Transjugular intrahepatic portosystemic shunt in a patient with cavernomatous portal vein occlusion

A 23-year-old woman with liver cirrhosis secondary to primary sclerosing cholangitis was referred to us for the treatment of recurrent bleeding from esophageal varices that had been refractory to endoscopic sclerotherapy. Her portal vein was occluded, associated with cavernous transformation. A transjugular intrahepatic portosystemic shunt (TIPS) was performed after a preprocedural three-dimensional computed tomographic angiography evaluation to determine feasibility. The portal vein system was recanalized and portal blood flow increased markedly after TIPS. Esophageal varices disappeared 3 weeks after TIPS. Re-bleeding and hepatic encephalopathy were absent for 3 years after the procedure. We conclude that with adequate preprocedural evaluation, TIPS can be performed safely even in patients with portal vein occlusion associated with cavernous transformation.     

Three-dimensional morphology of the masseter muscle in patients with mandibular prognathism

OBJECTIVE: To compare the morphology of the masseter muscle in patients with mandibular prognathism with that of normal subjects. METHODS: Three-dimensional X-ray computed tomography (CT) was performed on 69 patients with mandibular prognathism and compared with 91 normal subjects. The angle of the muscle direction in relation to the Frankfurt horizontal plane and the area and the ratio of length of the short to long axes (s/l ratio) on the section perpendicular to the muscle direction were measured. RESULTS: The mean angle, area and s/l ratio in patients with mandibular prognathism was 76.6 degrees (s.d. 4.4 degrees), 318.3 mm2 (s.d. 77.2 mm2) and 0.312 (s.d. 0.049), respectively. Those of the normal subjects were 65.1 degrees (s.d. 4.4 degrees), 368.3 mm2 (s.d. 97.2 mm2) and 0.393 (s.d. 0.054), respectively. The angle was significantly larger, and the area and s/l ratio were significantly smaller than those of normal subjects (P < 0.001). CONCLUSION: The morphology of the masseter muscle in mandibular prognathism is significantly different from that of normal subjects. Our results may be helpful in evaluating the results of orthognathic surgery.     

Alpha-synuclein has an altered conformation and shows a tight intermolecular interaction with ubiquitin in Lewy bodies

Alpha-synuclein, a protein in which two mutations have been identified that cause autosomal dominant Parkinson's disease, is thought to serve as a nidus for the development of a Lewy body. We hypothesized that alpha-synuclein would display different intra- and intermolecular associations in Lewy bodies than it does in its normal intracellular compartments. Using sensitive fluorescence resonance energy transfer (FRET) techniques, we found evidence that alpha-synuclein is more compact and in closer association with other alpha-synuclein molecules in Lewy bodies than it is in the neuropil. In addition, we found evidence of a close, direct intermolecular interaction between the N terminus of alpha-synuclein and ubiquitin. These observations provide support for the hypothesis that in Lewy bodies alpha-synuclein adopts an altered three-dimensional structure and undergoes N-terminal ubiquitination.     

The effect of continuous intra-articular and intra-bursal infusion of lidocaine on postoperative pain following shoulder arthroscopic surgery

We evaluated the effects of continuous intra-articular and intra-bursal infusion of lidocaine on postoperative pain following shoulder arthroscopic surgery. Forty-one ASA I-II patients scheduled for shoulder arthroscopic surgery, were allocated into following four groups. The patients, after intra-articular arthroscopic surgery, either received intra-articular lidocaine (Group I, n = 10) or did not (Group III, n = 10). The patients after extra-articular arthroscopic surgery either received intra-bursal lidocaine (Group II, n = 11) or did not (Group IV, n = 10). Group I and Group II received 8 ml of 1% lidocaine intra-articularly and intra-bursally, respectively, at the end of surgery, followed by continuous infusion of 1% lidocaine at the rate of 2 ml.hr-1 for 24 hours. The intensities of postoperative pain were evaluated by Visual Analogue Scale (VAS), 2, 5, 8, 12, 18 and 24 hours after surgery, and by the number of patients' request for supplemental analgesic for 24 hours. The VAS scores and the number of analgesic requests were significantly lower (P < 0.05) in Group I than Group III, and in Group II than Group IV throughout the postoperative observation period. No adverse effects were observed during this study. We conclude that continuous intra-articular and intra-bursal infusion of lidocaine provides effective postoperative pain relief for shoulder arthroscopic surgery.     

