A case of sphenoid ridge meningioma presenting as subarachnoid hemorrhage

The authors present a case of sphenoid ridge meningioma presenting as subarachnoid hemorrhage. A 56-year-old man came to our hospital with a complaint of severe headache developed during evacuation of the bowels. Computed tomogram on admission revealed a mass lesion of high density, which was homogeneously enhanced with contrast media, in the medial part of the left sphenoid ridge, but no evidence of the intracranial hemorrhage. Nevertheless, the cerebrospinal fluid obtained by lumbar puncture was bloody, indicating the occurrence of subarachnoid hemorrhage. Cerebral angiograms showed no abnormality except for the downward displacement of the suprachnoidal segment of the left internal carotid artery. During the operation, the adhesion between the tumor and the cortical vein was observed and the subarachnoid hemorrhage was recognized exclusively around the vein. These findings indicates that the present hemorrhage may be derived from the vein. In the previous reports of meningioma associated with intracranial hemorrhage, the origin of hemorrhage and the pathophysiological mechanism for hemorrhage have been speculated from both operative and histological findings. In consideration of these speculations, we discussed the possible mechanism for the breakdown of the cortical vein in the present case.     

Expression of neurite outgrowth factor and gicerin during inner ear development and hair cell regeneration in the chick

Several cell adhesion molecules are expressed in the developing inner ear. The present study focused on gicerin, a novel member of the immunoglobulin superfamily, in an attempt to improve our understanding of the development and regeneration of chick inner ear. Gicerin is known to homophilically interact with itself and to bind to neurite outgrowth factor (NOF). The data collected herein show that gicerin is highly expressed in auditory epithelium and acoustic ganglion during early embryogenesis. The immunoreactivity of gicerin in the auditory epithelium decreases more rapidly than that in the acoustic ganglion as the mature hair cells become distinguishable. At the post-hatch stage, the expression of gicerin is not observed. In contrast, NOF was expressed on the basement membranes around the auditory epithelium, and in the acoustic ganglion during development and after birth, but not in the auditory epithelium. Following noise damage, gicerin is transiently re-expressed on the damage receptor epithelium when active cell proliferation is observed in the epithelium. This positive reaction immediately disappears as immature short hair cells appear. These results suggest that gicerin may be associated with cell proliferation in the auditory epithelium, and play a role in neurite extension of the acoustic ganglion cells in conjunction with NOF.     

Heat shock protein Hsp60-reactive gamma delta cells: a large, diversified T-lymphocyte subset with highly focused specificity.

Previously, we detected a subset of gamma delta T cells in the newborn mouse thymus that responded to the mycobacterial heat shock protein Hsp60, as well as with what seemed to be a self-antigen. All of these cells expressed V gamma 1, most often in association with V delta 6+. It was not clear, however, whether similar, mature gamma delta cells with Hsp60 reactivity are common outside of the thymus, or rather, whether they are largely eliminated during development. From the data presented here, we estimate that gamma delta cells responding to Hsp60 comprise 10-20% of normal splenic and lymph node gamma delta T cells. Such cells, derived from adult spleen, always express a V gamma 1-J gamma 4-C gamma 4 gamma chain, although not all cells with this gamma chain show Hsp60 reactivity. Many of these V gamma 1+ cells also express V delta 6-J delta 1-C delta, though fewer than in V gamma 1+ cells from the newborn thymus. Extensive diversity is evident in both the gamma and delta chain junctional amino acids of the receptors of these cells, indicating that they may largely develop in the thymus of older animals or undergo peripheral expansion. Finally, we found that all such cells responding to both a putative self-antigen and to mycobacterial Hsp60 respond to a 17-amino acid synthetic peptide representing amino acids 180-196 of the Mycobacterium leprae Hsp60 sequence. This report demonstrates that a large subset of Hsp60-reactive peripheral lymphoid gamma delta T cells preexists in normal adult mice, all members of which respond to a single segment of this common heat shock protein.     

Combined tongue flap and V-Y advancement flap for lower lip defects.

A combined tongue flap and V-Y advanced flap were used for reconstruction of the lower lip after radical excision of squamous cell carcinoma. This V-Y advancement flap is useful because the procedure does not require any difficult technique, and preservation of the orbicularis oris muscle and the branch of the mental artery and nerve are possible. The vermilion is reconstructed with a tongue flap, with almost no disturbance in the patients' speaking or eating and satisfactory cosmetic results. We describe this procedure in two cases.     

