Ischemic strokes result from thrombotic or embolic occlusion of one of the vessels that supply blood to the brain. The primary constituents of the initial thrombus are platelets and fibrin, with erythrocytes and other blood cells becoming trapped as thrombosis continues. Therefore, the recent improvements in therapy have focused on inhibiting platelets and dissolving fibrin. A new generation of thrombolytic agents (plasminogen activators) has been developed over the last decade. However, the clinical improvement has at best been marginal and the frequency of serious intracranial hemorrhage remains unchanged. Therefore, we have extensively reviewed the medical literature to determine the reason for the unsatisfactory clinical outcomes with current pharmacological therapies.
Blood Cells ; Brain ; Erythrocytes ; Fibrin ; Fibrinolytic Agents ; Intracranial Hemorrhages ; Stroke* ; Thrombolytic Therapy ; Thrombosis

PURPOSE: The main factor limiting endovascular treatment of intracranial aneurysms is the shape of the a-neurysmal sac, especially the width of the neck. We describe an early experience and technical aspects of treating wide-necked cerebral aneurysm using a Guglielmi detachable coil (GDC) and simultaneous application of a temporary balloon. MATERIALS AND METHODS: Four cases of unruptured wide-necked cerebral aneurysm were treated with GDC, with simultaneous application of a temporary balloon. Patients were aged between 29 and 49 years. On admission, clinical presentation was subarachnoid hemorrhage (SAH) in all cases. Hunt and Hess grade was II in two cases, III in one case, and traumatic SAH in one case. In all patients angiography revealed an asymptomatic a-neurysm after rupture of another aneurysm or traumatic SAH. The aneurysms were occluded with GDC-10, and a Cirrus balloon occlusion system was used simultaneously. All procedures were performed under endo-tracheal general anesthesia and systemic heparinization. RESULTS: All cases were treated successfully, without parent artery compromise. The occlusion rate at the end of the procedure was total in three cases and subtotal in one. In one case a heparin-related hematoma occurred during post-procedural treatment and the patient eventually expired. One patient underwent follow-up angiography after 6 months, and the coil was not changed. CONCLUSION: An aneurysm may not be completely occluded, but with regard to coil compaction and parent artery preservation, the technique is an attractive alternative.
Anesthesia, General ; Aneurysm ; Angiography ; Arteries ; Balloon Occlusion ; Follow-Up Studies ; Hematoma ; Heparin ; Humans ; Intracranial Aneurysm* ; Neck ; Parents ; Rupture ; Subarachnoid Hemorrhage

Magnetic resonance images frequently demonstrate asymmetrical mucosal volume in the nasal area of asymptomatic patients. To further evaluate this phenomenon, sequential MR examinations of the nasal cavity and paranasal sinuses were performed three to four times during a 3 to 8 hours period in ten normal volunteers. The study demonstrated that the mucosal volume changes alternated from side to side during this period in eight volunteers. Changes were also observed within the ethmoid sinuses, nasal septum and nasolacrimal ducts. Awareness of MR findings of nasal cycle may reduce the likehood of inflammatory disease being confused with normal physiologic changes, and also may provide another method in the study of this physiologic phenomenon.
Ethmoid Sinus ; Healthy Volunteers ; Humans ; Methods ; Nasal Cavity ; Nasal Septum ; Nasolacrimal Duct ; Paranasal Sinuses ; Volunteers

No abstract available.
Pancreaticoduodenectomy*

No abstract available.
Doxorubicin* ; Drug Therapy, Combination* ; Etoposide* ; Fluorouracil* ; Mitomycin* ; Retrospective Studies* ; Stomach Neoplasms*

No abstract available.
Biopsy, Fine-Needle* ; Breast Neoplasms* ; Breast* ; Diagnosis*

Barbiturates* ; Brain* ; Membranes*

PURPOSE: To determine the correlation between areas of decreased parenchymal attenuation seen in cases of bronchiectasis, and the severity and extent of the condition, as revealed by HRCT and the plmonary function test (PFT). MATERIALS AND METHODS: The findings of forty-five patients with bronchiectasis who had undergone PFT and HRCT were retrospectively analysed. CT scores were calculated according to the severity and extent of the condition, and areas of low attenuation, and the correlation coefficients between these were determined. Bronchiectasis was classified as either cylindrical or cystic, and using Student's t test, the statistical significance of the results of the PFT were determined. RESULT: The severity and extent of bronchiectasis correlated with the extent of areas of low attenuation (r > .45, p < .05), with especially significant correlation between the extent of these areas and the extent of the condition (r =.84, p=.0001). Correlation was greater in cases involving the cylinlrical variety than the cystic. The extent of low attenuation areas correlated with FEV1, FVC, MMEF, and DLCO (r > .44, p < .01). The functional parameters of the PFT which help differentiate between cylindrical and cystic bronchiectasis are FEV1, FVC, MMEF, DLCO (p < .01), RV, and TLC (p < .05). CONCLUSION: In patients with bronchiectasis, the extent of the condition correlated closely with the extent of low attenuation, and the latter, especially in cases of cylindrical bronchiectasis, showed significant correlation with the extent of abnormalities revealed by the pulmonary function test.
Bronchiectasis* ; Humans ; Respiratory Function Tests* ; Retrospective Studies

Barbiturates* ; Brain* ; Membranes* ; Phospholipids*

Skin metastases from internal cancers are unusual; from a hepatoma they are extremely rare. The most common clinical presentation are solitary or multiple nodules that have appeared in one area of the body. Other forms include inflammatory and sclerodermoid metastatic growths. Case one was a 54-year-old male who had had partial hepatectomy of the right lobe of his liver following diagnosis of hepatocellular carcinoma five years ago. He presented with a 10 month history of a solitary nodule on the chin. Another case was a 46-year-old male, who had developed hepatocellular carcinoma forming a large subcutaneous mass by hemat,ogenous metastasis of the left zygomatic bone, masseter muscle and subcutaneous fat. Additional metastases were observed in the portal vein and multiple bones including the right shoulder, the 1st, 2nd, 3rd sacral spine and the right 3rd, 7th rib. In view of the clinical and histopathologic findings both skin tumors were considered to originate from the liver. The skin metastases may be indicative of progression by the primary tumor and also the first indication that a malignant tumor has not been eradicated.
Carcinoma, Hepatocellular* ; Chin ; Diagnosis ; Hepatectomy ; Humans ; Liver ; Male ; Masseter Muscle ; Middle Aged ; Neoplasm Metastasis* ; Portal Vein ; Ribs ; Shoulder ; Skin ; Spine ; Subcutaneous Fat