Transcatheter arterial embolization in the management of gynecological neoplasms

Six patients were treated with transcatheter arterial embolization (TAE). Three patients suffered from intractable genital bleeding; the other three patients were preoperative cases of a stage III adenocarcinoma of the uterine cervix and two of these had gestational trophoblastic disease. Bleeding was stopped in all three cases of intractable hemorrhage; one patient rebled after 6 days. In the three preoperative cases, transcatheter arterial embolization was thought to be effective in decreasing intraoperative blood loss. There are no other reports of application of this technique to preoperative cases to decrease intraoperative blood loss in gynecological cases.     

The use of an omental pedicle graft to prevent small-bowel obstruction after restorative proctocolectomy

(Received for publication on Nov. 21, 1997; accepted on Sept. 11, 1998)     

Relationship between middle ear pressure,mucosal lesion,and mastoid pneumatization

Objectives: The inflammatory changes of pneumatic space mucosa are thought to affect the development of pneumatic space and the function of transmucosal gas exchange. So, it is assumed that the mucosal change is deeply involved in the onset and healing process of otitis media with effusion (OME). The objective of this study is to investigate whether the growth of the mastoid cells and the middle ear transmucosal gas exchange function in patients with OME are affected by the histopathologic changes in middle ear mucosa, and whether these two factors are changed by the treatment of OME. Materials and Methods: From 65 children with OME, middle ear mucosal specimens were collected during indwelling of a tympanic tube, and their histopathologic changes were compared with cell growth area measured on radiographic films and with the change in the middle ear total pressure (METP). Results: Suppression of the cell growth area was stronger and the METP stayed lower in cases with a higher degree of mucosal lesion. Significant expansion of pneumatic area was observed after 2 years of tube indwelling, and the peak METP showed a significant increase after 1.5 years. This increase in the METP was caused by diffusion/absorption of CO₂ and O₂ and indicated recovery of the transmucosal gas exchange function. Conclusions: The growth of the mastoid cells and the middle ear transmucosal gas exchange function are closely affected by the subepithelial histopathologic changes in middle ear mucosa, and these two factors recover by the treatment of OME.     

VARIED PULMONARY LESIONS WITH INTRAALVEOLAR LARGE LAMELLAR BODIES IN AN AUTOPSY CASE WITH BUSULFAN THERAPY

Characteristic pulmonary findings in an autopsy case of a 46-year-old female who presented heavy dyspnea as her chief complaint after 3 months of busulfan therapy for chronic myeloid leukemia were reported. The pulmonary findings were classified into four types: I. alveolar proteinosis type, II. intra-alveolar fibrosis type, III. interstitial fibrosis type, and IV. lipid pneumonia type with cholesterol granuloma. No other case with various findings like this case has been previously reported. It was considered that type I is the basic type, type II is a type that developed from type I, type III is a type with interstitial cell infiltration and fibrosis and type IV is a lipidrich variant of type I. A large lamellar body was first found in the granular material of type I. It is supposed that such a body consists of osmiophllic body which originated from type B alveolar epithelial cells and blood plasma.     

A modified method of immediate loading using BrÅnemark implants in edentulous mandibles

According to the original protocol, BrÅnemark implants require a two-step surgical procedure in order to become osseointegrated. The two-stage surgery is sometimes uncomfortable for the patient, and recent research has shown that osseointegration can also be achieved with a one-stage technique with early or immediate loading of the implants in good quality bone, which simplifies and shortens treatment for the patient's benefit. The aim of this study was to evaluate the immediate loading of BrÅnemark implants with a screw-retained prosthesis in edentulous mandibles. Forty-three patients each had three BrÅnemark implants of varying lengths and diameters installed in the inter-foramina mandibular area. The implant installation procedures were performed according to the standard protocol with avoidance of over-preparation of the implant sites. The prosthesis framework was prefabricated in advance and was cast and separated into three parts, followed by adjustment in the mouth, with a soldering, impression made in situ; finally, the framework was sent to the laboratory for completion of the bridge. The fixed implant bridge was usually delivered to the patient later the same day. Three of the 129 implants failed to osseointegrate, yielding a success rate of 97.6%, with a follow-up period ranging from 3 to 49 months. The results obtained in this study were encouraging, and thus far this modified method of immediate loading in the anterior edentulous mandible appears to be predictable.     

Neurosyphilis with mesiotemporal magnetic resonance imaging abnormalities

We describe a patient with mesial temporal T2-weighted image hyperintensity on magnetic resonance imaging that mimicked paraneoplastic limbic encephalitis. The patient showed pupillary abnormalities suggestive of a diagnosis of neurosyphilis, and the diagnosis was supported by the results of a serum Treponema pallidum hemagglutination assay (TPHA) and cerebrospinal fluid examination. Making a diagnosis of neurosyphilis is occasionally difficult because of the variety of clinical and imaging findings. Appropriate diagnosis and commencing adequate treatment are needed for a good prognosis; thus, neurosyphilis should be included in the differential diagnosis of mesiotemporal magnetic resonance imaging abnormalities.     

Relationship between severity of middle ear mucosal lesion and middle ear pneumatic space volume in patients with otitis media with effusion.

