Cysts of the pineal gland

Thirty-two cases of pineal cyst diagnosed by magnetic resonance imaging (MRI) were reviewed and are described. The pineal cyst was demonstrated to be an area with slightly less intensity than the surrounding tissue and with slightly greater intensity than the CSF on T1-weighted images. On the T2-weighted images this lesion was identified as a high-intensity area with smooth margins and was homogeneous in nature. In three cases presenting with headache, compression of the vein of Galen was identified, and compression of the quadrigeminal plate was demonstrated in five cases. No patients presented with both pineal and quadrigeminal lesions. Of the cases, 63% were not detected by CT scanning alone. There were two cases in which the cyst ruptured and collapsed spontaneously during follow-up. It is emphasized that the presence of this lesion, which was more frequent than previously expected, should be kept in mind when diagnosing pineal tumors and should not be misdiagnosed. Surgery should not be undertaken unless the lesion produces symptoms due to the compression of the quadrigeminal plate, aqueduct, or the vein of Galen.     

Congenital frontal bone defect with intact overlying scalp

An unusual case of a congenital frontal bone defect with intact overlying scalp and intact underlying dura mater is reported. Although spontaneous healing by the intact underlying dura mater by regeneration was expected, it did not occur. Cranioplasty was done for protective and cosmetic purposes. A review of the literature of congenital skull defects shows that spontaneous regeneration does not occur in this rare anomaly.     

Isolated dissection of the main trunk of the superior mesenteric artery

A 47-year-old male with sudden onset of abdominal pain was diagnosed as having a tight stenosis and a long irregular narrowing of the main trunk of the superior mesenteric artery (SMA), which induced transient ileus. The patient was successfully treated by a patch angioplasty using an autologous saphenous vein. An intraoperative finding revealed the isolated dissection of the SMA, and a histological examination confirmed the dissection of the SMA, in which false lumen was thrombosed.     

Antigen induced arthritis (AIA) can be transferred by bone marrow transplantation: evidence that interleukin 6 is essential for induction of AIA

OBJECTIVE: To investigate the role of bone marrow cells (BMC) in the induction of antigen induced arthritis (AIA), the expression of 3 major proinflammatory cytokines, interleukin 1beta (IL-1beta), tumor necrosis factor-alpha (TNF-alpha), and IL-6, was examined in the bone marrow (BM) of mice with AIA. We also examined whether AIA could be transferred by bone marrow transplantation (BMT). METHODS: Expression of IL-1beta, TNF-alpha, and IL-6 in BMC was assessed by immunohistochemistry throughout the course of AIA. BMT experiments were performed using 2 different mouse genotypes, wild type (IL-6+/+) and IL-6 deficient (IL-6-/-) mice, as a donor. The gradation of AIA was evaluated histologically. RESULTS: IL-6 was highly expressed in the BM at induction as well as during progression of AIA, while TNF-alpha showed a marginal expression, and no significant expression of IL-1beta was detected throughout the course of AIA. In BMT experiments, all irradiated IL-6+/+ mice developed typical AIA by transplantation of BMC from immunized IL-6+/+ mice, whereas almost no irradiated IL- 6+/+ mice transplanted with BMC from the immunized IL-6-/- mice developed definite arthritis. CONCLUSION: These results suggest that BMC play a critical role and IL-6 is a key cytokine for the induction and progression of AIA. There may be clinical benefits in the blockade of IL-6 and BMT in the treatment of rheumatoid arthritis.     

Matrix metalloproteinase-9-dependent exposure of a cryptic migratory control site in collagen is required before retinal angiogenesis

Retinal neovascularization is a leading cause of human blindness. However, little is known concerning the molecular mechanisms controlling retinal neovascularization in vivo. Here we provide evidence that exposure of a collagen type IV cryptic epitope detected by monoclonal antibody (mAb) HUIV26, delineates sites of vascular bud formation and represents one of the earliest structural remodeling events required before vessel out-growth. Exposure of these cryptic sites was inhibited in matrix metalloproteinase (MMP)-9-deficient but not MMP-2-deficient mice implicating MMP-9 in their exposure. Retinal endothelial cell interactions with the HUIV26 epitopes induced endothelial cell migration, which was blocked by mAb HUIV26. Importantly, subcutaneous administration of mAb HUIV26 potently inhibited retinal angiogenesis in vivo. Taken together, these findings suggest a novel mechanism in which MMP-9 facilitates exposure of HUIV26 cryptic sites, thereby promoting retinal endothelial cell migration and neovascularization in vivo.     

Outcome of punctal plug occlusion therapy for severe dry eye syndrome

PURPOSE: Punctal occlusion using a silicone plug is one way of treating tear-deficient dry eye and it has been reported to be effective. We studied the outcome of punctal plug occlusion therapy for severe dry eye syndrome at our dry eye clinic. SUBJECTS AND METHODS: Subjects were 76 eyes of 51 patients [6 eyes of 5 males, 70 eyes of 46 females, mean age: 58.6 +/- 13.4 (mean +/- standard deviation), 49 eyes of 30 patients with Sj?gren's syndrome, 27 eyes of 21 patients without Sj?gren's syndrome] with severe tear-deficient dry eye who underwent punctal occlusion using a silicone plug (Punctal plug, FCI Co. Ltd, France) during the period of Nov. 1996 to Mar. 2000 at our dry eye clinic. They were under observation for 632 +/- 405 days (mean +/- standard deviation). We studied if there is difference in tolerance between the sizes of punctal plug, compared epithelial damage before and after plug insertion, and studied relief in symptoms using self-assessment. RESULTS: In tolerance of punctal plugs, 55.9% of all plugs were lost during our follow up, but there was no difference in time to loss between the sizes. Epithelial damage was reduced (p < 0.001). Dryness was the most reduced symptom: 26 patients (79%) got better, and only epiphora was increased, with 12 patients (36%) complaining slightly. CONCLUSION: Punctal plug occlusion therapy for tear-deficient dry eye is conclusively very effective.     

