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  • Author or Editor: Takeshi Ito x
  • By Author: Yamamoto, Shinjiro x
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Kenichi Saito, Haruhide Ito, Takeshi Hasegawa and Shinjiro Yamamoto

✓ Levels of the plasmin-α 2-plasmin inhibitor complex (PLN-A2PI complex) and α 2-plasmin inhibitor (A2PI) were determined by enzyme-linked immunosorbent assay (ELISA) with monoclonal antibodies in 59 patients with 66 chronic subdural hematomas (SDH's). Normal concentrations of the PLN-A2PI complex and A2PI in plasma are below 0.8 µg/ml and 60.5 ± 16.1 µg/ml, respectively (mean ± 2 standard deviations). The hematoma fluid contained high concentrations of the PLN-A2PI complex (4.58 ± 2.60 µg/ml) and low concentrations of A2PI (10.32 ± 4.81 µg/ml), while both values in the plasma of 12 patients with chronic SDH's were within the normal range. This represents local hyperfibrinolytic activity in the hematoma.

Stuporous or comatose patients had higher PLN-A2PI complex levels than did the alert and the drowsy or disoriented patients. The layering type of hematoma as seen on computerized tomography scans showed the highest PLN-A2PI complex levels among five types of hematoma. In the fluid drained postoperatively from the subdural cavities of chronic SDH's, both the PLN-A2PI complex and A2PI levels decreased gradually in healing cases. In two patients with hematoma reaccumulation after surgery, both levels increased. The postoperative increase of the PLN-A2PI complex represents the recurrence of intermittent cycles of fibrinolysis, bleeding, coagulation, and hemostasis in the subdural space.

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Takeshi Hasegawa, Haruhide Ito, Shinjiro Yamamoto, Katsuhiko Haba and Hideaki Murata

✓ The authors describe a case of atypical unilateral prominent hyperostosis frontalis interna in a 50-year-old Japanese woman with psychiatric symptoms. Radiological, computerized tomographic, operative, and histological findings of this rare case are presented.

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Cerebral gumma

Case report

Wen-Zern Hwang, Takeshi Hasegawa, Haruhide Ito, Takashi Shimoji and Shinjiro Yamamoto

✓ A case of focal cerebral syphilitic gumma of the right temporal lobe is reported. Angiography showed moderate focal hypervascularity with stretched vessels, and irregularity of the vessel walls. Plain computerized tomography revealed an area of low density that enhanced strongly after intravenous administration of contrast medium.

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Takeshi Hasegawa, Haruhide Ito, Katsuo Shoin, Yuzaburo Kogure, Toshihiko Kubota and Shinjiro Yamamoto

✓ A case of Nelson's syndrome with an adrenocorticotropic hormone-secreting pituitary chromophobe microadenoma is presented to demonstrate the potential capability of rapid sequential (dynamic) computerized tomography (CT) scanning for the diagnosis of a pituitary microadenoma that was isodense with the adjacent pituitary gland on conventional enhanced CT scanning. The dynamic CT scans showed transient high density in this microadenoma contrasting with the pituitary gland in the early-enhancement phase, and thereafter the contrast density was indistinguishable from that of the pituitary gland in the delayed-enhancement phase. For the detection of pituitary microadenoma, dynamic CT combined with subsequent delayed CT scanning can provide diagnostic and localizing information.