Clinical study of growing up aneurysms: report of 25 cases

Twenty-five cases of patients with growing up aneurysms are reported. Growth of the aneurysm was confirmed by repeated angiography within 1 month in 11 cases (short-term group), and for over 1 month in the other 14 cases (long-term group) following the initial angiography. Clinical history, shape and growth pattern of aneurysms, as well as hemodynamic factors that effect the growth were investigated in each group. The aneurysms were classified according to the shape into dome-type (smooth contour) and bleb-type (irregular contour). In all cases of the short-term group, the first angiography was performed because of rupture of the aneurysm. In this group, 4 cases bled again because of enlargement or the development of an aneurysmal bleb. Growth rate and the initial size of the aneurysm did not effect the potential of re-rupture. In the long-term group, 9 cases out of 14 (64.3%) had "non-ruptured aneurysm" at the time of first angiography. In the follow up, 5 cases were ruptured (two because of re-bleeding and three for the first time). In 3 out of these 5 cases, a bleb was demonstrated on initial angiography, and in another case, a bleb was demonstrated in follow-up angiography. Only one case ruptured because of the growth of the aneurysmal dome. Most of the aneurysms that rupture, in the follow-up survey, showed a larger growth rate in comparison with aneurysms that did not rupture. Many cases of this long-term group were associated with hypertension or vascular abnormalities which would effect the aneurysmal growth.(ABSTRACT TRUNCATED AT 250 WORDS)     

Brain-derived neurotrophic factor requirement for activity-dependent maturation of glutamatergic synapse in developing mouse somatosensory cortex

The maturation of cortical circuitry critically depends on experience. Recently, a model of silent synapse has been proposed as a mechanism of activity-mediated transition of immature synapse to mature synapse. It is not clear, however, how activity could regulate this transition. Here, we show the evidence that endogenous brain-derived neurotrophic factor (BDNF) is required for the maturation of glutamatergic synapse in developing mouse somatosensory cortex. Field potential recordings of thalamocortical glutamatergic synaptic activity with brain slices from the BDNF mutant mice showed that AMPA receptor responses are low, but NMDA receptor responses remain high in layer 4, thus, the relative contribution of AMPA receptor response is significantly lower compared to the age-matched wild-type mouse. Furthermore, optical images of development of thalamocortical connectivity with a voltage-sensitive dye showed that NMDA receptor-dominant synapse is established first in layer 4 and layer 5/6 then AMPA receptor response appears later in concomitant with reduction of NMDA receptor response in layer 4 and that the maturation of the silent synapse is impaired in the BDNF mutant mice. In layer 5/6, NMDA receptor response was suppressed without upregulation of AMPA receptor response. This process also required BDNF function. Interestingly, whisker-trimming of the wild-type mouse from just after birth showed quite similar results with the homozygous mutant of their whiskers left intact. Therefore, we would propose that BDNF is a critical mediator for the maturation of glutamatergic synapse in developing mouse somatosensory cortex.     

Hemiparkinsonism associated with the unilateral striatal necrosis: a case report

We report a patient with hemiparkinsonism associated with unilateral striatal necrosis of the contralateral side. The patient was an 18-year-old woman who had a two-month-history of difficulty in executing skilled movements with her right upper extremity. Neurological examination revealed that she had cogwheel rigidity and bradykinesia in her right upper and lower extremities. MRI revealed a well-delineated low signal intensity in T1-weighted and high signal intensity in T2-weighted images in the region of the putamen on the left side. Her laboratory data were unremarkable and mitochondrial gene mutation studies revealed no abnormality. It is extremely rare to encounter a case of parkinsonism associated with unilateral striatal necrosis.     

A new fibular osteotomy in association with high tibial osteotomy (a comparative study with conventional mid-third fibular osteotomy)

A new technique for dividing the fibula when performing a high tibial osteotomy is described. The head of the fibula is enucleated and morselized. The technique is simple and safe with a low complication rate.

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Résumé  En cas d’ostéotomie supérieure du tibia, nous décrivons une nouvelle technique d’ostéotomie péronière avec énucléation et morcellement de la tête du péroné. On peut employer pour ce faire la même incision cutanée que pour l’ostéotomie du tibia. L’incidence de complications est faible.

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Accepted: 17 March 2000     

Treatment of ununited fracture of the hook of hamate by low-intensity pulsed ultrasound: a case report

A patient presented 4 months after sustaining a fracture of the hook of hamate. X-rays and computed tomography scanning of the carpal tunnel confirmed the presence of an ununited fracture. Low-intensity ultrasound was applied to the fracture site. After 4.5 months of exposure to ultrasound, union was confirmed by both x-rays and computed tomography scanning of the carpal tunnel. (J Hand Surg 2000; 25A:77-79.     

Aortocaval fistula with acute right heart failure during surgery: case report

A 71-year-old man was transferred to our institution with suspected of impending rupture of the abdominal aorta. The clinical manifestations included abdominal pain, pulsatile mass, and abdominal bruit. We made on early diagnosis of aortocaval fistula based on enhanced computed tomography and color Doppler flow imaging. Surgical repair was performed 24 hours after the onset of symptoms. At the introduction of anesthesia, cardiac arrest with high central venous pressure occurred. After resuscitation and rapid clamping of the proximal aorta, surgical closure of the fistula with graft replacement was performed successfully.     

The Effect of Carboxyl-Terminal Propeptide of Type I Collagen (c-Propeptide) on Collagen Synthesis of Preosteoblasts and Osteoblasts

Recently we found that the carboxyl-terminal propeptide of type I collagen (c-propeptide) is a major secretory protein of osteoblasts. Mature osteoblasts secreted 64 nM c-propeptide, and it was reported that 40 nM c-propeptide inhibited collagen synthesis at 80% of the control level. In this study, we investigated the effect of c-propeptide on collagen synthesis of preosteoblasts and osteoblasts, and found that preosteoblasts downregulated collagen synthesis by 40 nM c-propeptide, but osteoblasts were not affected by the same condition. When the binding activities of c-propeptide for preosteoblasts and osteoblasts were compared, osteoblasts showed weak affinity to c-propeptide compared with preosteoblasts, and the number of receptors for c-propeptide decreased in osteoblasts. These results imply that a decrease of receptors in osteoblasts might reduce the sensitivity of osteoblasts to c-propeptide. Received: 6 August 1999 / Accepted: 9 May 2000 / Online publication: 22 September 2000     

Primary bone tumors of the femur presenting with spinal symptoms: a report of two cases and review of the literature

Two case reports of femoral bone lesions simulating lumbar spinal disease are presented. Physical examination and case history were strongly suggestive of lumbar spinal pathology. In case 1, surgical resection of a venous hemangioma in the lumbar epidural space was performed but did not relieve pain. In case 2, conservative treatments for a protruded disk were performed for 3 months before an accurate diagnosis was made. After correct diagnoses were made, excision of the femoral tumors brought rapid relief of all abnormal findings in both cases. Compared with other causes of sciatica, femoral bone tumors are rare. However, careful attention should be paid to rule out these lesions if the diagnosis of a lumbar spinal disease is uncertain. Bone scintigraphy seems to be a sensitive diagnostic method to detect extraspinal osseous lesions.