If we assume that the state of suppression of pneumatic cells is the result of suppression of pneumatic cell growth by inflammatory stimulation in the middle ear pneumatic space, it is possible to improve the state of suppression by performing sufficient treatment during the growth period of the pneumatic cells. We indwelt a tympanic membrane ventilation tube (hereinafter referred to as tube) for treatment of otitis media with effusion (OME) in child patients aged 3-13 years and investigated the following points: i) relationship between the severity of inflammation of the lamina propria of middle ear mucosal specimens (hereinafter referred to as lamina propria) collected at the time of tube indwelling and the degree of growth of the pneumatic space; and ii) changes in the pneumatic space associated with treatment by tube indwelling, which was studied by comparing the above-described mucosal severity with the pneumatic space area of 2 years after tube indwelling, and with increase in the pneumatic space volume measured periodically after tube indwelling. The results indicated that mastoid cell growth suppression is higher in patients with a higher degree of inflammatory changes in the lamina propria. In association with treatment by tube indwelling, effusion accumulated in the pneumatic space and mucosal swelling disappeared early after the treatment, or 2 months of tube indwelling. After that, in patients with severe mucosal lesion, a long time, 1.5-2 years, was found to be required for repneumatization accompanying regrowth of the temporal bone. We confirmed that the severity of inflammation of the lamina propria is deeply involved in the growth and repneumatization of the pneumatic cells.     

A case of bitemporal epilepsy that was well controlled after unilateral lobectomy]

Here we report a case of bitemporal epilepsy that was well controlled after unilateral temporal lobectomy. The patient was a 31-year-old woman, who was born in an asphyxia state and had a history of a febrile convulsion. Complex partial seizure(CPS) preceded by abdominal aura appeared at the age of three. Despite anticonvulsant medication, the seizures gradually increased in frequency and sometimes developed into secondary generalized convulsions. Her scalp electroencephalogram(EEG) showed interictal spikes and seizure activities arising from the bilateral temporal lobes. No apparent lateralities in regard to the size or blood flow at the hippocampus were detected by MRI and SPECT studies. Intracranial EEG monitoring revealed that 80% of the clinical seizures originated from the left mesial temporal lobe, which was the non-dominant side for speech and memory functions as demonstrated by Wada test. Therefore, we performed a left temporal lobectomy that resulted in the complete disappearance of CPS. The present case exemplified the usefulness of intracranial EEG monitoring to clarify the dominant epileptic focus for surgery.     

Optic disc excavation in the atrophic stage of Leber's hereditary optic neuropathy: comparison with normal tension glaucoma

BACKGROUND: Abnormal optic disc excavations are reportedly seen in patients with Leber's hereditary optic neuropathy (LHON), a mitochondrial dysfunction disease. We examined the disc morphology in the eyes of patients with LHON at the atrophic stage and compared it to that in eyes with normal-tension glaucoma (NTG). METHODS: We studied 15 LHON patients with the 11778 mutation, 15 patients with NTG, and 25 normal subjects. The optic disc morphology was analyzed by Heidelberg retinal tomography (HRT). Ten parameters of the optic disc obtained by HRT were evaluated, including the diagnostic classification of glaucoma. RESULTS: Six of the nine morphological HRT parameters of the LHON patients, the exceptions being disc area, mean cup depth, and maximum cup depth, differed significantly from those of the normals. NTG patients had a significantly greater mean and maximum cup depth than LHON patients. The HRT glaucoma diagnostic software classified 22 (73%) of the 30 optic discs in LHON patients as glaucomatous. CONCLUSION: The optic discs at the atrophic stage of LHON eyes have glaucoma-like morphological changes. However, the cups were significantly deeper in NTG than LHON. The similarity in the optic disc findings in LHON and NTG suggests that alterations in mitochondrial function may be related to optic disc excavations.     

Evaluation of tumor angiogenesis using dynamic enhanced magnetic resonance imaging: comparison of plasma vascular endothelial growth factor, hemodynamic, and pharmacokinetic parameters

PURPOSE: To assess whether tumor angiogenesis of breast cancers can be predicted on the basis of dynamic magnetic resonance imaging (MRI). MATERIAL AND METHODS: Seventy-one patients with 71 breast cancers underwent Gd-DTPA enhanced dynamic MRI. Two regions of interest measurements were obtained in the periphery and in the center of the breast cancers. Hemodynamic parameters obtained by dynamic MRI included peak time, contrast enhancement ratio (CE ratio), and washout ratio. The triexponential concentration curve of Gd-DTPA was fitted to a theoretical model based on compartmental analysis. The transfer constant (or permeability surface product per unit volume of compartment "k") was obtained using this method. Tumor angiogenesis was assessed by plasma vascular endothelial growth factor (P-VEGF). RESULTS: The P-VEGF was positive in 28 of 71 tumors (39%). The CE ratio, washout ratio, and k in the periphery in P-VEGF positive breast cancers (mean 178%, 18%, and 1.5 x 10(-2) (s(-1)) were significantly greater (P<0.01, P<0.05, and P<0.03)) than those for P-VEGF negative breast cancers (mean: 151%, 14%, and 1.1 x 10(-2) (s(-1)). The peak time in the periphery in P-VEGF positive breast cancers was more marked than for P-VEGF negative breast cancers, but this difference was not significant. CONCLUSION: The hemodynamic and pharmacokinetic analysis of MRI provides valuable information about angiogenesis of breast cancers.