Periodontal tissue regeneration by recombinant human collagen peptide granules applied with β-tricalcium phosphate fine particles

OBJECTIVES

Recombinant human collagen peptide (RCP) is a recombinantly created xeno-free biomaterial enriched in arginine-glycine-aspartic acid sequences with good processability whose use for regenerative medicine applications is under investigation. The biocompatibility and osteogenic ability of RCP granules combined with β-tricalcium phosphate (TCP) submicron particles (β-TCP/RCP) were recently demonstrated. In the present study, β-TCP/RCP was implanted into experimental periodontal tissue defects created in beagles to investigate its regenerative effects.

METHODS

An RCP solution was lyophilized, granulated, and thermally cross-linked into particles approximately 1 mm in diameter. β-TCP dispersion (1 wt%; 500 μL) was added to 100 mg of RCP granules to form β-TCP/RCP. A three-walled intrabony defect (5 mm × 3 mm × 4 mm) was created on the mesial side of the mandibular first molar and filled with β-TCP/RCP.

RESULTS

A micro-computed tomography image analysis performed at 8 weeks postoperative showed a significantly greater amount of new bone after β-TCP/RCP grafting (2.2-fold, P < 0.05) than after no grafting. Histological findings showed that the transplanted β-TCP/RCP induced active bone-like tissue formation including tartaric acid-resistant acid phosphatase- and OCN-positive cells as well as bioabsorbability. Ankylosis did not occur, and periostin-positive periodontal ligament-like tissue formation was observed. Histological measurements performed at 8 weeks postoperative revealed that β-TCP/RCP implantation formed 1.7-fold more bone-like tissue and 2.1-fold more periodontal ligament-like tissue than the control condition and significantly suppressed gingival recession and epithelial downgrowth (P < 0.05).

CONCLUSIONS

β-TCP/RCP implantation promoted bone-like and periodontal ligament-like tissue formation, suggesting its efficacy as a periodontal tissue regenerative material.

Water-resistant antibacterial properties of a graphene oxide/cetylpyridinium chloride complex formed on medical gauze fibers

OBJECTIVES

Graphene oxide (GO) is a nanocarbon material with a high aspect ratio (width:thickness) and abundant anionic functional groups on its surface. In this study, we attached GO to the surface of medical gauze fibers, constructed a complex with a cationic surface active agent (CSAA), and demonstrated that the treated gauze exhibits antibacterial activity even after rinsing with water.

METHODS

Medical gauze was immersed in GO dispersion (0.001%, 0.01%, and 0.1%), rinsed with water, dried, and subjected to the Raman spectroscopy analysis. Subsequently, the gauze treated with 0.001% GO dispersion was immersed in 0.1% cetylpyridinium chloride (CPC) solution, immediately rinsed with water, and dried. Untreated, GO-only, and CPC-only gauzes were prepared for comparison. Each gauze was placed in a culture well, seeded with Escherichia coli or Actinomyces naeslundii, and turbidity was measured after 24 h of incubation.

RESULTS

The Raman spectroscopy analysis of the gauze after immersion and rinsing showed a G-band peak, indicating that GO remained on the surface of the gauze. The turbidity measurements indicated that GO/CPC-treated gauze (GO-treated and rinsed, followed by CPC-treatment and rinsing) significantly decreased turbidity compared to the other gauzes (P<0.05), suggesting that the GO/CPC complex remained on the gauze fibers even after water rinsing and showed antibacterial activity.

CONCLUSIONS

The GO/CPC complex imparts water-resistant antibacterial properties to gauze and has the potential to be widely used for the antimicrobial treatment of clothes.