Lactate accumulation following concussive brain injury: the role of ionic fluxes induced by excitatory amino acids

During the first few minutes following traumatic brain injury, cells are exposed to an indiscriminate release of glutamate from nerve terminals resulting in a massive ionic flux (e.g., K⁺ efflux) via stimulation of excitatory amino acid (EAA)-coupled ion channels. The present study was undertaken to elucidate the causal relationship between these ionic shifts and lactate accumulation in the injured brain, by examining the effects of ouabain (an inhibitor of Na⁺/K⁺-ATPase), Ba²⁺ (an inhibitor of non-energy-dependent glial K⁺ uptake) and kynurenic acid (KYN; a broad-spectrum EAA antagonist) on lactate accumulation. Two microdialysis probes were placed bilaterally in the rat parietal cortex. One was perfused with a test drug (1.0 mM ouabain, 2.0 mM Ba²⁺ or 10 mM KYN) and the other with Ringer's solution (control) for 30 min prior to injury. Following a 2.2–2.7 atm fluid-percussion injury, lactate levels in the dialysate increased (up to 116.6% above baseline) for the first 16 min and returned to baseline levels within 20 min after injury. This lactate accumulation was attenuated by preinjury administration of ouabain and KYN and was prolonged by Ba²⁺ administration. These findings indicate that lactate accumulation following concussive brain injury is a result of increased glycolysis which supports ion-pumping mechanisms, thereby, restoring the ionic balance which was disrupted by stimulation of EAA-coupled ion channels.     

Expression of intercellular adhesion molecule (ICAM)-1 by a subset of astrocytes in Alzheimer disease and some other degenerative neurological disorders

Summary Intercellular adhesion molecule-1 (ICAM-1) was localized immunohistochemically in postmortem brain tissue of Alzheimer's disease (AD), progressive supranuclear palsy, amyotrophic lateral sclerosis, Pick's disease, and controls. In controls, only capillaries were stained for ICAM-1. In affected areas of neurologically disease brains, a subset of reactive astrocytes was also strongly stained. In addition, there were irregular, diffuse patches of positive staining in the tissue matrix. In AD, many of these patches had dense cores which corresponded with senile plaques. Double immunostaining for glial fibrillary acidic protein and ICAM-1 indicated that some reactive astrocytes at the periphery of senile plaques were positive for ICAM-1. Within such plaques, microglial aggregates were stained intensely for leukocyte function-associated antigen-1 (LFA-1), the adhesion molecule for ICAM-1. The LFA-1/ICAM-1 system appears to play an important role in the interaction of astrocytes and microglia in several neurological diseases.Supported by grants from the Foundation for Total Health Promotion (HA), the Sasakawa Research Foundation (HA), the Alzheimer Society of B.C. and the MRC of Canada, as well as donations from individual British Columbians     

Histological findings at the boundary of craniopharyngiomas

Although a craniopharyngioma is grossly well circumscribed, microscopically the borders are frequently irregular and may be associated with gliosis in the adjacent brain tissue. In the current study, we investigated the histology of the interface between craniopharyngiomas and surrounding normal structures such as the hypothalamus and pituitary gland. Histologically, we classified the findings at the boundary of craniopharyngiomas into three types. In type 1, a relatively thick capsule-like tissue was identified at the boundary between the craniopharyngioma and surrounding normal structure composed of tumor cells and inflammatory changes. In type 2, a craniopharyngioma had a relatively clear cleavage between the surrounding gliosis. In type 3, the boundary had some interdigitation of the tumor in the surrounding gliotic layer adjacent to the craniopharyngioma. In types 1 and 3, surgeons may fail to accomplish complete resection of the tumor. These histological features may result in recurrence of craniopharyngioma even after gross total resection.     

Functional aortic stenosis diagnosed in fetal period

We report a case of fetal congenital heart disease prenatally diagnosed as critical aortic valve stenosis at 25 weeks of gestation. Fetal echocardiography demonstrated severe mitral regurgitation, aortic valve stenosis, hypocontractility of the left ventricle, and showed retrograde flow in the aortic arch like HLHS (hypoplastic left heart syndrome). However, soon after delivery, improvement in the baby's hemodynamics and myocardial contractility were recognized without any treatment.