A case of internal carotid-posterior communicating artery aneurysm presenting pure acute subdural hematoma

The incidence of acute subdural hematoma (SDH) due to a ruptured intracranial aneurysm varies from 0.5% to 7.9% of all intracranial aneurysms. Pure acute SDH without subarachnoid hemorrhage (SAH) is rare. According to the literature, only 18 cases (including our case) of pure acute SDH identified by CT scan have been reported. Here we report a case of an internal carotid-posterior communicating artery (IC-PC) aneurysm presenting pure acute SDH identified by CT. We summarize the 18 reported cases. A 55-year-old female experienced severe headache on October 9, 1999, which did not improve after medication. Four days later, left ptosis began. She was admitted to the department of ophthalmology to treat oculomotor nerve paresis. A computed tomography (CT) scan obtained on admission, revealed no obvious abnormality. She was treated by hormonal therapy, but her symptoms continued. Ten days later, she suddenly lost consciousness and was transferred to our hospital. Although the CT scan revealed a thick left SDH with marked midline shift, SAH was absent. Her neurological state was Hunt & Kosnik grade IV. A left carotid angiogram revealed an IC-PC aneurysm with active extravasation. The patient was taken to the operating room for emergency removal of the SDH and aneurysmal neck clipping. During the operation, adhesion between the aneurysmal dome and the arachnoid was observed, but subarachnoid hemorrhage was not identified at all. The aneurysm was successfully clipped. Postoperatively, her consciousness improved immediately. In this case, the pure acute SDH identified by CT was responsible for causing the direct hemorrhage into the subdural space via an adhesive lesion.     

Solitary Splenic Metastasis from Ovarian Cancer Successfully Treated by Hand-Assisted Laparoscopic Splenectomy: Report of a Case

Solitary splenic metastasis is an extremely rare phenomenon for which splenectomy is generally indicated because a good prognosis can be achieved if chemotherapy is given postoperatively. We report herein a case of solitary splenic metastasis from ovarian cancer, which was completely removed by hand-assisted laparoscopic surgery. Received: June 25, 2001 / Accepted: January 8, 2002     

Long-term visual prognosis of choroidal neovascularization in high myopia: a comparison between age groups

OBJECTIVE: To analyze visual outcome in highly myopic patients of different age groups with choroidal neovascularization (CNV). DESIGN: Retrospective observational case series. PARTICIPANTS: We reviewed the medical records of 63 consecutive patients (73 eyes) with myopic CNV. The patient population was divided into two groups according to age at onset of CNV (< or =40 and >40 years old). INTERVENTION: Demographic and clinical data were obtained from the patients' medical records. MAIN OUTCOME MEASURES: Visual acuity at least 3 years after CNV diagnosis. RESULTS: Group 1 (< or =40 years old) consisted of 22 patients (26 eyes), and group 2 (>40 years old) consisted of 41 patients (47 eyes). Throughout the follow-up period, group 1 retained better visual acuity than group 2. Almost half the patients in group 1 retained a final visual acuity better than 20/40. No significant change occurred in the logarithm of the minimum angle of resolution (logMAR) in group 1 during follow-up. Group 2 had worse visual acuity at the initial evaluation than did group 1, and a statistically significant worsening of logMAR was found during the follow-up period. More than half of the patients in group 2 had a final visual acuity less than 20/200. In addition, group 2 had a larger area of CNV, and chorioretinal atrophy was more frequently seen after the regression of CNV than in group 1. CONCLUSIONS: The visual prognosis of myopic CNV is influenced by age at onset. The results of this study indicate that patient age at the time of onset of myopic CNV should be considered when determining the therapeutic course.     

Optical coherence tomography of choroidal neovascularization in high myopia

AIM: To investigate morphologic changes in the eye with choroidal neovascularization (CNV) in high myopia using optical coherence tomography (OCT). METHODS: Optical coherence tomography was performed in 35 patients (42 eyes) with myopic CNV. Myopic CNV was divided into active, scar, or atrophic stages based on funduscopic and fluorescein angiographic findings. The characteristics of OCT findings in each stage were identified. RESULTS: In the active stage (11 eyes), OCT clearly displayed a neovascular membrane as a highly reflective dome-like elevation above the retinal pigment epithelium (RPE). No apparent subretinal fluid accumulation around the CNV was identified. In the scar stage (12 eyes), only the surface of the CNV showed high reflectivity, which was markedly attenuated below the surface. In the atrophic stage (19 eyes), the CNV had become totally flat and chorioretinal atrophy around the regressed CNV showed high reflectivity. CONCLUSIONS: Optical coherence tomography demonstrated characteristic features at each stage of myopic CNV. Optical coherence tomography appears to be useful in evaluating the stage and activity of myopic CNV.     

