Idiopathic hypertrophic cranial pachymeningitis with perifocal brain edema--case report

A 51-year-old female presented with an extremely rare case of idiopathic hypertrophic cranial pachymeningitis manifesting as markedly thickened frontotemporal meninges with expanding perifocal edema. Magnetic resonance imaging with gadolinium revealed enhancement of the thickened dura mater protruding into the brain parenchyma accompanied by focal edema causing a mass effect. Histological examination of a biopsy specimen revealed thickened dura with infiltrating lymphocytes. Serological and immunological tests were normal. No inflammatory response or evidence of malignant tumors was observed. The patient was treated with predonisolone, resulting in marked improvement of the mass effect. High-dose steroid therapy appears to be effective for intracranial pachymeningitis associated with expanding perifocal brain edema.     

Microbiome composition comparison in oral and atherosclerotic plaque from patients with and without periodontitis

Odontology - There is no conclusive evidence regarding a causal relationship between periodontitis and atherosclerosis. In this study, we examined the microbiome in the oral cavity and atheromatous...     

A case of occupational asthma caused by arrowhead scale in mandarin orange-worker]

A 50-year-old woman with occupational asthma, whose attacks were provoked by inhalation of Arrowhead scale (Unapsis Yanonensis Kuwana) attached to the leaves of mandarin oranges is reported. She experienced asthmatic attacks while picking leaves and harvesting mandarin oranges. Because Arrowhead scale-dust stuck to the leaves was suspected to be the allergen, tests of allergy were performed using an extract of the allergen prepared by Unger's method in our laboratory. Asthmatic attack was provoked 90 minutes after inhalation of the extract of cocoon. Histamine was not released, but leukotriene D4 production was induced by the addition of the extract to whole blood. Basophils were activated by addition of anti-IgG anti-sera as well as the extract. These data indicate that LT released from target cells in response to the worm elements, as well as histamine, is important as a chemical mediator.     

New titanium spacer for cervical laminoplasty: initial clinical experience. Technical note

Many commercially available hydroxyapatite (HA) spacers for cervical laminoplasty have been introduced but have disadvantages such as lack of plasticity, easy cracking, and occasional difficulty in fixation by sutures. Here we present the short-term results of a newly designed titanium spacer (Laminoplasty Basket) in open-door cervical laminoplasty, and evaluated clinically and radiologically. The titanium box-shaped spacer with two arms for fixation was easily inserted and fixed into the laminoplasty space with 4-mm or 5-mm length screws after the posterior cervical arch was repositioned for the canal expansion. Twenty-one patients with cervical myelopathy due to spondylosis or ossification of the longitudinal ligament or developmental narrow canal observed for more than 6 months postoperatively were enrolled in this study. The neurological condition of these patients improved from 9.4 points on the Japanese Orthopaedic Association scale preoperatively to 13.5 points at 6 months after surgery. Postoperative radiological evaluation showed no laminar closure or implant failure and cervical spine curvature was maintained. These results seemed to have no significant difference compared with those using HA spacers. This titanium spacer is a potential substitute for conventional HA or other similar devices in cervical laminoplasty.     

A case of cerebrospinal fluid eosinophilia associated with shunt malfunction

A 3-month-old female patient presented with a meningomyelocele at the lumber region associated with congenital hydrocephalus. She underwent ventriculoperitoneal (V-P) shunt surgery using the Sophy system. The shunt system was replaced due to a malformation. Following replacement, the patient presented with cerebrospinal fluid (CSF) eosinophilia at the age of 8 months. The eosinophilic granulocytosis of the CSF improved dramatically following systemic prednisolone administration. CSF eosinophilia without accompanying inflammation or pyrexia in the present case may have resulted from an allergic response to a foreign material such as the silicone tube pressure valve of the Sophy system or the sutures rather than bacterial or fungal infection. Based on our results, we believe that some patients may experience CSF eosinophilia following postoperative V-P shunt due to an allergic reaction to the shunt equipment. Prompt steroid treatment can produce spontaneous regression in such cases.     

Synthesis and structure-activity relationships of 5,6,7,8-tetrahydro-4H-thieno[3,2-b]azepine derivatives: novel arginine vasopressin antagonists

A variety of novel heterocyclic compounds having thienoazepine, pyrroloazepine, furoazepine, and thienodiazepine skeletons were synthesized, most of which exhibited potent antagonism of [(3)H]-AVP specific binding in assays using rat liver (V1), rat kidney (V2), human platelet plasma membranes, and recombinant human CHO cells (V2), as well as antagonizing AVP-induced hypertension in rats (V1, intravenous) and showing a diuretic effect in rats (V2, oral). By detailed studies of the structure-activity relationships of these compounds, the thienoazepine derivative 1 was found to be a very potent combined V1 and V2 antagonist. After further pharmacological and toxicological evaluation as well as physical properties, the hydrochloride 2 (JTV-605) of compound 1 was selected for clinical studies as a potent AVP antagonist with a long duration of action.     

Laminoplasty with preservation of posterior cervical elements: surgical technique

OBJECTIVE: We have developed a modified laminoplasty procedure that preserves the posterior cervical elements, and we have used it to treat multilevel cervical canal stenosis, with or without spondylotic changes, in 30 patients. METHODS: In this procedure, the posterior bony elements, such as the spinous processes, are not completely detached from the ligaments and musculature and are repositioned in the midline, to maintain normal cervical anatomic relationships. Thirty patients (mean age, 55.2 yr) were registered and evaluated in this study, with a mean follow-up period of 18.1 months, between November 1995 and October 2000. The rates of bony union of the reconstructed laminae and alignment of the cervical spine were assessed by using computed tomographic scans and lateral radiographs. RESULTS: All patients except one noted some improvement in sensation, motor function, or both. Changes in spinal curvature were noted for two patients for whom a kyphotic deformity had developed before surgery (because of S-shaped or straight curvature). The average decrease in the range of motion was 7.26 degrees. Estimated rates of bony fusion at the sites of the gutters, spacers, and spinous processes were 94.6, 62.3, and 86.6%, respectively. A stable bony arch was assumed to be achieved with bony fusion at the gutters on the hinge side, as well as the spinous processes, approximately 6 months after surgery. CONCLUSION: Our new technique of cervical laminoplasty preserves the posterior musculature and bony elements. This new procedure also helps maintain correct spinal alignment.