrates that proliferation rate and glucose metabolism are not necessarily co-related in all glioma cell lines. The values of K(1) and V(d) for ACPC and AIB under different growth conditions suggest that these tumor cell lines can up-regulate amino acid transporters in their cell membranes when their growth conditions become adverse and less than optimal.

We reported a rare case of pleomorphic TSH-producing pituitary adenoma with calcification and reviewed the literature. A 25-year-old female was admitted to our hospital with a complaint of anterior neck swelling. An endocrinological examination demonstrated elevated serum levels of free triiodothyronine (FT3: 5.6 pg/ml), free thyroxin (FT4: 2.2 ng/dl), TSH (5.85 microIU/ml), and TSH a-subunit (5.9 ng/ml), whereas a physical examination revealed no goiter. CT scan showed a suprasellar isodensity mass with dense calcification. Contrast-enhanced T1-weighted images revealed a less enhancing tumor extending from the left upper portion of pituitary fossa into suprasellar cistern. The patient underwent gross total removal of the tumor via the right pterional approach. Microscopically, medium-sized to enlarged tumor cells with marked pleomorphism and prominent calcification were observed. The tumor cells displayed positive reaction for TSH (beta-subunit). The MIB-1 index averaged 2.9%. The histological diagnosis was a pleomorphic TSH-producing pituitary adenoma. Postoperatively, the serum levels of FT3, FT4, TSH, and TSH alpha-subunit decreased to normal range. Follow-up MR images showed no evidence of recurrent tumor 3 years after the resection. All of six patients with densely calcified TSH-producing pituitary adenoma, previously reported in the literature, remained well without tumor recurrence. We suggest that this type of TSH-producing pituitary adenoma may be associated with favorable prognosis despite histologically pleomorphic appearance.

We reported a rare case of supratentorial primitive neuroectodermal tumors (sPNET) and reviewed the literature. A 15-year-old girl presented with a one-month history of headache and vomiting. CT scans showed a huge, solid and cystic tumor with calcification, occupying the left anterior cranial fossa. The solid portion of the tumor was hypointense on T1-weighted images, slightly hyperintense on T2-weighted images, hyperintense on diffusion- weighted images, isointense on fluid-attenuated inversion recovery (FLAIR) images, and strongly enhanced after administration of contrast medium. The expansile tumor had a broad attachment to the dura matter of the anterior cranial fossa. The patient underwent an uneventful extirpation of the tumor. Microscopically, the solid tumor contained small, round poorly-differentiated cells with pleomorphic nuclei and brisk mitotic activity. The tumor cells were immunoreactive for synaptophysin and GFAP, whereas lack of MIC2 gene product expression was confirmed using the monoclonal antibody 12E7. The MIB-1-positive rate was 43%. The histological diagnosis was sPNET. Postoperatively, a dose of 30.6Gy was administrated to the whole brain and a boost of 19.6Gy to the T2-hyperintensity lesion. The patient successively received a dose of 30.4Gy to the whole spine and Linac stereotactic radiotherapy with a marginal dose of 16.8Gy at the tumor bed. Three months after radiotherapy the patient received chemotherapy using carboplatin and etoposide. Follow-up MR images showed no evidence of recurrent tumor 5 months after the radiochemotherapy. On the basis of MR findings on both diffusion-weighted and FLAIR images, preoperative diagnosis of sPNET may be important for choosing appropriate therapeutic strategies for this tumor.

Visinin-like protein-3, which is one of the neuronal calcium sensors, has been shown to be mainly expressed in cerebellar Purkinje cells, but cellular function of this protein has not yet been elucidated. We examined the tissue distribution of murine visinin-like protein-3 transcripts using real-time reverse transcription-PCR. Visinin-like protein-3 mRNA was found to be expressed in peripheral tissues. Particularly, the expression of the transcript in the thymus was significantly higher than in other peripheral tissues. In addition, B6RVTC1 thymoma cells robustly expressed visinin-like protein-3 mRNA. To identify a target protein of visinin-like protein-3, we performed a pull-down experiment using glutathione S-transferase-tagged visinin-like protein-3 and two-dimensional electrophoresis. We demonstrated that microsomal cytochrome b(5) was a Ca(2+)-dependent binding partner of visinin-like protein-3. In a co-immunoprecipitation experiment, it was observed that hippocalcin, as well as visinin-like protein-3, could interact with cytochrome b(5). Furthermore, we confirmed that the sequence Val(114)-Tyr(127) at the C-terminal tail of cytochrome b(5) is the minimal structural requirement for binding to visinin-like protein-3. In addition, the loop His(19)-His(25) at the N terminus of visinin-like protein-3 is essential for binding to cytochrome b(5). Microsomal cytochrome b(5) was also shown to be a potential activator of cytochrome P450. The present findings raise the possibility that visinin-like protein-3 may link Ca(2+) signaling to the machinery of microsomal monooxygenase complex composed of cytochrome b(5), cytochrome P450, and some reductases. This report provides the first evidence of an interaction between visinin-like protein-3 and microsomal cytochrome b(5).

