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OBJECTIVE Chronic subdural hematoma (CSDH) is a common form of intracranial hemorrhage with a recurrence rate of 9.2%-26.5% after bur hole surgery. Occasionally patients with bilateral CSDH undergo unilateral surgery because the contralateral hematoma is deemed to be asymptomatic, and in some of these patients the contralateral hematoma may subsequently enlarge, requiring additional surgery. The authors investigated the factors related to the growth of these hematomas. METHODS Ninety-three patients with bilateral CSDH who underwent unilateral bur hole surgery at Aizu Chuo Hospital were included in a retrospective analysis. Findings on preoperative MRI, preoperative thickness of the drained hematoma, and the influence of antiplatelet or anticoagulant drugs were considered and evaluated in univariate and multivariate analyses. RESULTS The overall growth rate was 19% (18 of 93 hematomas), and a significantly greater percentage of the hematomas that were iso- or hypointense on preoperative T1-weighted imaging showed growth compared with other hematomas (35.4% vs 2.3%, p < 0.001). Multivariate logistic regression analysis showed that findings on preoperative T1-weighted MRI were the sole significant predictor of hematoma growth, and other factors such as antiplatelet or anticoagulant drug use, patient age, patient sex, thickness of the treated hematoma, and T2-weighted MRI findings were not significantly related to hematoma growth. The adjusted odds ratio for hematoma growth in the T1 isointense/hypointense group relative to the T1 hyperintense group was 25.12 (95% CI 3.89-51.58, p < 0.01). CONCLUSIONS The findings of preoperative MRI, namely T1-weighted sequences, may be useful in predicting the growth of hematomas that did not undergo bur hole surgery in patients with bilateral CSDH.

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OBJECTIVE -Advanced glycation end products (AGEs) are a risk factor for diabetic complications. We have developed an assay method for N-(carboxymethyl)valine (CMV) of the hemoglobin (CMV-Hb), which is an AGE generated from HbA 1c . Herein, we describe the clinical utility of CMV-Hb measurement for the diagnosis of diabetic nephropathy. RESEARCH DESIGN AND METHODS-BALB/c mice were immunized with carboxymethylated Hb and monoclonal antibody raised against CMV-Hb. This antibody was characterized by a surface plasmon resonance. We developed a latex immunoassay using the antibody and measured CMV-Hb from erythrocytes in type 2 diabetic patients and healthy control subjects (age 64.6 Ϯ 12.0 vs. 61.1 Ϯ 13.2 years, NS; HbA 1c 6.9 Ϯ 1.5 vs. 5.2 Ϯ 0.4%, P Ͻ 0.0001).RESULTS -A monoclonal antibody against CMV-Hb ␤-chain NH 2 -terminal and an assay method for measurement for CMV-Hb were both developed in our laboratory. CMV-Hb levels were significantly greater in the diabetic patients than in the control subjects (18.2 Ϯ 6.9 vs. 12.7 Ϯ 6.9 pmol CMV/mg Hb, P Ͻ 0.0001). No correlation was found between CMV-Hb and HbA 1c or CMV-Hb and glycated albumin. Levels of CMV-Hb increased as the diabetic nephropathy progressed.CONCLUSIONS -We established an assay method for CMV-Hb and confirmed the presence of CMV-Hb in circulating erythrocytes. CMV-Hb was more prevalent in diabetic patients than in healthy subjects. Furthermore, it was significantly higher in patients with diabetic nephropathy, suggesting that the presence of CMV-Hb may be a valuable marker for the progression of diabetic nephropathy. Diabetes Care 24:891-896, 2001A dvanced glycation end products (AGEs), formed by nonenzymatic reactions during sustained hyperglycemia in vivo, are thought to play a crucial role in diabetic complications such as diabetic microangiopathy and macroangiopathy (1-3). AGEs, however, are heterogeneous structures that include carboxymethyl lysine (CML) (4), pentosidine (5), pyrraline (6), crosslines (7), and the recently described structure imidazolone (8). It is reported that the concentrations of CML and pentosidine are related to the severity of diabetic nephropathy (5,9).Recently, we established a specific assay for CML and demonstrated that CML-Hb concentrations were related to the development of hemodialysis-related amyloidosis (10). It was also reported that carboxymethylated proteins may be associated with the development of vascular complications of diabetes (11). The in vivo glycation process results in two different products: early glycation end products and AGEs. HbA 1c , an early glycation product, is now widely considered to be an essential marker for controlling diabetes. It has been reported that AGEs can occupy specific receptors for AGEs (RAGEs) on cells and thereby activate various genes including NF-␤, with the expression of inflammatory cytokines (11), which may either initiate or propagate diabetic complications.On the basis of these findings, we decided to develop an assay for N-(carboxymethyl)valine (CMV) of the Hb (CMV-H...

We report an extremely rare case of pial arteriovenous fistula (AVF) caused by trauma. A 61-year-old man suffered from brain contusion by a traffic accident. He was neurologically normal on admission. However, his headache gradually worsened, and partial seizures occurred thereafter. He presented with general tonic seizure 7 days after the head injury. Magnetic resonance imaging demonstrated the exacerbation of brain edema and an abnormal vein near the contusion. Subsequent angiography showed a pial AVF, which was considered to be responsible for the brain edema. After treatment of the AVF by direct surgery, the brain edema was ameliorated. We should take into consideration the formation of vascular disease in cases with unexpected worsening of edema after brain injury.

Background: N ε-(Carboxymethyl)lysine (CML), a well-characterized and major advanced glycation end product structure, is produced via a Maillard reaction by nonenzymatic glycation and/or oxidation. Although few of the carboxymethylation sites of lysine residues on proteins have been identified, it is known that the possible lysine glycation site in hemoglobin (Hb) is Lys-66 on the β chain. We aimed to develop an assay for the Hb with a CML (CML-Hb) site specific to Lys-66 on the Hb β chain and to determine whether the lysine residue at that site is carboxymethylated. Methods: Ala-His-Gly-Lys-Lys(CM)-Val-Leu-Gly-Ala-Phe-Ser-Cys, the peptide derived from the β chain of human Hb, was synthesized as an immunogen, and a monoclonal antibody against the peptide was prepared. A latex immunoassay method was established using the antibody on an automatic analyzer. In this study, 20 samples from healthy subjects and 80 samples from nondiabetic patients undergoing hemodialysis (HD) were analyzed. Results: The latex immunoassay method using the antibody correlated significantly with the ELISA method using the antibody (r = 0.95; P &lt;0.001). Between healthy subjects (n = 20) and nondiabetic HD patients (n = 80), a significant difference was seen in circulating CML-Hb (525 ± 76 vs 778 ± 137 pmol CML/mg of Hb; P &lt;0.0001). Conclusion: The latex method for the CML-Hb site specific to Lys-66 on the β chain can measure large numbers of samples on an automatic analyzer.

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Our present in vitro study clearly showed the superior characteristic of trehalose to produce fewer AGEs. Based upon the results of this study, we propose that the application of trehalose should be considered for CAPD solution.