Rose bengal-decorated rice husk-derived silica nanoparticles enhanced singlet oxygen generation for antimicrobial photodynamic inactivation

Rice husks are well known for their high silica content, and the RH-derived silica nanoparticles (RH NPs) are amorphous and biocompatible; therefore, they are suitable raw materials for biomedical applications. In this study, rose bengal-impregnated rice husk nanoparticles (RB-RH NPs) were prepared for their potential photosensitization and ¹O₂ generation as antimicrobial photodynamic inactivation. RB is a halogen-xanthene type's photosensitizer showing high singlet oxygen efficiency, and the superior photophysical properties are desirable for RB in the antimicrobial photodynamic inactivation of bacteria. To enhance the binding of anionic RB to RH NPs, we conducted cationization for the RH NPs using polyethyleneimine (PEI). The control of the RB adsorption state on cationic PEI-modified RH NPs was essential for RB RH-NP photosensitizers to obtain efficient ¹O₂ generation. Minimizing RB aggregation allowed highly efficient ¹O₂ production from RB-RH NPs at the molar ratio of RB with the PEI, X_RB/PEI. = 0.1. The RB-RH NPs have significant antimicrobial activity against Streptococcus mutans compared to free RB after white light irradiation. The RB-RH NP-based antimicrobial photodynamic inactivation can be employed effectively in treating Streptococcus mutans for dental applications.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10853-023-08194-z.

Sustained antibacterial coating with graphene oxide ultrathin film combined with cationic surface-active agents in a wet environment

Antimicrobial surfactants contained in mouthrinse have excellent efficacy, but are not retained on the tooth surface (are rinsed away) due to their low water resistance and thus do not exhibit sustained antibacterial activity. We have developed a new coating method using graphene oxide (GO) that retains the surfactant on the tooth surface even after rinsing with water, thus providing a sustained antibacterial effect. Ultra-thin films of GO and an antimicrobial agent were prepared by (1) applying GO to the substrate surface, drying, and thoroughly rinsing with water to remove excess GO to form an ultrathin film (almost a monolayer, transparent) on the substrate surface, then (2) applying antimicrobial cationic surface active agents (CSAAs) on the GO film to form a composite coating film (GO/CSAA). GO/CSAA formation was verified by scanning electron microscopy, Raman spectroscopy, X-ray photoelectron spectroscopy, and ζ-potential and contact angle measurements. GO/CSAA was effective at inhibiting the growth of oral pathogens for up to 7 days of storage in water, and antibacterial activity was recovered by reapplication of the CSAA. Antibacterial GO/CSAA films were also formed on a tooth substrate. The results suggest that GO/CSAA coatings are effective in preventing oral infections.

Periodontal tissue engineering using an apatite/collagen scaffold obtained by a plasma- and precursor-assisted biomimetic process

BACKGROUND AND OBJECTIVES

In the treatment of severe periodontal destruction, there is a strong demand for advanced scaffolds that can regenerate periodontal tissues with adequate quality and quantity. Recently, we developed a plasma- and precursor-assisted biomimetic process by which a porous collagen scaffold (CS) could be coated with low-crystalline apatite. The apatite-coated collagen scaffold (Ap-CS) promotes cellular ingrowth within the scaffold compared to CS in rat subcutaneous tissue. In the present study, the osteogenic activity of Ap-CS was characterized by cell culture and rat skull augmentation tests. In addition, the periodontal tissue reconstruction with Ap-CS in a beagle dog was compared to that with CS.

METHODS

The plasma- and precursor-assisted biomimetic process was applied to CS to obtain Ap-CS with a low-crystalline apatite coating. The effects of apatite coating on the scaffold characteristics (i.e., surface morphology, water absorption, Ca release, protein adsorption, and enzymatic degradation resistance) were assessed. Cyto-compatibility and the osteogenic properties of Ap-CS and CS were assessed in vitro using preosteoblastic MC3T3-E1 cells. In addition, we performed in vivo studies to evaluate bone augmentation and periodontal tissue reconstruction with Ap-CS and CS in a rat skull and canine furcation lesion, respectively.

RESULTS

As previously reported, the plasma- and precursor-assisted biomimetic process generated a low-crystalline apatite layer with a nanoporous structure that uniformly covered the Ap-CS surface. Ap-CS showed significantly higher water absorption, Ca release, lysozyme adsorption, and collagenase resistance than CS. Cell culture experiments revealed that Ap-CS was superior to CS in promoting the osteoblastic differentiation of MC3T3-E1 cells while suppressing their proliferation. Additionally, Ap-CS significantly promoted (compared to CS) the augmentation of the rat skull bone and showed the potential to regenerate alveolar bone in a dog furcation defect.

