[A Case of Carotid Free-Floating Thrombus Treated by Carotid Ultrasonography-Guided Endovascular Approach].

We experienced a case of carotid free-floating thrombus treated by carotid ultrasonography-guided endovascular approach. A 63-year-old man was brought to our hospital with the chief complaint of sudden onset left hemiplegia. MRI revealed acute infarction of the right MCA territory due to the right M1 occlusion. Carotid ultrasonography showed a pedunculated, polypoid mobile plaque floating with the cardiac beat. We attempted ultrasonography-guided endovascular treatment. Under proximal balloon protection, the floating plaque was successfully aspirated into the Penumbra aspiration catheter. Carotid stent was also placed to stabilize the residual pedicle of the plaque. Aspirated plaque was identified as fresh thrombus by pathological examination. Carotid ultrasonography-guided endovascular approach was effective for getting the picture of real-time dynamics of the carotid FFT.

Using an indwelled test tube as a good "navigator" during enterostomy closure.

Surgeons often have difficulty in identifying a suitable incision line to enter the peritoneal cavity for stoma mobilization during enterostomy closure. A mini-size test tube that is preoperatively placed into the stoma can act as an efficient guide in finding a free area to enter the peritoneal cavity, by supplying efficient counter traction and a palpable marker of the intestinal wall.

A cluster epidemic of influenza A(H1N1)pdm09 virus infection in four captive cheetahs (Acinonyx jubatus).

In January 2019, four cheetahs (Acinonyx jubatus) kept at a Japanese zoo intermittently showed respiratory signs following the incidence of seasonal influenza in animal caregivers. Respiratory materials (saliva, sputum and food tray swabs) were non-invasively collected from the four cheetahs. Although we were unable to isolate the virus, the NP gene of influenza A virus was detected in three of the cheetahs but not in the fourth cheetah that had nearly recovered. From a food tray swab which tested weakly positive by a commercial influenza detection kit, we were able to obtain the whole-genome sequence of the influenza A virus. Analysis of the genome, A/cheetah/Kanagawa/2/2019(H1N1), revealed that the virus was closely related to influenza A(H1N1)pdm09 viruses isolated from humans in Japan in the 2018-2019 winter. Production of haemagglutinin inhibition (HI) antibodies (64-128 HI) against an A(H1N1)pdm09 virus in plasma samples confirmed infection of all four cheetahs. The animals continued to produce antibodies for at least 314 days after disease onset. These findings strongly suggest that reverse zoonotic transmission of A(H1N1)pdm09 virus occurred from human to cheetah and subsequently from cheetah to cheetah in the zoo. We also show that specimens can be safely and non-invasively collected from non-domesticated animals and used to investigate respiratory infectious diseases.

Parallel Stent Retriever Technique for a Refractory Middle Cerebral Artery Embolism: A Technical Case Report.

Objective: To report a patient who achieved complete recanalization using the parallel stent retriever (SR) technique for a refractory acute middle cerebral artery (MCA) embolism. Case Presentation: An 86-year-old woman underwent an emergency thrombectomy for acute right MCA occlusion. Although thrombectomy has been attempted three times with the conventional technique using a single SR, no recanalization was achieved. Then, an innovative technique was used to deploy two SRs in parallel with the M1 segment of the MCA. Pulling them back simultaneously, the thrombus was retrieved, and complete recanalization was achieved. Conclusion: The parallel SR technique is a feasible method and can be considered as one of the last treatment resorts for acute refractory embolisms at the major MCA trunk.

Chordoid glioma with calcification and neurofilament expression: case report and review of the literature.

BACKGROUND: Chordoid glioma of the third ventricle is a rare type of brain tumor that was recently categorized as a novel tumor entity. Despite low-grade histologic features, the clinical outcome in reported cases was poor. CASE DESCRIPTION: A 61-year-old woman presented to our institution with a history of syncope. On presentation, she was alert and oriented, and her systemic examination was unremarkable. Computed tomographic scan showed a well-circumscribed, slightly hyperdense mass with calcification and a cystic component in the anterior part of the third ventricle. The mass was homogenously enhancing after the intravenous administration of contrast material, and its maximum diameter was 3.5 cm. The preoperative diagnosis was craniopharyngioma. Because the tumor seemed to invade the hypothalamus bilaterally, the operative plan was to reduce the tumor volume, followed by radiosurgery. The patient underwent partial removal of the tumor via a bifrontal basal interhemispheric approach. The histologic and immunohistochemical findings indicated CG. Surprisingly, tumor cells showed NFP expression. The residual tumor was treated by GKRS and showed no regrowth at 1-year follow-up. CONCLUSIONS: Chordoid glioma is considered a glial neoplasm with distinct morphological and clinicopathologic features, but there may also be other unknown characteristics because of its rarity. To the best of our knowledge, this is the second reported case of CG with calcification and, at the same time, the second case with NFP expression in the English literature. Calcification and expression of NFP should not exclude CG in the differential diagnosis of a third ventricular tumor. The authors also suggest that the combination of microsurgery and GKRS is a safe and effective treatment strategy for CG.

[Bilateral thalamic glioma in an adult: a case report and review of the literature].

We report a case of a 36-year-old woman who had a rare bilateral thalamic glioma (BTG). She complained of memory disorder T1-weighted magnetic resonance imaging revealed enlarged bilateral thalami with homogenous isointensity and no contrast enhancement. Histological examination of the biopsy specimen identified diffuse astrocytoma (WHO grade II). BTG is a rare variant of thalamic neoplasms, which can be distinguished clinically and radiologically from other gliomas. In most of the reported cases, the presenting symptoms were cognitive impairment varying from personality changes to frank dementia. Death usually occurs within two years after onset, independently of adjuvant therapy such as radiotherapy and chemotherapy. On neuroimaging, all of the BTG had a similar appearance, with both thalami being symmetrically enlarged. Our patient has been given radiotherapy and concominant and adjuvant temozolomide in Stupp's regimen. At the time of this writing (5 months after the consultation), there are no neurological symptoms, and no changes on neuroimaging.

