Clinical analyses and short-term prognoses of neonates with subependymal cysts

Twenty-one neonates with subependymal cysts detected by neurosonography soon after birth were prospectively examined. The clinical and cranial sonographic findings were evaluated with respect to short-term prognosis. The prognosis was poor in 6 patients with congenital viral infection (4 with cytomegalovirus infection and 2 with rubella infection). Five patients also had neurodevelopmental abnormalities (2 with neonatal epileptic seizures, 2 with chromosomal abnormalities, and 1 with lissencephaly). The remaining 10 patients had normal psychomotor development. The incidence of congenital viral infection was statistically correlated with a poor neurodevelopmental outcome. A correlation did not exist between the short-term prognosis and each of the other clinical factors or cranial sonographic findings. Our evidence suggests that further investigation of possible subependymal cyst etiologies is required during a careful, long-term follow-up period.     

One-shot dual-energy subtraction imaging

Dual-energy subtraction imaging by a single x-ray exposure (one shot) can easily be performed by using computed radiography with scanning laser-stimulated luminescence. In a phantom study, a thin copper filter placed between two imaging plates produced a dual-energy subtracted image from a single x-ray exposure. One-shot dual-energy subtraction imaging was also useful in the diagnosis of thoracic lesions.     

Prevalence and risk factors for knee osteoarthritis in elderly Japanese men and women

BACKGROUND: The aims of the present study were to examine the prevalence and risk factors for knee osteoarthritis in elderly Japanese men and women. METHODS: We examined 598 of the 1513 inhabitants of Miyagawa village aged > or = 65 years (393 women, 205 men). Baseline data, obtained with standard questionnaires, included information on age, past history, sports activity, working, knee pain, smoking, and intakes of alcohol and milk. Bone mineral density of the forearm was measured using dual energy X-ray absorptiometry. Anteroposterior radiographs of both knees were graded for osteoarthritis using the Kellgren-Lawrence grading system. Definite osteoarthritis was defined as a grade of 2 or higher. We used logistic regression analysis by the stepwise method to determine the risk factors for radiographic knee osteoarthritis. RESULTS: The prevalence of definite radiographic knee osteoarthritis was 30.0% overall: 17.7% in men and 36.5% in women. The prevalence of symptomatic knee osteoarthritis was 21.2% overall: 10.7% in men and 26.7% in women. There were significant differences in the risk of radiographic knee osteoarthritis with body mass index (BMI), sex, age, and bone mineral density (BMD). CONCLUSIONS: The prevalence of definite radiographic knee osteoarthritis was 30.0% and that of symptomatic knee osteoarthritis was 21.2%. We found that higher BMI, female sex, older age, and higher BMD were significantly associated with an increased risk for radiographic knee osteoarthritis.     

Surgical treatment of spontaneous dissection of the superior mesenteric artery: a case report.

A case of a 46-year-old man with spontaneous dissection of the superior mesenteric artery (SMA) demonstrated by ultrasonography is presented. He was successfully treated by emergency aorto-SMA bypass surgery, but complicated with bilateral internal iliac aneurysm. The patient has remained asymptomatic with full employment.     

Regional system for support of home care]

In order to meet the needs for medical care after discharge from hospital of serious or intractable neurological disease patients, in 1978, Shinrakuen Hospital in Niigata City launched the Continuing Medical Care Section providing home visit by doctors and periodical home nursing. In the article published in 1990 reporting the 13-year practice of this section, the author advocated the necessity of the across-the-board and continuing regional care system in support of homecare and proposed a desirable model. Since then, with the policy shift from hospital care to homecare facing the progress of aging society, various homecare services have been developed. The author opened in 1997 an organized clinic of internal and neurological medicine in Niigata City, and, on the basis of long term care insurance program founded in 2000, put into practice the homecare system of cooperation between the prefectural and municipal administration, medicine and nursing. In this article, based on her article in 1990, the author adds the report on the development of this regional care system and evaluates the efficacy of homecare supported by regional system in intractable neurological disease medical care.     

Effect of long-term cilostazol administration on coronary flow velocity and coronary flow reserve]

Cilostazol, a novel potent inhibitor of phosphodiesterase, increases coronary flow. The effects of cilostazol on coronary flow velocity and coronary flow reserve were studied in 103 patients with coronary artery disease who underwent coronary angiography. Cilostazol 200 mg/day was administered for 3 months (31 patients) or 6 months (37 patients), and coronary flow reserve were measured before and after the cilostazol administration. Coronary flow reserve were measured twice at an interval of 6 months in the control group (35 patients). The Doppler guide wire was advanced into the coronary artery with no significant vessel stenosis. After obtaining continuous baseline coronary flow velocity, an intracoronary infusion of papaverine (10 mg) was performed to measure coronary flow reserve. There were no significant differences in coronary flow velocity just before intracoronary papaverine infusion between the initial and follow-up studies in any of the 3 groups. Coronary flow reserve increased significantly after cilostazol administration in the 3 months and 6 months groups compared with before administration (3 months group: 2.8 +/- 0.8 vs 2.4 +/- 0.9, p < 0.05; 6 months group: 2.8 +/- 1.0 vs 2.4 +/- 0.7, p < 0.01). However, there was no significant difference in coronary flow reserve in the control group between follow-up and initial studies (2.7 +/- 0.8 vs 2.5 +/- 0.8, NS). In conclusion, the long-term oral administration of cilostazol for 3 or 6 months improves coronary flow reserve.     

