Curvularin Isolated From Phoma macrostoma Is an Antagonist of RhlR Quorum Sensing in Pseudomonas aeruginosa.

Quorum sensing (QS) is an attractive target for the treatment of multidrug-resistant Pseudomonas aeruginosa, against which new antibiotics are urgently needed. Because LasR is at the top of the QS hierarchy controlling Rhl and PQS systems, most QS inhibitors have been targeted to LasR. However, it has recently been reported that in clinical isolates of P. aeruginosa, LasR is frequently mutated and nonfunctional, and RhlR independently acts to produce virulent factors that maintain toxicity. Thus, for effective treatment of chronic cystic fibrosis infections, RhlR antagonists is needed to prevent the LasR-independent Rhl system, but RhlR antagonists have rarely been reported. In this study, we found that curvularin, an aromatic compound with a cyclized alkyl side chain isolated from Phoma macrostoma, at a low micromolar concentration of 1-30 µM potently and selectively inhibited pyocyanin and rhamnolipid production without affecting the cell viability of P. aeruginosa. Only high concentration (more over 100 µM) curvularin negligibly inhibited biofilm formation and elastase production, suggesting that curvularin at low concentrations selectively inhibits RhlR. The QS antagonism by curvularin was investigated in experiments using QS competition and signaling molecules assays with QS gene expression analysis, and the results showed that, indeed, at low concentrations, curvularin selectively antagonized RhlR; in contrast, it negligibly antagonized LasR only when applied at a high concentration. The exclusive RhlR antagonizing activity of curvularin at low concentrations was confirmed using QS mutants; specifically, curvularin at low concentrations inhibited pyocyanin and rhamnolipid production by selectively antagonizing N-butanoyl homoserine lactone (BHL)-activated RhlR. Moreover, by targeting RhlR, curvularin reduced the in vivo virulence of wild-type P. aeruginosa as well as lasR mutants in Caenorhabditis elegans. Overall, low-concentration curvularin is a pure RhlR antagonist in P. aeruginosa, and to the best of our knowledge, this is the first report describing an RhlR antagonist from natural resources. Hence, curvularin has great potential for the development of chronic P. aeruginosa infection therapeutics and for the study of RhlR function in the complex QS system.

Characteristics of amniotic mesenchymal stromal cells derived from term and preterm labor.

OBJECTIVE: Amniotic mesenchymal stromal cells (AMSCs) can be obtained from the mesoderm of human amniotic membrane. AMSCs derived from term baby show increased expression of genes associated with apoptosis and senescence. The objective of this study was to examine gene expression profiles of AMSCs derived from preterm (preterm AMSCs) and term labors (term AMSCs) and analyze common and different mechanisms. MATERIALS AND METHODS: We isolated and cultured AMSCs from 43 placentas: 27 from term labor and 16 from preterm labor. Microarray analysis and gene network analysis were performed to compare gene expression profile (GEP) of preterm (n = 6) with term AMSCs (n = 10). Senescence-associated gene (CDKN2A and CDKN2B) expression was also measured by reverse transcription quantitative PCR. RESULTS: GEP demonstrated that preterm AMSCs showed upregulation of nicotinamide adenine dinucleotide biosynthetic process and downregulation of extracellular matrix, cholesterol import and transport, lipid storage, and maintenance of location. CDKN2A and CDKN2B genes showed similar expression levels between term and preterm AMSCs. CDKN2A gene expression was correlated with CDKN2B expression and population doubling time. Compared to term AMSCs, preterm AMSCs showed significantly different expression of genes associated with inflammatory response which could be one of the major players in labor events. CONCLUSION: Increased CDKN2A expression in AMSCs is associated with placental membrane aging which participates in both preterm and term labor. To the best of our knowledge, this is the first report to demonstrate the association of AMSCs with labor.

Association of Depression With Atrial Fibrillation in South Korean Adults.

