Search

Objectives: Endoscopic ultrasonography (EUS) plays an important role in the diagnosis of pancreatobiliary diseases. However, an appropriate sedation method for EUS has not been established. Therefore, this study aimed to examine the safety and complications of sedation with pentazocine or pethidine hydrochloride for outpatient diagnostic EUS., Methods: We retrospectively reviewed 1302 consecutive cases in our department that underwent outpatient diagnostic EUS between April 2019 and September 2021. Until June 2020, EUS was performed under sedation with midazolam and pentazocine (pentazocine group) in principle; after June 2020, sedation with midazolam and pethidine hydrochloride (pethidine hydrochloride group) was used. A cohort of patients with comparable backgrounds was identified using propensity score matching., Results: A total of 486 cases were included in this study. Sedation-related adverse events during the endoscopic procedures were not significantly different between the groups. The median time spent in the recovery room after EUS was significantly shorter in the pethidine hydrochloride group than in the pentazocine group (69 versus vs. 77 min; p  < 0.001). The frequency of nausea or vomiting after EUS was significantly lower in the pethidine hydrochloride group than in the pentazocine group (0% [0/486] vs. 6.2% [29/486]; p  < 0.001). The frequency of readmission to the recovery room after discharge was significantly lower in the pethidine group than in the pentazocine group (0 [0%] vs. 18 [3.7%], respectively; p  < 0.001)., Conclusions: The combination of midazolam and pethidine hydrochloride is a more favorable anesthetic than the combination of midazolam and pentazocine for diagnostic EUS in outpatients., Competing Interests: The authors declare no conflict of interest., (© 2024 The Author(s). DEN Open published by John Wiley & Sons Australia, Ltd on behalf of Japan Gastroenterological Endoscopy Society.)

Antiapoptotic protein, including Mcl-1, expression is frequently observed in pancreatic cancer. Gemcitabine plus nabpaclitaxel (GnP) is the standard chemotherapy for metastatic pancreatic cancer (MPC); however, predictive markers for its efficacy remain unestablished. This study evaluated the association between GnP's therapeutic effects and Mcl-1 expression in tissue samples obtained using endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for pancreatic tumor or percutaneous ultrasound-guided biopsy for metastatic liver tumor. We retrospectively reviewed 38 patients with histologically diagnosed MPC who received GnP as the first-line chemotherapy at our institute between December 2014 and July 2018. Post-immunohistochemistry analysis for Mcl-1 expression detection, patients were divided to into two groups based on the cell proportion showing Mcl-1 immunoreactivity: positive (> 20%; 23 [60.5%] patients) and negative (≤ 20%; 15 [39.5%] patients) groups. Clinical characteristics did not differ between the two groups. The Mcl-1 positive group showed a significantly higher disease control rate (95.7% vs. 73.3%; P = 0.046), longer progressionfree survival (PFS) (7.2 months vs. 4.9 months; P = 0.018) and longer overall survival (OS) (14.9 months vs. 9.2 months; P = 0.008) than the Mcl-1 negative group. Multivariate analysis showed that Mcl-1 expression was an independent predictive marker for PFS and OS. Mcl-1 expression could be a predictive marker for favorable response to GnP., (© 2024. The Author(s).)

Background: Germline breast cancer susceptibility gene (gBRCA) mutation in patients with pancreatic cancer (PC) is not common in clinical practice. Therefore, factors that efficiently show gBRCA mutations and the real-world outcomes of olaparib maintenance therapy have not been fully established. In the present study, we clarified the indicators for the effective detection of gBRCA mutation and the efficacy and safety of olaparib as maintenance therapy., Methods: We retrospectively analyzed 84 patients with PC who underwent gBRCA testing (BRACAnalysis, Myriad Genetics, Salt Lake City, UT, USA) at our institute between January 2021 and March 2022. For each patient, clinical data were extracted from medical records., Results: The median patient age was 64 y (29-85 y), and 41 patients (48.8%) were male. The gBRCA mutations were identified in 10 (11.9%) patients; two patients had BRCA1 mutation and eight had BRCA2 mutation. All patients with gBRCA mutation had a family history of any cancer, and eight of them had a family history of Hereditary Breast and Ovarian Cancer syndrome (HBOC)-related cancer. The gBRCA mutation rate was higher for patients with PC with a family history of HBOC-related cancer compared to that in patients with PC having a family history of other cancers and no family history of cancer (22.9% vs. 4.1%; P = 0.014). In our study, eight out of 10 patients with gBRCA-positive PC received olaparib after platinum-based chemotherapy. The best responses to platinum-based chemotherapy included a complete response in one patient (12.5%) and a partial response in seven patients (87.5%). The median duration of treatment with platinum-based chemotherapy plus olaparib was 17.5 months (8-87 months), and the duration of treatment with olaparib maintenance therapy was 11 months (1-30 months). During olaparib maintenance therapy, three patients showed no disease progression. One of these three patients underwent conversion surgery after receiving olaparib for 12 months., Conclusions: The gBRCA testing should be considered proactively, especially in patients with PC with a family history of HBOC-related cancer., (© 2024. The Author(s).)

