A case of traumatic carotid-cavernous sinus fistula (CCF) associated with an intradural pseudoaneurysm is reported. A 42-year-old man developed traumatic CCF after severe head trauma. Cerebral angiography demonstrated a direct CCF associated with an intradural pseudoaneurysm at the C2 portion. Transarterial balloon embolization of the CCF caused severe subarachnoid hemorrhage. A CCF with an intradural pseudoaneurysm is life-threatening and requires emergency treatment. However, balloon occlusion in such cases is contraindicated because of possible rupture of a pseudoaneurysm. Trapping or a direct surgical approach is the treatment of choice.

Adult↗

PubMed1991

Computed tomographic evaluation of bleeding sites in primary pontine hemorrhages.

BACKGROUND: With the aim of identifying common bleeding sites and probable parent vessels in "small" primary pontine hemorrhages, we reviewed computerized tomographic scans of 20 patients with hematomas less than 2.5 cm in diameter. SUMMARY OF REPORT: We used scans depicting the upper and lower pons and plotted the centers of the hematomas, assuming them to be a probable source of bleeding. No predilection sites were found on the axial plane. CONCLUSIONS: Both the paramedian and the long and short circumferential arteries were probable sources of hemorrhage in the present series.

Adult↗

PubMed1991

Genetic control of rat T-cell response to Staphylococcus aureus enterotoxins (SE).

Rat T cells, like those of mouse and human origin, respond strongly to superantigens (SAg) derived from Staphylococcus aureus enterotoxins A and B (SEA, SEB). Lewis and ACI are high responders, whereas Brown Norway (BN) is a low responder. Congenic and back-cross rat studies indicate that the degree of responsiveness is controlled by at least one non-MHC gene. The action of these genes may reside in the antigen-presenting cells (APC), since both Sephadex G10 non-adherent BN spleen cells and purified BN T cells in the presence of Lewis APC can respond well to SE. Responses to concanavalin A (Con A) and SEA generally segregate together in back-cross rats. Surprisingly, the degree of responsiveness to Con A and SEA is not correlated with the susceptibility to experimental allergic encephalomyelitis (EAE) either in independently derived inbred rat strains or in (Lewis x BN) x BN back-cross rats.

Animals↗

PubMed1990

Cloning of cDNA for proteinase 3: a serine protease, antibiotic, and autoantigen from human neutrophils.

Closely similar but nonidentical NH2-terminal amino acid sequences have been reported for a protein or proteins in human neutrophils whose bioactivities is/are diverse (as a serine protease, antibiotic, and Wegener's granulomatosis autoantigen) but that share(s) several features: localization in the azurophil granules, a molecular mass of approximately 29 kD, reactivity with diisopropylfluorophosphate, and the ability to degrade elastin. We previously purified one such entity, termed p29b. Using a monospecific antibody, we have cloned from human bone marrow a cDNA encoding the complete p29b protein in its mature form, along with pre- and pro-sequences. The predicted amino acid sequence agrees closely with the NH2-terminal sequence obtained previously from purified p29b, as well as with sequences newly obtained from CNBr fragments. The primary structure is highly homologous to elastase, cathepsin G, T cell granzymes, and other serine proteases, and shares both the catalytic triad and substrate binding pocket of elastase. Hybridization of the full-length cDNA with restriction enzyme digests of human genomic DNA revealed only one fragment. This suggests that the closely related species described previously are the same, and can be subsumed by the term used for the first-described activity, proteinase 3. Proteinase 3 is more abundant in neutrophils than elastase and has a similar proteolytic profile and specific activity. Thus, proteinase 3 may share the role previously attributed to neutrophil elastase in tissue damage, and has the potential to function as an antimicrobial agent.

Amino Acid Sequence↗

PubMed1990

Fatal aneurysmal rupture: a survey of 60 grade-5 cases.

The purpose of the present study was to describe the clinical course of patients with Grade-5 ruptured aneurysms (WFNS grading). Among 250 consecutive cases of ruptured aneurysms, 60 Grade-5 patients were reviewed retrospectively, consisting of 24 males and 36 females with an average age of 58 years. Thirty-two patients were directly transferred to our clinic, while the remaining 28 were referred from other clinics. Duration from rupture to arrival at our clinic was within 1 hour in 25 cases and within 2 hours in 43 cases. Systolic blood pressure on admission was 186 mmHg on average. Obvious misdiagnoses by primary physicians were made in 7 cases. Ventricular drainage and clipping/trapping of the aneurysms were performed in 7 and 25 cases, respectively. Forty-nine patients died and the remaining 11 survived. One made a good recovery, 1 was moderately disabled, 8 severely disabled, and 1 in a vegetative state. The prognosis for Grade-5 patients is well known as being extremely poor, which also was the case in our series. Early referral and early surgical intervention have not changed this poor prognosis. Possible improvement of the outcome of this group might be expected by 1) public health and primary physician education on aneurysmal subarachnoid haemorrhage, and 2) control of blood pressure during referral.

