Myelodysplastic syndromes with nephrotic syndrome

It is sometimes reported that the immunological abnormalities in myelodysplastic syndromes (MDS) induce autoimmune disease (i.e., acute systemic vasculitic syndrome, chronic cutaneous vasculitis, polyneuropathy, relapsing polychondritis, and steroid-responsive pulmonary disorders). We investigated the clinical features of patients with MDS accompanied by nephrotic syndrome. We enrolled 125 patients with MDS who were admitted between January 1979 and May 1996 in this study. The renal function was assessed based on the laboratory data and the findings at the physical examination. The diagnoses of nephrotic syndrome and glomerular disease were established when 24-hr urinary excretion was more than 3.5 g and serum total protein was less than 6.0 g/dl, and when the 24-hr protein excretion was more than 1.5 g. Five patients (4%) had glomerular disease, and three (2.4%) had nephrotic syndrome. Of the five patients with glomerular disease, two had refractory anemia (RA), and three had chronic myelomonocytic leukemia (CMMOL). Three of the total 11 patients with CMMOL were diagnosed as having nephrotic syndrome. Among the CMMOL patients, those with nephrotic syndrome showed higher absolute monocyte numbers than did those without nephrotic syndrome (8830 +/- 4677/microl vs. 3061 +/- 2887/microl, P = 0.03). One CMMOL patient was treated with VP-16 and hydroxyurea. As the white blood cell count in this patient decreased, the 24-hr urine protein excretion and the serum tumor necrosis factor alpha level decreased. The relationship between nephrotic syndrome and CMMOL was not clear. High monocyte count and the serum cytokines in MDS patients may play a partial role in the evolution of glomerulonephritis, and CMMOL may be closely related to nephrotic syndrome.

Functional magnetic resonance imaging of auditory cortex: with special reference to the side of aural stimulation

PURPOSE

To determine whether left- or right-side uniaural stimulation produces different fMRI activation patterns.

METHODS

Subjects were 12 volunteers (8 right-handed, 4 left-handed) with normal hearing. Functional imaging using FE-type multishot echo planar imaging was obtained in the axial plane during pure-tone and pseudoword tasks. Auditory stimuli were presented to each ear individually. In pure-tone tasks, subjects heard clustered sequences at 2000 Hz. In pseudoword tasks, subjects heard spoken Japanese syllables. The numbers of activated pixels in the auditory cortex were counted and compared for pure-tone and pseudoword tasks, as was activation according to the side of aural stimulation.

RESULTS

In right-handed subjects, prominent activation in pure-tone tasks was noted in the dominant hemisphere in 100% of cases and was unrelated to the side of the stimulation. In pseudoword tasks, prominent activation was noted on the side contralateral to the stimulus in 62.5-100% of cases. In left-handed subjects, prominent activation was noted on the side contralateral to the stimulus in both pure-tone and pseudoword tasks.

CONCLUSION

Left- and right-side stimulation produced differences in fMRI responses, especially between pure-tone and pseudoword tasks. Moreover, right-handedness and left-handedness affected results. This type of auditory fMRI may be a noninvasive indicator of language lateralization.

Brain tumors in surgical neuropathology of intractable epilepsies, with special reference to cerebral dysplasias

Surgical specimens from 30 patients (13 males and 17 females) with intractable epilepsy with brain tumors and allied lesions were histopathologically examined: 4 of nonneurogenic origin (1 angiolipoma with cortical dysplasia and 3 cavernous hemangiomas), 2 low-grade fibrillary astrocytomas, 1 pleomorphic xanthoastrocytoma, 3 pilocytic astrocytomas with nuclear polymorphism, 1 oligoastrocytoma, 9 gangliogliomas, 3 gangliogliomatous lesions combined with tuberous sclerosis-like dysplastic changes, and 7 undetermined lesions suspected of being mixed glioma, dysembryoplastic neuroectodermal tumor (DNT), or dysplasia. They were all located supratentorially: in the temporal lobe in 21, frontal lobe in 6, and parietooccipital lobe in 3. The age of onset was under 20 years in most patients. Some kinds of dysplasias, such as focal cortical dysplasia, glioneuronal heterotopia, and clustered neurons in the hippocampus and amygdaloid nucleus, were combined in 11 cases, especially those with age of onset under 10 years. Pilocytic astrocytoma-like features were seen in 5 of the gangliogliomas and 3 of the undetermined lesions, and DNT-like features in 2 of the former and 3 of the latter. Gangliogliomas, pilocytic astrocytomas, mixed gliomas, DNTs, and dysplasias may be closely inter-related in the development of intractable epilepsies of young patients.