Background: Although patients with advanced pancreatic cancer (PC) often experience dysgeusia with zinc deficiency during chemotherapy, data on zinc supplementation for dysgeusia and its effects on nutritional status are scarce. We aimed to examine the efficacy of zinc supplementation in patients with advanced PC., Methods: Thirty-three patients with unresectable PC who presented with dysgeusia and zinc deficiency during chemotherapy and received zinc acetate hydrate between January 2018 and December 2022 were included. We evaluated the changes in serum zinc levels and the improvement in dysgeusia. Among the 26 patients who received zinc supplementation for 12 weeks, we also compared patient characteristics and changes in serum zinc and albumin levels between patients who showed improvement in dysgeusia (effective group) and those who did not (non-effective group)., Results: The serum zinc level increased significantly after zinc supplementation (median: 60 µg/dL at baseline, 99.5 µg/dL at 4 weeks, 101 µg/dL at 8 weeks and 101 µg/dL at 12 weeks). The rate of improvement in dysgeusia increased over time (18.2% at 4 weeks, 33.3% at 8 weeks, and 42.4% at 12 weeks). Comparing the effective group and non-effective group revealed that while the median serum albumin level of the effective group did not change, the non-effective group showed a significant decrease from baseline to 12 weeks (3.2 g/dL to 3.0 g/dL, p = 0.03)., Conclusion: Zinc supplementation significantly increased serum zinc levels, improving dysgeusia. Zinc supplementation might also contribute to maintaining nutritional status in patients with unresectable PC., (© 2024. The Author(s) under exclusive licence to Japan Society of Clinical Oncology.)

Objectives: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is used for pathological diagnosis and obtaining samples for molecular testing, facilitating the initiation of targeted therapies in patients with pancreatic cancer. However, samples obtained via EUS-TA are often insufficient, requiring more efforts to improve sampling adequacy for molecular testing. Therefore, this study investigated the use of oil blotting paper for formalin fixation of samples obtained via EUS-TA., Methods: This prospective study enrolled 42 patients who underwent EUS-TA for pancreatic cancer between September 2020 and February 2022 at the Osaka International Cancer Institute. After a portion of each sample obtained via EUS-TA was separated for routine histological evaluation, the residual samples were divided into filter paper and oil blotting paper groups for analysis. Accordingly, filter paper and oil blotting paper were used for the formalin fixation process. The total tissue, nuclear, and cytoplasm areas of each sample were quantitatively evaluated using virtual slides, and the specimen volume and histological diagnosis of each sample were evaluated by an expert pathologist., Results: All cases were cytologically diagnosed as adenocarcinoma. The area ratios of the total tissue, nuclear, and cytoplasmic portions were significantly larger in the oil blotting paper group than in the filter paper group. The frequency of cases with large amount of tumor cells was significantly higher in the oil blotting paper group (33.3%) than in the filter paper group (11.9%) (p = 0.035)., Conclusions: Oil blotting paper can increase the sample volume obtained via EUS-TA on glass slides and improve sampling adequacy for molecular testing., (© 2024 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

