ノウケッカンナイ チリョウ ノ サイゼンゼン

Brain surgery has made a great contribution to the treatment of cerebrovascular disease in the last half of this century. On the other hand, endovascular treatment using catheter without invasive craniotomy has made rapid progress recently. Various cerebrovascular diseases can be treated with this technique irrespective of hemorrhage or ischemia. By means of groin puncture (femoral artery puncture) specialized devices and materials can be delivered up to intracranial lesion where brain surgery is unable to access. In this paper, illustrative cases including coil embolization for cerebral aneurysm, Merci clot retriever for cardiogenic cerebral embolism and carotid artery stenting are demonstrated and issues and future perspective of the recent advances in the endovascular treatment for cerebrovascular disease are discussed

Lateral abdominal wall hematoma as a rare complication after carotid artery stenting: a case report

Abdominal wall hematoma is a rare and life-threatening complication after carotid artery stenting (CAS), but it can occur when activated clotting time is prolonged. We report a right lateral abdominal wall hematoma caused by rupture of the superficial circumflex iliac artery after CAS in a 72-year-old man with severe stenosis of the origin of the right internal carotid artery. We performed CAS for the targeted lesion while activated clotting time exceeded 300 seconds. After 2 hours, he complained of right lateral abdominal pain. Abdominal computed tomography revealed an extensive hematoma in the right lateral abdominal wall. Activated clotting time was 180 seconds at this point. Seven hours later, he developed hypotension and hemoglobin level dropped to 11.3 g/dl. Subsequent computed tomography showed enlargement of the hematoma. Emergent selective angiography of the external iliac artery revealed active bleeding from the right superficial circumflex iliac artery. Transcatheter arterial embolization with Gelfoam and microcoils was performed successfully. With more CAS procedures being performed, it is important for endovascular surgeons and radiologists to consider the possibility of abdominal wall hematoma in this situation

PICA communicating artery aneurysm

This report presents a rare case of such an aneurysm arising from such a communicating artery. A 66-year-old woman presented with a subarachnoid hemorrhage located predominantly in the cisterna magna with intraventricular hemorrhage. Angiography showed hypoplasia of the right posterior inferior cerebellar artery. Its vermian territory was supplied by the communicating artery from the posterior medullary segments of the left posterior inferior cerebellar artery. An aneurysm was on that communicating artery itself at a nonbranching site. The aneurysm was trapped the next day. Postoperative computed tomography showed no infarct in the right posterior inferior cerebellar artery territory. Trapping is applicable when other collateral vessels supply the contralateral posterior inferior cerebellar artery territory

Pathognomonic consideration of clinical features of dural arteriovenous malformations

Dural arteriovenous malformations (dural AVMs) were reported sporadically. However, the diagnosis has become easier due to recent developments in clinical imaging modalities. It is known that dural AVMs present various signs and symptoms according to locations and/or specific pathophysiological conditions and occasionally cause serious neurological deficits with intracranial hemorrhage or venous infarction. There are few reports which describe the management of patients with dural AVMs. In this paper, clinical features of dural AVMs observed in our service are reviewed with special attention to angiographic findings. Seventy-five cases of dural AVM treated between 1976 and 1995 were divided into two groups : 69 cases with single lesions and 6 cases with multiple lesions. The lesions were located in anterior fossa (AF), cavernous sinus (CS), transverse-sigmoid sinus (TS) or superior sagittal sinus (SSS). From their pathognomonic aspects, the cases were classified into two types : the apoplectic type (hemorrhage or venous infarction) and the non-apoplectic type (no evidence of hemorrhage or venous infarction). Among 69 cases with single lesions, 8 involved the AF, 28 CS, 31 TS and 2 SSS. Patients of 60-69 years age predominated in our series. Males predominated in AF cases (M : F = 7 : 1), females in CS cases (M : F = 5 : 23). Among these, intracranial hemorrhages were noted in 5 AF, 1 CS, 11 TS and 2 SSS, respectively. On the other hand, venous infarctions were noted in 5 TS and 1 SSS. Twelve of 13 hemorrhagic cases exhibited intracerebral hematoma. The rate of apoplectic attacks by location was 63 % in the AF, 4 % in CS, 35 % in TS and 100 % in SSS, respectively. All cases of the apoplectic type demonstrated cortical venous reflux in the angiograms, whereas reflux was seen in only 7 (14 %) out of 50 non-apoplectic cases. Among the 19 apoplectic cases, 17 (89 %) showed the so-called isolated sinus, which was noted in only 4 (8 %) out of 50 non-apoplectic cases. A venous lake, meaning a dilated draining vein such as a saccular aneurysm of the vein, was also thought to be a warning sign of apoplexy. Draining vessels were cut at proximal sites in 7 out of the 8 AF cases surgically and successfully. Most of the CS lesions were treated by embolization and/or radiation therapy, and the TS lesions by embolization or conservative method. No episode of rebleeding has occurred after treatment. Most of the patients had an excellent or good outcome, although 3 cases demonstrated a fair or poor outcome in the apoplectic group. There were 6 cases (14 lesions) with multiple dural AVMs. However, 5 out of the 14 lesions caused apoplexy, all of these cases had an excellent or good outcome after treatment. There were 5 cases (83 %) of sinus thrombosis and 3 (50 %) of thrombosis in the deep vein of the legs, indicating that multiple dural AVMs may be associated with generalized thrombosis of the venous system. In conclusion, if dural AVMs are associated with cortical venous reflux, isolated sinus and/or a venous lake angiographically, the lesions have a high risk of intracranical hemorrhage or venous infarction. Therefore, such patients need urgent treatment