[Basic approaches in minimally invasive cardiac surgery (MICS) and its selection]

Recently, minimally invasive cardiac surgery (MICS) has been developed and popularized as a less stressful and less invasive technique in the field of cardiac surgery. There are eight currently available MICS approaches for open heart surgery. The optimum approach should be selected for each patient based on the results of preoperative examination including chest X-ray, computed tomography, and angiography. Between December 1996, when we first introduced MICS for mitral repair, and the end of November 1998, we performed MICS in 67 patients [excluding cases of MIDCAB]. These included 11 patients who received the Port-Access (Heartport, Inc.) system. Although no patients died in hospital stay, one died of cerebrovascular bleeding eight months later. All patients were evaluated in the outpatient department as being NYHA class I. In view of future technological progress, we expect that MICS will gradually become more widespread in cardiac surgery.

Differential effects of wortmannin on the release of substance P and amino acids from the isolated spinal cord of the neonatal rat

1. Effects of wortmannin, an inhibitor of myosin light chain kinase, on the release of substance P and amino acids, GABA and glutamate, were investigated in the isolated spinal cord preparation of the neonatal rat. 2. Wortmannin at 0.5 - 10 microM depressed the release of substance P evoked by high-K+ (90 mM) medium from the spinal cord (IC50 = 1.1 microM). Wortmannin also depressed the high-K+ (70 mM)-evoked release of substance P from cultured dorsal root ganglion neurons of neonatal rats. In contrast, the high-K+ (90 mM)-evoked release of GABA and glutamate from the spinal cord was not affected by wortmannin (0.1 - 10 microM). 3. Upon stimulation of a dorsal root, a monosynaptic reflex and a subsequent slow ventral root depolarization were evoked in the ipsilateral ventral root of the same segment in the isolated spinal cord preparation. The magnitude of the slow ventral root depolarization was depressed gradually to about 70% of the control during the course of 30 min under wortmannin (1 microM). In contrast, the monosynaptic reflex was unaffected by wortmannin. 4. Immunofluorescent staining revealed that immunoreactivities of substance P and myosin II were colocalized at presynaptic terminals in the dorsal horn of the neonatal rat spinal cord. 5. The present results suggest that myosin phosphorylation by myosin light chain kinase may play a crucial role in the release of substance P, but not in the release of GABA and glutamate in the neonatal rat spinal cord. This may reflect a difference in the exocytic mechanisms of substance P-containing large dense core vesicles and amino acid-containing small clear vesicles.

[Evaluation of an ultrasonic cutting and coagulating system (harmonic scalpel) for performing a segmental and wedge resection of the lung]