Aim: The aim of this paper was to examine effectiveness of maintaining venous blood flow through dissected, but not harvested, grafts on prostaglandin I2 production and endothelial cell regeneration after implantation., Methods: Using 10 dogs, 8-cm-long bilateral jugular veins were dissected; 1 was harvested, and immersed in heparinized blood for 60 or 120 min. The other was left in situ with retained blood flow until harvest after 60 or 120 min. Two 1-cm-long specimens were obtained from these 4 graft types and subjected to PGI2 assay or silver nitrate staining for measurement of endothelial cell coverage area. The remaining 6-cm portions of the 120-min grafts were autogenously implanted into the abdominal aorta, retrieved after 7 days and assayed and measured., Results: Comparisons between groups suggested beneficial effects of preserving venous blood flow until implantation on endothelial coverage and PGI2 production (p<0.05)., Conclusion: Venous blood flow through dissected vein grafts effectively helps preserve PGI2 production.

Vascular closure staple clips made of titanium were originally developed for microvascular anastomosis. Clinical applications for these clips include arteriotomy closure for carotid endarterectomy, extracranial-intracranial bypass, and dural closure. This is the first report in which vascular closure staple clips have been used successfully for direct repair of a tear on the internal carotid artery (ICA). This report involves a 65-year-old man who presented with sudden onset of headache. Admission computerized tomography scans demonstrated a diffuse and thick subarachnoid hemorrhage in the basal cisterns. Cerebral angiograms demonstrated a broad-based, small bulge on the superomedial wall of the left ICA. Intraoperatively, an extremely thin-walled aneurysm was seen on the segment of the ICA at the C-2 vertebral level. The aneurysm ruptured abruptly, although no surgical manipulation was being performed on the aneurysm itself. After temporary clips were applied on the vessel, a large tear of the ICA was repaired with vascular closure staple clips. Reconstruction with the vascular closure staple clips required only a short period of temporary occlusion of the ICA. Postoperative angiograms revealed reduction of the aneurysm bulge and good patency of the ICA. The postoperative course was uneventful, and the patient has been free of symptoms. The vascular closure staple clipping procedure is useful for urgent repair of an aneurysm tear. This method is a new treatment option for these fragile aneurysms in cases in which other options, such as encircling clips or bypass procedures, may have drawbacks or be impossible.

Unlabelled: Assessments of herpes simplex virus 1 thymidine kinase (HSV-tk)/ganciclovir (GCV) treatment response, early in the course of therapy, are important in the evaluation and clinical management of patients. This study addresses whether imaging amino acid transport, glucose utilization, and passive vascular permeability provides an early indication of treatment response and can predict long-term outcome., Methods: Fischer 344 rats with intracerebral HSV-tk transduced RG2TK+ xenografts were studied. GCV-treated (50 mg/kg twice daily) and saline-treated control animals were compared; triple-label quantitative autoradiography was performed 3 d after initiating treatment, and long-term survival was determined. Autoradiograms of (18)F-FDG, (67)Ga-diethylenetriaminepentaacetic acid ((67)Ga-DTPA), and (14)C-aminocyclopentane carboxylic acid ((14)C-ACPC) were obtained; measurements of (14)C-ACPC and (67)Ga-DTPA plasma clearance (K(1)), (14)C-ACPC transport ( partial differential K(1)), relative glucose utililization (R), and normalized radioactivity (% dose/g) were obtained in tumor and brain tissues. Adjacent sections were stained to detect apoptotic cells, microvessels, and type L neutral amino acid transporter in tumor and normal brain., Results: GCV treatment reduced partial differential K(1) and % dose/g of (14)C-ACPC in RG2TK+ xenografts to approximately 30% of that in nontreated animals (from 34 +/- 9 [mean +/- SD] to 9.5 +/- 2.7 microL/min/g and from 0.28 +/- 0.09 to 0.11 +/- 0.04 % dose/g, respectively). GCV had a significant but substantially smaller effect than toxicity on glucose utilization and little or no effect on passive vascular permeability of RG2TK+ xenografts. These differences could not be explained by differences in plasma amino acid or glucose concentration at the time of the study. Histology revealed a large fraction of dead tumor cells and only a sparse distribution of apoptotic cells in GCV-treated tumors. Many CD34-positive endothelial cells in GCV-treated tumors showed only weak or marginal LAT1 staining, whereas CD98 staining remained unchanged. Survival was significantly increased by GCV treatment from 18 +/- 4 to 56 +/- 17 d., Conclusion: (14)C-ACPC influx, K(1)(ACPC), facilitated transport, partial differential K(1)(ACPC), and % dose/g (ACPC) are good indicators of early treatment response after HSV-tk/GCV gene therapy. The parametric images and changes in K(1)(ACPC), partial differential K(1)(ACPC), and % dose/g (ACPC) are substantial and are better than the corresponding measures obtained in the same animals and in the same tissue (tumor) regions with (67)Ga-DTPA and (18)F-FDG. Amino acid transport imaging may be a good surrogate paradigm to monitor treatment response of brain tumors.

We have experienced a case of acute pulmonary embolism after lung cancer operation. The case was a 74-year-old male. He underwent left upper lobectomy due to squamous cell carcinoma. He fell into shock state suddenly on the 6th day postoperatively. We diagnosted acute pulmonary embolism, performed urgent embolectomy under percutaneous cardiopulmonary support (PCPS). Postoperative course was smooth, and he has returned to normal daily life. Urgent diagnosis and management are indispensable for acute pulmonary embolism after lung cancer operation from the aspect of residual among of pulmonary vascular bed.