Introduction: Portal vein aneurysm (PVA) is a rare saccular or fusiform portal vein dilatation. The management and optimal treatment of PVA remain unknown., Case Presentation: A 53-year-old man with hepatitis C virus (HCV) infection was diagnosed with PVA measuring 28 mm in diameter. Under observation, his liver fibrosis progressed, and the PVA diameter gradually increased to 52 mm. The patient was treated with elbasvir-grazoprevir for 12 weeks, and HCV disappeared. After achieving sustained virological response, liver fibrosis improved and the PVA progression ceased., Conclusion: HCV clearance by direct-acting antiviral treatment not only regressed liver fibrosis but may have also restrained the progression of PVA in a patient with cirrhosis type C and PVA., Competing Interests: The authors have no conflicts of interest to declare., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Purpose: Pancreatic cancer (PC) has one of the worst prognoses among all solid cancers. Hospital volume has been shown to be significantly associated with outcomes in patients with PC undergoing surgery. Nonetheless, the association between hospital volume and prognosis in patients with metastatic PC remains unclear. This study aimed to examine the association between hospital volume and prognosis in patients with metastatic PC using large-scale population-based cancer registry data., Methods: This retrospective observational study was conducted using data from the Osaka Cancer Registry database. Data of patients with metastatic PC over 10 years (2009-2018) were obtained. Hospitals were categorized into high-volume hospitals (HVHs; ≥ 240 patients diagnosed with PC for 10 years), middle-volume hospitals (MVHs; 120-239 patients diagnosed with PC for 10 years), and low-volume hospitals (LVHs; < 120 patients diagnosed with PC for 10 years). Multivariate analysis was performed to identify factors associated with overall survival (OS)., Results: The analysis included 8,929 patients with metastatic PC. Median OS was significantly more favorable in HVHs than in MVHs and LVHs. Multivariate analysis adjusted for hospital volume, age, primary tumor site, year of diagnosis, chemotherapy, and radiotherapy revealed that hospital volume was an independent factor associated with OS (HVHs vs. MVHs: hazard ratio [HR], 1.10; 95% confidence interval [CI], 1.03-1.16; P = 0.003, HVHs vs. LVHs: HR, 1.20; 95% CI, 1.13-1.27; P < 0.001)., Conclusion: Hospital volume is an independent prognostic factor in patients with metastatic PC, suggesting an association between hospital volume and treatment outcomes., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: The effectiveness of chemotherapy in older adult patients with biliary tract cancer (BTC) remains to be established, despite the fact that the majority of patients diagnosed with BTC tend to be aged ≥ 70 years. In this study, we used three databases to examine the effectiveness of chemotherapy in a large patient population aged ≥ 70 years with metastatic BTC., Methods: Using a large Japanese database that combined three data sources (Osaka Cancer Registry, Japan's Diagnosis Procedure Combination, the hospital-based cancer registry database), we extracted the data from patients pathologically diagnosed with metastatic BTC, between January 1, 2013, and December 31, 2015, in 30 designated cancer care hospitals (DCCHs). A cohort of patients with comparable backgrounds was identified using propensity score matching. The log-rank test was used to examine how chemotherapy affected overall survival (OS)., Results: Among 2,622 registered patients with BTC in 30 DCCHs, 207 older adult patients aged > 70 years with metastatic BTC were selected. Chemotherapy significantly improved the prognosis of older adult patients, according to propensity score matching (chemotherapy, 6.4 months vs. best supportive care, 1.8 months, P value < 0.001). The number of patients receiving chemotherapy tends to decrease with age. Gemcitabine plus cisplatin (GC) and gemcitabine plus S-1 (oral fluoropyrimidine) (GS) combination therapy were frequently performed in the chemotherapy group for patients under 80 years of age (70-74 years, 61.7%; 75-79 years, 62.8%). In contrast, monotherapy including GEM and S-1 was more frequently performed in age groups over 80 years (80-84 years, 56.2%; 85-89 years, 77.7%; ≥90 years, 100%). In the chemotherapy group among older adult patients aged < 85 years, the median OS was significantly longer according to age-group analysis of the 5-year age range following propensity score matching., Conclusions: In older adult patients with metastatic BTC who received chemotherapy, prolonged survival was observed. Chemotherapy may be a viable option for patients with metastatic BTC who are aged < 85 years., (© 2023. The Author(s).)

Background: Nanoliposomal irinotecan (nal-IRI) plus 5-fluorouracil (5-FU)/levo-leucovorin (Levo-LV) was approved for unresectable pancreatic cancer (UR-PC) in March 2020 in Japan. Levo-LV is administered by intravenous infusion over 120 min following 90 min intravenous infusion of nal-IRI (conventional method), causing a significant burden on both patients and the outpatient chemotherapy room owing to the prolonged administration time. Thus, from July 2021, we introduced the simultaneous intravenous administration of nal-IRI and Levo-LV (parallel method) with the approval of the institutional regimen committee., Methods: We retrospectively reviewed the data of 69 patients with UR-PC who received nal-IRI plus 5-FU/Levo-LV at our hospital between June 2020 and October 2021. We examined the safety of the parallel method and compared the treatment outcomes and administration times between the two methods., Results: The median age was 66 years (54%, male). Disease statuses were locally advanced, metastatic, and postoperative recurrence after pancreatectomy in 7, 50, and 12 patients, respectively. Nal-IRI plus 5-FU/Levo-LV treatment was second and third-line or later in 35 and 34 patients, respectively. No intravenous line problems were observed during the parallel administration of nal-IRI and Levo-LV. Although there were no significant differences in response rates and adverse events between the two methods, the administration time was significantly shorter in the parallel method than in the conventional method., Conclusion: The parallel administration of nal-IRI and Levo-LV is clinically safe and not inferior in efficacy. Moreover, parallel administration may offer convenience to patients and healthcare workers by reducing administration time., (© 2023. The Author(s).)