Right ventricular myxoma in a 71-year-old female

Right ventricular myxoma in elderly is vey rare and this is the 36th case report of right ventricular myxoma in Japan. A healthy 71-year-old female with no symptoms or constitutional signs except heart murmur was hospitalized. Findings of transthoracic echocardiogram, CT scan, MRI and angiocardiogram demonstrated a mobile tumor in the right ventricular outflow tract. Transesophageal echocardiogram clearly revealed that the stalk was arising from the right ventricular free wall. Under cardiac arrest, right atriotomy was made and a gelatinous tumor (4.5 × 2 × 2 cm in size, 7.3 g in weight) was excised with 5 mm of surrounding endocardium and a few millimeters of underlying myocardium through the tricuspid valve. Histopathologically, the tumor was diagnosed as a myxoma. Her postoperative course was uneventful.     

Spontaneous splenic rupture after mitral valve replacement for infective endocarditis

We report a successful treatment of massive bleeding due to spontaneous splenic rupture after mitral valve replacement. A 61-year-old man was admitted to our hospital for intermittent high fever. An echocardiogram demonstrated a large vegetation on the posterior cusp of the mitral valve and mitral regurgitation of moderate degree. Staphylococcus epidermidis was cultured from his arterial blood. He underwent a mitral valve replacement after 3 weeks of antimicrobiological therapy with penicillin G crystalline and minocycline hydrochloeide. The patient fell into hemorrhagic shock on postoperative day 11 after complaining dull pain on his left upper abdomen for 3 days. A computed tomography demonstrated a splenic rupture and massive hematoma in the retroperitoneum. A splenic arterial embolization was done before splenectomy. The blood and clot of 2800 g were sucked from peritoneal and retroperitoneal cavities. There were no mycotic aneurysms nor abscess but the torn capsule on the swelled and partially necrotic spleen. The patient discharged uneventfully on postoperative day 43. Infective endocarditis frequently causes splenic infarction but rarely splenic rupture. Anticoagulation therapy after mitral valve replacement might have emphasized the bleeding in the patinet.     

Substrate specificity of HMRZ-86 for β-lactamases,including extended-spectrum β-lactamases (ESBLs)

HMRZ-86 was designed as a new chromogenic cephalosporin to detect extended-spectrum β-lactamases (ESBLs) and similar evolved β-lactamases, such as metallo-β-lactamases, derepressed AmpC, and extended oxacillinase. We report here our investigation of the kinetic parameters of several types of β-lactamases to show the enzymatic characteristics of HMRZ-86. The Michaelis constant (K _m values of HMRZ-86 for ESBLs were twice to three and half times as high as those of nitrocefin, and the maximum velocity (Vmax) was one-fifth that of nitrocefin. The K _m and Vmax of HMRZ-86 for AmpC were both smaller than those of nitrocefin. The kinetic parameters of HMRZ-86 for metallo β-lactamase (MBL) were very variable, depending on the type of buffer solution used and the concentration of zinc ions. For MBL, the K _m values of HMRZ-86 were higher than those of nitrocefin, but the Vmax values were almost the same as those of nitrocefin. Although the chemical structure of HMRZ-86 is similar to that of nitrocefin, we think the enzymatic reactivities of the two entities for β-lactamases are very different.     

A case of intractable recurrent abdominal cutaneous ulceration caused by self-injection of menstrual blood

The causes of recalcitrant cutaneous ulcerations are various and complex. Self-injury is one of them, and self-injected substances have also been reported. In our case, autologous menstrual blood was used, resulting in incurable cutaneous ulcerations and inappropriate operations being performed several times by plastic surgeons. Meticulous care is indispensable for treatment of patients with Munchausen’s syndrome.     

A New Arthroscopic-Assisted Drilling Method Through the Radius in a Distal-to-Proximal Direction for Osteochondritis Dissecans of the Elbow

We developed a new arthroscopic-assisted drilling method through the radius in a distal-to-proximal direction for osteochondritis dissecans (OCD) of the elbow. Only 1 drill hole is created in the radius by use of a single 1.8-mm K-wire inserted from the shaft of the radius approximately 3 cm distal to the humeroradial joint into the joint, which allows drilling of the entire OCD lesion. The forearm is supinated so that the tip of the K-wire is at the lateral side of the lesion in the humeral capitellum, and drilling is performed at 30° elbow flexion. The flexion angle is changed from 30° to 60° to 90° to 120° while maintaining supination, to drill in 4 sites (1 site for each angle of flexion) of the lateral side of the OCD lesion. Next, we move the forearm from supination to pronation so that the tip of the K-wire is placed in the medial side of the lesion in the humeral capitellum, and as with the lateral side, drilling is performed in 4 sites. With this technique, the entire OCD lesion can be vertically drilled under arthroscopic guidance. This method is minimally invasive, and an early return to sports could be possible.