In order to prevent the local recurrence of malignant tumors, it is important for surgeon to maintain a sufficient margin between the tumor and the edge at resection. For this reason we do not use an auto-suturing device, but instead use the ultrasonic cutting and coagulating system (HARMONIC SCALPEL, ETHICON ENDO-SURGERY Cincinnati, Ohio) whenever we perform either a segmental resection or a wedge resection of the lung. The subjects investigated consisted of 24 cases of lung tumors (15 metastatic tumors, 5 cases with primary lung cancer, 3 inflammatory tumors; and one benign tumor). The type of operation included 10 segmental resections and 14 wedge resections, with 21 open thoracotomies and 3 instances of thoracoscopic surgery, while 15 were single resections and 9 were multiple resections. Little bleeding was seen at the resection of the parenchyma and the vessels of the lung. However prolonged air leakage was observed in some cases that needed pleurodesis. The mean duration time of the surgery was 266 minutes, and the mean blood loss was 173 ml. The operative duration was a little longer than normal, because many cases were not first thoracotomies and some cases had multiple tumors. Nevertheless the amount of blood loss was slight. The longest post-operative period was two years and six months, no local recurrence has yet been seen in any of malignant cases. We consider this system to be very effective for performing a resection of the lung parenchyma because of the reduced blood loss and the apparent increased prevention of recurrence.

Combination of surface anatomy MRI and MR venography to demonstrate cerebral cortex and cortical veins on one image

We assessed in 12 patients the value of MR images in which a surface anatomy scanning (SAS) image and an MR venogram are added. We obtained SAS images using the half-Fourier technique and MR venograms with the 2D phase-contrast technique. The added images provided sufficient information concerning brain surface as well as cortical veins. Their findings correlated with those at surgery in six patients who underwent scalp incision marking. This technique provides valuable anatomical information preoperatively.

Endobronchial hamartoma treated by an Nd-YAG laser: report of a case

Endobronchial hamartomas are only rarely encountered. They cause irreversible lung damage due to bronchial obstruction if not diagnosed early and treated properly. Among the various treatments for this rare disease, a surgical resection remains the most popular. We herein report a case of a 53-year-old man presenting with an endobronchial hamartoma which was successfully excised by laser irradiation via a rigid bronchoscope, along with a review of 113 patients with this disease reported in the literature.

[Results of resection of T3 primary lung cancer]

Primary resection for lung cancer was performed in 711 patients. Extensive surgery was performed in 99 T3 lung cancer (13.7%). Overall 5-year survival rate was 31.7%. Overall hospital mortality was 7.5%. Mean 5-year survival was 34.9% for patients with complete resection, 0% for patients with incomplete resection (p < 0.05). In patients with complete resection, mean 5-year survival was greater in patients with N0 (39.1%) than in patients with N1 (23.5%) or N2 (27.7%), but there was no statistically significant difference. There was also no statistically significant difference between adenocarcinoma and squamous cell carcinoma. Mean 5-year survival rate for patients with invasion of chest wall was 34.1%, with invasion of mediastinal pleura was 37.5%, with invasion of main bronchus was 58.3%, with interlobular invasion was 18.7%. Complete resection of T3 lung cancer may yield long time survival.

3D-CT angiography of cerebral arteriovenous malformations

We studied 76 patients with cerebral arteriovenous malformations (AVMs) using dynamic-CT with intravenous injection of contrast material and reconstructed three-dimensional images (3D-CT angiography). All patients received stereotactic radiotherapy (gamma-knife). We compared 3D-CT angiography with conventional angiography to determine the usefulness of this technique. 3D-CT angiography could be performed in conjunction with usual axial high-resolution CT without any additional scanning time and within 10-30 minutes for the overall study. Most niduses and drainers of AVMs were clearly visualized by 3D-CT angiography. 3D-reconstruction was very helpful in demonstrating the niduses, drainers, and three-dimensional structure of AVMs. Demonstrations of feeders were not remarkable. Dynamic CT was very helpful in dose planning for gamma-knife radiosurgery, because gamma-knife angiograms were limited in terms of angles, magnification, and establishing precise localizations using a head frame. 3D-CT added information on trails of drainers and was useful in reducing the volume of irradiation. 3D-CT angiography of cerebral AVMs could be performed routinely, and three-dimensional imaging was helpful in demonstrating the complex anatomy of cerebral AVMs. This technique was very helpful in planning gamma-knife radiosurgery.