Given the safety issues associated with flammability characteristics of alternative environmentally-friendly refrigerants, it is vital to establish measurement systems to accurately analyse the flammability of these mildly flammable refrigerants. In this study, we used a customised Hartmann bomb analogue to measure the minimum ignition energy (MIE) and laminar burning velocity (BV) for refrigerant/air mixtures of pure ammonia (R717), R32, R1234yf and mixtures of R32 and R1234yf with non-flammable refrigerants of R134a, R125 and carbon dioxide (R744). The MIEs of R717, R32, and R1234yf were measured at an ambient temperature of 24 °C to be (18.0 ± 1.4), (8.0 ± 1.5) and (510 ± 130) mJ at equivalence ratios of 0.9, 1.27 and 1.33, respectively. Adding the non-flammable refrigerants R134a, R125 and R744 along with R32 at volumetric concentrations of 5% each to R1234yf reduced the latter compound's flammability and increased its MIE by one order of magnitude. The laminar burning velocities of pure R717 and R32 were measured at an equivalence ratio of 1.1 using the flat flame method and found to be 8.4 and 7.4 cm/s, respectively. Adding 5% R1234yf to R32 decreased the laminar burning velocity by 11%, while a further 5% addition of R1234yf resulted in a decrease of over 30% in the laminar burning velocity., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Monitoring of intracranial pressure (ICP) is considered to be fundamental for the care of patients with severe traumatic brain injury (TBI) and is routinely used to direct medical and surgical therapy. Accordingly, some guidelines for the management of severe TBI recommend that treatment be initiated for ICP values >20 mmHg. However, it remained to be accounted whether there is a scientific basis to this instruction. The purpose of the present study was to clarify whether the basis of ICP values >20 mmHg is appropriate., Subject and Methods: We retrospectively reviewed 25 patients with severe TBI who underwent neuroimaging during ICP monitoring within the first 7 days. We measured cerebral blood flow (CBF), mean transit time (MTT), cerebral blood volume (CBV), and ICP 71 times within the first 7 days., Results: Although the CBF, MTT, and CBV values were not correlated with the ICP value at ICP values ≤20 mmHg, the CBF value was significantly negatively correlated with the ICP value (r = -0.381, P < 0.05) at ICP values >20 mmHg. The MTT value was also significantly positively correlated with the ICP value (r = 0.638, P < 0.05) at ICP values >20 mmHg., Conclusion: The cerebral circulation disturbance increased with the ICP value. We demonstrated the cerebral circulation disturbance at ICP values >20 mmHg. This study suggests that an ICP >20 mmHg is the threshold to initiate treatments. An active treatment intervention would be required for severe TBI when the ICP was >20 mmHg.

Traumatic brain injury (TBI) is widely known to cause dynamic changes in cerebral blood flow (CBF). Ischemia is a common and deleterious secondary injury following TBI. Detecting early ischemia in TBI patients is important to prevent further advancement and deterioration of the brain tissue. The purpose of this study was to clarify the cerebral circulatory disturbance during the early phase and whether it can be used to predict patient outcome. A total of 90 patients with TBI underwent a xenon-computed tomography (Xe-CT) and subsequently perfusion CT to evaluate the cerebral circulation on days 1-3. We measured CBF using Xe-CT and mean transit time (MTT: the width between two inflection points [maximum upward slope and maximum downward slope from inflow to outflow of the contrast agent]) using perfusion CT and calculated the cerebral blood volume (CBV) using the AZ-7000W98 computer system. The relationships of the hemodynamic parameters CBF, MTT, and CBV to the Glasgow Coma Scale (GCS) score and the Glasgow Outcome Scale (GOS) score were examined. There were no significant differences in CBF, MTT, and CBV among GCS3-4, GCS5-6, and GCS7-8 groups. The patients with a favorable outcome (GR and MD) had significantly higher CBF and lower MTT than those with an unfavorable one (SD, VS, or D). The discriminant analysis of these parameters could predict patient outcome with a probability of 70.6%. During the early phase, CBF reduction and MTT prolongation might influence the clinical outcome of TBI. These parameters are helpful for evaluating the severity of cerebral circulatory disturbance and predicting the outcome of TBI patients.

Trisomy 8 (+8), one of the most common chromosomal abnormalities found in patients with myelodysplastic syndromes (MDS), is occasionally seen in patients with otherwise typical aplastic anemia (AA). Although some studies have indicated that the presence of +8 is associated with the immune pathophysiology of bone marrow (BM) failure, its pathophysiology may be heterogeneous. We studied 53 patients (22 with AA and 31 with low-risk MDS) with +8 for the presence of increased glycosylphosphatidylinositol-anchored protein-deficient (GPI-AP(-) ) cells, their response to immunosuppressive therapy (IST), and their prognosis. A significant increase in the percentage of GPI-AP(-) cells was found in 14 (26%) of the 53 patients. Of the 26 patients who received IST, including nine with increased GPI-AP(-) cells and 17 without increased GPI-AP(-) cells, 14 (88% with increased GPI-AP(-) cells and 41% without increased GPI-AP(-) cells) improved. The overall and event-free survival rates of the +8 patients with and without increased GPI-AP(-) cells at 5 yr were 100% and 100% and 59% and 57%, respectively. Examining the peripheral blood for the presence of increased GPI-AP(-) cells may thus be helpful for choosing the optimal treatment for +8 patients with AA or low-risk MDS., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Laparoscopic duodeno-jejunal bypass with sleeve gastrectomy (DJB-SG) has been introduced as a novel metabolic surgery from Asia recently. It provides benefits of avoiding the risk of remnant gastric cancer, minimization of malnutrition from duodenal switch. Here, we introduce the technique of single-loop anastomosis duodeno-jejunal bypass with sleeve gastrectomy (SADJB-SG) and compare with other gastric bypass surgeries. Fifty morbid obese patients underwent our novel procedure, laparoscopic SADJB-S from 2011 to 2013. Operative complication, weight loss, and diabetes remission were followed. All procedures were completed laparoscopically. The mean operative time was 181.7 ± 38.4 min, and the mean hospital stay was 3.8 days. Three minor early complications (6 %) were encountered but no major complication was noted. There was no significant difference in perioperative parameters between the SADJB-SG and gastric bypass except a longer operation time. The mean BMI decreased from 38.4 to 25.4 at 1 year after surgery with a mean weight loss of 32.7 % which is higher than gastric bypass. Laparoscopic SADJB-SG appears to be an ideal metabolic/bariatric surgery, whereas the efficacy is non-inferior to gastric bypass.

