Background: The deep-lying cisternal part of the Sylvian fissure stem is structurally complex. A more developed posterior orbital gyrus (pOG) adds complexities to the dissection in that plane because adhesion between the pOG and the temporal lobe is much thicker and stronger in such cases. The purpose of this study was to suggest a method of preoperative estimation of the degree of development of the pOG by using only axial-view computed tomographic (CT) images. Methods: First, we retrospectively classified 32 patients who underwent clipping of the anterior circulation aneurysms via the transsylvian approach at our institution into three types as follows, according to the degree of difficulty of the Sylvian fissure stem dissection evaluated using operative videos: type A, difficult; type B, normal; and type C, easy. Second, we hypothesized that an imaginary line (line D) joining the medial point of the Sylvian fissure with the limen insulae on axial CT images corresponds to the posterior rim of the pOG. Then, we evaluated the characteristics of line D in each case. Results: Five cases were type A, and line D was curved with a backward convexity, with a mean length of 4 cm. Eleven cases were type B, and line D was curved with a backward convexity, with a mean length of 3.5 cm. Sixteen cases were type C, and line D was curvilinear or straight, with a mean length of 3.48 cm. Conclusion: Preoperative evaluation of the morphological feature of the pOG is useful in estimating the degree of difficulty of Sylvian fissure stem dissection via the transsylvian approach.
Daikenchuto is recorded in Kampo textbooks as a prescription for abdominal disorders. We considered fukuchukan (coldness in the abdomen) as equaling a sensation of coldness centering on the navel, and we examined the usefulness of using Daikenchuto as a medication for this symptom. We administered Daikenchuto to 90 patients who presented with coldness of the navel. The patients were divided into 2 groups : the first group had accompanying digestive symptoms, the second had no accompanying digestive symptoms. We then examined their response rates, and improvement rates for coldness centering on the navel. We also examined the abdominal strength and pulse strength for responders and non-responders, respectively.The Digestive Symptoms group consisted of 64 patients. In this group, the response rate was 81.3%.The improvement rate of coldness centering on the navel was 92.3% in responders and 41.7% in non-responders, and the difference was highly statistically significant (p<0.001). The Non-digestive Symptoms group consisted of 26 patients. In this group, the response rate was 38.5%. The improvement rate of coldness centering on the navel was 100% in responders and 43.8% in non-responders, and the difference was statistically significant (p= 0.022).In a comparison of all 90 responder and non-responder cases, weak abdominal strength was 62.9% in responders and 42.9% in non-responders, intermediate abdominal strength or above was 37.1% in responders and 57.1% in non-responders, and the difference between abdominal strength and response rate (p=0.076) was non-significant. Weak pulse was 54.8% in responders and 40.7% in non-responders, intermediate pulse strength or above was 45.2% in responders and 59.3% in non-responders, and the difference between pulse strength and response rate (p=0.221) was non-significant. 13 of these cases were above intermediate, for both abdominal strength and pulse strength.We conclude that for patients presenting with a sensation of coldness centering on the navel, there is a strong possibility that the efficacy of Daikenchuto-syo is suggested, regardless of whether or not there are other digestive symptoms. Moreover, Daikenchuto proved effective in 13 cases where both abdominal strength and pulse strength were above an intermediate level, suggesting that a sensation of coldness centering on the navel can be the key to finding the sensho of Daikenchuto-sho.Daikenchuto, fukuchukan, sensation of coldness centering on the navel, no accompanying digestive symptoms, sensho
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