CONCLUSION

Ap-CS fabricated by the plasma- and precursor-assisted biomimetic process provided superior promotion of osteogenic differentiation and bone neoformation compared to CS.

Antibacterial coating of tooth surface with ion-releasing pre-reacted glass-ionomer (S-PRG) nanofillers

OBJECTIVES

Surface pre-reacted glass-ionomer (S-PRG) fillers release antibacterial borate and fluoride ions. We fabricated nanoscale S-PRG fillers (S-PRG nanofillers) for antibacterial coating of tooth surfaces and assessed the antibacterial effects of this coating in vitro. In addition, we creating a canine model of periodontitis to evaluate the effectiveness of S-PRG nanofiller application on tooth roots and improvement of periodontal parameters.

METHODS

Human dentin blocks were coated with S-PRG nanofiller (average particle size: 0.48 μm) and then characterized by scanning electron microscopy (SEM), energy dispersive X-ray spectrometer (EDX), and ion-releasing test. Antibacterial effects of dentin blocks coated with S-PRG nanofiller were examined using bacterial strains, Streptococcus mutans and Actinomyces naeslundii. Next, we created an experimental model of periodontitis in furcation of premolars of beagle dogs. Then, S-PRG nanofiller coating was applied onto exposed tooth root surfaces. Periodontal parameters, gingival index (GI), bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL), were measured from baseline until 4 weeks. In addition, bone healing was radiographically and histologically examined.

RESULTS

SEM and EDX revealed that S-PRG nanofillers uniformly covered the dentin surface after coating. Dentin blocks coated with S-PRG nanofiller showed ion-releasing property, bacterial growth inhibition, and sterilization effects. In the experimental periodontitis model, S-PRG nanofiller coating significantly reduced clinical inflammatory parameters, such as GI (P < 0.01) and BOP (P < 0.05), compared to uncoated samples. In addition, PPD and CAL significantly decreased by S-PRG nanofiller coating (2 weeks: P < 0.05; 3 and 4 weeks: P < 0.01), suggesting the improvement of periodontitis. Micro-CT and histology revealed that bone healing of furcation defects was enhanced by S-PRG nanofiller coating.

CONCLUSION

S-PRG nanofiller coating provides antibacterial effects to tooth surfaces and improves clinical parameters of periodontitis.

Bone forming ability of recombinant human collagen peptide granules applied with β-tricalcium phosphate fine particles

Recombinant human collagen peptide, developed based on human collagen type I, contains an arginyl-glycyl-aspartic acid (RGD)-rich motif to enhance cell behavior and is anticipated as a xeno-free polymer material for use in tissue engineering. We fabricated granules containing recombinant human collagen peptide (RCP) applied with beta-tricalcium phosphate fine particles (RCP/β-TCP) as bone filling scaffold material and assessed the bone forming ability of RCP/β-TCP. Recombinant peptide was thermal crosslinked and freeze-dried to prepare RCP. An aqueous dispersion of β-TCP fine particles was added to RCP to obtain RCP/β-TCP. Subsequently, RCP/β-TCP were characterized using scanning electron microscopy (SEM), energy dispersive X-ray spectrometry (EDX), and cell culture assessments. Furthermore, RCP/β-TCP were implanted into rat cranial bone defects for radiographic and histological evaluations. In SEM and EDX analyses of RCP/β-TCP, β-TCP particles dose-dependently covered the surface of RCP. Cell culture tests showed that RCP/β-TCP remarkably promoted proliferation and mRNA expression of various genes, such as integrin β1 and osteogenic markers, of osteoblastic MC3T3-E1 cells. Histomorphometric assessment at 4 weeks showed that RCP/β-TCP significantly promoted new skull bone formation compared to RCP (p < 0.05) and control (no application) (p < 0.01). Accordingly, these findings suggest RCP/β-TCP possess bone forming capability and would be beneficial for bone tissue engineering therapy.