Association of preoperative photoreceptor displacement and improved central scotoma after idiopathic macular hole surgery

OBJECTIVE: To investigate the relationship between preoperative photoreceptor displacement and postoperative scotoma after unilateral idiopathic macular hole surgery. DESIGN: Prospective nonrandomized comparative self-controlled trial. PARTICIPANTS: Twenty patients who underwent successful surgery for unilateral idiopathic macular hole participated in the study. METHODS: Kinetic perimetry using red and green filter glasses, black binocular fixation targets, and red and green selective monocular stimuli was performed preoperatively. Scanning laser ophthalmoscope (SLO) microperimetry was performed preoperatively and postoperatively. RESULTS: Sixteen patients had photoreceptor displacement preoperatively. In preoperative SLO microperimetry, all eyes with a macular hole had a scotoma; postoperatively, 12 of 16 had no scotoma. All four eyes with no preoperative photoreceptor displacement were noted to have a postoperative scotoma. The prevalence of postoperative scotoma in patients with preoperative photoreceptor displacement (4 of 16; 25%) was significantly lower than that in patients without preoperative photoreceptor displacement (4 of 4; 100%) (P = 0.03). CONCLUSIONS: The presence or absence of photoreceptor displacement preoperatively should affect postsurgical visual function. Photoreceptor damage may occur in eyes without photoreceptor displacement preoperatively, resulting in scotoma postoperatively.     

Study on difference in olfactory response in dysosmia patients

Using 1952 dysosmia patients, we studied the difference in olfactory response to 5 types of odorous substances used in the standard olfactory acuity test in Japan--beta-phenyl ethyl alcohol, methyl cyclopentenolone, isovaleric acid, gamma-undecalactone, and scatol. Olfactory dysfunctions included 887 patients with chronic paranasal sinusitis, 255 with allergic rhinitis, 326 with common cold sequela, 77 with complications from head injuries, 28 with drug-induced dysosmia, 39 with congenital dysosmia, 257 with dysosmia of unknown etiology, and 83 miscellaneous. The standard olfactory acuity test before treatment indicated that 82 patients detected only one odor within the detection threshold and 157 within the recognition threshold; 40 responded only to isovaleric acid at the detection threshold and 101 at the recognition threshold. Both figures were significantly greater than those who responded to other odors (p < 0.01). No specific trends were noted in etiologies of dysosmia that allowed smelling of isovaleric acid only either at the detection or recognition threshold. Among those whose olfactory thresholds were judged to be scaled out against all 5 odorous substances, 552 were rated as scaled out at the detection threshold and 630 at the recognition threshold. During post treatment, 33 scaled out at the detection threshold and 32 scaled out at the recognition threshold improved enough to smell 1 type of odor. Of these, 15 scaled out at the detection threshold and 13 scaled out at the recognition threshold became able to smell only isovaleric acid. Those becoming able to smell only isovaleric acid either at the detection or recognition threshold, significantly outnumbered those becoming able to smell other odors (p < 0.01). No outstanding cause of dysosmia was seen in those able to smell isovaleric acid. This data indicates that olfactory function for detecting isovaleric acid is relatively resistant to disease and is most likely to be restored. The difference in olfactory response of patients with olfactory dysfunction such as those above may be due to variations in the number of olfactory receptor proteins for specific odors within olfactory cells or different responses to the type of molecules of odor-emitting substances.     

Early results in the initial 15 cases of laparoscopic radical prostatectomy in Akita University Medical Center

We herein report our experience and early results of laparoscopic radical prostatectomy in 15 cases of localized prostate cancer (11 T1c and 4 T2a tumors) performed between March 2000 and October 2001. The operative procedure was almost identical to the Montsouris technique. Conversion to the open procedure was required only in the first case because of a widely opened bladder neck that involved the ureteral orifice. No severe intraoperative or postoperative complications were observed. The mean operating time and blood loss was 383 minutes and 640 ml including intraoperative urine, respectively. Only one patient required blood transfusion. All 14 patients with a successful procedure could take fluid and walk freely on postoperative day 1. Twelve (86%) of the 14 patients could take food on postoperative day 1 and a Foley catheter was successfully removed on day 6 to 8 in 12 (86%) cases. Histologically, positive surgical margin was observed in 5 (33%) cases and all of them were considered non-organ confined (pT3 or more). Without adjuvant hormonal therapy, biochemical (PSA) failure was observed in 5 (36%) cases (median follow-up period: 11 months). Continence has been well maintained in 12 patients with no need for a pad by 3 months postoperatively and 2 patients are using only 1 pad/day for caution's sake. In terms of early postoperative recovery, intraoperative blood loss and maintenance of continence, laparoscopic radical prostatectomy may give a satisfactory result. Although long-term follow-up is required to assess disease control and maintenance of sexual function, laparoscopic radical prostatectomy may become an alternative for the treatment of organ-confined prostate cancer.