Traumatic internal carotid artery dissection due to compression by a helmet strap

It is well known that wearing a helmet can reduce the risk of head injury in a traffic accident. We report a case of traumatic cervical internal carotid artery dissection due to compression by the strap of a helmet after a motorcycle accident. A 21 year-old man fell off his motorcycle and his head was struck at the right parietal region. His helmet prevented head injury, but the helmet strap which was fixed around his neck compressed his cervical internal carotid artery. He lost consciousness and developed left hemiparesis two hours after being admitted to an emergency department. Cerebral angiography revealed dissection of he right cervical internal carotid artery. This lesion was treated successfully by stent placement two months after the accident. The cause of carotid dissection was thought to be compression of his neck by the helmet strap. If the strap of a helmet is fixed around the neck, it can cause carotid artery injury during an accident, so it can be concluded that the strap of a helmet should be fixed firmly at the chin.     

Atlanto-axial subluxation posssibly due to eosinophilic granuloma of the axis: a case report

A 29-year-old male presented with symptoms of acute severe neck pain with no other neurological symptoms. He had noticed lymph node swelling with pain in his neck about 2 months before admission and had been treated by the transoral administration of antibiotics for about 10 days. His neck was protected with a neck collar and an evaluation of any possible neck lesion was performed. Plain X-ray film and CT scans of the cervical spine showed an anterior subluxation of the atlas and an anterior declination and erosion of the dens. The MRI findings showed long T1 and T2 values in many parts of the bone marrow of the body of the axis and the dens, and both the bone marrow and thickend soft tissue between the pharynx and the axis were slightly enhanced. Inflammatory disease, tuberculosis, rheumatoid arthritis, malignant lymphoma, and leukemia were all ruled out based on the laboratory data, Ga schintigrams and other examinations. Almost no changes in the lesion were observed on MRI at about 6 weeks after admission. As a result, we presumed that this lesion was not likely to be malignant, but might be some kind of granuloma, especially an eosinophilic granuloma. A laminectomy of the atlas and a resection of the posterior margin of the foramen magnum and upper portion of the lamina of the axis was performed to achieve decompression of the craniovertebral junction, and posterior fusion was performed with a rod betweeen the occipital bone and the C4 lamina. The rod was fixed with screws and wires to the occipital bone and with lamina hooks to the axis and C4 laminas. At 14 months postoperatively, the patient is doing well and the axis and the dens have been reconstructed without any need to resect the lesion, or perform either chemothrapy or radiotherapy. Our clinical findings of this case correlate with the opinion that an immobilization of the lesion is a sufficient treatment for many cases of eosinophilic granuloma. Although a biopsy or histological examination of the lesion was not performed, the clinical course of this case strongly suggests that this lesion was indeed an eosinophilic granuloma.     

Posterior cingulate hypoperfusion in Alzheimer's disease, senile dementia of Alzheimer type, and other dementias evaluated by three-dimensional stereotactic surface projections using Tc-99m HMPAO SPECT

Hypoperfusion in the posterior cingulate cortex is thought to be useful for the early diagnosis of dementia of Alzheimer type (DAT). In the present study, we compared the incidence of posterior cingulate hypoperfusion in patients with Alzheimer's disease (AD), patients with senile dementia of Alzheimer type (SDAT), and patients with other types of dementia, as evaluated by three-dimensional stereotactic surface projection (3D-SSP) imaging. The subjects were 20 AD patients, 20 SDAT patients, 13 frontotemporal dementia patients, and 3 other types of dementia patients. A SPECT study was performed 5 minutes after the injection of 740 MBq technetium-99m hexamethylpropylene amine oxime. 3D-SSP images were obtained with global normalization to perform the statistical analysis. The normal database of 3D-SSP consisted of 15 healthy volunteers. Hypoperfusion was considered to be significant when the Z-score was over 2.5. Posterior cingulate hypoperfusion was observed in 13 of 20 AD patients (65%), in 5 of 20 SDAT patients (25%), but in none of other type of dementia patients. Posterior cingulate hypoperfusion was considered to be a finding specific to DAT, and this finding was thought to be useful to diagnose DAT patients, especially for AD patients. However, it was considered to be difficult to diagnose early-stage SDAT patients.     

Reduction of radiation exposure in CT perfusion study using a quantum de-noising filter

CT perfusion study requires repeatedly scanning the same part of the patient's head, resulting in an increase of local radiation exposure. The purpose of this study was to assess the feasibility of the ultra-low-dose technique with a quantum de-noising filter. The newly developed quantum de-noising filter selectively reduced noise by two-thirds, while maintaining spatial resolution. The low-dose protocol using the quantum de-noising filter and slow rotation speed accomplished a 68% reduction in the local radiation dose compared with the previous standard protocol. The quantum de-noising filter is considered to be useful to reduce radiation exposure and to improve image quality in CT perfusion study.     