Objectives: To clarify the mechanism for poor patency of vein grafts after thrombectomy and the time limit for successful salvage operation, we investigated the time course of biologic degenerative changes in thrombosed vein grafts. Materials and methods The right femoral artery was replaced with a femoral vein graft in 25 mongrel dogs. After 3 months, grafts were explanted in 5 dogs (control grafts), and the remaining 20 dogs underwent femoral artery ligation to create a thrombosed graft. Of the 20 grafts, 5 were explanted at 3 days after ligation (group I-3) and 5 were explanted at 5 days after ligation (group I-5). Of the remaining 10 grafts, 5 underwent thrombectomy at 3 days after ligation (group II-3) and 5 underwent thrombectomy at 5 days after ligation, and were reimplanted into the left femoral artery, then explanted 28 days after reimplantation. The grafts were assessed with immunohistochemistry and prostaglandin (PG) I(2) assay (6-keto-PGI(1alpha))., Results: Of the 25 grafts, occlusion recurred in 3 in group II-5 within 28 days after reimplantation. There were significant differences between group I-5 and group I-3 or control grafts for percentage of areas positive for alpha-actin, total number of cells per field, and proliferating cell nuclear antigen (PCNA)-positive cells in layer of thickened intima and atrophied media (I/M), and for total cell and PCNA- positive cell numbers per field in the adventitia. Mean 6-ketoPGF(1alpha) was 40 +/- 14.1 pg/mg/min in control dogs, 84 +/- 18.9 pg/mg/min in group I-3, and 15.4 +/- 7.7 pg/mg/min in group I-5, demonstrating a significant reduction in group I-5 (P =.009)., Conclusion: Graft wall cell viability and PGI(2) production in thrombosed vein grafts are well preserved for up to 3 days. Therefore graft salvage operations no later than 3 days after thrombotic occlusion may provide acceptable long-term patency of salvaged grafts.

A rare case in presented of a patient with edema formation along the optic pathway, which was caused by metastatic suprasellar tumor mimicking craniopharyngioma. A 63-year-old female with visual disturbance, diabetes insipidus, and symptomatic panhypopituitarism was admitted to our hospital. CT images showed a suprasellar mass lesion. MR images demonstrated a heterogeneously enhanced tumor and edema along the optic nerve and tract. Although no cystic component is shown in radiological findings, these features are commonly observed in cases of craniopharyngioma. The patient underwent removal of the tumor by the transcranial approach. Since histological examination revealed adenocarcinoma, the tumor was diagnosed as metastatic brain tumor originating from non-recurrent rectal cancer operated on eight years previously. Conventional radiotherapy with a dose of 50GY was performed for the residual tumor. The tumor size was unchanged, but the edema had disappeared 7 months after the operation. Edema spreading along the optic tract was reported as a characteristic MR finding for diagnosis of craniopharyngiomas as distinguished from other common parasellar tumors. However, it is suggested that edema of the optic pathway seems to be caused not only by craniopharyngioma but also other suprasellar lesions. Even if there was a characteristic radiological finding for some specific diseases, metastasis should be kept in mind as a differential diagnosis, because of its various appearance in neuroimages.

Between 1985 and 2001, eight patients with intracranial ependymomas underwent surgery at our hospital. The cases included six infratentorial ependymomas, one supratentorial ependymoma and one supratentorial anaplastic ependymoma. Infratentorial ependymomas were classified according to origin and extension. The lateral type tumors originated from the lateral part of the fourth ventricle in four cases. The midfloor type tumors originated from the inferior half of the fourth ventricular floor in two cases. The three totally resected tumors were the lateral type tumors. The remaining one case with the lateral type tumor underwent nearly total resection of the tumor, since the tumor involved lower cranial nerves. All patients with the midfloor type tumors underwent incomplete resections of the tumors, because the tumors infiltrated into brain stem. Lower cranial nerve involvement and brain stem invasion implied incomplete resection and had the poor prognosis. In intracranial ependymomas, all four patients with total resections have been alive, whereas three of four patients with incomplete resections have died. The mean survival time of all patients with intracranial ependymomas was 127 months from the time of the initial surgery. There were no deaths in the patients with tumors showing MIB-1 index < 10% (n = 4). The mean survival time of the patients with tumors showing MIB-1 index > or = 10% (n = 4), was 30 months. The extent of the resection, the age of the patients and MIB-1 index are important factors in the outcome in patients with intracranial ependymomas. Two representative children aged less than 3 years with the midfloor type tumors were presented. In a patient treated with conventional radiation and chemotherapy, residual tumor repeatedly enlarged within 12 months despite several resections of the tumor. The patient died 32 months after the initial resection. In contrast, the other patient received multidisciplinary treatment including Linac stereotactic radiotherapy (SRT) with a marginal dose of 27 Gy in 9 fractions, have been still alive for 45 months after the initial resection. The residual tumor slightly decreased in size and remained stable without evident growth 12 months after SRT. SRT may provide good local control for patients with intracranial ependymomas and have a favorable impact on survival.

A case of astrocytoma with extracranial extension after malignant transformation is presented. The patient was a 58-year-old female who suffered from headache. The initial magnetic resonance imaging (MRI) demonstrated a slightly hyperintense tumor on T 2-weighted images in the tip of the left temporal lobe, and no contrast enhancement on gadolinium-enhanced T 1-weighted images(Gd-T 1 WI). On digital subtraction angiography, there was no tumor staining. The initial diagnosis was made as low-grade astrocytoma. However two months later, her symptoms aggravated suddenly. MRI revealed a remarkably growing tumor with ring-like enhancement on Gd-T 1 WI. She underwent a temporal lobectomy, which pathologically demonstrated a glioblastoma. After surgery, chemotherapy and radiotherapy were performed. The tumor invades the skull base and extended into the infratemporal fossa 25 months after surgery.