Mutation of the phosphatidylinositol N-acetylglucosaminyltransferase subunit A (PIG-A) gene in hematopoietic stem cells (HSCs) results in the loss of glycosylphosphatidylinositol-anchored proteins (GPI-APs) on HSCs, but minimally affects their development, and thus can be used as a clonal maker of HSCs. We analyzed GPI-APs expression on six major lineage cells in a total of 574 patients with bone marrow (BM) failure in which microenvironment itself is thought to be unaffected, including aplastic anemia (AA) or myelodysplastic syndrome (MDS). GPI-APs-deficient (GPI-APs(-) ) cells were detected in 250 patients. Whereas the GPI-APs(-) cells were seen in all six lineages in a majority of patients who had higher proportion ([dbmtequ]3%) of GPI-APs(-) cells, they were detected in only limited lineages in 92.9% of cases in the lower proportion (<3%) group. In all 250 cases, the same lineages of GPI-APs(-) cells were detected even after 6-18-month intervals, indicating that the GPI-APs(-) cells reflect hematopoiesis maintained by a self-renewing HSC in most of cases. The frequency of clones with limited lineages seen in mild cases of AA was similar to that in severe cases, and clones with limited lineages were seen even in two health volunteer cases. These results strongly suggest most individual HSCs produce only restricted lineages even in a steady state. While this restriction could reflect heterogeneity in the developmental potential of HSCs, we propose an alternative model in which the BM microenvironment is mosaic in supporting commitment of progenitors toward distinct lineages. Our computer simulation based on this model successfully recapitulated the observed clinical data., (Copyright © 2012 AlphaMed Press.)

Introduction: Traumatic brain injury (TBI) is widely known to cause dynamic changes in cerebral blood flow (CBF). In particular, secondary brain insults have been reported to decrease CBF. The purpose of this study was to clarify the cerebral circulation in different types of TBI., Methods: Sixty-nine patients with TBI were divided into four groups, the subdural hematoma group, the contusion/intracerebral hematoma group, the diffuse axonal injury group, and the diffuse brain swelling group. In these patients, we simultaneously performed Xe-CT and perfusion CT to evaluate the cerebral circulation on post-injury days 1-3. We measured CBF using Xe-CT and mean transit time using perfusion CT and calculated the cerebral blood volume using the AZ-7000 W98 computer system., Results: There were no significant differences in the Glasgow Coma Scale score on arrival or the Glasgow Outcome Scale score between the groups. The patients who had suffered focal TBI displayed more significant cerebral circulation disturbances than those that had suffered diffuse TBI. We were able to evaluate the cerebral circulation of TBI patients using these parameters., Conclusion: Moderate hypothermia therapy, which decreases CBF, the cerebral metabolic rate oxygen consumption (CMRO2), and intracranial pressure might be effective against the types of TBI accompanied by cerebral circulation disturbance. We have to use all possible measures including hypothermia therapy to treat severe TBI patients according to the type of TBI that they have suffered.

Aims: Neurointensive care has reduced the mortality and improved the outcome of patients for severe brain damage, over recent decades, and made it possible to perform this therapy in safety. However, we have to understand the complications of this therapy well. The purpose of our study was to determine the systemic circulation disturbance during the initiation of therapeutic hypothermia by using this continuous neurointensive monitoring system., Materials and Methods: Ten severe brain damage patients treated with hypothermia were enrolled. All patients had Glasgow Coma Scale (GCS) less than or equal to 8, on admission., Results: We verified that heart rate, cardiac output, and oxygen delivery index (DO2I) decreased with decreasing core temperature. We recognized that depressed cardiac index (CI) was attributed to bradycardia, dehydration, and increased systemic vascular resistance index (SVRI) upon initiation of hypothermia., Conclusion: Although the hypothermia has a therapeutic role in severe brain damage patients, we have to carry out this therapy while maintaining their cardiac output using multimodality monitoring devices during hypothermia period.

Subarachnoid hemorrhage (SAH) causes dynamic changes in cerebral blood flow (CBF), and results in delayed ischemia due to vasospasm, and early perfusion deficits before delayed cerebral vasospasm (CVS). The present study examined the severity of cerebral circulatory disturbance during the early phase before delayed CVS and whether it can be used to predict patient outcome. A total of 94 patients with SAH underwent simultaneous xenon computed tomography (CT) and perfusion CT to evaluate cerebral circulation on Days 1-3. Cerebral blood flow (CBF) was measured using xenon CT and the mean transit time (MTT) using perfusion CT and calculated cerebral blood volume (CBV). Outcome was evaluated with the Glasgow Outcome Scale (good recovery [GR], moderate disability [MD], severe disability [SD], vegetative state [VS], or death [D]). Hunt and Hess (HH) grade II patients displayed significantly higher CBF and lower MTT than HH grade IV and V patients. HH grade III patients displayed significantly higher CBF and lower MTT than HH grade IV and V patients. Patients with favorable outcome (GR or MD) had significantly higher CBF and lower MTT than those with unfavorable outcome (SD, VS, or D). Discriminant analysis of these parameters could predict patient outcome with a probability of 74.5%. Higher HH grade on admission was associated with decreased CBF and CBV and prolonged MTT. CBF reduction and MTT prolongation before the onset of delayed CVS might influence the clinical outcome of SAH. These parameters are helpful for evaluating the severity of SAH and predicting the outcomes of SAH patients.