Laparoscopic fundoplication for a case of esophageal hiatal hernia after gastroschisis repair.

BACKGROUND: Esophageal hiatal hernia and gastroesophageal reflux have been recognized as inevitable complications after the definitive gastroschisis operation. Patients with refractory gastroesophageal reflux require anti-reflux surgery; however, the surgical adhesions may complicate subsequent surgical therapy, especially in the cases treated by staged repair. CASE PRESENTATION: A male infant who showed a severe gastroesophageal reflux due to hiatal hernia after staged abdominal fascial closure of gastroschisis. In spite of continuous conservative management, frequent vomiting and hematemesis had become progressively worse at the age of 8 months. Laparoscopic Nissen fundoplication was attempted and completed with no adverse events. CONCLUSIONS: Laparoscopic fundoplication may be applied, as a first-line approach, for the treatment of gastroesophageal reflux in this difficult group of patients, after the repair of congenital abdominal wall defect.

An abnormal accumulation of fluorine-18-FDG PET in cytomegalovirus enteritis--a case report.

The source of a fever of unknown origin (FUO) and watery diarrhea in a 63-yr-old female with a history of disturbance of consciousness due to moyamoya disease was examined. Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET), colonoscopy, blood analysis, and determination of cytomegalovirus (CMV) antigenemia were performed. FDG was found to be accumulated in the wall of a dilated colon, and extended from the transverse to sigmoid colon. Colonoscopy revealed edematous, inflammatory, and punched out lesions in accordance with the areas of abnormal FDG uptake. A biopsy specimen showed the antibody of CMV in the colonic mucosa, and CMV antigenemia was detected by an immunohistochemical assay using a monoclonal antibody for CMV pp65 antigen. From these findings, we strongly suspected CMV enteritis.

[Cranial surgery without shaving: practice and results in our hospital].

Hair removal or shaving, even if partial, increases mental anguish of patients, especially in female. Several reports demonstrating successful cranial surgery without hair removal led us to start cranial surgery with completely preserving hair. The purpose of this study was to demonstrate our methods and tips of cranial surgery without hair removal and to evaluate the rate of postoperative infection in these patients. We performed 82 procedures without shaving, including craniotomy for brain tumors, trauma, intracranial aneurysms and so on (n = 70), ventriculo-peritoneal shunt placement (n = 5), and other miscellaneous procedures (n = 7). All the patients were highly satisfied with the cosmetic results keeping their hair. We observed 5 patients whose wounds took relatively long time to be cured (6.1%), and 2 patients whose wounds were infected (2.4%). All infections were superficial and cured by the application of antibiotic ointment. There was no significant difference between the rate of wound complication in patients whose heads were shaven (5/82) and the rate in those whose head were not shaven (7/82). So we suggest that neurosurgery without shaving is safe, and does not increase the risk of severe wound infection. In addition, it helps patients to look normal and to start their routine earlier.

Intraventricular chordoid meningioma presenting with Castleman disease due to overproduction of interleukin-6. Case report.

A rare case of chordoid meningioma in the lateral ventricle observed in an adult is reported. The first clinical manifestation of the disease was a prolonged fever of unknown origin. Abnormalities in the patient's blood chemistry, principally polyclonal hypergammaglobulinemia (immunoglobulin [Ig]G, IgA, and markedly IgE) and an elevated serum level of C-reactive protein, were associated with the disease. The tumor was histologically confirmed to be a chordoid meningioma, and its surgical removal resulted in complete resolution of the patient's symptoms. By combining reverse transcription-polymerase chain reaction and immunohistochemical analysis, it may be shown that cytokine production, including that of interleukin (IL)-6, IL-1beta, and vascular endothelial growth factor, plays a role in the pathogenesis of chordoid meningioma associated with Castleman syndrome.

Aurora-B dysfunction of multinucleated giant cells in glioma detected by site-specific phosphorylated antibodies.

OBJECT: The origin of multinucleated giant cells in glioma has not been made clear. In a previous paper the authors studied multinucleated giant tumor cells by using mitosis-specific phosphorylated antibodies to determine the phosphorylation of intermediate filaments and demonstrated that these cells stay in the early mitotic stage, undergoing neither fusion nor degeneration. In the current study the authors investigated the possible genetic causes of multinucleated giant tumor cells. METHODS: Cultured mono- or multinucleated human glioma cells were immunostained with monoclonal antibodies (mAbs) 4A4, YT33, TM71, HTA28, YG72, and alphaAIM-1. The three former antibodies revealed a particular mitotic cell cycle through site-specific phosphorylation of vimentin; that is, the early phase, mid phase, and late phase, respectively. The three later antibodies demonstrated phosphorylation of H3 at Ser28, phosphorylation of vimentin at Ser72, and aurora-B, respectively, making it possible to identify aurora-B distribution and function during mitosis. In addition, paraffin-embedded tissue sections obtained in three patients with giant cell glioblastoma were also examined. Multinucleated giant tumor cells immunoreacted with the mAb 4A4 and alphaAIM-1 but not with YT33, TM71, HTA28, and YG72 in vitro and in vivo. CONCLUSIONS: Findings in this study indicated that multinucleated giant tumor cells remain in the early mitotic phase because of aurora-B dysfunction, effecting aberrations in cytoplasmic cleavage without affecting nuclear division.