Effect of suplatast tosilate,a Th2 cytokine inhibitor,on cough variant asthma

STUDY OBJECTIVE: Th2 cytokines play an important role in the pathogenesis of asthma. Our study objective was to determine the effect of suplatast tosilate, a Th2 cytokine inhibitor, on patients with cough-variant asthma. METHODS: Twenty patients with cough-variant asthma (CVA) were assigned to a suplatast tosilate (100 mg three times daily) group or a placebo group for 6 weeks in a double-blind randomized study. The cough scores, medication scores, pulmonary function, bronchial hyperresponsiveness to methacholine, cough threshold for capsaicin, percentage of eosinophils and concentrations of eosinophilic cationic protein (ECP) in hypertonic saline-induced (induced) sputum were evaluated. The main outcome measures were capsaicin cough threshold and concentrations of ECP in induced sputum. RESULTS: In the suplatast group, the cough scores and the medication scores decreased significantly over time. The percentage of eosinophils in induced sputum significantly decreased from 53.5+/-5.6% to 13.6+/-2.6%. The cough threshold for capsaicin improved significantly from 2.72+/-3.41 microM to 39.7+/-22.7 microM in the suplatast group. The concentrations of ECP in induced sputum decreased significantly from 435+/-123 microg/l to 56+/-34 microg/l in the suplatast group. The bronchial responsiveness to methacholine changed from 8.45+/-3.43 units to 11.4+/-3.76 units in the suplatast group. CONCLUSIONS: Suplatast improved the cough scores and the cough threshold for capsaicin in patients with CVA without significant side effects, suggesting the effectiveness of suplatast in the treatment of CVA. Suplatast also decreased the percentage of eosinophils and concentrations of ECP in induced sputum, suggesting improvement in eosinophilic inflammation in patients with CVA. Further pharmacodynamic research is needed to explain the precise mechanism.     

Denopamine,a selective beta1-receptor agonist and a new coronary vasodilator

Up until now, it has been suggested that nitrate and/or calcium channel blockers were effective against variant angina pectoris. On the other hand, it is known that about 20% of variant angina pectoris was refractory to both nitrate and calcium channel blockers. In Japan, it has been reported that denopamine, which is an oral beta1-adrenoceptor selective agonist developed by the Japanese pharmaceutical industry (Tanabe Seiyaku), is effective in those refractory cases. To date, in Japan nine cases have been recognized of patients with vasospastic angina pectoris whose symptoms were relieved by taking denopamine, including one case in which the author has had personal experience. Eight of these nine cases were refractory, and were not relieved by combined therapy using both nitrate and a calcium channel blocker. It was also documented that denopamine was effective in cases where attacks were not relieved by prazosin or magnesium, which have been documented as effective in other refractory cases. In a study of canine coronary arteries, localization of beta-adrenoceptor subtypes was documented, with the beta1-adrenoceptor predominantly found in the conduit coronary artery. In recent years it has been emphasized that the principal role of sympathetic nerves was not associated with the constrictive action of alpha-adrenoceptors, but with the coronary dilative action of beta-adrenoceptors. It would therefore be worthwhile to determine whether denopamine is able to relieve vasospastic angina pectoris in many more cases.     

Nitric oxide-mediated vasodilatory effect of atrial natriuretic peptide in forearm vessels of healthy humans

1. The aim of the present study was to determine whether the vasorelaxant effect of atrial natriuretic peptide (ANP) is, in part, endothelium dependent in humans. 2. We used veno-occlusive plethysmography to measure forearm blood flow (FBF) during intra-arterial infusions of ANP (4, 8, 16, 32 pmol/min per dL forearm tissue volume) before and after the inhibition of nitric oxide (NO) synthesis by N(G)-monomethyl-L-arginine (L-NMMA; 100 micromol) in seven normal healthy subjects. 3. Atrial natriuretic peptide caused a dose-dependent increase in FBF both before and after L-NMMA and significantly reduced the plasma concentration of angiotensin (Ang) II. Administration of L-NMMA significantly diminished the increase in FBF in response to ANP infusion (P < 0.05). 4. These results suggest that the forearm vasodilative response to ANP is modulated, in part, by an endothelium-derived NO-mediated mechanism associated with a decrease in AngII caused by ANP.     

