Kazuhisa Himi

Growth of totally thrombosed giant aneurysm within the posterior cranial fossa

SummaryWe report a case in which growth of a totally thrombosed giant aneurysm of the posterior cranial fossa was demonstrated by computed tomography (CT) scans repeated after 4 years. A magnetic resonance (MR) image demonstrated an onion-skin-like, laminated structure within a calcified wall. The laminated structure had developed around an old thrombosis, without any communication to the flowing blood. It showed intensities indicating recent clots, revealing that the giant aneurysm had grown by recurrent intramural hemorrhage rather than by intraluminal accumulation of thrombotic materials. This case illustrates that totally thrombosed giant aneurysms still have the potential of growth.

Magnetic resonance imaging of cavernous sinus cavernous hemangiomas.

SummaryRadiological findings of surgically verified cavernous hemangiomas of the cavernous sinus are presented with special reference to the appearance in magnetic resonance imaging. Differences in radiological features of the cavernous sinus cavernous hemangiomas and intracerebral cavernous hemangiomas are discussed.

Growth of a giant aneurysm following complete thrombosis by detachable balloon occlusion

A giant basilar artery aneurysm demonstrating growth and causing neurological deterioration even after complete detachable balloon occlusion is reported. Autopsy revealed total thrombosis of the aneurysm and a hemiconcentric, onion skin-like, laminated structure. Numerous vascular channels and multiple fresh intramural hemorrhages were noted within the outer margin of the aneurysmal wall. Repeated intramural hemorrhages appeared to have been responsible for the aneurysmal laminated structure and contributed to progressive aneurysmal growth. This case demonstrates that the growth of some giant aneurysms is not dependent upon the continuity with the parent artery, and progressive enlargement cannot always be prevented by balloon occlusion.

Use of digital subtraction fluoroscopy to diagnose radiolucent aspirated foreign bodies in infants and children

OBJECTIVES Most tracheobronchial foreign bodies in children are radiolucent, and accurate diagnosis of such foreign bodies is not always easy. This can result in delay of diagnosis or misdiagnosis of foreign body aspiration. We report the usefulness and pitfalls of use of digital subtraction fluoroscopy (DSF) to diagnose radiolucent aspirated foreign bodies in infants. METHODS From 1991 through 1999, DSF was conducted for a total of 19 patients (ranged from 11 months to 4 years and 7 months in age (mean 1.8+/-0.9 years)) who were suspected to have radiolucent aspirated foreign bodies. Since DSF revealed abnormal findings in a trachea or main bronchus in 18 cases, inspection was performed for foreign body bronchofiberscopically. In the one remaining case, no abnormality was recognized on DSF, but since the symptoms at the time of onset strongly suggested aspirated foreign body, bronchofiberscopy was also performed. RESULTS Foreign body was verified bronchoscopically in 13 of 19 cases, and all 13 (100%) had abnormal findings on DSF, including obstruction of the trachea in two, obstruction of the bronchial lumen in nine, and indistinct visualization of the bronchial lumen in two. Bronchial stenosis was verified bronchoscopically in five of the remaining six cases, including mucus plug in three, granuloma in one and mucosal edema in one case. All five patients (100%) had abnormal findings on DSF, including obstruction of the bronchial lumen in four and indistinct visualization of the bronchial lumen in one. In the one remaining patient with normal findings of DSF, no foreign body or pathological bronchial changes were noted. CONCLUSIONS DSF was very sensitive in the diagnosis of foreign body aspiration and stenotic changes in the bronchial lumen. However, its diagnostic specificity for aspirated foreign body itself was not high (17%). Therefore, when abnormalities are found on DSF, we recommend to perform flexible bronchofiberscopy initially under general anesthesia via a tracheal tube. When a foreign body is verified, rigid ventilation bronchoscopy is successively performed to retrieve the foreign body.

Heat and pain sensations induced by arterial injection of low-osmolality contrast media: a comparison of patients' discomfort with ionic saline, nonionic glucose, and vasodilator nitrate.

C linical symptoms such as heat and pain are two of the most frequent and finpleasant adverse effects experienced after intravascular injection of iodinated contrast media. Recently, nonionic dimeric contrast media (iotrolan, iiodixanol) have been developed [1], and their osmolality has been reduced to the physiologic level. However, subjective discomforts associated with these contrast media have not yet been eliminated. Although it has been established that heat and pain are caused mainly by tile high osmolality of the contrast media [2], it is possible that other factors also may play active roles. The aim of this study was to determine what factors and mechanisms are involved in causing heat and pain from the administration of the contrast media presently being used. The following agents were analyzed in our study: glucose as a model of a nonionic agent, saline (NaCl) as a model of an ionic agent, and nitrate as a vasodilator. Clinical studies on heat and pain induced by contrast media have been conducted [1, 3-7], but studies with test solutions involving actual patients have not been reported [8, 9]. Our study was designed to obtain the expression of sensations, which could be obtained only from human volunteers.

