Multiple giant fusiform aneurysms with hydrocephalus

Multiple giant fusiform aneurysms are uncommon. We report such a case of multiple giant fusiform aneurysms involving both internal carotid arteries and the basilar artery associated with hydrocephalus. The neurological deficits presented in this case were due to pontine infarction, which was suspected to be produced by thrombosis from the aneurysm, and a hydrocephalus might have been caused by a "water-hammering" effect of the elongated basilar artery.     

Impact of transvenous embolization via superior ophthalmic vein on reducing the total number of coils used for patients with cavernous sinus dural arteriovenous fistula

Neurosurgical Review - Although transvenous embolization (TVE) via the superior ophthalmic vein (SOV) is adopted in treating cavernous sinus dural arteriovenous fistula (CS DAVF), its effect on the...     

The effect of frailty on the quality of life and lower urinary symptoms following robot-assisted radical prostatectomy: A longitudinal analysis (FRARP-QL Study)

ObjectivesWe aimed to evaluate the effect of frailty on health-related quality-of-life (HRQOL) and lower urinary symptoms (LUTS) following robot-assisted radical prostatectomy (RARP) in patients with prostate cancer (CaP).Materials and MethodsWe longitudinally evaluated geriatric 8 (G8), HRQOL, and LUTS for 12 months in 118 patients with RARP from January 2017 to April 2020. Patients were divided into frail (G8 ≤14) and nonfrail (G8 >14) groups. We compared the effect of frailty on HRQOL and LUTS between the frail and nonfrail groups before and 12 months after RARP.ResultsThe median age of patients was 68 years. The number of patients in the frail and nonfrail groups were 41 and 77, respectively. No significant difference in patients’ background was observed between the groups, except for the presence of cardiovascular disease (22% vs. 7.8%, P = 0.041). There was no significant difference in HRQOLs and LUTS between the groups at baseline. Similarly, HRQOLs, LUTS, and pad-free continence rates were not significantly different between the groups at 12 months after RARP. In the nonfrail group, LUTS at 12 months following RARP significantly improved compared to those at the baseline, but it did not significantly improve in the frail group. Multivariable logistic regression analysis demonstrated that frailty was not significantly associated with LUTS worsening.ConclusionsFrailty was not significantly associated with the worsening of HRQOL, LUTS, and pad-free continence rates in patients treated with RARP.     

Prognostic significance of the Ki67 index and programmed death-ligand 1 expression after radical cystectomy in patients with muscle-invasive bladder cancer

ObjectivesTo investigate the association between Ki67 index and programmed death-ligand 1 (PD-L1) expression in muscle-invasive bladder cancer (MIBC) patients after RC.Materials and MethodsWe retrospectively evaluated 262 MIBC patients treated with RC between April 2004 and April 2020. The impact of Ki67 index and PD-L1 expression on prognosis was evaluated by univariate Cox regression analysis. In addition, a pathomolecular risk score, including Ki67 and PD-L1, was developed to predict prognosis and pathological factors. We also evaluated the link between the Ki67 index and PD-L1 under the IL-6 stimulation in the bladder cancer cell lines of T24 and 5637 cells.ResultsThe median age and follow-up period was 69 years and 52 months, respectively. Ki67 index and PD-L1 expression were significantly associated with tumor recurrence. Univariate Cox regression analysis showed that pT3–4, mixed histology, lymphovascular invasion positive (LVI+), pN+, Ki67-high (>17%), and PD-L1+ were significantly associated with recurrence-free survival (RFS). The pathomolecular risk score was developed using resection margin+ (1 point), mixed histology (1 point), LVI+ (1 point), pN+ (1 point), and Ki67-high (1 point). RFS and overall survival were significantly shorter in patients with higher pathomolecular risk scores (>1) than in those with lower risk scores (≤1). Cell proliferation was significantly increased in the T24 and 5637 cells under the IL-6 stimulation, while PD-L1 expression was not.ConclusionsA significant effect of Ki67-high and PD-L1 expression on poor prognosis was observed in patients with MIBC. Further studies are necessary to elucidate the precise mechanisms of cell proliferation and PD-L1 expression in patients with MIBC.     

Changes in circulating blood volume following isoflurane or sevoflurane anesthesia

Changes of circulating blood volume (CB volume) measured by the dual indicator dilution method were observed in 33 chronically instrumented mongrel dogs following either alpha-chloralose-urethane (C group), additive isoflurane (I group) or sevoflurane anesthesia (S group). These anesthetic groups were each divided into two subgroups with regard to respiratory care, namely Cp, Ip and Sp for those with intermittent positive pressure ventilation (six animals per subgroups), and Cs, Is and Ss for those with spontaneous breathing (five animals per subgroups).The CB volume under positive pressure ventilation remained unchanged in the Ip and Sp groups at both 0.5 and 1.0 MAC, and in the Cp group. The CB volume remained essentially unchanged in the Cs and Is groups at both 0.5 or 1.0 MAC, but the plasma volume tended to increase slightly in the Is group at 1.0 MAC.In the Ss group under spontaneous breathing, however, the CB volume increased from 84.4 ± 7.0 to 91.4 ± 7.7 at 0.5 MAC, and to 91.4 ± 10.2ml·kg^–1 at 1.0 MAC (0.01 P 0.05). These increases were caused by an increase in the plasma volume.The above data suggests that a concomitant increase in the venous pressure associated with an increase in the intrathoracic pressure produced by positive pressure ventilation would attenuate changes in the CB volume during sevoflurane anesthesia.(Hamada H, Takaori M, Kimura K, et al.: Changes in circulating Blood volume following isoflurane or sevoflurane anesthesia. J Anesth 7: 316–324, 1993)     