Primary cardiac leiomyosarcoma growing rapidly and causing right ventricular outflow obstruction

Leiomyosarcomas are extremely rare primary cardiac tumors. We report a rapidly growing primary leiomyosarcoma of the right ventricle, which obstructed the right ventricular outflow tract within one month after symptom onset in a 68-year-old man. Two-dimensional echocardiography was useful in diagnosing the extent and progression of the tumor. The tumor was surgically resected on an emergency basis, and the right ventricle and pulmonary artery were successfully reconstructed. Recurrence of the tumor on the right ventricle was observed, and the patient was overcome by sudden dyspnea and died three months after surgery.

MRI findings of multiple malignant gliomas: differentiation from multiple metastatic brain tumors

Multiple malignant gliomas are relatively uncommon, but are sometimes difficult to differentiate from multiple metastatic brain tumors. We analyzed the MR findings of four cases of multiple gliomas, comparing them with 12 cases of multiple metastatic brain tumors. All tumors were pathologically proven by surgical operation or autopsy. Gliomas were located in the deep white matter of the cerebrum, with none found in the posterior fossa. Tumors were relatively large, and irregular, thick, ring-like enhancement was noted after the administration of Gd-DTPA. Intratumoral hemorrhage was noted in only one case. High signal intensity on T2WI around the tumor suggested that edema was greater and more extensive than in metastatic tumors and was seen even in the corpus callosum. One autopsied case that showed this high intensity presented not only edema but also tumor infiltration. Metastatic tumors were located mainly in the corticomedullary junction of the brain. They were relatively small, and eight of 12 tumors showed, nodular or smooth ring-like enhancement. Intratumoral hemorrhage was noted in four cases. Edema was noted mainly around the tumor. We conclude that differential diagnosis between gliomas and metastases is possible to some extent by MRI.

[Relationship between imaging and pathological features and clinical factors in surgical cases of temporal lobe epilepsy]

The relationships between imaging, pathology and presumed causes in surgical cases of temporal lobe epilepsy (TLE) was studied. The subject was 62 patients (33 males and 29 females) who had had no attacks for more than one year after surgery. Average age at surgery was 28.2 +/- 9.9 years. Obvious neurological abnormalities were not found in these cases. MRI, PET and SPECT were performed. Hematoxylin and eosin was used for pathological judgement. Their medical charts were used to investigate their clinical factors. Although patients suspected of having encephalitis/meningitis had been hospitalized for 2 days to three months during childhood due to disturbance of consciousness with high fever and convulsion for several days; they were not diagnosed with encephalitis/meningitis at that time, and they suffered almost no handicaps other than epilepsy for several years following their comatose episodes. [Result] (1) On MRI, mesial temporal sclerosis (MTS) was detected in 48 of 52 patients (92%); 32 (62%) had high-signal intensity on T 2-weighted images; 31 (60%) had atrophy ¿23 (44%) had high-signal intensity on T 2 + atrophy¿; 5 (10%) had calcified lesions; and 2 (4%) had cystic lesions. On PET and SPECT, abnormal cerebral blood flow was noted in 33 of 36 (92%). (2) On pathological findings (61 cases), Ammon's horn sclerosis (AHS), tumors, gliosis in lateral temporal and meningeal inflammatory finding were detected in 42 (69%), 10 (23%) and 8 (13%) cases, respectively, whereas 2 showed no abnormalities. The 2 patients with normal pathology showed both high-signal intensity and atrophy on MRI. (3) The presumed causes of TLE were encephalitis/meningitis and/or suspected of these diseases in 15 patients (24%), injuries at birth in 5 (8%), and none in 42 (68%). The presumed causes in the 43 patients with AHS were encephalitis/meningitis in 11, injuries at birth in 3, and none in 29. Of the 15 patients in whom encephalitis/meningitis was estimated as the causes of TLE, only 6 (40%) had pathological evidence of meningeal inflammatory finding. Of the 42 patients in whom cause could not be determined, 2 had pathological evidence of meningeal inflammatory finding.

