This study was performed to clarify the effects of kallidinogenase (human urine) (SK-827) on the common carotid hemodynamics in patients with old cerebral thrombosis. A total of 11 patients including 6 males and 5 females were examined in this study, with ages ranging from 65 to 78 years (mean: 72 years) . Six patients were intravenously administered 0.15 PNA (p-nitro-aniline) units for 30 minutes and the other 5 were administered 0.30 PNA units in the same way. The common carotid hemodynamics was evaluated by ultrasonic quantitative flow measurement system (QFM-1000) before administration and 15, 30, 60 and 120 minutes after administration. Mean blood flow and mean blood velocity of the common carotid artery showed a significant increase, while cerebral circulatory resistance showed a significant decrease at 15 and 30 minutes after SK-827 administration. There were no differences between administration of 0.15 PNA units and 0.30 PNA units in the effects of SK-827 on the common carotid hemodynamics. These results indicate that intravenous SK-827 administration may have beneficial effects on the common carotid hemodynamics in patients with old cerebral thrombosis.
Advances have been made recently in non-invasive technology for evaluating patients with carotid occlusive disease. High-resolution carotid B-mode scanning has a significant advantage of defining the nature of the atherosclerotic plaque and its surface. However, there are still unresolved problems in evaluating data from B-mode carotid imaging. False positive and false negative scans were reviewed and then placed into four error categories : 1) technical errors ; 2) poor visualization due to the carotid artery (for example, kinking of the carotid artery, calcification, low echo plaques) ; 3) misdiagnosis due to surrounding structures (for example, lymph nodes) ; and 4) side-lobes, multiple reflections, and slice thickness artifact. The accuracy of B-mode carotid imaging is directly related to the quality of the image. To identify plaques, it is very helpful to move the transducer slowly and at a constant speed (the authors call this consecutive B-mode scanning) . B -mode carotid imaging can non-invasively access not only luminal but also intrawall anatomical information.
Glioma cases operated on since 1980 were analyzed in regard to the role of intraoperative ultrasonography (IOUS) . Perioperative MRI's and/or CT scans, and stained specimens and pathological reports were also reviewed. 3 cases of low-grade astrocytoma, 1 case of metastatic malignancy (for comparison), 2 cases of gemistocytic astrocytoma or astrocytoma with gemistocytic proliferation, and 1 case of glioblastoma multiforme were presented. Low-grade astrocytomas were generally hyperechoic with indistinct margins. IOUS was mostly helpful for guiding open biopsy maneuvers, but less so for needle biopsy. When located deep in the thalamus, however, IOUS was helpful in guiding needle biopsy. Gemistocytic astrocytomas were rather hyperechoic and proved good candidates for either echo-guided needle biopsy or open biopsy. Malignant gliomas were well visualized and good candidates both for needle biopsy and extensive excision under ultrasound guidance.
To investigate end-tidal carbon dioxide partial pressure (PET CO2) response in suspected cases of normal pressure hydrocephalus (NPH), velocity in middle cerebral artery (MCA) was measured by transcranial Doppler sonography (TCD) . A total of 23 patients of suspected NPH, 8 men and 15 women, whose ages ranged from 30 to 82, were included in this study. They underwent shunt surgery for ventriculomegaly the control group consisted of 30 healthy volunteers and 4 patients of asymptomatic hydrocephalus. CO2 reactivity (CO2R) was evaluated by the change of MCA velocity in response to PETCO2 elevation (30-60 mmHg) . The shunt was effective in thirteen patients, but 10 patients did not respond to the surgery. In most of the shunt-effective group (90%), CO2R was more than 0.20, whereas in all of the shunt-ineffective group, CO2R was less than 0.20. We conclude that CO2R is a good indicator of reversibility from NPH and that it is useful to differentiate shunt-effective patients from ineffective patients.
We tried to evaluate the usefulness of the transcranial color flow imaging (TCFI) as a noninvasive imaging method for Intracranial space occupied lesion (I-SOL) . METHOD-TCFI (ATL, ULTRAMARK 9® 2.25 MHz phazed arrey, 90° sector scan) was applied from the.. bitemporal “acoustic window” to 22 meningiomas, 12 pituitary adenomas, 5 gliomas, I intraventricular tumor, 4 arteriovenous malformations (AVM), 7 intracerebral hematomas (ICH), 8 chronic subdural hematomas (CSH), 2 acute epidural hematomas (AEH), and 1 pediatric arachnoid cyst. RESULT-We were able to detect 12 meningiomas, 7 adenomas, 1 cystic glioma, 1 ventricular tumor, 2 AVMs, 6 ICHs, 6 CSHs, 2 AEHs, and 1 arachnoid cyst, as clearly defined lesions on B-mode images. It was difficult to visualize the region of the posterior fossa. Frontal and high convexity regions were also difficult to investigate. CONCLUSION-TCFI has great advantages : movability, noninvasiveness and blood flow detection factors. It provides an useful diagnostic method for the I-SOL.