Molecular pharmacology of glucocorticoids: recent advances and future perspectives

Abstract Glucocorticoids are one of the most widely used bullets for the treatment of inflammatory and immune disorders. They act by binding to their specific intracellular receptor, the glucocorticoid receptor (GR), which is a transcription factor belonging to the nuclear receptor superfamily. It is believed that the GR, upon binding ligand, elicits transcriptional regulation of target gene expression via orchestrated interaction with DNA, coregulators, other transcription factors, and chromatin. This model has raised the possibility that a certain class of ligand might variably modulate GR-mediated intracellular signals. Moreover, crystallographic analysis of the ligand-binding domain of the nuclear receptor has given structural insight into the ligand-dependent modularity of the receptor function. This advanced technology would allow the molecular pharmacologic development of a ligand that could dissociate therapeutic actions from the undesirable metabolic effects of glucocorticoids in the near future.

Nanomolar concentrations of tri-n-butyltin facilitate gamma-aminobutyric acidergic synaptic transmission in rat hypothalamic neurons

Tri-n-butyltin (TBT), an environmental pollutant, is accumulated in edible mollusks and fishes. It has also become a health concern in today's society. In the present study, to elucidate the possible neurotoxic action of TBT, the effect on spontaneous gamma-aminobutyric acid (GABA) release from GABAergic nerve terminals projecting to rat ventromedial hypothalamic neurons was examined using "synaptic bouton" preparation with a nystatin perforated patch recording mode under voltage-clamp conditions. The threshold concentration of TBT to affect the synaptic transmission was 10 to 30 nM. TBT at 30 nM or higher concentrations increased the frequency of GABAergic miniature inhibitory postsynaptic currents in a dose-dependent manner, whereas the current amplitude and current kinetics were not affected. The removal of either external Ca2+ or application of Cd2+ attenuated the TBT-induced facilitation of neurotransmission. TBT at 1 microM induced an inward current in more than one-half of the cells. This current persisted even after TBT was washed out. The present results indicate that TBT at environmentally relevant concentrations (30-100 nM) facilitates the GABAergic neurotransmission in the mammalian brain and the external Ca2+ is needed in this facilitation. Because the concentration of TBT accumulated in some mollusks and fishes has been reported to reach levels of 100 nM or more, such accumulation of TBT in some mollusks and fishes is thus suggested to be hazardous to the health of humans.

[The effect of C 1 esterase inhibitor on ischemia: reperfusion injury in the rat brain]

BACKGROUND

Despite the current interest in thrombolytic therapy for acute stroke, ischemia-reperfusion injury remains a potentially hazardous complication. The complement system is thought to play a major role in initiating some of the inflammatory events occurring in the reperfusion injury. This study was conducted to explore the effect of C 1 esterase inhibitor (C 1 INH) on the reperfusion injury in rat middle cerebral artery (MCA) occlusion-reperfusion model.

METHODS

Twenty-nine male Wistar rats were used. Intraluminal MCA occlusion was performed for 60 minutes. Just before the reperfusion, C 1 INH(50 IU/kg, C 1 INH group, n = 15) or saline (control group, n = 14) was administrated. Forty-eight hours after the reperfusion, infarct volume and myeloperoxidase(MPO) activity of the brain were evaluated.

RESULT

Infarct volume and MPO activity were significantly smaller in the C 1 INH group(86.5 +/- 76.8 mm3, 0.38 +/- 0.30 U/g) than in control group(179 +/- 92.8 mm3, 1.37 +/- 0.46 U/g) (p < 0.01).

CONCLUSION

The results of this study provided the first evidence that C 1 INH reduced polymorphonuclear leukocytes(PMN) accumulation and reperfusion damage in the brain.

Direct clipping of a large basilar trunk aneurysm via the posterior petrosal (extended retrolabyrinthine presigmoid) approach--case report

A 53-year-old female presented with an unruptured, large basilar trunk aneurysm manifesting only as headache with no neurological deficits, including absence of cranial nerve dysfunction. Cerebral angiography disclosed a large aneurysm with a wide neck arising from the midbasilar artery. We treated the aneurysm surgically via the posterior petrosal approach. Five angled clips were applied sequentially to the aneurysm and the basilar artery was successfully reconstructed. Electrophysiological monitoring was continued during the operation and showed no changes. Following the operation, the patient suffered from transient right abducens nerve palsy, which persisted for 3 months. Postoperative angiography showed that the aneurysm was obliterated, and the patency of the basilar artery was preserved.