A randomized multicenter trial comparing resection and radiochemotherapy for resectable locally invasive pancreatic cancer

BACKGROUND: Though the outcome of resection for locally invasive pancreatic cancer is still poor, it has gradually improved in Japan, and the 5-year survival is now about 10%. However, the advantage of resection over radiochemotherapy has not yet been confirmed by a randomized trial. We conducted this study to compare surgical resection alone versus radiochemotherapy without resection for locally invasive pancreatic cancer using a multicenter randomized design. METHODS: Patients with pancreatic cancer who met our preoperative criteria for inclusion (pancreatic cancer invading the pancreatic capsule without involvement of the superior mesenteric artery or the common hepatic artery, or without distant metastasis) underwent laparotomy. Patients with operative findings consistent with our criteria were randomized into a radical resection group and a radiochemotherapy group (200 mg/m(2)/day of intravenous 5-fluorouracil and 5040 cGy of radiotherapy) without resection. The 2 groups were compared for mean survival, hazard ratio, 1-year survival, quality of life scores, and hematologic and blood chemical data. RESULTS: Twenty patients were assigned to the resection group and 22 to the radiochemotherapy group. There was 1 operative death. The surgical resection group had better results than the radiochemotherapy group as measured by 1-year survival (62% vs 32 %, P=.05), mean survival time (>17 vs 11 months, P < .03), and hazard ratio (0.46, P=.04). There were no differences in the quality of life score or laboratory data apart from increased diarrhea after surgical resection. CONCLUSIONS: Locally invasive pancreatic cancer without distant metastases and major arterial invasion appears to be best treated by surgical resection.     

Etiology of nocturia and clinical efficacy of naftopidil on nocturia in patients with benign prostatic hyperplasia--analysis of frequency volume charts

The etiology of nocturia in 70 patients with benign prostatic hyperplasia (BPH) who had nocturia of two or more times were examined based on frequency volume charts (FVC). Nocturia was classified into four groups: nocturnal polyuria, low capacity, combined nocturia, and no evidence of abnormality. Nearly half of the cases had nocturnal polyuria only. A little under 70% of patients had associated nocturnal polyuria (nocturnal polyuria+combined nocturia). Naftopidil was administered for three months to the patients with BPH who had nocturia with a urinary frequency of two or more times. Clinical efficacy was evaluated in 32 patients based on FVC and naftopidil was shown to improve nocturia. The improvement in nocturia was determined by the increment in voided volume.     

A comparison of perioperative factors with two methods of coronary artery bypass grafting (CABG): off-pump and conventional

BACKGROUND: The safety and efficiency of off-pump coronary artery bypass grafting (OPCAB) are still controversial. The purpose of this study was to evaluate this approach in comparison with the conventional cardiopulmonary bypass technique (cCABG). METHODS: A retrospective review of patients who had undergone coronary artery bypass grafting independently without other operations between January 1, 1999 and September 30, 2001 was performed. The patients were divided into two groups: those who underwent OPCAB and the remainder for cCABG. The perioperative factors of the two groups were compared. RESULTS: A total of 152 OPCAB and 142 cCABG cases were reviewed. Compared with cCABG, OPCAB significantly reduced the amount of catecholamine needed on admission to ICU, intubation time, overall hospital length of stay, and neurologic events. There were also trends for decreases in ICU length of stay, mortality, and renal failure. On the other hand, OPCAB did not affect perioperative blood loss. CONCLUSIONS: Overall OPCAB is safer and more efficient than cCABG. However, we have to note in anesthetic management that OPCAB does not reduce blood loss.     

Assessment of the enhancement in predictive accuracy provided by systematic biopsy in predicting outcome for clinically localized prostate cancer

PURPOSE: Current localized prostate cancer treatment outcome nomograms rely on prostate specific antigen (PSA), tumor stage and grade. We investigated whether the addition of prostate biopsy features may enhance the accuracy of a nomogram predicting recurrence after radical prostatectomy (RP). MATERIALS AND METHODS: Clinical data from 1,152 patients who underwent RP were used and included PSA, clinical stage, biopsy Gleason grade and systematic biopsy information that quantified the amount of cancer and high grade cancer. Predictive accuracy for freedom from recurrence after RP was assessed with and without tumor quantification in the biopsy by the area under the receiver operating characteristics curve (AUC). RESULTS: Percentage and number of cores with cancer, and percentage and number of cores with high grade cancer were predictors of outcome when added to models that included PSA, Gleason grade and clinical stage (all p <0.0001). Nomogram accuracy with 3 traditional variables (AUC 0.790) was minimally enhanced with the addition of percentage or number of positive cores (AUC 0.804 and 0.800, respectively), or percentage or number of cores with high grade cancer (AUC 0.802 and 0.800, respectively). Maximum predictive accuracy of 0.811 was achieved after supplementing the traditional 3-variable nomogram with various combinations of additional pathological predictors. CONCLUSIONS: The information provided by systematic biopsies substantially improves the ability to predict outcome following RP. However, some incremental predictive accuracy was achieved by adding systematic biopsy features.     

Electrical preconditioning attenuates progressive necrosis and cavitation following spinal cord injury

This study evaluates the influence of preconditioning and subsequent electrical stimulation on the formation of primary and secondary lesions following spinal cord injury in rats. The dorsal surface of the spinal cord at the T7 level was stimulated 24 h before right-side hemisection (500 Hz, 10 pulses/train, at an inter-train interval of 10 sec for 2 h). Stimulation was again administered immediately after injury and then every 24 h for 7 days. Preconditioning electrical stimulation of the spinal cord activated reactive astrocytes, then significantly attenuated edema, progressive necrosis, and cavitation, especially in the secondary cavity lesions (24 h, 1 week, and 3 weeks post-injury). Upregulation of glial fibrillary acidic protein (GFAP) and vimentin immunoreactivity, a measure of reactive astrocytic response, were increased at 1 week after injury in the rats treated with electrical stimulation. These results suggest that preconditioning with electrical stimulation prevents the formation of secondary lesions after spinal cord injury. This beneficial effect may be related to the ability of electrical stimulation to attenuate trauma-induced cellular cascades.