Susceptibilities of bacteria isolated from patients with lower respiratory infectious diseases to antibiotics (2000)

From October 2000 to September 2001, we collected the specimen from 410 patients with lower respiratory tract infections in 16 institutions in Japan, and investigated the susceptibilities of isolated bacteria to various anti-bacterial agents and antibiotics and patients' characteristics. Of 499 strains that were isolated from specimen (mainly from sputum) and assumed to be bacteria causing in inflammation, 493 strains were investigated. The breakdown of the isolated bacteria were: Staphylococcus aureus 78, Streptococcus pneumoniae 73, Haemophilus infiuenzae 99, Pseudomonas aeruginosa (non-mucoid) 64, P. aeruginosa (mucoid) 14, Klebsiella pneumoniae 25, Moraxella subgenus Branhamella catarrhalis 21, etc. Of 78 S. aureus strains, those with 4 micrograms/ml or more of MIC of oxacillin (methicillin-resistant S. aureus: MRSA) occupied 53.8%. Vancomycin and arbekacin had the most potent activities against MRSA as observed in 1999. The frequency of S. pneumoniae exhibiting low sensitivity to penicillin (penicillin-intermediate S. pneumoniae: PISP + penicillin-resistant S. pneumoniae: PRSP) was 38.4% being consistent with that in 1999 (34.7%). PRSP accounted for 11.0% of the total, being more than that in 1999 (3.0%). Carbapenems had strong activities against S. pneumoniae. Especially, panipenem inhibited the growth of all 73 strains at 0.125 microgram/ml. Generally, all drugs had strong activities against H. influenzae with MIC80s of 8 micrograms/ml or less. The drug that had the strongest activity against H. infiuenzae was levofloxacin, which inhibited the growth of 94 of the 99 strains at 0.063 microgram/ml. Tobramycin had a strong activity against P. aeruginosa (both mucoid and non-mucoid) with MIC80 of 1 microgram/ml. The mucoid strain was little isolated (14 strains) but the susceptibilities to all drugs were better than the non-mucoid strain. K. pneumoniae showed good susceptibilities to all drugs except ampicillin and the MIC80S were 2 micrograms/ml or less. Particularly, cefpirome, cefozopran, and levofloxacin had strong bactericidal activities against K. pneumoniae with MIC80s of 0.125 microgram/ml, and cefotiam, second-generation cephems, also had a favorable activity being MIC80 of 0.25 microgram/ml. Also, all drugs generally had strong activities against M. (B.) catarrhalis. MIC80s of all drugs were 2 micrograms/ml or less. The drug having the strongest activity was imipenem and levofloxacin inhibiting all 21 strains at 0.063 microgram/ml. Most of the patients with respiratory infection were aged 70 years or older, accounting for approximately a half of the total (44.4%). As for the incidence by the diseases, bacterial pneumonia and chronic bronchitis were the highest, being noted in 38.0% and 31.7% of all the patients, respectively. The bacteria frequently isolated from the patients with bacterial pneumonia were S. aureus (18.3%) and S. pneumoniae (16.1%). In contrast, H. infiuenzae (20.4%) and P. aeruginosa (both mucoid and non-mucoid: 16.7%) were frequently isolated from the patients with chronic bronchitis. Before the drug administration, the bacteria frequently isolated from all the patients were S. pneumoniae (24.3%) and H. infiuenzae (26.7%). The frequency of isolated S. pneumoniae tended to decrease with the increase in the number of administration days while that of isolated H. infiuenzae did not. The frequency of isolated P. aeruginosa tended to increase with the duration of administration. The isolated bacteria were comparable between the patients already treated with penicillins and cephems. In the patients treated with aminoglycosides, macrolides, and quinolones, P. aeruginosa was most frequently isolated (33.3 to 40.0%).