Giant aneurysm of the azygos anterior cerebral artery--case report

A 77-year-old female presented with a giant aneurysm of the azygos anterior cerebral artery (ACA) manifesting as acute onset of akinetic mutism caused by enlargement of the aneurysm resulting from rapid thrombus formation within the aneurysmal sac. Thrombus removal to obtain decompression of the aneurysmal bulk and tension was performed before parent artery occlusion to prevent thromboembolic events. The aneurysmal neck was completely clipped with preservation of the parent artery and all branches. This strategy for direct neck clipping of a giant thrombosed distal ACA aneurysm can reduce the possibility of ischemic sequelae.

[A case of high flow CCF with congestive hemorrhage]

The authors report a case of high flow CCF with intracerebral hemorrhage during treatment with endovascular coil embolization. A 52-year-old woman had been in good health until a sudden onset of orbital bruit and left orbital tinnitus occurred. Conjunctival chemosis and diplopia caused by left abducens palsy gradually progressed. Left internal carotid arteriography revealed a carotid-cavernous sinus fistula with direct high-flow shunt. The fistula drained into the superior orbital vein, inferior petrosal sinus, intercavernous sinus and sphenoparietal sinus with significant cortical reflux. The attempt at transarterial balloon occlusion failed. Then transvenous coil embolization was performed. During the course of endovascular treatment, follow up CT depicted intracerebral hemorrhage. Intracerebral hemorrhage was asymptomatic and thought to be caused by venous hypertension from cortical reflux. The patient underwent direct occlusion of the left sphenoparietal sinus for prevention of further hemorrhage via craniotomy. Lastly, the cavernous sinus was completely occluded by transvenous coil embolization. The signs and symptoms resolved 3 months after the procedures.

[Angiographically occult high cervical dural arteriovenous malformation secondary to intracranial hypertension: a case report]

We have recently encountered a case of high cervical arteriovenous malformation which caused subarachnoid hemorrhage. A 54-year-old male was admitted to our hospital due to sudden onset of severe headache. Neurological examination revealed right sixth nerve palsy which suggested elevated intracranial pressure. A CT scan showed subarachnoid hemorrhage predominantly in the posterior fossa, massively ventral to the brain stem, with reflux into the fourth ventricle. No abnormal vascular lesions were found in the first cerebral angiography which included four vessels and bilateral thyrocervical trunks. Ten days later, the second cerebral angiography demonstrated an arteriovenous shunt via the right vertebral artery draining into the epidural space of the upper cervical region. A suboccipital craniotomy and laminectomy of the atlas were performed. An abnormally dilated vein along the right C1 nerve ventral root which drained into the tortuous dilated coronary venous plexus on the ventral side of the spinal cord was found. We made a diagnosis of dural arteriovenous malformation fed by the C1/C2 radicular artery via the right vertebral artery and draining into the radiculomedullary vein and the epidural venous plexus. The interruption of both intra- and extradural draining veins was carried out. The postoperative course was uneventful.

[Brain surface clear cell ependymoma: case report]

We report a case of brain surface clear cell ependymoma. A 13-year-old boy presented with complaints of right hypesthesia. Computed tomography and magnetic resonance image showed a left fronto-parietal cystic, calcified mass lesion. He underwent total resection of the tumor including cyst wall. The tumor located on the surface of the parietal lobe was sharply demarcated from the surrounding brain tissue and there was no continuity with the ventricular wall. Histological examination of the surgical specimens showed oligodendroglioma-like cells that had round unclei, clear cytoplasm which formed perivascular pseudorosettes, and immunoreactivity for glial fibrillary acidic protein (GFAP). Electromicroscopically, microvilli were seen. The findings were compatible with clear cell ependymoma. The cyst wall was lined with a layer of single cuboidal cells and, immunohistochemically, had no basal membrane. The inner surface of the cyst was positive for EMA, and the cuboidal cells were positive for GFAP. We discuss possible mechanisms for tumor growth in our case and the histogenesis of its cyst.

Ventral T-1 neurinoma removed via hemilaminectomy without costotransversectomy--case report

A 39-year-old male presented with a spinal neurinoma originating from the T-1 anterior root and located ventral to the spinal cord. The tumor was removed by hemilaminectomy with only partial facetectomy without costotransversectomy. No stabilization was necessary, and no complications secondary to surgery occurred. Costotransversectomy is not necessary for neurinoma ventral to the spinal cord within the spinal canal at T-1 level because the transverse process protrudes more laterally and the spinal canal of the T-1 vertebra is wider than at other thoracic levels.