A 46-year-old woman presented to our hospital with a rapidly growing lump in her right breast. Fine-needle aspiration (FNA) cytology and core needle biopsy of the mass revealed many epithelioid cells admixed with multinucleated Langhans-type giant cells, neutrophils, lymphocytes, and stromal cells, leading to a diagnosis of granulomatous mastitis. Mammography and ultrasonography provided little information for differentiating between granulomatous mastitis and carcinoma. This patient was successfully treated with low dose and short period of corticosteroid therapy.

Fibromuscular dysplasia (FMD) can develop in many different arteries, but iliac artery aneurysms are rare. A 69-year-old Japanese woman was admitted to our hospital for treatment of a right common iliac artery aneurysm. Aortography revealed aneurysms in both the right common iliac artery and the left internal iliac artery. Notably, the right common iliac artery aneurysm had a "string-of-beads" appearance. At surgery, the aneurysms were resected, and replaced with Y-shaped vascular prostheses. The histopathological diagnosis was fibromuscular dysplasia (FMD). We report this case of common iliac artery aneurysm caused by FMD due to its rarity.

We report a rare case of a primary intracerebral malignant fibrous histiocytoma (MFH) with malignant progression from a premalignant stage. A 73-year-old male presented with mild hemiparesis on the right side of his body 4 months prior to admission. MR images showed a homogenously enhanced mass in the left parietal lobe. The patient underwent an uneventful extirpation of the solid mass. Microscopically, the solid tumor contained histiocytic cells and spindle-shaped fibroblastic cells arranged in a storiform pattern. The tumor cells were immunoreactive for vimentin, MAC 387 (macrophage marker) and alpha-1-antitrypsin. The MIB-1-positive rate was 1%. The histological diagnosis was fibrous histiocytoma. Postoperative MR images demonstrated no abnormally enhanced lesions. The patient's neurological symptoms and signs gradually improved. One year after surgery, he developed right hemiparesis. MR images showed a heterogeneously enhanced mass in the left sensorimotor area. This recurrent tumor was totally resected. Microscopically, the tumor was composed of atypical spindle-shaped cells, forming a storiform pattern. Pleomorphism was prominent, and necrotic foci were also seen. The MIB-1 labeling index averaged 11%. The histological findings corresponded to those of MFH. Unfortunately, the patient died of interstitial pneumonia contracted during postoperative radiotherapy. Early detection and resection at a stage of low malignant potential, followed by radiochemotherapy, are crucial for the management of this mesenchymal tumor.

Background: Enhancement of re-endothelialization inhibits the progression of intimal hyperplasia. We investigated uptake of Lipoprostaglandin E(1) (LPGE(1)) by endothelial cells (ECs) and vascular smooth muscle cells (VSMCs), and effects of the LPGE(1) on re-endothelialization of vein grafts., Methods: Primary cultured ECs and VSMCs were obtained from mongrel dogs, and incubated in mediums containing 0.5, 5, 50, and 250 ng/ml of DiI-LPGE(1) (DLPGE(1)); its uptake was visualized by the standard rhodamine excitation, and assessed by flow cytometry. In an implantation study, the bilateral femoral veins of 18 animals were implanted into the femoral artery, and the animals were given 0.2 microg/kg LPGE(1) for 2 weeks. Percentages of EC coverage area of the grafts (%EC) were measured by silver nitrate staining at intervals of 3, 7, and 21 days after implantation., Results: VSMCs showed significant uptake in all of the mediums containing DLPGE(1), whereas the ECs revealed no fluorescence. In flow cytometry, histograms of VSMCs showed a specific notch of DLPGE(1), which increased the height according to the grade of the concentrations. The notch did not appear in the histograms of the ECs incubated with any concentration nor in the VSMCs incubated in control medium. These results suggested that LPGE(1) is predominantly absorbed by the VSMCs and exuded PGE(1) then acts on the VSMCs itself and on ECs alike. The %EC at 7 days was 58.4+/-1.9% in the DLPGE(1) group and 31.6+/-6.8% in controls (p<0.05) showing a significant enhancing effect of DLPGE(1) on re-endothelialization of the vein grafts., Conclusions: In an animal model, daily administration of LPGE(1) resulted in significant enhancement of vein graft re-endothelialization. LPGE(1) was absorbed by the VSMCs, whereas the ECs showed no uptake, therefore the enhancement is probably due to a paracrine effect of VSMCs.

We present the case of an infant with medulloblastoma with extensive nodularity, which had been called cerebellar neuroblastoma. MR imaging clearly revealed a nodular enhancement, which appeared as a grape-like lesion. Single photon emission CT revealed markedly high iodine-123 metaiodobenzylguanidine uptake in the enhancing tumor. Iodine-123 metaiodobenzylguanidine single photon emission CT may be useful in the diagnosis of medulloblastoma with extensive nodularity, which has been considered to be a subgroup of medulloblastoma with extensive neuronal differentiation.

