Observation of CSF pulsatile flow in MRI--the signal void phenomenon

In a comparative study of MR images of 289 neurosurgical patients, loss of the signal intensity (signal void phenomenon) of CSF in the aqueduct was observed in 77 patients. This signal void phenomenon was seen most frequently in infants with chronic subdural hematoma (12 of 18) and patients of all age groups suffering from communicating hydrocephalus (10 of 14). It is known that CSF in the cranial cavity flows toward the spinal CSF space in to and fro manner responding to brain parenchyma pulsations. The velocity of this flow is to be faster in the narrower parts through the ventricular systems such as the aqueduct, Monro's foramen and the 4th ventricles. We think that in T2 weighted images signal void phenomenon reflects "high velocity signal loss" due to CSF flow. When the subarachnoid adhesions secondary to subarachnoid hemorrhage stagnate CSF flow in the subarachnoid space, the intraventricular CSF flow forms the main buffer for changes of the brain volume. This causes an increase in the amplitude of the pulsatile flow in the ventricular systems. Therefore the signal void phenomenon in the aqueductal CSF becomes more pronounced. It may be possible to differentiate normal circulation of CSF from abnormal with the bigger amplitude of CSF pulsatile flow, to understand the mechanisms of the normal pressure hydrocephalus or to diagnose a shunt malfunction. Therefore more insight in the CSF flow as imaged by MRI is needed, quantification of CSF flow will be the subjects of our further research.     

Effects of Fucoxanthin on the Inhibition of Dexamethasone-Induced Skeletal Muscle Loss in Mice

Fucoxanthin (Fx) has preventive effect against muscle atrophy and myotube loss in vitro, but it has not yet been examined in vivo. Therefore, we aimed to investigate the effect of Fx on dexamethasone (Dex)-induced muscle atrophy and fat mass in mice. ICR mice were fed with Fx diets from 2 weeks before Dex treatment to the end of the study. Muscle atrophy was induced in the mice by oral administration of Dex. Body weight was significantly lower by Dex treatment. Visceral fat mass in the Fx-treated group were significantly lower than those in the control group. The Dex-induced decrease in tibialis anterior muscle mass was ameliorated by Fx treatment. Fx treatment significantly attenuated muscle lipid peroxidation compared with the control and Dex-treated groups. The phosphorylation of AMPK was significantly higher in the Dex-treated group than in the control group. The expression of cytochrome c oxidase (COX) IV was significantly higher in the Fx-treated group than in the control group. These results suggest that Fx may be a beneficial material to prevent muscle atrophy in vivo, in addition to the effect of fat loss.     

Association between Preoperative Long-Chain Polyunsaturated Fatty Acids and Oxidative Stress Immediately after Total Knee Arthroplasty: A Pilot Study

Quadriceps muscle atrophy following total knee arthroplasty (TKA) can be caused by tourniquet-induced ischemia–reperfusion (IR) injury, which is often accompanied by oxidative stress and inflammatory responses. n-3 long-chain polyunsaturated fatty acids (LCPUFAs), such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), exert antioxidant and anti-inflammatory effects against IR injury, whereas n-6 LCPUFAs, particularly arachidonic acid (AA), exhibit pro-inflammatory effects and promote IR injury. This study aimed to examine whether preoperative serum EPA + DHA levels and the (EPA + DHA)/AA ratio are associated with oxidative stress immediately after TKA. Fourteen eligible patients with knee osteoarthritis scheduled for unilateral TKA participated in this study. The levels of serum EPA, DHA, and AA were measured immediately before surgery. Derivatives of reactive oxygen metabolites (d-ROMs) were used as biomarkers for oxidative stress. The preoperative serum EPA + DHA levels and the (EPA + DHA)/AA ratio were found to be significantly negatively correlated with the serum d-ROM levels at 96 h after surgery, and the rate of increase in serum d-ROM levels between baseline and 96 h postoperatively. This study suggested the preoperative serum EPA + DHA levels and the (EPA + DHA)/AA ratio can be negatively associated with oxidative stress immediately after TKA.     

Radiation tolerance of partially irradiated liver in a multidisciplinary treatment for hepatoma

