Chronic subdural hematoma (CSDH) is a common disease in the elderly, and the recurrence rate of CSDH is reported to range from 2.3 to 33%. We performed a retrospective review of a number of CSDH cases and the potential factors associated with CSDH recurrence. The patient population comprised 112 men and 65 women with a mean age of 74.7 years. We analyzed the following factors: age, sex, antiplatelet and anticoagulant use, hematoma laterality, hematoma thickness, degree of midline shift and internal architecture of the hematoma in the preoperative CT films, use of irrigation, direction of the drainage tube, width of the subdural space, and degree of midline shift and the presence of a massive subdural air collection in the postoperative CT films. Univariate analysis revealed that there was a trend for different rates of recurrence among the different types of hematomas. The presence of a postoperative massive subdural air collection tended to be associated with the recurrence of hematoma. Multivariate analysis revealed that separated hematomas were significantly associated with CSDH recurrence, whereas the presence of postoperative massive subdural air collection tended to be associated with hematoma recurrence. Neither univariate nor multivariate analysis could demonstrate an association between the direction of the drainage tube and the recurrence of CSDH.

OBJECTIVEAlthough abdominal obesity and related metabolic abnormalities are hypothesized to promote colorectal carcinogenesis, direct confirmation of this effect is required. Here, we examined the relation of early-stage colorectal neoplasia to visceral fat area and markers of insulin resistance.RESEARCH DESIGN AND METHODSSubjects were participants in a comprehensive health screening conducted at the Hitachi Health Care Center, Ibaraki, Japan. During a 3-year period (2004–2007), a total of 108 patients with early-stage colorectal neoplasia, including 22 with early cancer, were identified among individuals who received both colorectal cancer screening and abdominal computed tomography scanning. Three control subjects matched to each case subject were randomly selected from those whose screening results were negative. Conditional logistic regression analysis was used to examine the association of measures of obesity and markers of insulin resistance with colorectal neoplasia, with adjustment for smoking and alcohol drinking.RESULTSVisceral fat area, but not subcutaneous fat area, was significantly positively associated with colorectal cancer, with odds ratios (95% CI) for the lowest to highest tertile of visceral fat area of 1 (reference), 2.17 (0.45–10.46), and 5.92 (1.22–28.65), respectively (Ptrend = 0.02). Markers of insulin resistance, particularly fasting glucose, were also positively associated with colorectal cancer risk. In contrast, no associations were observed for colorectal adenomas.CONCLUSIONSThese results suggest that visceral adipose tissue accumulation and insulin resistance may promote the development of early-stage cancer but not adenoma in the colorectum.

OBJECTIVEWe examined the relationships of visceral fat area (VFA), subcutaneous fat area, and waist circumference, determined using computed tomography (CT), and BMI with metabolic risk factors in a large Japanese population.RESEARCH DESIGN AND METHODSStudy subjects comprised 6,292 men and women who participated in the Hitachi Health Study and received CT examinations in 2007 and 2008.RESULTSRegarding the clustering of metabolic risk factors, the odds ratios (ORs) for the VFA quintiles were 1.0 (ref.), 2.4, 3.4, 5.0, and 9.7 for men and 1.0 (ref.), 1.5, 2.6, 4.6, and 10.0 for women (P < 0.001 for trends in both sexes). For the highest quintiles, the OR for VFA was 1.5 to 2 times higher than those of the other anthropometric indexes in both sexes.CONCLUSIONSWe demonstrated a superior performance of VFA to predict the clustering of metabolic risk factors compared with other anthropometric indexes.

MR angiography is useful as the primary diagnostic tool for evaluating suspected intracranial steno-occlusive disease.

Several studies have shown the relation between Graves' disease and stenosis/occlusion of intracranial arteries. To our knowledge, only 31 cases, including our case, of concurrent Graves' disease and moyamoya syndrome or intracranial arterial stenosis/occlusion have been described. The patients were predominantly women, and their ages ranged from 10 to 54 years (mean, 29.3 years). Transient ischemic attacks and cerebral infarction were the common symptoms in these patients. Except one previous case and the present case, all cases showed thyrotoxicity when the cerebral ischemic event occurred. Among the 29 cases, in which the treatment regimen was known, antithyroid therapy was administered in 25 cases, and surgical treatment for cerebral vessel diseases was performed in 11 cases. Most of the patients eventually recovered from the neurological symptoms after medical and/or surgical treatment; one of the patients died, and one patient's condition worsened. Although the mechanism underlying intracranial arterial occlusion or stenosis in patients with Graves' disease has not been elucidated, several hypotheses have been described. Thyroid hormones may augment vascular sensitivity to the sympathetic nervous system and induce pathological changes in the arterial walls. An immune-mediated mechanism may play a role in the pathogenesis of these diseases. Atherosclerosis may be associated with these disorders. Vasculitis induced by antithyroid drugs may cause changes in the intracranial arteries. Finally, the possibility of a mere coincidence of Graves' disease and these vascular changes should also be considered. Cerebrovascular hemodynamic changes induced by thyrotoxicosis were considered to be responsible for the cerebral ischemic events. Excessive thyroid hormone production is considered to increase the cerebral metabolism and oxygen consumption. In addition, thyrotoxicosis-induced hypercoagulability may influence ischemic events. Therefore, the possibility of thyrotoxicosis should be considered when patients with Graves' disease show exacerbation of cerebral ischemic symptoms at follow-up. The necessity of surgery in addition to antithyroid therapy might be dependent on the mechanisms of the vascular changes and symptoms. If hyperthyroidism is associated with vascular changes and symptoms, antithyroid therapy may be adequate. However, if immune-mediated mechanisms or coincidences are considered to be associated with vascular changes and symptoms, like our case, surgical procedures might be needed.