A new EEG method for estimating cortical neuronal impairment that is sensitive to early stage Alzheimer's disease.

OBJECTIVES: To test the hypothesis that elecetroencephalographic (EEG) analysis is sensitive to cortical neuronal impairment in early stage Alzheimer's disease (AD), and that this analysis correlates with corresponding changes in cerebral blood flow.METHODS: We examined an EEG measure of neuronal impairment in the cerebral cortex in terms of its ability to detect very mild AD. This measure, the mean value of the resting state EEG alpha dipolarity (D(alpha)), approaches unity without cortical sulcal lesions, whereas brains with randomly distributed cortical sulcal lesions lower D(alpha) values well below unity. D(alpha) was evaluated in 25 patients with very mild AD, 33 patients with moderately severe AD, and 56 normal age-matched subjects. These subjects also received SPECT, and strong correlation between D(alpha) and regional cerebral blood flow (rCBF) was observed.RESULTS: D(alpha) values greater than 0.977 correctly classified normal subjects, but also included 10% of very mild AD. D(alpha) values less than 0.952 correctly classified very mild AD as well as moderately severe AD, but also included 10% of normal subjects. D(alpha) values also correlated positively with bilateral temporal-parietal rCBF (a characteristic finding in AD patients); both declined with increasing dementia severity.CONCLUSIONS: Analysis of D(alpha) in this sample supports the hypothesis that early stages of AD can be discriminated from normal aging using measures of cortical neuronal impairment. Furthermore, dementia severity, as reflected by the degree of impairment, is reflected in declining D(alpha) values and increasing variance (greater spread of the D(alpha) values).     

膨胀型和浸润型肝细胞癌超微结构的比较

目的了解膨胀型肝癌（ＥＨＣＣ）的超微结构与其生物学特性的关系．方法用透射电镜对ＥＨＣＣ和ＩＨＣＣ（浸润性肝癌）各２０例对比观察．结果全部４０例肝癌分为３组：分化较成熟型ＥＨＣＣ（１６例），分化未成熟型ＥＨＣＣ（４例），分化未成熟型ＩＨＣＣ（２０例）．分化较成熟型ＥＨＣＣ的超微形态和癌周肝组织相似，其特点为：癌细胞质膜发育较好；核规则圆形、核膜平滑；核仁圆形实心唯体积肥大；细胞器丰富、发育较好．而分化未成熟型ＥＨＣＣ和ＩＨＣＣ的超微形态，与癌周肝组织差异显著，其特点为：癌细胞质膜发育不良；核形不规则，畸形核显著，核膜不平滑，假包含体众多；核仁巨大畸形；细胞器大多肿胀变性．结论ＥＨＣＣ的大多数（８０％）为分化较成熟型，少数为分化未成熟型．癌细胞分化较好，可能是该型生长缓慢并呈膨胀型生长的原因之一．但该型具有较强的潜在侵袭性和向浸润型转化的倾向．     

Lymph nodes around the posterior gastric artery: their existence,frequency, and clinical implications

Purpose

The lymphatic flow along the posterior gastric artery (PGA) is considered of possible clinical importance in terms of lymphatic metastasis; however, little is known about the lymph nodes (LNs) around this artery. The purpose of this study was to establish if LNs exist around the PGA and to evaluate their clinical implications.

Methods

We examined the tissues surrounding the PGA from 21 cadavers to search for LNs. We also investigated the patterns of lymphatic metastases in patients who underwent surgery for gastric neoplasms at our institute to detect their presence along the PGA.

Results

The PGA was identified in 11 cadavers, and LNs around the PGA were detected microscopically in 2 of these. Lymphatic metastasis directly to the LNs at the splenic artery without any metastases was regarded as skip metastasis along the PGA. Skip metastasis was found in two of ten patients who underwent surgery for remnant gastric cancer.

Conclusions

The existence of LNs around the PGA was confirmed, and based on our findings, lymphatic metastasis through the PGA is possible in patients with remnant gastric cancer.

     

Left ventricular rupture associated with Takotsubo cardiomyopathy

A 70-year-old woman was admitted to the hospital with chest discomfort after quarreling with her neighbors. Electrocardiography revealed ST-segment elevation in leads I, II, III, aVL, aVF, and V2 through V6. Coronary angiography demonstrated normal arteries, but left ventriculography showed apical akinesis and basal hyperkinesis. Takotsubo cardiomyopathy was diagnosed on the basis of these characteristic findings. The creatine kinase and creatine kinase-MB concentrations were elevated at admission and reached maximum levels 6 hours after admission. The plasma level of brain natriuretic peptide was 10.7 pg/mL (reference range, <18.4 pg/mL) on the first hospital day. ST-segment elevation in leads I, II, III, aVL, aVF, and V2 through V6 persisted at 72 hours after admission. On the third hospital day, sudden rupture of the left ventricle occurred, and despite extensive resuscitation efforts, the patient died. Takotsubo cardiomyopathy presents in a manner similar to that of acute myocardial infarction, but ventricular systolic function usually returns to normal within a few weeks. To our knowledge, this is the first reported case of fatal left ventricular rupture associated with takotsubo cardiomyopathy. We suggest that takotsubo cardiomyopathy may be a newly recognized cause of sudden cardiac death.     