Radiation tolerance of the partially irradiated liver was studied in eight patients with primary hepatoma treated by a multimodal approach. Seven patients were treated by transarterial embolization therapy (TAE) with Lipiodol-MMC, and two patients were treated by operation, combined with radiotherapy. Six patients had liver cirrhosis and the other one had renal dysfunction. Respiration-gated irradiation was employed to reduce a treatment volume for seven patients. Radiation portals were carefully tailored using the embolized Lipiodol or a metal clip inserted into the tumor as references. Two or three portals were used for each patient. The treatment volume ranged from 64 to 1400 cm3. The target dose ranged from 50.4 Gy to 81.0 Gy, from 73.5 to 108.6 in TDF. Liver function tests (GOT, GPT, LDH, ALP, ChE and total Bilirubin) were examined for 30 weeks after initiation of irradiation. Three patients showed abnormal value in more than 5 tests. Of these three patients, the hepatic hilum was included in the treatment volume in two, and the tumor progressed during the observation period in two. Leukopenia and thrombopenia were observed, but these values were not below 2000 and 40000/mm3, respectively, although the thrombocyte count before irradiation was below 100000/mm3 in 7 patients. AFP titers decreased after the treatment in six out of seven patients with abnormally elevated pretreatment titer. The survival period after staring irradiation was 6.5 to 25 months. "The volume dose" did not correlate well with the degree of the liver function aggravation.(ABSTRACT TRUNCATED AT 250 WORDS)     

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)     

Diffuse lymphangiomatosis of bone

Two cases of lymphangiomatosis of bone, a very rare systemic condition characterized by both skeletal and parenchymal lesions, are presented. The skeletal changes have an appearance similar to haemangiomas in the spine, and soap-bubbly lesions in the flat bones. One case carried the diagnosis of eosinophilic granuloma for 18 years. The findings on MRI, which have not been previously well-established, are discussed.     

Intraoperative indirect monitoring of electrocardiogram

The electrocardiogram (ECG) is used as a standard monitoring method during anesthesia and operation. But during the operation of severely burnt patients, the electrodes for ECG cannot be placed on the ideal points for the standard limb leads. We tried the indirect monitoring of the ECG. We placed the electrodes on the sheet over the operating table, and connected the patient and the electrodes with water. By this way the ECG similar to the standard limb leads could be recorded. This method is useful for the patients, with such diseases as severe burn, severe atopic dermatitis and epidermolysis bullosa hereditaria.     

Current topics in the regulation of prostanoids--3. Prostanoid synthases and prostanoid receptors

Formation of biologically active prostanoids from PGH2 occurs through a set of synthases for PGD, PGE, PGF, PGI and TXA2, following the cyclooxygenase reaction. Over the past few years, the genes of several prostanoid synthases have been cloned and the characteristics of the enzymes are now determined. In addition, receptors for prostanoids were also cloned and their structures were determined as G-protein coupled seven-transmembrane domain types belonging to the rhodopsin-type receptor superfamily. Based on these molecular biological findings, the mechanism of the diverse effects of prostanoids are being clarified. Selective inhibitors against the synthases and the selective agonists and antagonists for the prostanoid receptors are now being investigated rapidly for clinical application.     

A case of ABO-incompatible renal transplant patient with non-insulin-dependent diabetes mellitus; long-standing observation of serial glomerular change by protocol biopsy

A 41-yr-old patient with non-insulin-dependent diabetes mellitus (NIDDM), before and after ABO-incompatible renal transplant, is reviewed using serial protocol biopsy. Although she recovered from delayed hyperacute rejection (DHAR) immediately post-transplantation, her graft function deteriorated gradually. A mild acute transplant glomerulitis, noted at the 155th day post-transplantation, progressed to pronounced chronic transplant glomerulopathy over 5 yr. In the specimen of the last biopsy, at 5 yr post-transplantation, glomeruli demonstrated an exudative hyaline lesion, which was characteristic of diabetic nephropathy in addition to chronic transplant glomerulopathy. Therefore, we made a diagnosis of this glomerular lesion as chronic transplant glomerulopathy complicated by diabetic glomerulopathy. Considering the result of this case, the protocol biopsy is a useful procedure to diagnose an accurate cause of graft dysfunction in individual cases. It is concluded that the protocol biopsy is apparently useful for the detection of various pathological processes occurring in allograft and may contribute to a strategy for improvement of graft survival.     

Schizophrenia and the serotonin-2A receptor promoter polymorphism

Serotonin-2A (5-HT2A) receptors have received much investigative attention in schizophrenia because (1) several studies have shown a decrease in the number of 5-HT2A receptors in the prefrontal cortex of postmortem brains of schizophrenic patients; (2) atypical antipsychotic drugs are antagonists for 5-HT2A receptors; and (3) a positive association between a T to C polymorphism at position 102 of the 5-HT2A receptor gene and schizophrenia has been reported. A G to A polymorphism at position -1438 of the 5-HT2A receptor gene was studied in 119 schizophrenic patients and 106 healthy control subjects, all of whom were Japanese. The genotype and allele frequencies did not differ between the patients and control subjects. Furthermore, the genotype frequency did not differ according to diagnostic subtype, family history, age at onset of illness, or daily dosage of antipsychotic medication. Our results suggest that the polymorphism does not contribute to the etiology or clinical characteristics of schizophrenia. However, the gene is greater than 20 kbp in length, and thus it is possible that other areas that affect expression of the gene may vary. We found that the -1438G/A variant was in linkage disequilibrium with the T102C polymorphism.