[Bilateral aplasia of the internal carotid artery: a case report]

We report a case of bilateral aplasia of the internal carotid arteries. A 59-year-old man was admitted with generalized convulsions. Computed tomography and magnetic resonance imaging of the head showed normal findings. Three-dimensional computed tomography, angiography, and intra-arterial digital subtraction angiograms showed bilateral aplasia of the internal carotid arteries. The bilateral ophthalmic arteries were filled from the hypoplastic carotid arteries, and the anterior and middle cerebral arteries were filled from the basilar artery via the posterior communicating arteries. Associated with this bilateral aplasia of the internal carotid arteries, intracranial aneurysms and megadolicho-basilar anomaly were reported. Angiography is to be recommended if IC aplasia is suspected.

The effects of nonsteroidal anti-inflammatory drugs on immune functions of human peripheral blood mononuclear cells

It is generally accepted that the nonsteroidal anti-inflammatory drugs (NSAIDs) exhibit anti-inflammatory effects primarily through inhibition of prostaglandin (PG) synthesis. However, effects of NSAIDs on immune responses are not fully understood. This study investigated effects of indomethacin and a new NSAID (d-2-[4-(3-methyl-2-thienyl)phenyl]propionic acid, termed as M-5011 in this study) on cytokine production, lymphocyte proliferation, activities of natural killer (NK) and lymphokine activated killer (LAK) cells and secretion of immunoglobulin (Ig). Both indomethacin and M-5011 augmented interleukin (IL)-2 production, whereas they suppressed IL-6 production both at the protein and mRNA levels. These two NSAIDs augmented proliferation of phytohemagglutinin (PHA)-stimulated PBMC and enhanced NK and LAK cell activities. In contrast, indomethacin was more potent than M-5011 in inhibition of both PG synthesis and Ig secretions by pokeweed mitogen (PWM)-stimulated PBMC. These results suggest that these two NSAIDs equally augment cell-mediated immunity, whereas indomethacin was more potent than M-5011 in the inhibition of humoral immunity and PG synthesis.

Primarily extracranial jugular foramen neurinoma manifesting with marked hemiatrophy of the tongue: case report

BACKGROUND

There have been no detailed descriptions of the clinical symptoms of a primarily extracranial jugular foramen neurinoma (JFN), because this type of tumor is extremely rare.

CASE DESCRIPTION

Although the 51-year-old woman presented with only mild complaints of dysphagia and hoarseness, neurologic examination revealed marked left hemiatrophy of the tongue. Although magnetic resonance imaging suggested a JFN, the patient's mild symptoms and normal jugular foramen were potentially misleading in the diagnosis of this patient. Surgical exploration demonstrated that the tumor originated from the extracranial portion of the 10th cranial nerve, extending into the jugular foramen. Subtotal resection ameliorated the 12th cranial nerve palsy.

CONCLUSION

The authors present a case of a primarily extracranial JFN manifesting as a 12th nerve palsy. The clinical symptoms and signs produced by a tumor in this extremely rare location are discussed.

Association of a dolichoectatic middle cerebral artery and an intracranial cavernous hemangioma--case report

A normotensive, non-smoking 41-year-old female with a history of generalized seizures from the age of 4 years presented with a left middle cerebral artery (MCA) fusiform aneurysm and an ipsilateral frontal lobe cavernous hemangioma. Surgical exploration demonstrated that the fusiform aneurysm-like lesion was a dolichoectatic MCA with no arteriosclerotic change. The pathogenesis of dolichoectasia is obscure, but the association of a dolichoectatic MCA and an intracranial cavernous hemangioma is suggestive of congenital factors.

De novo vertebral artery-posterior inferior cerebellar artery aneurysm: a case report

BACKGROUND

There have been few reports of de novo aneurysms in the posterior circulation since most de novo aneurysms occur in the anterior circulation.