Importance: The risk of atrial fibrillation (AF) in people with depression is not fully known. Depression is associated with sympathetic activation and emotional stress, which might increase the risk of new-onset AF. Objective: To assess the incidence of new-onset AF in those with and without depression using data from a nationwide health care database. Design, Setting, and Participants: This cohort study obtained data from the Korean National Health Insurance Service database and enrolled people who underwent a nationwide health checkup in 2009. People younger than 20 years and those with a history of heart valve surgery, previous diagnosis of mitral stenosis, or who were diagnosed with AF between January 1, 2002 and December 31, 2008 were excluded. The risk of new-onset AF (occurring between 2009 and 2018) was compared in people who were and were not diagnosed with depression within a year before the 2009 nationwide health checkup. Data were analyzed between August 1, 2020 and October 31, 2020. Exposure: Previous diagnosis of depression. Main Outcomes and Measures: Cumulative incidence and risk of new-onset AF between 2009 and 2018 in participants with and without depression. Kaplan-Meier analysis was conducted to assess incidence of AF, and Cox proportional hazards regression was used to calculate adjusted and unadjusted hazard ratios (HRs) and 95% CIs. Results: A total of 5 031 222 individuals with a mean (SD) age of 46.99 (14.06) years (2 771 785 men [55.1%]) were included in the analysis; of these individuals, 148 882 (3.0%) had a diagnosis of depression in the year before the 2009 health checkup and 4 882 340 (97%) did not. People with depression vs those without depression were older (aged 56.7 vs 46.7 years) and more likely to be women (96 472 [64.8%] vs 2 162 965 [44.3%]). Prevalence of hypertension, diabetes, dyslipidemia, and heart failure was higher in the depression group. The cumulative incidence of new-onset AF was significantly higher in people with depression vs without depression in the Kaplan-Meier analysis and showed steady divergence throughout 10 years of follow-up (cumulative incidence, 4.44% vs 1.92%; log-rank P < .001). After adjusting for covariates, depression was associated with a 25.1% increased risk of new-onset AF (HR, 1.25; 95% CI, 1.22-1.29; P < .001). People with recurrent episodes of depression showed even higher risk of new-onset AF (HR, 1.32; 95% CI, 1.27-1.37; P < .001). Young age and female sex had significant interactions with depression, which suggests that young people and women with depression may have an increased risk of new-onset AF. Conclusions and Relevance: This study found that depression was associated with a significantly increased cumulative incidence and risk of new-onset AF. Recurrent episodes of depression were associated with even higher risk. These findings suggest the need for adequate screening for AF in people with depression, particularly in younger people and women.

Non-genetic risk factors for atrial fibrillation are equally important in both young and old age: A nationwide population-based study.

AIMS: There are several non-genetic risk factors for new-onset atrial fibrillation, including age, sex, obesity, hypertension, diabetes, and alcohol consumption. However, whether these non-genetic risk factors have equal significance among different age groups is not known. We performed a nationwide population-based analysis to compare the clinical significance of non-genetic risk factors for new-onset atrial fibrillation in various age groups. METHODS AND RESULTS: A total of 9,797,409 people without a prior diagnosis of atrial fibrillation who underwent a national health check-up in 2009 were included. During 80,130,090 person-years of follow-up, a total of 196,136 people were diagnosed with new-onset atrial fibrillation. The impact of non-genetic risk factors on new-onset atrial fibrillation was examined in different age groups. Obesity, male sex, heavy alcohol consumption, smoking, hypertension, diabetes and chronic kidney disease were associated with an increased risk of new-onset atrial fibrillation. With minor variations, these risk factors were consistently associated with the risk of new-onset atrial fibrillation among various age groups. Using these risk factors, we created a scoring system to predict future risk of new-onset atrial fibrillation in different age groups. In receiver operating characteristic curve analysis, the predictive value of these risk factors ranged between 0.556 and 0.603, and no significant trends were observed. CONCLUSIONS: Non-genetic risk factors for new-onset atrial fibrillation may have a similar impact on different age groups. Except for sex, these non-genetic risk factors can be modifiable. Therefore, efforts to control non-genetic risk factors might have relevance for both the young and old.

Differences in Electrophysiologic Values between Preoperative and Intraoperative Neurophysiologic Monitoring.

AIM: To compare preoperative and intraoperative electrophysiologic values in patients who underwent brain and spine surgeries. MATERIAL AND METHODS: A retrospective medical record review was conducted on patients who underwent brain and spine surgery between January 2014 and July 2018. Patients underwent preoperative electrophysiologic monitoring within a week before the operation and intraoperative monitoring during the surgery. Monitoring parameters included the onset latency (msec) and amplitude (mV) of motor evoked potential (MEP), somatosensory evoked potential (SEP), electroneuronography, and brainstem auditory evoked potential (BAEP). RESULTS: The latency of the MEP and SEP were significantly prolonged while the amplitude was decreased during operation. Specifically, patients with abnormal findings in their preoperative assessments showed more prominent differences compared to those with normal findings. However, there was no significant difference between preoperative and intraoperative results based on which side of the hemisphere was affected or unaffected. Unlike the MEP and SEP parameters, there were no significant changes in the facial electroneuronography and BAEP parameters. CONCLUSION: There were differences in the preoperative and intraoperative monitoring parameters. Further studies are necessary to understand the underlying mechanisms behind these changes during surgery.

Development of a Microbial Decontamination System Combining Washing with Highly Activated Calcium Oxide Solution and Antimicrobial Coating for Improvement of Mandarin Storability.