Forty thymomas and thymic carcinomas were classified in terms of WHO histologic typing, Masaoka staging system, and p53 expression. In WHO histologic typing, type A, AB, B1, B2, B3, and C were 1, 10, 16, 5, 4, and 4 cases, respectively. In Masaoka staging system, I, II, III, and IV were 15, 9, 10, and 6 cases, respectively. Thirteen thymomas exhibited positive p53 expression and 27 did not. Type A and AB thymomas had more favorite prognosis than type B3 and C thymomas, and prognosis of type B1 and B2 was middle. Staging by the Masaoka system also correlated with survival rates. Patients who had p53-negative thymomas survived longer than those who had p53-positive thymomas. A treatment strategy for thymomas and thymic carcinomas should be made on the basis of WHO histologic typing, Masaoka staging system, and p53 expression.

A 38-year-old woman with Chiari I malformation presented with spinal cord edema preceding syringomyelia manifesting as a 5-month history of nuchal pain and numbness of the upper extremities. Magnetic resonance imaging showed spinal cord edema, a poorly defined syrinx at the C-2 to T-2 levels, and distorted cerebellar tonsils. Computed tomography revealed cerebrospinal fluid (CSF) density in the center of spinal cord edema, and positron emission tomography revealed no uptake of L-[methyl-11C]methionine, indicating a non-neoplastic lesion. Craniocervical decompression achieved excellent clinical and neuroradiological outcomes. The success of surgical treatment supports the theory that patients with Chiari I malformation have increased transmural flow of CSF, causing spinal cord edema that progresses to syringomyelia. Early treatment of patients with spinal cord edema is indicated to prevent permanent spinal cord injury due to progressive syringomyelia.

We reported a rare case of third ventricular chordoid glioma and reviewed the literature. A 25-year-old male presented with a two-year history of voracious appetite. Three months prior to admission, he developed progressive memory impairment. CT scan showed a well circumscribed, slightly hyperdense mass without calcification in the third ventricle. The 4.5-cm oval mass occupying the anterior part of the third ventricle was homogeniously enhanced on MR images after administration of contrast medium. Small cystic components were present in the periphery of the mass. CT-guided stereotactic biopsy was performed. Microscopically, epithelioid tumor cells were embedded in mucinous stroma containing a lympho-plasmacytic infiltration. The tumor cells were immunoreactive for GFAP and vimentin. The MIB-1-positive rate was 1.2%. The histological diagnosis was a chordoid glioma. One month after the biopsy, a right frontal craniotomy was performed to remove the tumor via the anterior transcallosal interfornitial approach. The tumor arising from the anterior part of the third ventricle wall was soft, mildly vascular and light-grayish. The tumor was completely resected. The histological findings were identical with those of the biopsy specimens. Postoperatively, the patient developed diabetes inspidus, hyperthermia, worsening memory impairment, and transient hyponatremia. The patient's symptoms gradually improved and follow-up MR images showed no evidence of recurrent tumor 17 months after the resection. Despite low-grade appearance, attachment of the tumor to the hypothalamus preclude complete resection, and this may result in tumor recurrence and less favorable prognosis in the current reports. Early detection and aggressive resection followed by stereotactic radiotherapy are important in the management of chordoid glioma.

The immunological screening of breast cancer was performed with IgG autoantibodies by the serological analysis of recombinant cDNA expression library methods to explore novel tumor associated antigens. We have focused on a small zinc finger protein metallopanstimulin-1 (MPS-1). MPS-1 mRNA was ubiquitously expressed in normal human tissues except the brain and the placenta. In Western blot analysis, MPS-1 was easily detected strongly in actively proliferating cells and three breast cancer cell lines. In the tissue the protein of MPS-1 in cancer cells was more abundant than that of surrounding normal cells. Screening of tissue specimens by immunohistochemistry revealed 50.4% positive for MPS-1 in 125 cancer patients. These data suggest that MPS-1 could be applicable to the immunotherapy of breast cancer.

Orbital neuroma is a rare disease accounting for a certain percentage of all orbital tumors. However, because of the anatomical features of the orbit, the origin of the tumor has been diagnosed in only a few cases. The authors report a case of orbital neuroma arising from a short ciliary nerve that was confirmed during surgery. The patient was a 72-year-old female. She visited our hospital with complaints of left visual disturbance, exophthalmus and diplopia. Neurological examination on admission also revealed Marcus gunn pupil sign. CT scan and MRI imaging showed a left orbital tumor located along the superior surface of the optic nerve and adjacent to the posterior pole of the eye ball. She underwent superior orbitotomy through a transcranial approach. The tumor was encapsulated and adhered tightly to the sclera, short ciliary nerve, and optic nerve. For this reason, it was removed without a part of the adhered capsule. Since histological examination revealed neuroma, the tumor was diagnosed as short ciliary nerve neuroma. Postoperatively no additional deficits occurred. The exophthalmus, diplopia and Marcus gunn pupil sign disappeared and visual acuity was improved after the surgery. In such a case of short ciliary nerve neuroma, it is possible to remove the tumor without any neurological deficit, if careful consideration of microsurgical anatomy is made.