Traumatic occlusion of the bilateral vertebral arteries associated with fracture of the cervical spine--a case report

A case of traumatic occlusion of the bilateral vertebral arteries associated with fracture of the cervical spine is reported. A 34-year-old man, having no previously noted medical problems, fell to the bottom of a bathtub with a depth of 80 cm, and hit the vertex fronto-parietal region of his head. He was transferred to our hospital 6 hours after his fall with a crush fracture of the cervical spine at the C6 level. On admission he was alert, but having pain in the vertex region, dysarthria, blurred vision and hemiparesis. Roentgenograms confirmed a crush fracture of the C6 vertebral body. Computed tomograms of the brain revealed a high density of basilar artery. Cervical traction with a Halo brace was then carried out. Twelve hours after the trauma, left oculomotor and right facial palsy appeared followed by bilateral oculomotor palsy and respiratory difficulty. At the 14th hour, he displayed bilateral Babinski's signs and tetraparesis. Tetraparesis became complete with right-side Horner's syndrome at 16 hours. Cerebral arteriograms performed 20 hours after the trauma showed a complete occlusion of the right vertebral artery and an incomplete occlusion of the left vertebral artery at the C6-7 intervertebral disk space. Conscious level deteriorated to a 200 level on the Japan coma scale 28 hours after the trauma and to a 300 level after 32 hours. Computed tomograms revealed a marked low density on the cerebellum and brain stem 38 hours after the accident. He expired on the 22nd day after the trauma.(ABSTRACT TRUNCATED AT 250 WORDS)     

Traumatic posterior fossa hematoma

The traumatic posterior fossa hematoma was regarded as relatively rare thing, but recently, as the result of the prevalence of CT scanners, the number of reported cases is increasing. We report nine cases of traumatic posterior fossa hematoma. We divided into two categories: one was the acute epidural hematoma, the other was the acute subdural hematoma with cerebellar contusion. Five were cases of the acute epidural hematoma, three were cases of the acute subdural hematoma with cerebellar contusion and a case had both an epidural and a subdural hematoma. All the cases had struck the occipital region and had the occipital bone fracture. The prognosis of the five cases of the acute epidural hematoma was excellent, but that of the four cases of the acute subdural hematoma with cerebellar contusion was poor and they all died inspite of the removal of the hematoma executed in three cases. We estimated that the hitting forth was extremely strong in cases of the subdural hematoma with cerebellar contusion, and that the momentary deformity of the occipital bone might injure the cerebellum directly. Once a hematoma was produced in the posterior fossa, it oppresses the brainstem and causes the acute hydrocephalus, so the state of consciousness and respiration deteriorate suddenly. In cases of the acute epidural hematoma, appropriate surgical intervention could save the patients and resulted in good outcome. But in some cases of the fulminant type acute epidural hematoma of the posterior fossa caused by tearing the sinuses, though we have not experienced, patients die before the diagnosis and treatment.(ABSTRACT TRUNCATED AT 250 WORDS)     

Innervation of the superficial pineal of the rat using retrograde tracing methods

Fast blue (FB), rhodamine microspheres (RH), horseradish peroxidase (HRP), and wheat germ agglutinin-horseradish peroxidase conjugate (WGA-IIRP) were used as retrograde tracers to study the innervation of the rat superficial pineal gland (SP). One of the tracers was injected into the gland of each animal. All four retrograde tracers injected into the gland always labeled neurons in the superior cervical ganglia (SCG). No retrograde labeling was ever seen in the suprachiasmatic nuclei, paraventricular hypothalamic nuclei, lateral hypothalamus, habenular nuclei, amygdalar nuclei, or superior salivatory nuclei. Retrograde labeling was seen in the anterior hypothalamic nuclei, anterior thalamic nuclei, lateral geniculate bodies, and midbrain tectal structures when a tracer spread from the injection site to the overlying cortex, tectum, or commissures. Control studies included injection of tracer into the subarachnoid space around the SP or into structures adjacent to the SP. Only the injection of FB or WGA-HRP into the subarachnoid space labeled neurons in the SCG. This labeling was probably due to the spread of tracer to the choroid plexus. These results agree with recent work confirming the existence of a direct projection of the SCG into the interstitium around pinealocytes. The evidence does not substantiate an innervation originating in the habenular nuclei; the superior salivatory nuclei; or any other diencephalic, midbrain, pontine, or medullary structure.