Primary pontine haemorrhage revealed by pneumoencephalo-roulette tomography,and a report on surgically treated cases

Summary Pneumoencephalo-roulette tomography has been carried out in seven cases of primary pontine haemorrhage. An extensive mass lesion has been distinctly visualized in all cases during life without any severe complications.An intrapontine haematoma has been removed in a 47-year-old male, and a ventriculo-atrial shunt has been done in a 41-year-old male. These two surgically treated patients have survived primary pontine haemorrhage. Eight cases of successful surgical approach to intrapontine haematoma have been previously reported in the literature.     

Conditioning stimulation of the central amygdaloid nucleus inhibits the jaw-opening reflex in the cat.

To elucidate a function of the central amygdaloid nucleus (ACE) in the trigeminal system, the ACE conditioning effect on the jaw-opening reflex (JOR) regarded as a nociceptive reflex was investigated in the cat anesthetized with pentobarbital sodium. The JOR to molar tooth pulp stimulation with an intensity 1.2-1.5 times the threshold was recorded in the ipsilateral digastric muscle. As conditioning stimulation, a train of 33 rectangular pulses (0.5 ms in duration) at 330 Hz with an intensity of 300 microA was applied to the ipsilateral ACE. The conditioning stimulation inhibited a JOR that had a latency of 7.90 +/- 0.88 ms (n = 36). The inhibition was maximum (83.1 +/- 11.2%) at a conditioning-test (C-T) interval of 110 ms and continued for C-T intervals of up to 1,000 ms. Likewise, microinjection of 0.5 M monosodium glutamate (10 microliters) into the ACE-inhibited the JOR for approximately 10 min. Additionally, the ACE conditioning stimulation inhibited the JOR induced by the stimulation of the sensory trigeminal nuclear complex in a similar manner, but not the jaw-opening response induced by the stimulation of the trigeminal motor nucleus (Mo V). Also, the conditioning stimulation influenced neither the evoked potentials induced by the tooth pulp stimulation at the main sensory and rostral nuclei nor the jaw-closing reflex induced by the stimulation of the mesencephalic trigeminal nucleus (Mes V). These results suggest that the excitation of the cell bodies in the ACE exerts an inhibitory modulation on the JOR with no effect on the non-nociceptive reflex such as the jaw-closing reflex at the level of Mo V.     

Cost effectiveness of high resolution computed tomography with interferon-gamma release assay for tuberculosis contact investigation

Background

Tuberculosis contact investigation is one of the important public health strategies to control tuberculosis worldwide. Recently, high resolution computed tomography (HRCT) has been reported as a more accurate radiological method with higher sensitivity and specificity than chest X-ray (CXR) to detect active tuberculosis. In this study, we assessed the cost effectiveness of HRCT compared to CXR in combination with QuantiFERON^®-TB Gold In-Tube (QFT) or the tuberculin skin test (TST) for tuberculosis contact investigation.

Methods

We constructed Markov models using a societal perspective on the lifetime horizon. The target population was a hypothetical cohort of immunocompetent 20-year-old contacts with smear-positive tuberculosis patients in developed countries. Six strategies; QFT followed by CXR, QFT followed by HRCT, TST followed by CXR, TST followed by HRCT, CXR alone and HRCT alone were modeled. All costs and clinical benefits were discounted at a fixed annual rate of 3%.

Results

In the base-case analysis, QFT followed by HRCT strategy yielded the greatest benefit at the lowest cost ($US 6308.65; 27.56045 quality-adjusted life-years [QALYs])[year 2012 values]. Cost-effectiveness was sensitive to BCG vaccination rate.

Conclusions

The QFT followed by HRCT strategy yielded the greatest benefits at the lowest cost. HRCT chest imaging, instead of CXR, is recommended as a cost effective addition to the evaluation and management of tuberculosis contacts in public health policy.     

Anterior capsular plaque in congenital cataract: occurrence, morphology, immunofluorescence, and ultrastructure

PURPOSE: To study occurrence, morphology, immunofluorescence, and ultrastructural features of congenital anterior capsular plaque (ACP) obtained from pediatric eyes undergoing cataract surgery. METHODS: Two hundred sixty consecutive pediatric eyes undergoing congenital cataract surgery were enrolled in the present study. Anterior lens epithelium from cataract without ACP and with ACP was collected. Wholemounts of lens epithelium were stained with hematoxylin-eosin. Five-micrometer-thick sections of large ACPs were subjected to immunofluorescence localization of collagen type I, collagen type IV, alpha-smooth muscle actin (alpha SMA), and alpha A-crystallin. Ultrathin sections were studied by transmission electron microscope. RESULTS: The overall occurrence of ACP in pediatric eyes undergoing congenital cataract surgery was 11.5%. The occurrence of ACP was highest in mature cataract followed by nuclear, lamellar, and mixed cataract. The wholemount of anterior lens epithelium revealed nonplaque and plaque region or ACP. Depending on the area, ACPs can be classified as small, medium, and large. The extracellular matrix of ACP was fibrous and amorphous. It was rich in collagen type I. The cells of the ACP were surrounded by a network of collagen type IV and were positive for alpha SMA and alpha A-crystallin. The cells of the ACP were rich in rough endoplasmic reticulum and mitochondria. CONCLUSIONS: The occurrence of ACP in pediatric eyes undergoing cataract surgery for congenital cataract was 11.5%. ACP was more associated with mature cataract. Epithelial mesenchymal transdifferentiation of lens epithelial cells may be involved in the development of congenital ACP.     