Intraparenchymal blood-fluid levels in traumatic intracerebral haematomas

SummaryBlood-fluid levels within the cerebral parenchyma are observed more frequently on CT and MRI in traumatic intracerebral haematomas than in those of other aetiologies. The intraparenchymal blood-fluid interface can be formed without a fluid cavity. It is suggested that the blood-fluid levels represent layering of red blood cells within areas of contusion necrosis as well as extensive contusion oedema. The more extensive the damage to brain tissue, the more often blood-fluid levels formed. A poorer outcome can be therefore predicted when an intraparenchymal blood-fluid interface is seen.

Complete disappearance of the nasopharyngeal cancer with intracranial extension by intra-arterial cisplatin infusion: report of two cases

Abstract Two cases of nasopharyngeal cancer with intracranial extension were treated with intra-arterial cisplatin infusion with systemic infusion of sodium thiosulfate (STS) followed by continuous IV infusion of 5-FU for 120 h. After two courses of intra-arterial chemotherapy, tumors had completely disappeared. Subsequently, full doses of external irradiation were applied. Both of them survived 5 years after the initiation of the treatment, but one died of the original cancer after just 5 years.

Clinical usefulness of iomeprol 400 mgl/ml in cardioangiography evaluation of patient discomfort and hemodynamic and ECG effects.

It is well known that the nonionic contrast media cmrently used are safer than ionic high-osmolar contrast media (1). However, contrast media-related cardiovascular adverse effects are still observed, especially in high-risk patients following their injection into left ventricle and coronary arteries (2,3). Iomeprol 400 (400 mgI/mL) (Iomeron; Bracco SpA, Milan, Italy; Eisai, Tokyo, Japan), which has been recentily developed, has some advantages such as 30-50 mg/mL higher iodine content and a lower osmolality of 750 mosm/kg • H20 than existing nonionic monomeric contrast media (4,5). Consequently, we can expect iomeprol 400 to have a better image and reduction of osmolality-related adverse effects such as patient discomfort and untoward hemodynamic and ECG changes. It is also noteworthy tha~ the use of iomeprol 400 is imperative and of clinical value, especially for the obese and broad-chested patients during cine cardioangiography. In this study, to determine the patient tolerance, safety, and usefulness of iomeprol 400 in cardioangiography, we compared the patient discomfort and hemodynamic and ECG effects of iomeprol 400 with those of iomeprol 350 (350 mgI/mL) during left ventriculography (LVG) and coronary angiography using a crossover design.

Monitoring shunt flow by jugular bulb oxygen saturation during therapeutic embolisation of cerebral arteriovenous malformations

The shunt flow to perfusion flow ratio in patients with cerebral arteriovenous malformation (AVM) can be evaluated from the arterial and jugular bulb oxygen saturations (S aO2 and S jO2). We employed this technique to assess the progress of shunt obliteration during therapeutic embolisation procedures. Data from a consecutive series of 15 large supratentorial high-flow AVMs (maximum diameter > 4 cm) were analysed. The S jO2 before embolisation was significantly higher than the S jO2 at the end of the embolisation. Continuous monitoring of S jO2 revealed a progressive decrease in association with an increase in the circulation time, as well as disappearance of early veins and evidence of steal during the embolisation procedure. This technique is useful for real-time assessment of the progress of embolisation.

A simple technique for minimising complications of percutaneous transluminal angioplasty for internal carotid stenosis

The application of percuteneous transluminal angioplasty (PTA) to the treatment of cerebrovascular diseases risks complications caused by emboli flowing into the intracerebral arteries. We report here a simple technique to prevent such complications of PTA for internal carotid artery stenosis. The principle of the technique is to occlude the common carotid artery with a latex balloon mounted on a guiding catheter during the PTA procedures. This usually gives rise to retrograde flow from the internal carotid artery, which carries debris away to the external carotid artery. We treated 18 cases of internal carotid artery stenosis by this technique. It was confirmed before the PTA procedure that slow injection of contrast medium through the guiding catheter demonstrated retrograde flow from the internal carotid artery. Excellent results were obtained in all cases, without any complications. We found that the proximal occlusion technique was much easier to perform than the distal occluion technique. The present technique appears to offer a practical and useful procedure for treating internal carotid artery stenosis.