A case of malignant peritoneal mesothelioma showed complete remission with chemotherapy

A 71-year-old woman presented with an abdominal mass and ascites and was subsequently admitted to our hospital in June 1995. Further examination revealed that the mass was malignant and, as a result, surgery was indicated. However, the mass demonstrated widespread peritoneal dissemination, which therefore could not be resected, and pathological findings suggested a malignant peritoneal mesothelioma. The patient showed a remarkable response to combined chemotherapy with an accompanying intraperitoneal injection of cisplatin and etoposide and an intravenous injection of caffeine. However, owing to side effects, this regimen was discontinued. The patient was administered a combination drug of uracil and tegafur (UFT) in addition to intraperitoneal injection of cisplatin as an outpatient. By the 223rd day after surgery, the tumor mass and ascites had completely disappeared according to the CT. Hence chemotherapy was judged to have resulted in complete remission. Such a marked response to chemotherapy is rare in an advanced malignant peritoneal mesothelioma such as the present case. Eight months later, the tumor recurred in the pleura. Another regimen of chemotherapy with cisplatin and CPT-11 was performed. However, this treatment proved ineffective. The patient subsequently died of respiratory failure in January 1997 due to the mesothelioma. This is a case report of complete remission of malignant peritoneal mesothelioma by combined chemotherapy.

Surgical treatment of epilepsy from schizencephaly with fused lips

BACKGROUND

Surgical treatment of schizencephaly with fused lips has been reported in few cases. In all of the previously reported cases, temporal lobectomy was selected as a major surgical treatment, except for one case with cortical resection. We present a case of direct resection of dysplastic walls of the schizencephalic cleft and the surrounding epileptic area.

CASE

This 20-year-old college student with medication-resistant epilepsy was surgically treated by subpial cortical resection of the epileptogenic area around a schizencephalic cleft. Magnetic resonance imaging showed an unilateral schizencephalic cleft with fused lips in the right parietal lobe. Pathologic examination demonstrated dysplastic neurons in the epileptogenic cortex. Intraoperative electrocorticography clearly detected epileptiform discharges around the cleft, and the epileptogenic lesion was completely resected. He has been seizure-free for 1 year since the operation and he has no neurologic deficits.

CONCLUSION

Subpial resection of the dysplastic cortex surrounding the cleft under the guide of electrocorticography is an effective and minimally invasive procedure for the treatment of schizencephaly.

[Minimally invasive approach for mitral valve, aortic valve, and atrial septal defect surgery]

We successfully introduced minimally invasive cardiac surgery (MICS) to japan by performing thoracoscopic clipping of a patent ductus arteriosus in July 1992. MICS via a small right parasternal incision (Cosgrove procedure) was applied for one patients with severe rheumatic mitral stenosis, one with severe aortic regurgitation, and one with atrial septal defect (ASD). Mitral valve replacement (MVR), aortic valve replacement (AVR), and direct closure of the ASD were performed successfully by MICS for the the first time in Japan. All three patients required no blood transfusion and had no complications postoperatively, being discharged from hospital at 15, 13, and 9 days after their operations. MICS was satisfactory for mitral valve and ASD operations, but AVR by this approach took much longer than by standard midline sternotomy due to the poor surgical field obtained via the small right parasternal incision. A minimally invasive approach for surgery on the aortic valve and ascending aorta may require transection of the sternum or some other method. MICS has several advantages, including less trauma and pain, faster patient recovery, shorter ICU and hospital stays, a lower cost, and a better cosmetic outcome. Therefore, it is better for the patient when it is feasible. MICS should develop and be applied to more patients with cardiovascular disease in the future. Some of the standard cardiovascular operations may soon be replaced by MICS.

Three-dimensional imaging of cortical structure, function and glioma for tumor resection

A three-dimensional brain imaging protocol with PET and MRI was used to visualize the cortical structure in relation to brain function and glioma infiltration to determine tumor resectability.

