[Aldolase deficiency].
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Biomedical subjects
Publications and source records attributed to S Kajihara.
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A case with two cerebral aneurysms, in which one at the origin of the left superior cerebellar artery (SCA) grew and presented with Weber's syndrome and obstructive hydrocephalus, is reported. The patient was a 69-year-old female, who had severe headache and vomited. On admission, neck stiffness was recognized. CT scan showed findings of subarachnoid hemorrhage. Angiograms demonstrated two saccular aneurysms at the right middle cerebral artery (MCA) bifurcation and at the origin of the left SCA. Craniotomy and neck clipping of the aneurysm at the right MCA was performed. After discharge, left oculomotor palsy appeared and gradually progressed. Severe headache and right hemiparesis suddenly occurred two years after the first attack. On the second admission, CT scan revealed high density on the brain surface and a well enhanced round lesion at the left ambient cistern. Left vertebral angiogram demonstrated increase in size of the aneurysm at the left SCA. The patient was discharged after conservative therapy. Drowsiness and urinary incontinence appeared, and she was admitted for the third time three years after the first admission. CT scan showed an enhancing mass lesion sized 25 X 30 mm beside the left midbrain and obstructive hydrocephalus. The aneurysm at the SCA no longer seen on the left vertebral angiogram. V-P shunt was performed. Both Weber's syndrome and obstructive hydrocephalus in this case indicate an aneurysmal natural history, in which aneurysm becomes gigantic and thrombosed spontaneously.
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It has been known that significant narrowing of the subclavian or innominate artery may cause cerebrovascular ischemic symptoms, especially vertebrobasilar insufficiency. This condition has been named as the subclavian steal syndrome (SSS). Recently, percutaneous transluminal angioplasty (PTA) has been developed and used in treating occlusive vascular lesions. In this report, we presented a 61-year-old man who suffered from SSS and treated by PTA. He complained of dizziness and dysesthesia on his left upper extremity which got worse on exertion. The left radial pulse was diminished and the left brachial blood pressure was lower about 50 mmHg than the right. Bruits were recognized over the left suprasubclavicular area. Arch aortogram revealed an 80% stenosis of the proximal left subclavian artery and retrograde flow of the left vertebral artery on late arterial phase. PTA was successfully performed at the same time as angiography via the right femoral artery without any complications. His clinical symptoms improved immediately following PTA. A month after PTA, left retrograde vertebral angiogram demonstrated that the dilation of the treated segment of the left subclavian artery continuously remained. Because of several advantages such as a technical easiness and a more safety, PTA will be a useful therapeutic tool for not only SSS but also other obstructive diseases of brachiocephalic arteries prior to some surgical treatments. However, it is necessary to avoid some possible complications, especially embolism into the cerebral circulation in this technique, and the careful procedure should be done under the co-operation with vascular surgeons and radiologists.
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To identify the route of hepatitis C virus (HCV) transmission, we investigated the sexual transmission of HCV by examining HCV markers among spouses of patients with chronic liver disease (CLD) due to HCV. Of 83 spouses, 14 (16.9%) had elevated serum aspartate aminotransferase or alanine aminotransferase, 20 (24.1%) had detectable anti-HCV antibodies, and 17 (20.5%) had measurable HCV-RNA in serum. However, the seropositivity rate of anti-HCV antibodies (24.1%) of patients' spouses was not significantly higher than that (15.4-27.5%) of an unselected population in the same district. Ten patient-spouse pairs underwent nucleotide sequence analysis of the HCV core and envelope genes. Overall the sequence homology of 10 couples (91.1%) was not significantly higher than that of 10 randomly chosen unrelated pairs (88.2%). As reported earlier, in an age and sex matched case-control study of HCV transmission, a history of surgery is a prominent HCV risk factor. These results suggest that sexual transmission of HCV is rare.