Surgical management of squamous-cell carcinomas arising in burn scar of the scalp

A series of seven patients with squamous-cell carcinoma that arose in the area of an old scalp burn is presented, and the patient's profiles, surgical procedures and results are reviewed. In six patients, burn scar of the scalp caused by direct exposure to fire in their infancy was a pathogenesis underlying the development of the malignancy, and the time interval was estimated to be an average of 53 years. In five patients there was evidence of intracranial invasion of the carcinoma involving the dura mater and cerebral parenchyma, as revealed by neuroradiological examinations and surgery. All patients were treated by extensive excision of the lesion, and to cover defects of the scalp and cranium, a variety of reconstructive techniques were used involving advancement, transposition or free latissimus dorsi musculocutaneous flaps combined with microvascular anastomosis. Radiochemotherapy was undertaken additionally in some patients either before or after surgery. Complete excision was accomplished in two patients, in whom the carcinoma was found localized within the layer of the scalp or in the depth of the periosteum. The survival time in these patients ranged from 73 to 87 months. In contrast, incomplete resection was performed in the remaining five patients, in whom the dura mater had been invaded with simultaneous involvement of the middle part of the superior sagittal sinus. The outcome resulted in poor prognosis, and all the patients except one died in 9 to 24 months after surgery due to continuous growth of the tumor in the intracranial cavity. Therefore, total resection facilitated by early detection prior to intracranial invasion is mandatory for successful treatment of such scalp carcinomas.     

Positron emission tomographic evaluation of histological malignancy in gliomas using oxygen-15 and fluorine-18-fluorodeoxyglucose

HEADTOME III, a high resolution PET, has been employed using 15O and 18F labelled pharmaceuticals to evaluate histological malignancy of gliomas preoperatively. PET study was applied on eighteen preoperative gliomas including two recurrent cases. Haemocirculatory and metabolic indices of regional cerebral blood flow (rCBF), cerebral blood volume (rCBV), oxygen extraction fraction (rOEF), cerebral metabolic rates for oxygen (rCMRO2) and glucose (rCMRGI) were measured in the viable portion of the tumour, and the contralateral grey and white matter. In the tumour region, rCBF and rCBV were variable and unrelated to grades of tumour malignancy. rCMRO2 and rOEF values reduced significantly (p less than 0.01) relative to the contralateral brain tissue. The average rCMRGI values was 3.00 +/- 1.06 mg 100 ml-1 min-1 (mean +/- SD) for 7 low grade gliomas (grade II), and 5.91 +/- 3.61 mg 100 ml-1 min-1 for 11 high grade gliomas (grade III and IV). These results would support that anaerobic glycolysis increased in the metabolism of gliomas with malignancy. In comparison with normal volunteers, rCBF, rCMRO2, and rCMRGI values in the contralateral grey matter of gliomas were markedly reduced (p less than 0.01, p less than 0.05, p less than 0.01, respectively) possibly due in part to raised intracranial pressure and depressed cerebral functional activity, so that rOEF was increased to a level of approximately 0.5.(ABSTRACT TRUNCATED AT 250 WORDS)     

MRSA meningitis in postoperative patients. Report of 4 cases

Four cases of postoperative meningitis caused by methicillin-resistant Staphylococcus aureus (MRSA) are reported together with a review of the literature. These 4 cases were treated successfully by intravenous administration of minomycin, fosfomycin, and cefmetazole. Factors associated with the development of meningitis included multiple craniotomies, the presence of ventricular drainage or a ventriculo-peritoneal shunt, and irradiation.     

Ventriculoperitoneal shunts with the use of pressure-adjustable valve in the management of hydrocephalus

Sixteen patients with hydrocephalus of varied etiology who underwent ventriculo-peritoneal shunts utilizing pressure-adjustable valves were reviewed, and the usefulness of the pressure-adjustable valve in the management of hydrocephalus was evaluated. Before shunting all patients had CT evidence of hydrocephalus with Evans' Index greater than 30%. High-, medium- and low-pressure settings were chosen in 3, 11 and 2 patients respectively, according to the CSF pressure as measured during lumber puncture or ventricular drainage. Following the shunting procedures with programmable pressure valves, hydrocephalus was alleviated with Evans' Index being 27% on the average, as evaluated by CT scans. Such clinical symptoms as disturbed consciousness, dementia and increased intracranial pressure all subsided. There were no mortality, infection or revision during the follow-up period of 5 to 16 months. Of particular note was that, among these 16 cases, there were three illustrative cases in which programmable pressure valves were found useful in coping with newly developed subdural effusion and low-intracranial-pressure syndrome, by manually adjusting the valves to higher pressure settings.