Purpose: Small but repeated head trauma, as represented by boxing-related punch-drunk syndrome and dementia pugilistica, occasionally cause dyskinesia and marked brain dysfunction following long-term post-traumatic follow-up, despite the absence of intracranial lesions, such as cerebral contusion and intracranial hemorrhage. We defined this condition as "cumulative head injury." To clarify its mechanism, we conducted an experiment involving appliciation of continuous head trauma of Tokai High Avoider (THA) rats, and examined subsequent marked function/histopathological changes., Methods: THA rats were divided into 3 categories based on the frequency of impact exposure: a control group (Group A), a group exposed to 1 impact set (Group B), and a group exposed to 3 impact sets (Group C). In each group, histopathological, spontaneous motility, and learning tests were conducted., Results: Histopathologically, no marked tissue destruction was observed in Group B or C. In Group C, the number of GFAP-positive cells were increased in acute-phase specimens of the hippocampus, cerebral cortex, and basilar cortex. With respect to chronic-phase histological changes, the numbers of GFAP-positive cells were increased in the hippocampus and the basilar cortex in Group C; however, these changes were less marked than in the acute stage. A marked function test identified emotional suppression in the acute stage and bimodal learning reduction in the acute to chronic stages in Group C., Conclusion: The results of this experiment revealed that the repetition of low-level trauma which did not lead to brain injury as revealed on pathological examination, induced emotional suppression and the bimodal reduction in learning results; further, this disorder exacerbated with an increase in impact frequency. The influence on marked brain function could be verified using a specific experimental system of THA rats. This model may be useful for evaluating the cumulative effects of repeated head trauma.

Protein phosphorylation plays a key regulatory role in a variety of cellular processes. To better understand the function of protein phosphorylation in seed maturation, a PCR-based cloning method was employed and five cDNA clones (pvcipk1-5) for protein kinases were isolated from a cDNA library prepared from immature seeds of kidney bean (Phaseolus vulgaris L.). The deduced amino acid sequences showed that the five protein kinases (PvCIPK1-5) are members of the sucrose non-fermenting 1-related protein kinase type 3 (SnRK3) family, which interacts with calcineurin B-like proteins (CBLs). Two cDNA clones (pvcbl1 and 2) for CBLs were further isolated from the cDNA library. The predicted primary sequences of the proteins (PvCBL1 and 2) displayed significant identity (more than 90%) with those of other plant CBLs. Semi-quantitative RT-PCR analysis showed that the isolated genes, except pvcbl1, are expressed in leaves and early maturing seeds, whereas pvcbl1 is constitutively expressed during seed development. Yeast two-hybrid assay indicated that among the five PvCIPKs, only PvCIPK1 interacts with both PvCBL1 and PvCBL2. These results suggest that calcium-dependent protein phosphorylation-signaling via CBL-CIPK complexes occurs during seed development.

The clinical characteristics of head trauma were evaluated in 18 wrestlers belonging to a female professional wrestling organization, 13 regular members and five trainees aged 15-34 years. Medical examinations for head trauma were performed in all wrestlers, and wrestlers treated at our emergency outpatient department were clinically evaluated. In addition, the relationships of head trauma with duration of the wrestling career of 1-16 years (mean 8 years) in the regular members, and less than 1 year in the five trainees, and body mass index (BMI) of 21.0-32.0 in the 16 subjects, excluding two trainees, was evaluated. Chronic symptoms were noted in four of the 18 wrestlers with long wrestling careers (16 years in 1, 13 years in 1, and 5 years in 2). Three wrestlers with symptoms immediately after head trauma showed recurrent retrograde amnesia and had low BMI (21.6, 21.6, and 23.1). Five wrestlers were treated at our emergency outpatient clinic, three required hospitalization and two showed intracranial traumatic changes on computed tomography (acute subdural hematoma in 1 and diffuse brain swelling in 1). Head trauma in female professional wrestlers is associated with longer wrestling career and low BMI. Periodic medical examinations are recommended to monitor for signs of head trauma.

An incidentally diagnosed unilateral orbital mass in a 34-year-old woman grew at an accelerated rate during pregnancy with deterioration of visual function. Removed early after delivery by a transcranial approach, the tumor was histologically diagnosed as a richly vascularized cystic schwannoma containing red blood cell components. The accelerated tumor growth was attributed to intratumoral hemorrhage. Although acoustic schwannomas have been reported to enlarge during pregnancy, this phenomenon has only been described once for orbital schwannomas. Because this type of tumor may enlarge during pregnancy and threaten visual function, surgery should not be delayed.