METHODS

Sixteen patients with glioma had a PET scan with 11C-methionine to visualize tumor infiltration. The PET images were co-registered to the patients' own MRI reconstructed to the three-dimensional brain surface images to indicate the gyral structure and the extent of tumor infiltration. Thirteen patients, who bore tumors adjacent to the language or motor cortex, had H2 15O activation study to locate the eloquent cortex. The area of tumor infiltration was superimposed on the brain surface images together with the language and/or motor cortex.

RESULTS

When a tumor was located within a single gyrus without influencing surface cortical gyrus pattern, the motor and language areas were identified morphologically by three-dimensional surface image alone. However, when the tumor caused swelling and deformation of cortical structure, functional mapping with H2(15)O activation technique was essential in locating them correctly. In such cases, the combined mapping of the facial motor area with oral movement and the language area with word repetition was the most useful method to identify the parasylvian structure in the dominant hemisphere. Total or near total resection of low-grade glioma in eight patients and the effective decompression of the active part of the malignant glioma in four patients was completed without causing functional neurological deterioration.

CONCLUSION

The three-dimensional expression of cortical structure and function combined with PET glioma imaging with 11C-methionine is useful for radical resection of cerebral glioma.

Coexistence of ganglioglioma and cortical dysplasia in a patient with intractable epilepsy--case report

An 8-year-old girl presented with coexistence of ganglioglioma and cortical dysplasia manifesting as intractable epilepsy. Preoperative computed tomography demonstrated a small calcified lesion in the left frontal lobe which was not diagnosed as ganglioglioma. Magnetic resonance imaging also failed to demonstrate positive evidence of ganglioglioma or cortical dysplasia. A calcified tumor and the surrounding epileptogenic areas were resected under electrocorticography (ECoG) guidance. Histological examination revealed coexistence of ganglioglioma and cortical dysplasia. The patient became seizure-free after surgery. Resection of the ganglioglioma together with the adjacent epileptogenic area under intraoperative ECoG guidance is important to achieve a successful surgical result in patients with ganglioglioma.

A monoclonal antibody that recognizes ganglioside GD1b in the rat central nervous system

A monoclonal antibody (MAb), generated by immunizing BALB/c mice with homogenized bovine retinal tissue, was specific to ganglioside GD1b incorporated into liposome membranes. The antibody (MAb-5G6), classified as IgM, immunostained intensely the perikaryon and processes of motoneurons in the cranial motor nuclei and spinal cord. Spinal and trigeminal ganglion cells were also immunopositive to the MAb. Some fiber tract systems, such as the spinal and mesencephalic trigeminal tracts, the solitary tract and the posterior funiculus, were also immunoreactive to the MAb. These findings suggest that MAb-5G6 labeled specifically neurons with axons extending outside of the central nervous system as a peripheral nerve. The immunoreactive substances were visualized under electron microscopy just beneath the postsynaptic membrane and just inside the plasmalemma of the thick dendrites. No axon terminal was immunolabeled by the MAb. In the rat embryos, immunoreactivity to MAb-5G6 was found in the dorsal and ventral root fibers on the 15th embryonic day (E15). However, cell bodies of the spinal ganglion cells and motoneurons were immunostained by MAb-5G6 at a later stage (E20). The ventral commissure fibers in the floor plate of the spinal cord were transiently immunolabeled during E13-15.

High prevalence of hantavirus infection in a group of Chinese patients with acute hepatitis of unknown aetiology