Clinical significance of exercise-induced negative U-waves in patients with anterior myocardial infarction

To elucidate the clinical significance of the exercise-induced negative U-wave (NU) in patients with anterior myocardial infarction, we compared the angiographic and scintigraphic findings in 15 patients with and 20 patients without NU, and obtained the following results: 1) On coronary angiography, all patients in the NU (+) group showed over 90% stenosis or total occlusion of the left anterior descending coronary artery (LAD). In the latter cases moderate to abundant collaterals were visualized on the anterior wall. In contrast, such a tendency was not observed in the NU (-) group. 2) Segments composed of viable myocardium (estimated by preservation of contraction at rest and T1-201 redistribution after exercise) numbered 30 of 45 segments (67%) in the NU (+) group, and 13 of 60 segments (22%) in the NU (-) group. Segments composed of lost myocardium (estimated by loss of contraction at rest and persistent defect in T1-201 uptake) numbered 7 of 45 segments (16%) in the NU (+) group, and 38 of 60 segments (63%) in the NU (-) group. 3) Exercise-induced NU was frequently observed on R-wave preserved leads with ST depression, but was also observed over abnormal Q waves, ST elevation and in isolation in some instances. 4) In 3 patients, preexisting exercise-induced NU was no longer observed and a transient stress-induced T1-201 defect disappeared after successful LAD revascularization. In conclusion, exercise-induced NU on precordial leads in patients with anterior myocardial infarction may be a sign suggesting the presence of jeopardized, but still salvageable, myocardium in the infarcted area.     

Dipolarity and dipole location during QRS and T waves in normal men estimated from body surface potential distribution

The dipolarity of the body surface potential distribution and the locus of the main dipole were estimated mathematically at 2 msec intervals in 27 normal men. The nondipolar content showed time-dependent fluctuation during the QRS. It increased sharply at early and later phases of the QRS. The main dipole moved smoothly within the actual cardiac region and was inscribed in a clockwise direction in most cases. The nondipolar content during the ST-T period was smaller and with less fluctuation than that during the QRS. The main dipole during the T wave moved less than 2 cm near the center of the heart. These results indicated that although a fairly large percentage of the body surface potential could be represented by a single moving dipole, the nondipolar content was larger during initial and late phases of the QRS. It was also suggested that the ventricular repolarization process can be better approximated by a single fixed dipole in normal men.     

The origin of lymphatic capillaries in murine testes

It is known that the seminiferous tubules are bathed in a sea of lymph in mice, which are commonly used in reproductive and immunological studies. Although testicular lymphatic vessels arising from the tunica albuginea can be macroscopically observed in mice, the exact distribution of the lymphatic capillaries remains unclear. In the present study, we investigated the distribution of lymphatic capillaries in normal testes by immunohistochemical staining with monoclonal antibodies against lymph vessel endothelium HA-receptor 1 (LYVE-1) and a platelet endothelial cell adhesion molecule (CD31). Moreover, normal lymphocytes were locally injected into the testes of recipient mice, and their migration was investigated with the use of LYVE-1 and CD31. The results showed that lymphatic capillaries were in and just beneath the tunica albuginea but not in the interstitium between the seminiferous tubules. It was also noted that these were abundant in the thickened tunica albuginea adjacent to the epididymis, but they were scarce in the thin tunica albuginea opposite the epididymis. When normal lymphocytes were locally injected into testes, the injected lymphocytes migrated between the seminiferous tubules and then drained into the lymphatic vessels in the tunica albuginea. These results suggest that tissue fluid might drain from lymphatic capillaries that arise just beneath the tunica albuginea.     

Congenital absence of the left circumflex coronary artery associated with acute myocardial infarction: a case report.

Among the congenital anomalies of the coronary arteries, a left circumflex artery (LCX) defect is extremely rare. A 49-year-old man who developed an acute anterior infarction underwent coronary angiography, which revealed complete occlusion of the left main trunk, but the territory usually supplied by the LCX had been perfused by the superdominant right coronary artery. Treatment of the left main trunk by percutaneous coronary intervention produced a favorable result. Accurate evaluation of the principal vessels and the extent of compensatory perfusion is important when diagnosing ischemic heart disease accompanied by anomalous coronary arteries and for choosing the best treatment modality.     

Sonographic detection of large spontaneous spleno-renal shunts and its clinical significance

The ultrasonographic findings of large spleno-renal shunts seen in five patients with liver cirrhosis and confirmed by CT and/or portography, are described. These spleno-renal shunts were seen in the left inter- or subcostal sections as transonic, mass-like lesions located between the splenic hilum and the left kidney, and by continuous scanning, they were found to be part of a tortuous, large tubular structure. Oesophageal varices were absent or minimal in these patients, and none of them had ever bled.