脳動脈瘤2006/09/07 07:36:37

Cerebral Aneurysms Jonathan L. Brisman, M.D., Joon K. Song, M.D., and David W. Newell, M.D. Volume 355:928-939 August 31, 2006 Number 9

脳動脈瘤に関する最新の常識というべき記載です。批判するよりかみしめて読まないといけません。未破裂があったら、様子をみるか、手術するか、血管内にするか---重要なのは、 Intracranial aneurysms that are incidentally discovered need not be treated in certain patients. ということです。

すこし前にSAHのreviewもでていて(354:387,2006)、一応これを世界の常識と考えた方がよいでしょう。

Neurolymphomatosis2006/09/08 17:46:14

Neuro-oncol 2003 5(2):104-115 Neurolymphomatosis Joachim M. Baehring, Denise Damek, Emily C. Martin, Rebecca A. Betensky and Fred H. Hochberg

The term "neurolymphomatosis" (NL) has included infiltration of the peripheral nervous system by lymphoma and nontumor lymphocytes. We describe NL as a lymphoma entity that affects cranial and peripheral nerves and roots. We reviewed the medical records of patients at the Massachusetts General Hospital (MGH) who registered between 1972 and 2000, as well as cases published in the English-language literature. Inclusion criteria were (A) histopathologic demonstration of lymphoma within peripheral nerve, nerve root/plexus, or cranial nerve or (B) CT/MRI or intraoperative evidence of nerve enlargement and/or enhancement beyond the dural sleeve in the setting of prior or concurrent lymphoma in systemic or CNS sites. We identified 25 patients with NL in addition to 47 reported by others. Four clinical presentations were (1) painful involvement of nerves or roots, (2) cranial neuropathy with or without pain, (3) painless involvement of peripheral nerves, (4) painful or painless involvement of a single peripheral nerve. Twenty of our patients and 44 of those reported had histopathologic confirmation of lymphoma infiltrating root or nerve. In the remainder, diagnosis was based upon clinical presentation, nodular nerve enlargement or enhancement, and lymphoma cells in spinal fluid or extraneural sites. For antemortem diagnosis, imaging studies were of greatest utility, followed by biopsy. Thirty-three patients of the combined series were not correctly diagnosed until postmortem examination. Systemic chemotherapy was used to address the multiple potential sites of involvement. When properly treated, NL carries a prognosis similar to primary CNS lymphoma in the modern era.

ずいぶん悪性リンパ腫の論文を読んだが、こんな古典的概念があるとは日本語の論文のどこにも書いていない。Lymphomatosis cerebriなんていっている人はこの言葉も知っていないといけない。自験例も、それがあるんですね,,,,

Detecting Awareness in the Vegetative State2006/09/20 16:57:56

Science 8 September 2006: Vol. 313. no. 5792, p. 1402

Brevia Detecting Awareness in the Vegetative State Adrian M. Owen,1* Martin R. Coleman,2 Melanie Boly,3 Matthew H. Davis,1 Steven Laureys,3 John D. Pickard2

We used functional magnetic resonance imaging to demonstrate preserved conscious awareness in a patient fulfilling the criteria for a diagnosis of vegetative state. When asked to imagine playing tennis or moving around her home, the patient activated predicted cortical areas in a manner indistinguishable from that of healthy volunteers.

Recent functional neuroimaging studies have suggested that "islands" of preserved brain function may exist in a small percentage of patients who have been diagnosed as vegetative.

植物状態の人でも正常人と同じようにfunctionalMRIでは局所的に反応する力がある。

Small vessels, Big problem2006/09/28 07:40:53

Greenberg SM; Small vessels, big problems. NEJM, 354:1451-1453,2006

1) Gould DB, Phalan FC, Breedveld GJ, et al. Mutations in Col4a1 cause perinatal cerebral hemorrhage and porencephaly. Science 2005;308:1167-1171 Col4a1変異が周産期脳出血と脳空洞症を生じる。 2)Douglas B. Gould, Ph.D., F. Campbell Phalan, B.A., Saskia E. van Mil, M.Sc., John P. Sundberg, Ph.D., Katayoun Vahedi, M.D., Pascale Massin, M.D., Marie Germaine Bousser, M.D., Peter Heutink, Ph.D., Jeffrey H. Miner, Ph.D., Elisabeth Tournier-Lasserve, M.D., and Simon W.M. John, Ph.D.Role of COL4A1 in Small-Vessel Disease and Hemorrhagic Stroke. NEJM, Volume 354:1489-1496,April 6, 2006 ,Number 14 IV型collagenalpha 1は血管基底膜の主要componentで脳のsmall vessel diseaseの原因となる可能性について指摘。

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