In southwestern China, small but substantial numbers of patients with acute hepatitis were found without known hepatropic viral infections (hepatitis A, B, C, D or E, cytomegalovirus, Epstein-Barr virus) and were receiving no hepatotoxic drugs. Prevalence of antibodies, both neutralizing and specific immunoglobulin (Ig)M and IgG, to Hantaan virus were evaluated in a cohort of 136 such patients: 83 were of unknown aetiology, 53 had known viral hepatitis and 59 healthy subjects acted as controls. The results showed that the incidence of neutralizing antibody to Hantaan virus in acute hepatitis patients with non-hepatitis A-E virus infections (13 of 83) was significantly higher than in those with A-E infections (0 of 53, P<0.01). Furthermore, the incidence of specific IgM antibody to Hantaan virus in acute hepatitis patients with non-hepatitis A-E virus infections (6 of 83) was significantly higher than in those with A-E infections (0 of 53, P<0.05) and in healthy subjects (0 of 59, P < 0.05). These findings suggest that Hantaan virus may be an important agent, contributing, at least in southwestern China, to a significant number of the cases of acute hepatitis of unknown aetiology. This hantavirus infection resulted in an acute hepatitis, differing from the typical diseases: haemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS).

Focal cortical dysplasia: appearance on MR images

PURPOSE

To clarify the magnetic resonance (MR) imaging characteristics of focal cortical dysplasia (FCD).

MATERIALS AND METHODS

The authors reviewed the MR images of 14 patients with FCD, which was confirmed with histologic examination.

RESULTS

MR images exhibited FCD in 13 of the 14 patients. All lesions were localized to part of one hemisphere. T2-weighted images showed blurring of the gray matter-white matter junction and abnormal signal intensity in the white matter in 11 patients. T1-weighted images showed blurring of the gray matter-white matter junction in seven patients, broad gyri in nine, thick cortices in nine, abnormal sulci in 10, and focal enlargement of the overlying subarachnoid space or adjacent ventricle in eight. Surgical specimens exhibited disruption of cortical lamination without abnormal gyration in all patients, cytomegalic neurons in the cortex in three, disorganized bizarre glial cells in the cortex in seven, ectopic neurons or bizarre glial cells in the white matter in nine, and blurring of the gray matter-white matter junction in one.

CONCLUSION

Blurring of the gray matter-white matter junction with abnormal signal intensity in the white matter on T2-weighted images is characteristic of FCD. The presence of ectopic neurons and bizarre glial cells, dysmyelination, and a reduction in the number of myelinated fibers might have been responsible for the MR imaging characteristics.

Quantitative regional cerebral flow measured by Tc-99M HMPAO SPECT in mood disorder

Depressed (n = 14) and remitted (n = 9) patients with mood disorder, patients with depressive disorder not otherwise specified (NOS; n = 10) and normal subjects (n = 8) underwent non-invasive and quantitative measurement of cerebral blood flow using HMPAO and SPECT in a resting state. The mean and regional cerebral blood flow (CBF) in twelve ROIs were compared among the four groups and correlations between CBF and the depressive symptoms were studies. The CBF was computed using graphical analysis on the SPECT console after a bolus injection of Tc-99m HMPAO and radionuclide angiography. The depressed group had significantly lower mCBF in the bilateral hemisphere and rCBF in all except one of the ROIs than the NOS and normal group. Significant negative correlations were found between the Hamilton scale for depression and rCBF in the bilateral lower frontal cortex after correcting for age in the mood disorder. Parallel analysis using both the quantitative and semiquantitative methods revealed that the former provided more global reduction of CBF in mood disorder. These results indicate that mean and regional CBF measured by this non-invasive method contributes to the objective evaluation of depressive symptoms. Negative correlations between HRSD and rCBF in the frontal regions indicate that frontal hypoactivity is closely related to depressive symptoms.

Unilateral megalencephaly in linear nevus sebaceous syndrome: a neuroradiological case report

We report a case of linear nevus sebaceous syndrome with seizure, mental retardation, and hemiparesis. Magnetic resonance imaging (MRI) clearly demonstrated associated brain malformations of unilateral megalencephaly with cortical dysplasia and white matter change ipsilateral to the sebaceous nevi of the face and neck. Although magnetic resonance angiography (MRA) demonstrated only distortion of the main cerebral arteries without any occlusive or dysplastic findings, single photon emission computed tomography (SPECT) using [123I]N-Isopropyl-p-iodoamphetamine (IMP) revealed hypoperfusion in the affected cerebral hemisphere.