A case of frontal atypical teratoid/rhabdoid tumor (AT/RT) was presented in the findings of single-photon emission computerized tomography (SPECT) using 201Tl-chloride (Tl) and 123I-metaiodobenzylguanidine (MIBG), and positron emission tomography using 18F-fluorodeoxyglucose (FDG) and (11C-methyl)-L-methionine (Met). A 16-year-old female had an episode of Jacksonian seizures one month prior to admission. CT scans showed an isodensity mass with heterogeneous enhancement in the left frontal lobe. MR images revealed a tumor with solid and cystic components and perifocal edema. SPECT demonstrated intense accumulation of Tl and MIBG in the enhancing lesion 15 min and 30 min after intravenous injection of tracers, respectively. The 6-hr delayed SPECT showed no retention of MIBG in the enhancing lesion. FDG-PET and Met-PET revealed high uptake of tracers in the enhancing lesion. Met did not accumulate in the frontal white matter, which appeared hyperintense on T2-weighted MR images. The patient underwent an uneventful extirpation of the solid mass, where Met had accumulated. Microscopically, the solid tumor contained rhabdoid cells, spindle-shaped cells resembling mesenchymal cells, and nests of small cells. The tumor cells were immunoreactive for vimentin, cytokeratin, and epithelial membrane antigen. The MIB-1 labeling index was 25%. The histological diagnosis was AT/RT. Postoperative course was uneventful. A dose of 32.4 Gy was administrated to the whole brain and a boost of 27.8 Gy to the T2-hyperintensity lesion. Five months after the radiotherapy, MRI showed neither abnormal enhancing lesions nor the T2-hyperintensity lesion. Multifarious studies using SPECT and PET are useful for differential diagnosis and for choosing optimal therapeutic strategy for this type of tumor.

We report herein the case of a 66-year-old man with basaloid squamous cell carcinoma (BSCC) of the esophagus. There are only 60 cases of BSCC of the esophagus previously reported in Japan. In our patient, endoscopic findings revealed a type 2 in the lower intrathoracic esophagus (Lt), and the tumor was intact with the aorta (T2). A biopsy suggested that it was adenosquamous cell carcinoma. An operation was done on June 11, 1996. With open thoracotomy, esophagectomy was performed with mediastinal lymphnode dissection by posterior mediastinal esophagogastrostomy. Histologically, the lesion of the tumor with ulceration was composed of BSCC, and other lesion was composed of typical squamous cell carcinoma (SCC). The immunohistochemical findings of the respected specimens led us to suspect that the basal-layer-type SCC had transformed into BSCC by undergoing differentiation and expansive proliferation. According to the prognosis, eventually the patient died of pneumonia due to methicillin resistant Staphylococcus aureus (MRSA) and candida 4 years and 9 months after the surgery.

Object: The characteristics of a previously unclassified paraclinoid aneurysm arising from the anterolateral (dorsal) wall of the proximal internal carotid artery were retrospectively analyzed in seven patients (five women and two men) who were treated surgically for an aneurysm in this unusual location., Methods: One patient presented with subarachnoid hemorrhage (SAH) caused by rupture of this aneurysm. The lesions were found incidentally (five cases) or during investigation of SAH due to another aneurysm (one case). There was a female predominance in this series; all female patients harbored multiple aneurysms. All patients underwent surgery. Removal of the anterior clinoid process was necessary because the proximal neck of the aneurysm was closely adjacent to the dural ring., Conclusions: This special group of aneurysms is very rare, is located exclusively in the intradural space, and carries the risk of SAH. The results of surgical treatment for this aneurysm are quite satisfactory.

Purpose: Porcelain aorta is an indication for axillofemoral bypass. However, the procedure has definitive flaws. We present a new method for achievement of aortofemoral bypass., Methods: The portion of the distal aorta for anastomosis is wrapped with a double polytetrafluoroethylene mesh and fixed to the adventitia with continuous sutures. The adventitia of the anastomotic site is cut over the mesh until the calcified surface is disclosed. Margins of the mesh and the peeled adventitia are fixed along the anastomotic margin with continuous sutures. After the aorta and distal arteries are occluded with balloon catheters, an opening on the bared calcification is made with an airdrill and enlarged with a laminectomy rongeur. The anastomosis is performed between a graft and the mesh-reinforced adventitia with continuous sutures. Over 6 years, this method has been applied to nine patients with porcelain aorta who are diabetic or undergoing dialysis. The indications were disabling claudication in three patients and limb salvage in six patients., Results: No anastomotic complications or operative deaths were seen, and satisfactory mid-term results were obtained, with follow-up ranging from 3 to 62 months after surgery. One patient died of coronary heart disease 3 years after surgery, but the grafts retained a good function., Conclusion: This method is safe and effective, and more liberal application of this method may help improve outcome and quality of life.

