Postoperative subarachnoid hemorrhage from an intracranial aneurysm after craniotomy for astrocytoma--case report

The authors present the first reported case of a glioma associated with a right posterior cerebral artery (PCA) aneurysm. A 37-year-old male underwent craniotomy and total removal of the glioma, which appeared, according to encephalographic findings, to be responsible for the initial symptom of loss of consciousness. The risk of craniotomy-induced bleeding from the aneurysm was thought to be low, since it was unruptured and was packed with coagulum. However, subarachnoid hemorrhage due to rupture of the PCA aneurysm occurred just after craniotomy, and clipping was performed 15 days after the first operation.     

Detection of human glioma-associated antigen by rat monoclonal antibody raised against syngeneic rat glioma cells

A monoclonal antibody termed "FR77" was obtained from a hybridoma clone established by fusion between P3x63Ag8.653 mouse myeloma cells and spleen cells of a Fischer F344 rat hyperimmune to syngeneic 9L/R3 glioma cells. Immunoperoxidase staining of various cultured cells showed that FR77 was reactive to both rat and human glioma cells, but was not reactive with other nonglioma cells. Immunohistochemical examination of paraffin-embedded or cryostat-frozen sections of various human tissues revealed that FR77 was strongly reactive with glioblastoma, grade III astrocytoma, and craniopharyngioma; partially reactive with intracerebral primitive neuroectodermal tumor, pineoblastoma, and desmoplastic medulloblastoma; and weakly reactive with low-grade astrocytoma. It was not reactive with other types of brain tumors and normal human tissues tested. The FR77-defined antigen was observed to be predominantly localized in the cytoplasm of antigen-bearing cells as suggested by the immunostaining pattern, but part of it was also expressed on the cell surface of glioma cells as demonstrated by a complement-mediated cytotoxic test. Fractionation of the antigenic component and periodic acid treatment of tumor tissue bearing the FR77-defined antigen indicated that the antigen is of a neutral glycolipid nature and that the antigenic determinant to FR77 is present on its sugar portion.     

Progress in the retrograde approach for chronic total coronary artery occlusion

After the introduction of the retrograde approach in percutaneous coronary intervention for chronic total occlusion (CTO), different kinds of strategies and techniques have been developed in order to achieve final success. However, it has not been fully demonstrated whether these strategies and techniques can really improve the final result. We observed one case, for which the initial attempt of the retrograde approach for a CTO lesion was unsuccessful despite the successful approach of a retrograde guidewire to the lesion, and with the second retrograde approach 3 years later being eventually successful by using various kinds of strategies and techniques. This case clearly demonstrates how the final success through the retrograde approach can be achieved by using a combination of the improved strategies and techniques for CTO lesions. © 2008 Wiley‐Liss, Inc.     

Immobilization-induced hypersensitivity associated with spinal cord sensitization during cast immobilization and after cast removal in rats

This study examined mechanical and thermal hypersensitivity in the rat hind paw during cast immobilization of the hind limbs for 4 or 8 weeks and following cast removal. Blood flow, skin temperature, and volume of the rat hind paw were assessed in order to determine peripheral circulation of the hind limbs. Sensitization was analyzed by measuring the expression of the calcitonin gene-related peptide (CGRP) in the spinal dorsal horn following cast immobilization. Two weeks post immobilization, mechanical and thermal sensitivities increased significantly in all rats; however, peripheral circulation was not affected by immobilization. Cast immobilization for 8 weeks induced more serious hypersensitivity compared to cast immobilization for 4 weeks. Moreover, CGRP expression in the deeper lamina layer of the spinal dorsal horn increased in the rats immobilized for 8 weeks but not in those immobilized for 4 weeks. These findings suggest that immobilization-induced hypersensitivity develops during the immobilization period without affecting peripheral circulation. Our results also highlight the possibility that prolonged immobilization induces central sensitization in the spinal cord.     

Inguinal hernia repair with the mesh plug method is safe after radical retropubic prostatectomy

Purpose

We evaluated the safety and efficiency of using the mesh plug method (MP) to repair inguinal hernias in patients with a history of radical retropubic prostatectomy (RRP). We also investigated how RRP influences the development of inguinal hernias and impacts their repair.