Objective: To estimate the usefulness of early dynamic 201Tl single photon emission computed tomography (SPECT) studies in distinguishing the histological malignancy of brain tumours., Methods: Dynamic 201Tl SPECT was performed for 3 min per scan for 15 min immediately after the administration of 201TlCl in 110 patients with brain tumours (111 lesions). The data obtained each 3 min were used for dynamic SPECT, and the five sets of data obtained were added to acquire static SPECT data. For static SPECT, the static thallium index (STI) was calculated as the ratio of 201Tl uptake in the tumour to that of the contralateral normal brain. The ratio of the 201Tl uptake for each 3 min was defined as the dynamic thallium index (DTI). The dynamic thallium rate (DTR), as a per cent, was calculated as DTR=(DTI for every 3 min)/STI H 100. The five values were approximated as a linear function and the slope (%/min) was calculated., Results: In static SPECT, there was no significant difference between the STI of malignant tumours (glioblastoma and anaplastic astrocytoma) and that of benign tumours (low-grade glioma, meningioma, pituitary adenoma, neurinoma and haemangioblastoma) (3.7+/-1.5, 5.0+/-3.5, respectively). On dynamic SPECT, DTI increased markedly over 15 min for malignant tumours. In contrast, the DTI of benign tumours increased slightly, steadily or decreased. The slope of the linear functions calculated from the DTRs was much higher in the malignant tumour group than in the benign tumour group (P<0.001)., Conclusions: We suggest that the performance of 201Tl dynamic SPECT for 15 min is useful for distinguishing malignant brain tumours from benign brain tumours and reduces the examination stress of patients.

Objective: The purpose of this study was to clarify the difference between cerebral blood flow (CBF) by perfusion computed tomography (CT) and that by xenon-enhanced CT (Xe-CT) through simultaneous measurement., Methods: Xenon-enhanced CT and perfusion CT were continually performed on 7 normal subjects. Ratios of CBF by perfusion CT (P-CBF) to CBF by Xe-CT (Xe-CBF) were measured for 5 arterial territories; 3 were territories of 3 major arteries (the anterior [ACA], middle [MCA], and posterior [PCA] cerebral arteries), and the other 2 were areas of the thalamus and putamen., Results: The ratios were 1.30 +/- 0.10, 1.26 +/- 0.15, 1.61 +/- 0.15, 0.801 +/- 0.087, and 0.798 +/- 0.080 for the ACA, MCA, PCA, thalamus, and putamen, respectively. Although a good correlation was observed between P-CBF and Xe-CBF for each territory, the ratios were significantly different (P < 0.0001) between 3 territory groups (group 1: ACA and MCA, group 2: PCA, and group 3: thalamus and putamen)., Conclusions: The difference in the ratio of P-CBF to Xe-CBF between the 3 territory groups was considered to result principally from the features of P-CBF. To evaluate P-CBF properly, its territorial characteristics should be taken into account.

We report a case of a 44-year-old woman with metastatic brain tumors who suffered peri-tumoral hemorrhage soon after stereotactic radiosurgery (SRS). She had been suffering from breast cancer with multiple systemic metastasis. She started to have headache, nausea, dizziness and speech disturbance 1 month before admission. There was no bleeding tendency in the hematological examination and the patient was normotensive. Neurological examination disclosed headache and slightly aphasia. Magnetic resonance imaging showed a large round mass lesion in the left temporal lobe. It was a well-demarcated, highly enhanced mass, 45 mm in diameter. SRS was performed on four lesions in a single session (Main mass: maximum dose was 30 Gy in the center and 20 Gy in the margin of the tumor. Others: maximum 25 Gy margin 20 Gy). After radiosurgery, she had severe headache, nausea and vomiting and showed progression of aphasia. CT scan revealed a peritumoral hemorrhage. Conservative therapy was undertaken and the patient's symptoms improved. After 7 days, she was discharged, able to walk. The patient died of extensive distant metastasis 5 months after SRS. Acute transient swelling following conventional radiotherapy is a well-documented phenomenon. However, the present case indicates that such an occurrence is also possible in SRS. We have hypothesized that acute reactions such as brain swelling occur due to breakdown of the fragile vessels of the tumor or surrounding tissue.

A 62-year-old female presented with a rare massive parenchymatous metastasis from abdominal malignant lymphoma. Computed tomography and magnetic resonance image revealed a large enhanced mass in the right basal ganglia. 123I-IMP SPECT showed increased uptake on both early and delayed images. A stereotactic biopsy was performed; histological examination revealed a diffuse large B-cell malignant lymphoma. The patient underwent stereotactic radiosurgery (SRS). Short-term cliniconeuroradiological follow-up showed both neurologic improvement and virtually complete disappearance of the tumor. Our findings suggest that 123I-IMP SPECT can help differentiate malignant lymphoma from benign lesions and other malignant brain tumors. In addition, SRS with conventional radiotherapy may be an effective therapeutic strategy to control malignant lymphoma.