Objective: Efficacy and duration of antibacterial activity of rifampicin-gelatin grafts against virulent organisms were evaluated in an animal model., Materials and Methods: Rifampicin-gelatin grafts were prepared with impregnation of Gelseal (Vascutek Ltd, Scotland) graft in 1 mg/mL rifampicin solution. Rifampicin-gelatin grafts (6 cm long; n = 24) and plain Gelseal grafts as controls (n = 4) were implanted into the canine abdominal aorta with inoculation of Staphylococcus epidermidis, Escherichia coli, or methicillin-resistant Staphylococcus aureus (MRSA), and the rifampicin-gelatin grafts were retrieved after 1 to 4 weeks. Disks cut from the retrieved rifampicin-gelatin grafts were placed on agar plates streaked with one of the organisms, and the graft antibacterial activity was assessed with the width of the inhibition zone., Results: In in vitro tests, initial inhibition zones (inhibition zone of 24 hours after incubation) of rifampicin-gelatin grafts against S epidermidis, MRSA, and E coli were 40.0 +/- 0.3 mm, 36.0 +/- 0.2 mm, and 11.8 +/- 0.1 mm, respectively. In the implantation, S epidermidis -inoculated rifampicin-gelatin grafts had no findings of graft infection, and no colony growth was recognized on the plates streaked with the perigraft fluids. Initial inhibition zones of S epidermidis -inoculated rifampicin-gelatin grafts retrieved at 1 or 2 weeks were 20.1 +/- 1.1 mm and 7.6 +/- 1.0 mm, respectively. In E coli -inoculated and MRSA-inoculated rifampicin-gelatin grafts, all of the eight animals had perigraft abscess, and blood culture test results probed septicemia in five animals with patent grafts at death. Inhibition zones against E coli or MRSA were not formed on the plates streaked with the same organism, whereas initial inhibition zones of E coli -inoculated and MRSA-inoculated rifampicin-gelatin grafts on S epidermidis -streaked plates were 8.0 +/- 0.2 mm and 18.5 +/- 0.5 mm, respectively. In the MRSA group, however, recolonization of high minimal inhibitory concentration strains developed within the inhibition zones as early as 24 hours. Histologically, neither organisms nor inflammatory cells were found in S epidermidis -inoculated rifampicin-gelatin grafts and tissue ingrowth was recognized at 2 to 4 weeks, whereas E coli -inoculated and MRSA-inoculated rifampicin-gelatin grafts had aggressive neutrophil infiltration into the graft interstices, revealing establishment of uncontrollable graft infection., Conclusion: These results suggested that rifampicin-gelatin grafts are clearly valid for S epidermidis infection, whereas no efficacy was recognized against either MRSA or E coli graft infection because of early development of high minimal inhibitory concentration MRSA strains or poor susceptibility.

We report the first case of a chronic intestinal pseudoobstruction (CIPO) in a patient with rheumatoid arthritis (RA) in whom a stoma was constructed at the sigmoid colon to decompress intracolonic pressure. The treatment improved quality of life in this patient, suggesting that surgical resection of the colon to decompress intracolonic pressure would be one of the options for the treatment of intractable CIPO. The resected specimen obtained from the sigmoid colon was found to be palisaded, with nuclei crowded in some areas of the inner circular muscle layer and thickened, with zonal or focal myxoid regions with interstitial fibrosis, composed of collagenous and elastic fibers, in the outer longitudinal muscle layer. Some of the smooth muscle cells in the outer longitudinal muscle layer showed mild degeneration with cytoplasmic vacuolar changes, but no inflammatory changes. However, further studies are required to determine whether these histopathological changes are unique to RA.

A patient with Moyamoya-like vessels after radiation therapy for treatment of a tumor in the basal ganglia is reported. He was diagnosed as Down syndrome at birth. He had a tumor in the left basal ganglionic region at 12 years of the age. The tumor increased in size at age 14. He underwent cerebral angiography, which did not show a stenosis nor occlusion of the internal carotid artery, anterior cerebral artery, nor the middle cerebral artery. He received radiation therapy with a total dose of 56 Gy. He presented a dressing apraxia at age 19. MRI showed cerebral infarction in the left temporo-occipital region. Right internal carotid angiography revealed a severe stenosis of the internal carotid artery and anterior cerebral artery as well as a severe stenosis of the middle cerebral artery on the right side. Moyamoya-like vessels were seen in the basal ganglionic region. Left internal carotid angiography also showed a stenosis of the internal carotid artery and anterior cerebral artery as well as a severe stenosis of the middle cerebral artery on the left side. Moyamoya-like vessels were seen in the basal ganglionic region. Leptomeningeal anastomose and transdural anastomose were bilaterally seen. These arterial occlusion and stenotic phenomenon corresponded to a previous radiation field. These Moyamoya-like vessels with arterial stenosis and occlusion were thought to be due to radiation-induced vasculopathy, because a previous cerebral angiography showed a normal caliber of cerebral arteries. This patient showed that patients with radiation therapy in their early childhood should be carefully observed considering the possibility of this phenomenon.

Objective and Importance: Two rare cases of middle cranial fossa neuroma located in the epidural space at the petrous apex are reported., Clinical Presentation: Two women, aged 58 and 49 years, were admitted to our hospital with diagnoses of cavernous sinus tumor. Analysis of preoperative computed tomography scans showed bone erosion of the petrous apex, and magnetic resonance imaging demonstrated the presence of an extradural mass located along the course of the petrous internal carotid artery in both patients., Intervention: The tumor was completely removed in one patient and partially removed in the other by use of the epidural middle cranial fossa transpetrosal approach. In both patients, histological examination of tumor specimens revealed neuroma., Conclusion: Because surgical exploration revealed that these epidural tumors adhered tightly to the internal carotid artery, and because they had no relationship to the trigeminal nerve, facial nerve, or proximal greater superficial petrosal nerve, in our opinion, these tumors originated from the distal portion of the greater superficial petrosal nerve or the deep petrosal nerve. These neuromas were mainly found in a site under the cavernous sinus at the petrous apex, a location not previously reported.

Objective: To examine the effect of transfection of oligodeoxynucleotides (ODNs) containing a CpG motif (CpG-ODN), of which the sequence was derived from circulating DNA in the sera of patients with systemic lupus erythematosus (SLE), on the expression of intercellular adhesion molecule-1 (ICAM-1) and synthesis of mRNA for proinflammatory cytokines and ICAM-1 in human umbilical vein endothelial cells (EC)., Methods: A CpG-ODN or a control analogue, GpC-ODN, was transfected into EC. ICAM-1 expression was examined by flow cytometry, and expression of mRNA in EC encoding interleukin 1 (IL1), IL6, IL8, tumour necrosis factor alpha (TNFalpha), interferon gamma (IFNgamma), and ICAM-1 was examined by semiquantitative reverse transcriptase-polymerase chain reaction., Results: The CpG-ODN augmented the expression of ICAM-1 on EC determined by flow cytometry and increased mRNA levels of IL6, IL8, TNFalpha, IFNgamma, and ICAM-1, but the GpC-ODN did not., Conclusion: Synthesised DNA, with a sequence corresponding to that of the fragment containing the CpG motif, in sera of patients with SLE was found to enhance ICAM-1 expression on EC, suggesting the participation of circulating DNA fragments in the pathogenesis of vasculitis in SLE.