Methods

Among 488 adult male patients who underwent inguinal hernia repair during a recent 5-year period, 37 had a history of RRP. We compared the characteristics and surgical outcomes of the patients who had undergone RRP (post-RRP group) with those who had not (non-RRP group).

Results

All post-RRP hernias were treated by MP. The 37 post-RRP patients had a collective 41 hernias, 40 of which were of the indirect type. The side affected by the hernia did not differ significantly between the groups. We compared the short-term surgical outcomes of the indirect post-RRP hernias vs. the indirect non-RPP hernias without recurrence and incarceration. The operation times, postoperative hospital stay, and mobility rates did not differ significantly between the two groups. The blood loss was almost equal in both groups.

Conclusion

Inguinal hernia repair after RRP may be difficult because of inflammatory changes in the preperitoneal cavity, but the surgical outcomes of MP were equivalent in patients with or without a history of RPP in this study. MP is a safe and effective method for post-RPP hernia repair.     

Localization of adenosine A2a receptor in retinal development and oxygen-induced retinopathy

PURPOSE: To investigate the association of adenosine A2a receptors (A2aR) with retinal vasculogenesis and angiogenesis that occurs in the canine model of oxygen-induced retinopathy (OIR). METHODS: One-day-old dogs were exposed to 100/o oxygen for 4 days and killed in oxygen (5 days old) and at 3, 10, 17, and 23 days after exposure to hyperoxia. Room air control animals were killed at 1, 5, 8, 15, 22, and 28 days of age. Immunolocalization of A2aR was performed on frozen sections, and reaction product density was quantified using microdensitometry. Cell types were identified in serial sections using antibodies against von Willebrand factor (endothelial cells) and GFAP (astrocytes), and enzyme histochemistry for menadione-dependent a-glycerophosphate dehydrogenase (M-a-GPDH) (to label angioblasts and developing blood vessels). RESULTS: A2aR immunoreactivity was associated with forming blood vessels and angioblasts in the nerve fiber layer (NFL) of peripheral retina. As development progressed, vascular labeling decreased, whereas labeling of neuronal elements increased. In OIR, A2aR immunoreactivity in the NFL was reduced after exposure to hyperoxia and significantly elevated in the inner retina throughout vascularized retina and in advance of forming vasculature in all oxygen-treated animals returned to room air. A2aR immunoreactivity was also prominent in fronds of intravitreal neovascularization. CONCLUSIONS: A2aR immunoreactivity was associated with developing retinal vessels. As development progressed, vascular-associated A2aR labeling decreased and, concomitantly, labeling of neuronal elements increased. A2aR immunoreactivity was significantly elevated at the edge of forming vasculature in all animals returned to room air after hyperoxia and in intravitreal neovas cular formations. These results provide additional evidence for the importance of A2aR and its ligand adenosine in retinal vascular development and in the vasoproliferative stage of canine OIR.     

Stroke patients' evolving symptoms assessed by tractography

PURPOSE: To test the hypothesis that an interval evolution in the location of the depicted sensorimotor tract relative to the infarct (the "tract-infarct relationship") may be related to stroke victims' symptom progression. MATERIALS AND METHODS: Patients (N = 7) who underwent multiple diffusion-tensor imaging (DTI) studies during symptomatic progression were included in this study. DTI was performed using a single-shot echo-planar imaging (EPI) technique with a motion-probing gradient in six orientations, a b-value of 800 seconds/mm2, and six image averages. The total scan time was four minutes and 24 seconds. Fiber-tracking of the sensorimotor pathways was performed, and the locations of these tracts were retrospectively assessed in relation to the evolution of the symptoms. RESULTS: Five of the seven patients showed an interval enlargement of the infarct on diffusion-weighted (DW) images. In two of these cases the lesion enlarged to involve the sensorimotor tracts, while in three cases the lesion enlarged only so far to come into close proximity to the sensorimotor tract. In the remaining two cases there was no interval enlargement of the infarct, and therefore the tract-infarct relationship could not account for the evolution of the symptoms in these cases. CONCLUSION: A tract-infarct relationship can be observed with the use of a fiber-tracking technique, and the results may improve our understanding of the symptom progression seen in stroke victims.