Design of a variable-stiffness robotic hand using pneumatic soft rubber actuators

In recent years, Japanese society has been ageing, engendering a labor shortage of young workers. Robots are therefore expected to be useful in performing tasks such as day-to-day support for elderly people. In particular, robots that are intended for use in the field of medical care and welfare are expected to be safe when operating in a human environment because they often come into contact with people. Furthermore, robots must perform various tasks such as regrasping, grasping of soft objects, and tasks using frictional force. Given these demands and circumstances, a tendon-driven robot hand with a stiffness changing finger has been developed. The finger surface stiffness can be altered by adjusting the input pressure depending on the task. Additionally, the coefficient of static friction can be altered by changing the surface stiffness merely by adjusting the input air pressure. This report describes the basic structure, driving mechanism, and basic properties of the proposed robot hand

Detection of reverse transcriptase activity by enzyme-linked immunosorbent assay in human immunodeficiency virus type 1.

An enzyme-linked immunosorbent assay (ELISA) using biotin-labelled oligo-dT primer and digoxigenin (Dig)-dUTP was designed to measure the reverse transcriptase (RT) activity of human immunodeficiency virus type 1 (HIV-1). The ELISA system involves the selective detection step of a newly synthesized cDNA by two specific bindings, biotin-streptavidin binding and alkaline phosphatase (AP)-conjugated anti-Dig-Dig binding, and the enzymatic amplification step to increase coloring generated by AP. This method was used to measure the activity of RT in the culture supernatants of peripheral leukocytes obtained from four anti-HIV-1-positive persons cocultivated with those from four anti-HIV-1-negative persons. RT activity was detected in all of four anti-HIV-1-positive culture supernatants but not in those cultivated with anti-HIV-1-negative supernatants alone. Thus, our improved ELISA for detection of HIV-1 appears to be sensitive enough and useful for routine laboratory work. This non-radioactive method will also be useful for detecting other retroviruses and for screening of RT inhibitors.</p

ノウケッカンナイ チリョウ

We reported the resent advansement of endovascular treatment for cerebral strokepatients, coil embolization for aneurysm, local fibrinolytic therapy for acute major cerebralartery occlusion and stent inplantation for cerebral artery stenosis. Detachable coil embolizationwas done for 101 patient with (105) cerebral aneurysms. Detachable coil treatment technologyfor cerebral aneurysms were effective and safe. We treated intraarterial local fibrinolysisfor 94 patients of acute major cerebral artery occlusion. Our clinical trial may indicate abetter choice for cases with acute ischemic cerebral stroke. Especially early treatment within4 hours from onset may lead to have more enhance of good clinical improvemant. Stentinplantation for carotid artery, vertebral artey and subculavian artery was done for 11patients with arterio-screlotic stenosis. Stent inplantation for cerebral artery stenosis iseffective, although we need more safety protection for embolism and prevention technologyagainst restenosis