After radiochemotherapy for a post-operative glioblastoma multiforme (GB), the majority of patients return at a later date with a recurrent. To assess whether 201TlCl uptake can be used as a prognostic indicator in patients with GB, we measured the ratio of 201TlCl uptake in tumor to 201TlCl uptake in normal brain (TL index) in 10 patients at the end of radiochemotherapy and followed all the patients until they returned with a recurrent. The TL indices at the end of radiochemotherapy indicated 1.36 to 6.82 (mean +/- SD; 3.59 +/- 1.84), and the terms of tumor recurrent were 3-12 months (5.55 +/- 3.10 month). There was a significant negative correlation between the TL indices and the terms of tumor recurrent (y = -1.28x + 10.14, r = 0.760, p < 0.01). Especially, three cases indicated less than 2.0 did not returned with a recurrent in 8 months and 7 cases more than 2.0 returned with a recurrent in 5 months. This study resulted that 201TlCl SPECT was clinically useful to predict the period of recurrent for GB.

Objective: The employment of surgical microscopy in the field of neurosurgery has significantly contributed not only to the advancement of surgical technique, but also the operative outcome as well. This technology has allowed surgeons to meet the demands for increasingly difficult levels of surgery, which usually require a long operative time. However, the surgeon and the assistant are restricted in their posture for a long time, leading to excessive muscular and ocular stress. To solve these problems, we have developed and clinically applied a three dimensional video microscope system for surgery, using a two binocular camera method, that allows surgical procedures to be performed over a video monitor., Method: Two 3CCD cameras were installed on the assistant's lens attachment and the camera lens attachment of the microscope for neurosurgery, manufactured by Carl Zeiss Co., Ltd. The surgery was performed by viewing the three dimensional picture on the monitor, which was created by processing the images from the cameras by a time-division method. In November 1998, the prototype was completed and, with numerous modifications, its clinical application has become possible. Currently, we have used it in 42 clinical cases., Results: 1) Instead of viewing the surgical field through a conventional surgical microscope, the surgeon and the assistant were able to perform microsurgery by viewing the stereoscopic vision on the video monitor, through polarized glasses. 2) The assistant is provided with a separate video monitor, so that the assistant can freely adjust the angle of vision 90-180 degrees, according to where he stands. 3) The nurses, resident surgeons and students can view the same three dimensional images displayed to the surgeon. This effectively contributes to the educational environment., Conclusion: Even during a long surgical procedure, the posture of surgeon and assistant became less restricted since there was no need to look through the eyepiece of the microscope and led to significant decrease in physical fatigue and ocular strain. In the 42 clinical trials, the operation proceeded uneventfully, without any serious complications.

The objective of this work is to propose a quantitative cerebral blood flow (CBF) calculation method for xenon CT (Xe-CT) by logically estimating the time course change rate (rate constant) of the arterial xenon concentration from that of end-tidal xenon concentration. A single factor, gamma (gamma), which is considered to reflect the diffusing capacity of the lung for xenon, was introduced to correlate the end-tidal rate constant (Kend-tidal) with the arterial rate constant (Karterial). When an appropriate value is given to gamma, it is possible to calculate the arterial rate constant (calculated Karterial) from Kend-tidal. A procedure was developed to determine the gamma value utilizing the characteristics of white matter lambda (lambda). This procedure was applied to three healthy volunteers. The gamma gammaalues for the three subjects were consistent with those directly calculated from end-tidal and arterial (abdominal aorta) xenon data. Hemispheric CBF values with use of calculated Karterial (47.3 +/- 10.3 ml/100 g/min) were close to the reported normative values. We conclude this method could make current Xe-CT examinations substantially reliable and quantitative in measuring CBF.

The accumulation levels of 201TlCl and Na(+)-K+ ATPase activity in tumor tissue were compared among glioblastoma, benign glioma and meningioma to study the difference in the mechanism of 201TlCl accumulation. The subjects were 19 cases comprised of 6 glioblastoma, 2 oligodendroglioma, 1 fibrillary astrocytoma, 1 pilocytic astrocytoma and 9 meningioma. Preoperative 201TlCl SPECT was performed in all the cases, and Thallium Index (TL index) was calculated by a ratio of 201TlCl in the tumor area and the contralateral area. In addition, cell membrane was extracted from the tumor tissue collected intraoperatively to determine Na(+)-K+ ATPase activity. No statistically significant difference in TL index was noted between the glioblastoma group (6.97 +/- 2.67) and the meningioma group (5.87 +/- 1.99). This fact showed that there was no difference in the accumulation level of 201TlCl between the two groups. On the other hand, the glioblastoma group indicated a higher value of Na(+)-K+ ATPase activity (49.13 +/- 43.76 mumole/hour/mg protein) than the meningioma group (7.73 +/- 13.84 mumole/hour/mg protein) (p < 0.05, t test). These results suggested the involvement of Na(+)-K+ ATPase activity in 201TlCl accumulation in glioblastoma and the influences of other accumulation mechanism than Na(+)-K+ ATPase activity such as the volume of intratumoral vascular bed in meningioma.