CASE DESCRIPTION

At the age of 46 years, the patient suffered a subarachnoid hemorrhage due to a ruptured right middle cerebral artery aneurysm, which was subsequently clipped. Eight years later, the patient experienced another subarachnoid hemorrhage of the posterior fossa predominance. A cerebral angiogram demonstrated a right vertebral artery-posterior inferior cerebellar artery (VA-PICA) aneurysm that had not been noted on the previous study.

CONCLUSIONS

The first case of a subarachnoid hemorrhage from a right de novo VA-PICA aneurysm is presented. The characteristics of de novo aneurysms in the posterior circulation are discussed.

[Ruptured traumatic aneurysms of the peripheral anterior cerebral artery: study of delayed hemorrhage after closed head injury]

We report three cases of ruptured traumatic aneurysms of the peripheral anterior cerebral artery after closed head injury. These cases were all young men with closed head injury due to traffic accidents. Consciousness level on admission was coma in all three cases. Case 1 was a 19-year-old man with interhemispheric hematoma on initial CT, then 7 days later his consciousness cleared. However, 14 days later he suddenly lapsed into a deep coma with a severe frontal hemorrhage. Case 2 was a 13-year-old boy. Plain skull films demonstrated a frontal depressed fracture, but CT scan showed no bleeding. Four days later his consciousness cleared but 11 days after trauma, he lapsed into a deep coma with a frontal hemorrhage. Case 3 was a 22-year-old man. Initial CT showed a slight ventricular hemorrhage. Fourteen days later, his consciousness had almost cleared, but then he lapsed into a deep coma with a large frontal hemorrhage 11 weeks after the trauma. These patients all died within a few days after intracranial bleeding. All patients underwent cerebral angiography but none of them showed filling defect. Autopsy was performed and ruptured aneurysms were found on the distal anterior cerebral artery that had no relation to the branch of bifurcation. Histological examination demonstrated a lack of elastic lamina and media in all of these three cases, so each of them was a victim of so-called false aneurysm. Twenty reported cases of ruptured traumatic aneurysms of the peripheral cerebral artery with delayed hemorrhage after closed head injury were reviewed. Factors in the traumatic aneurysm showed no relation to the duration of disturbed consciousness. Within one month, delayed hemorrhage due to ruptured traumatic aneurysm occurred. None of the delayed hemorrhages involved subarachnoid hemorrhage. Subdural hematoma was seen in the distal middle cerebral artery and frontal hemorrhage was found in the distal anterior cerebral artery. We consider that frontal hemorrhage is a predictive finding for the type of delayed hemorrhage due to traumatic aneurysm in the distal anterior cerebral artery.

[The mechanism of cardiorespiratory arrest due to subarachnoid hemorrhage]

This report describes the clinical course of patients with sudden cardiorespiratory arrest (CRA) due to subarachnoid hemorrhage (SAH). We have seen fifteen patients of SAH that presented initially as CRA. All of them were diagnosed as SAH by CT scan. The patients were divided into two groups; one group (early DOA group) included 11 patients, who had been recognized as CRA within 60 minutes from the onset of SAH, the other group (late DOA group) consisted of 4 patients, who developed CRA more than 60 minutes after the initial onset. The major mechanism leading to delayed CRA in the late DOA group appeared to have been from brain stem herniation, but another mechanism appeared to be involved in sudden CRA in the early DOA group. Sixty percent of our patients with CRA due to SAH had a low serum potassium concentration, though hypokalemia was observed in only 4 out of 100 patients with CRA due to diseases other than SAH. These facts suggest that sympathetic hyperstimulation might result not only from stress but also from a disorder of the central autonomic nervous system. We speculate that the mechanism leading to early CRA after SAH appears to result from a disorder of the central autonomic nerve system.

[Neurinoma of the short ciliary nerve: a case report]

Intraorbital neurinoma is a rare tumor and constitutes nearly 1.5% of the orbital tumors. A case of orbital neurinoma is reported. A 70-year-old woman was admitted with the chief complaint of impairment of visual acuity and proptosis of the left eye. A CT scan and MRI revealed a retrobulbar mass. Total removal of the tumor via the transcranial approach to the orbita resulted in improvement of the symptoms. The tumor was considered to be a neurinoma originating from the left short ciliary nerve.