Adult↗

PubMed1990

Indirect carotid-cavernous sinus fistula: transvenous embolization from the external jugular vein using a superior ophthalmic vein approach. A case report.

A case of indirect carotid-cavernous sinus fistula treated by combined transarterial and transvenous embolization is described. A 49-year-old woman with a right indirect carotid-cavernous sinus fistula draining solely to the right superior ophthalmic vein was treated first by transarterial embolization with polyvinyl alcohol particles. Then, by approaching through the superior ophthalmic vein from the right external jugular vein, the cavernous sinus was embolized with platinum wire using a tracker microcatheter, which resulted in marked clinical improvement. Transvenous embolization by approaching from the external jugular vein through the superior ophthalmic vein represents a promising alternative when shunted blood drains anteriorly to the superior ophthalmic vein.

Arteriovenous Fistula↗

PubMed1990

[(NA++K+)-ATPase inhibitor from bovine hypothalamus].

The presence of an endogenous ouabain-like substance in bovine hypothalamus is demonstrated on the bas is of the ability of acid acetone extracts of hypothalamus to inhibit (NA+ + K+)-ATPase activity, 86Rb uptake, 22Na efflux and (3H)ouabain binding. Partial purification of the substance was achieved by acetic acid fractionation followed by sephadex-G25 chromatography and subsequent desalting by mixed-bed resin. The results are discussed with relation to the important role of the sodium pump inhibitor in the regulation of (N+ + K+)-ATPase activity and sodium transport and hence in the pathophysiologic mechanisms of essential hypertension.

Animals↗

PubMed1990

Evaluation of brain edema using magnetic resonance proton relaxation times.

Experimental and clinical studies on the evaluation of water content in cases of brain edema were performed in vivo, using MR proton relaxation times (longitudinal relaxation time, T1; transverse relaxation time, T2). Brain edema was produced in the white matter of cats by the direct infusion method. The correlations between proton relaxation times obtained from MR images and the water content of white matter were studied both in autoserum-infused cats and in saline-infused cats. The correlations between T1 as well as T2 and the water content in human vasogenic brain edema were also examined and compared with the data obtained from the serum group. T1 and T2 showed good correlations with the water content of white matter not only in the experimental animals but also in the clinical cases. The quality of the edema fluid did not influence relaxation time and T1 seemed to represent almost solely the water content of the tissue. T2, however, was affected by the nature of existence of water and was more sensitive than T1 in detecting extravasated edema fluid. It seems feasible therefore to evaluate the water content of brain edema on the basis of T1 values.

Animals↗

PubMed1989

Thymic involution and thymocyte phenotypic alterations induced by murine mammary adenocarcinomas.

A profound thymic atrophy has been observed in mice bearing large adenocarcinomas of the mammary gland. Only 2 to 5% of thymocytes remained 4 wk after tumor implantation. Although there is a slight decrease in the overall percentages of Thy-1+ cells in tumor bearers, the majority of the remaining cells are of a Thy-1 low phenotype. There was a lower percentage of double positive (CD4+, CD8+) cells, an increase of CD4+ CD8- thymocytes, similar percentages of CD4- CD8+ cells and double negative (CD4- CD8-) thymocytes in tumor-bearing mice. In addition, an increased percentage of CD3 cells could be detected in these animals. These results indicate that proportionally less immature thymocytes are present in the atrophic thymuses of mammary tumor bearers. Enhanced levels of glucocorticoids are known to produce similar effects on the thymus. However, adrenalectomy of mice followed by tumor implantation did not result in reversal of the thymic atrophy. Furthermore, a study of serum corticosterone levels in tumor bearers indicated no significant changes during tumorigenesis. A study of several parameters of bone marrow (BM) populations indicate that there is an increase in cells of the granulocyte-macrophage lineage and a decrease in lymphocytes induced by tumor-derived granulocyte macrophage-CSF. An alteration of prothymocytes in the BM is not the main cause of the thymic atrophy because BM cells from normal and tumor-bearing mice reconstituted irradiated normal mice equally well. There was no preferential recruitment of double positive cells to the spleen as indicated by no significant differences in the levels of T cells of immature phenotype including the CD4+ CD8+ population in the spleens of tumor bearers. Because no major changes were observed in tumor bearers, either at their capacity to repopulate the thymus or at the patterns of subsequent redistribution of thymocytes, it was postulated that the thymic atrophy may be caused by a direct or indirect effect of the tumor or tumor-associated factor(s). Intrathymic injections of tumor cells into young normal recipient mice resulted in a significant reduction of the thymus weight and cellularity. These data suggest that mammary tumors can secrete factor(s) that are capable of severely impairing the normal development of cells of the T cell lineage.

Adenocarcinoma↗

PubMed1989

Validity of the third-derivative modulation spectroscopy.

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Journal Article↗

PubMed1989

Interdefect elastic interaction in glass fiber and the theory of tunneling systems.

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Journal Article↗