Reduction cranioplasty for macrocephaly with long-standing hydrocephalus and non-fused fontanelle in Chiari malformation type I

Introduction

Because hydrocephalus is diagnosed and treated at an early stage in pediatric patients, pediatric neurosurgeons rarely encounter patients with hydrocephalic macrocephaly. There are even fewer cases of infants with long-standing hydrocephalus in whom macrocephaly progresses and is accompanied by skull defect due to malunion of suture lines despite long-term CSF diversion treatment.

Case report

We report the case of a male infant with Chiari malformation type I who presented with congenital hydrocephalus and occipital encephalocele that progressed to hydrocephalic macrocephaly with frontal skull defect, despite numerous cerebrospinal fluid diversion operations. The patient eventually recovered successfully after reduction cranioplasty.     

Usefulness of contrast enhanced FLAIR imaging for predicting the severity of meningitis

The aim of this study was to evaluate whether contrast enhanced fluid attenuated inversion recovery (CE-FLAIR) imaging can be used to predict the severity of meningitis based on leptomeningeal enhancement (LE) score and cerebrospinal fluid signal intensity (CSF-SI) on CE-FLAIR. We retrospectively analyzed data collected from 43 consecutive patients admitted to our hospital due to meningitis. Clinical factors including initial Glasgow Coma Scale (GCS) score, CSF glucose ratio, log CSF protein, log CSF WBC, and prognosis were evaluated. The LE score was semi-quantitatively scored, and we evaluated CSF-SI ratio at the interpeduncular or quadrigerminal cisterns on CE-FLAIR. We evaluated the differences in clinical variables, LE scores and CSF-SI ratios between the recovery and the complication group. We assessed the correlation between clinical variables, LE scores and CSF-SI ratios. The values of log CSF protein, CSF-SI ratio, and LE score were significantly higher in the complication group (p value <0.05). GCS score and CSF glucose ratio were significantly lower in the complication group (p value <0.01). The LE scores had significant negative correlation with GCS scores and CSF glucose ratios (p value <0.001). The LE score was significantly positively correlated with the value of log CSF protein and CSF-SI ratio (p value <0.01). The CSF-SI ratio was negatively correlated with GCS score and CSF glucose ratio (p value <0.01). The CSF-SI ratio was positively correlated with the value of log CSF protein (p value <0.05). Our results suggest that LE score and CSF-SI ratio are well correlated with clinical prognostic factors. We may predict the clinical severity of meningitis by using LE scores and CSF-SI ration on CE-FLAIR imaging.     

Comparison between high and low molecular weight hyaluronates in knee osteoarthritis patients: open-label, randomized, multicentre clinical trial

Efficacy and safety of high and low molecular weight hyaluronates in knee osteoarthritis patients were compared in a randomized, open-label trial. Patients in the high molecular weight hyaluronate group were treated once weekly for 3 weeks and in the low molecular weight group once weekly for 5 weeks. We evaluated weight-bearing pain, degree of flexion, swelling and knee tenderness; frequency and amount of rescue medication; patient and investigator global assessment of pain, and safety over 12 weeks after final injection of study medication. Significant improvements in pain and WOMAC-Likert scores were observed in both groups, but not between groups. Knee joint pain improvement was noted in both groups by patients and investigators during follow-up. Close correlation was observed between patient- and investigator-reported data. There was no significant difference in side-effects between the groups. In conclusion, the efficacy and safety of high and low molecular weight hyaluronate are similar.     

Impact of Margin Assessment Method on Positive Margin Rate and Total Volume Excised

Background

For breast-conserving surgery, the method of margin assessment that most frequently achieves negative margins without increasing the volume of tissue excised is uncertain. We examined our institutional experience with three different margin assessment methods used by six experienced breast surgeons.

Methods

Patients undergoing breast-conserving surgery for invasive carcinoma during July to December of a representative year during which each method was performed (perpendicular, 2003; tangential, 2004; cavity shave, 2011) were included. The effect of margin method on the positive margin rate at first excision and the total volume excised to achieve negative margins were evaluated by multivariable analysis, by surgeon, and by tumor size and presence of extensive intraductal component (EIC).

Results

A total of 555 patients were identified, as follows: perpendicular, 140; tangential, 124; and cavity shave, 291. The tangential method had a higher rate of positive margins at first excision than the perpendicular and cavity-shave methods (49, 15, 11 %, respectively; p < 0.0001). Median volumes to achieve negative margins were similar (55 ml perpendicular; 64 ml tangential; 62 ml cavity shave; p = 0.24). Four of six surgeons had the lowest rate of positive margins with the cavity-shave method, which was significant when compared to the tangential method (p < 0.0001) but not the perpendicular method (p = 0.37). The volume excised by the three methods varied by surgeon (p < 0.0001). The perpendicular method was optimal for T1 tumors without EIC; the cavity-shave method tended to be superior for T2–T3 tumors and/or EIC.

Conclusions

Although the cavity-shave method may decrease the rates of positive margins, its effect on volume is variable among surgeons and may result in an increase in the total volume excised for some surgeons and for small tumors without EIC.     

Generation of Humanized Liver Mouse Model by Transplant of Patient-Derived Fresh Human Hepatocytes

Some research groups have produced immunodeficient mice with human liver tissue as a model system for the analysis of drug metabolism and liver regeneration. Mouse models are important for research and development of drugs and vaccines for viral infections. Recent progress in developing humanized mouse models permits studies of adaptive immune responses, innate host responses, and therapeutic approaches for several liver diseases of viral etiology. In this study, we generated a humanized liver mouse model by transplant with fresh patient-derived hepatocytes (1 × 10⁶ cells/mouse, intrasplenic injection) into preconditioned (50 mg/kg ganciclovir, intraperitoneal injection) mice (herpes simplex virus type 1 thymidine kinase [TK] transgene expressed within the liver of a highly immunodeficient mouse strain [NOG]). Successful reconstitution of human hepatocytes in TK-NOG mouse liver tissues was observed with a strong proliferation of human cells in a time-dependent manner, using cytokeratin 8/18 stain. Similarly, we detected significantly increased human albumin levels in TK-NOG mouse liver tissue and blood sera on immune staining and enzyme-linked immunosorbent assay. Therefore, this humanized liver mouse model provides a biomedical tool for studying human liver physiology, drug metabolism, and liver pathogenesis of viral etiology or liver regeneration.