Influences of intra-aortic balloon pumping on superior mesenteric flow dynamics

The influences of intra-aortic balloon pumping (IABP) on arterial flow of the superior mesenteric artery were assessed by Doppler echocardiography. The subjects were 13 patients postoperatively, requiring IABP support to control low cardiac output state, in which distal aspects of balloons were distal to the superior mesenteric artery. Superior mesenteric flow velocity integral in systole (IntS) and that in diastole (IntD) were measured from superior mesenteric flow pattern, and the sum of IntS and IntD (IntS + IntD) was calculated ON and OFF balloon pumping (IABP ON-OFF test). The same parameters were obtained with balloon inflating on every other beat (IABP 1:2 test); the cardic cycle with balloon assist was defined as "1:2 ON", and that without balloon assist was defined as "1:2 OFF". 1) IABP ON-OFF test. IABP increased IntS from 7.07 +/- 2.56 cm to 9.20 +/- 3.19 cm (p less than 0.05), IntD from 3.00 +/- 1.18 cm to 3.62 +/- 1.40 cm (p less than 0.05), and IntS + IntD from 10.07 +/- 3.48 cm to 12.82 +/- 4.04 cm. Cardiac output increased from 3.89 +/- 1.34 l/min to 4.24 +/- 1.64 l/min with IABP support. The increments in IntS, IntD and IntS + IntD with IABP are attributed, to a large extent, to an increase in cardiac output. 2) IABP 1:2 test. Without balloon inflation, IntS increased (1:2 ON; 7.16 +/- 2.91 cm, 1:2 OFF; 8.41 +/- 3.30 cm, p less than 0.05), and IntD decreased (1:2 ON; 3.51 +/- 1.60 cm, 1:2 OFF; 2.33 +/- 1.25 cm, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

A six-year follow-up study of childhood behavior problems

In order to study the outcome of childhood behavior problems and to investigate relationships between those behavior problems and mental health problems in later years, a survey which was conducted in 1977 was repeated after six years. Subjects were randomly selected children aged from three to seven years living in Bunkyo-ku in Tokyo in 1977. Out of 279 children, responses to the questionnaire were obtained for 201 children, with 39 refusing to co-operate and 39 having left the area. The main results were as follows: 1. Comparison of prevalence rates of individual behavior problems occurring in early childhood (from 3 to 7 years old), showed that behaviors such as overactivity, "difficult to control", persistence, stubbornness and poor relations with unfamiliar persons decreased rapidly with age. On the other hand, hypoactivity, withdrawal and shyness increased. For problems occurring in late childhood (from 9 to 13 years old), the prevalence of poor concentration and passive behavior problems increased with age, while aggressive behaviors decreased. Behaviors such as thumb-sucking, nail-biting, bed-wetting and tics decreased. 2. Over the six years of this study, many behavior problems in areas of activity, mood, volition, human relations and abnormal symptoms showed significant persistence, although the degree of the persistence was not very strong. 3. Significant relationships between behavior problems observed at age three to seven years and mental health problems such as refusal to attend school and antisocial behaviors after six years were not seen.     

Opsonic function and concentration of human serum ficolin/P35.

Collectins, C-type (Ca2+-dependent) animal lectins with both collagenous and carbohydrate recognition domains, function as opsonins against pathogens. We previously described an N-acetylglucosamine (GlcNAc)-binding lectin (ficolin/P35) with a collagen- and a fibrinogen-like sequence present in human serum. In this report we show that ficolin/P35 can serve as an opsonin and enhance the clearance of pathogens having surface GlcNAc. Ficolin/P35 bound to an Ra chemotype strain of Salmonella typhimurium (TV119) which has an exposed GlcNAc at the non-reducing termini of the polysaccharide. On the other hand, ficolin/P35 did not bind to LT2, a smooth type strain of S. typhimurium with additional O-polysaccharides covering GlcNAc. Ficolin/P35 enhanced the uptake of TV119 by monocytes or polymorphonuclear leukocytes but had no opsonic activity towards LT2. These results suggest that, like collectins, ficolin/P35 is a collagenous lectin which has a role in innate immunity against certain pathogenic organisms by acting as an opsonin. We prepared monoclonal antibodies against ficolin/P35 and developed an enzyme-linked immunosorbent assay (ELISA) for measuring ficolin/P35 concentrations in humans. The mean serum concentration of ficolin/P35 from 130 normal individuals was estimated to be 13.7 microg/ml.     

Accumulation of L-[2-(F-18)]fluorophenylalanine in peri-infarct area in a patient with acute cerebral infarction

We studied the brain uptake of amino acid in a patient with acute cerebral infarction with L-[2-(F-18)] fluorophenylalanine and positron emission tomography. The increased accumulation of the ligand was specifically found in the peri-infarct area where oxygen metabolism was still maintained but decreased later in the 72-day follow-up period. The kinetic analysis revealed that increased accumulation was not due to increased transport from the blood to the brain but to delayed washout from the brain to the blood. Although the mechanism is still unknown, abnormally high accumulation of L-[F-18]fluorophenylalanine may predict delayed neuronal changes after ischemic insults of the brain.