A 38-year-old woman visited our hospital with edema on her face and conjunctivae. The underlying disease was not clarified, and she did not visit the hospital afterwards. She suffered from diarrhea, polyarthralgia, Raynaud's phenomenon, malar rash and hair loss in the subsequent two years, and was hospitalized because of hypoproteinemia. Her urine, liver and heart test results did not account for her hypoproteinemia. She was diagnosed as having protein-losing enteropathy (PLE) associated with SLE based on the 99mtechnetium-labeled human serum albumin scintigraphy findings, clinical findings and laboratory results of antinuclear and anti-Sm antibodies. This case report demonstrates a strong association between PLE and SLE because PLE was aggravated along with the appearance of SLE symptoms and PLE subsided with prednisolone treatment along with improvement of SLE.

Objective: Reduced coronary reserve during reperfusion may cause postischemic diastolic dysfunction in pressure-overload-induced hypertrophy. We studied the effect of coronary flow regulation (simulated hyperemic or depressed flow) on postischemic cardiac function during reperfusion., Methods: Left ventricular pressure overload was induced in 4-week-old rats by abdominal aortic constriction. At 6 weeks of age, isolated Langendorff-perfused hearts (perfusion pressures: 75 mmHg in controls and 110 mmHg in the aortic constriction group) were subjected to hypothermic global ischemia (15 degrees C, 210 min), followed by 2 types of coronary flow regulation during the initial 20 min of reperfusion--manipulated high flow in control hearts (group I), manipulated low flow in control hearts (group II), manipulated high flow in aortic constriction hearts (group III), and manipulated low flow in aortic constriction hearts (group IV) (n = 6/group), and then constant pressure perfusion during the subsequent 45 min of reperfusion. Cardiac function was measured using an isovolumic balloon in the pre- and postischemic periods., Results: Aortic constriction hearts exhibited greater left ventricular end-diastolic pressure than did control hearts. The increase in left ventricular end-diastolic pressure did not differ between group I (3 +/- 2 mmHg) and group II (-1 +/- 1 mmHg) or between group III (29 +/- 5 mmHg) and group IV (30 +/- 6 mmHg). No difference was seen in postischemic recovery of left ventricular systolic pressure between high and low flow groups in control and aortic constriction hearts., Conclusion: Manipulations in coronary flow during reperfusion did not affect postischemic cardiac function in control or aortic constriction hearts, suggesting that depressed coronary flow during early reperfusion is not a primary cause of postischemic diastolic dysfunction in the hypertrophied myocardium.

Study Objectives: To determine the significance of serotonin in the pathogenesis of interleukin (IL) 6-induced pulmonary hypertension (IL-6-PH) in rats, the plasma serotonin concentrations, and the effects of a specific antagonist of the serotonin (5-hydroxytryptamine [5-HT]) receptor, 1-[o-(m-methoxyphenyl)ethyl]phenoxy]-3-(dimethylamino)-2-propyl hydrogen succinate hydrochloride (MCI) on the degree of pulmonary hypertension (PH) were investigated in MCI-treated IL-6-PH (IL-6-MCI-PH) rats., Measurements: The thickness of the media of small pulmonary arteries and the ratio of the weight of the right ventricle free wall (RV) to that of the left ventricle with the septum (LV + S) were measured as indexes of the degree of PH. Serotonin concentrations in plasma and in supernatants of cultured vascular smooth muscle cells (VSMCs) stimulated by IL-6 were measured by high-performance liquid chromatography. The amplification of DNA encoding the 5-HT receptor in the lung specimen and VSMCs was performed by polymerase chain reaction., Results: The degree of PH, as determined by the medial thickness of small pulmonary arteries, was significantly increased in IL-6-PH rats as compared with normal control rats (p<0.05), and that in IL-6-MCI-PH rats was not significantly different from that in normal control rats. The RV/LV + S weight ratio in the IL-6-PH rats was significantly higher than that in normal control rats (p < 0.01). The RV/LV + S weight ratio in IL-6-MCI-PH rats was significantly lower than that in IL-6-PH rats (p < 0.01) and was not significantly different from that in normal control rats. The serotonin concentration was significantly higher in IL-6-PH rats than in normal control rats (p < 0.02), and the serotonin concentration in IL-6-MCI-PH rats was not significantly different from that in the normal control rats. The expression levels of the 5-HT receptor messenger RNA in the lung tissue tended to increase in IL-6-PH rats but was suppressed in IL-6-MCI-PH rats. IL-6 significantly increased the amount of serotonin released from VSMCs (p < 0.02). The expression of the 5-HT receptor messenger RNA was observed with IL-6 stimulation as was observed with serotonin stimulation in VSMCs., Conclusions: Serotonin receptor antagonists could be considered as potentially useful agents for the treatment of chronic thromboembolic PH, as well as for that of primary PH and PH associated with collagen vascular diseases.