A new microbial decontamination system combining washing with a natural antimicrobial solution and coating with a carnauba wax (CW)-based antimicrobial coating was developed and its effects on mandarin storability were investigated. Mandarins were washed with an antimicrobial solution and/or coated with grapefruit seed extract-CW (GSE/CW). Values for the disease incidence of Penicillium digitatum in untreated mandarins; mandarins coated with GSE/CW without washing; and mandarins coated with GSE/CW after washing with a fumaric acid (FA) solution of slightly acidic electrolyzed water, a highly activated calcium oxide (CaO) aqueous solution, or CaO solution followed by FA solution were 96.0, 70.0, 78.8, 50.0, and 72.2%, respectively. GSE/CW coating after CaO washing was most effective in inhibiting P. digitatum growth during storage at 25 °C. Compared to untreated samples, GSE/CW coating alone or after CaO washing retained CO2 generation, firmness, and total polyphenol content of mandarins at 25 °C. Such treatments also effectively maintained mandarin pH, ascorbic acid concentration, and antioxidant capacity at both 4 and 25 °C. Moreover, GSE/CW coating after CaO washing more effectively inhibited P. digitatum growth at 25 °C and maintained ascorbic acid concentration and antioxidant capacity at 4 and 25 °C than GSE/CW coating alone. The microbial decontamination system integrating CaO washing and GSE/CW coating demonstrates potential for improving mandarin storability by inhibiting P. digitatum growth and improving the preservation of quality properties and sensory characteristics. PRACTICAL APPLICATION: This is the first study to develop a microbial decontamination system involving both washing with a natural antimicrobial solution and carnauba wax coating containing grapefruit seed extract to improve the storability of fruits. This system demonstrated a primary effect of inhibiting fungi that cause mandarin surface decay at 25 °C via the highly activated calcium oxide wash and secondary effects of delaying quality degradation and inhibiting fungal growth by the action of the antimicrobial coating. These effects led to improvements in mandarin storability, along with enhanced visual appeal while not affecting taste, flavor, or texture.

Coralmycin Derivatives with Potent Anti-Gram Negative Activity Produced by the Myxobacteria Corallococcus coralloides M23.

Seven new coralmycin derivatives, coralmycins C (1), D (2), E (3), F (4), G (5), H (6), and I (7), along with three known compounds, cystobactamids 891-2 (8), 905-2 (9), and 507 (10), were isolated from a large-scale culture of the myxobacteria Corallococcus coralloides M23. The structures of these compounds, including their relative stereochemistries, were elucidated by interpretation of their spectroscopic and CD data. The structure-activity relationships of their antibacterial and DNA gyrase inhibitory activities indicated that the para-nitrobenzoic acid unit is critical for the inhibition of DNA gyrase and bacterial growth, while the nitro moiety of the para-nitrobenzoic acid unit and the isopropyl chain at C-4 could be important for permeability into certain Gram-negative bacteria, including Pseudomonas aeruginosa and Klebsiella pneumoniae, and the ß-methoxyasparagine moiety could affect cellular uptake into all tested bacteria. These results could facilitate the chemical optimization of coralmycins for the treatment of multidrug-resistant Gram-negative bacteria.

Development of Anti-Insect Microencapsulated Polypropylene Films Using a Large Scale Film Coating System.

Films containing microencapsulated cinnamon oil (CO) were developed using a large-scale production system to protect against the Indian meal moth (Plodia interpunctella). CO at concentrations of 0%, 0.8%, or 1.7% (w/w ink mixture) was microencapsulated with polyvinyl alcohol. The microencapsulated CO emulsion was mixed with ink (47% or 59%, w/w) and thinner (20% or 25%, w/w) and coated on polypropylene (PP) films. The PP film was then laminated with a low-density polyethylene (LDPE) film on the coated side. The film with microencapsulated CO at 1.7% repelled P. interpunctella most effectively. Microencapsulation did not negatively affect insect repelling activity. The release rate of cinnamaldehyde, an active repellent, was lower when CO was microencapsulated than that in the absence of microencapsulation. Thermogravimetric analysis exhibited that microencapsulation prevented the volatilization of CO. The tensile strength, percentage elongation at break, elastic modulus, and water vapor permeability of the films indicated that microencapsulation did not affect the tensile and moisture barrier properties (P > 0.05). The results of this study suggest that effective films for the prevention of Indian meal moth invasion can be produced by the microencapsulation of CO using a large-scale film production system. PRACTICAL APPLICATION: Low-density polyethylene-laminated polypropylene films printed with ink incorporating microencapsulated cinnamon oil using a large-scale film production system effectively repelled Indian meal moth larvae. Without altering the tensile and moisture barrier properties of the film, microencapsulation resulted in the release of an active repellent for extended periods with a high thermal stability of cinnamon oil, enabling commercial film production at high temperatures. This anti-insect film system may have applications to other food-packaging films that use the same ink-printing platform.

Daphnane and Phorbol Diterpenes, Anti-neuroinflammatory Compounds with Nurr1 Activation from the Roots and Stems of Daphne genkwa.

The methanol extract of the roots and stems of Daphne genkwa and its constituents yuanhuacin (1) and genkwanine N were previously reported to have Nurr1 activating effects and neuroprotective effects in an animal model of Parkinson's disease (PD). In this study, four more daphnane-type diterpenes (acutilonine F (2), wikstroemia factor M1 (3), yuanhuadine (5), and yuanhuatine (6)) and two phorbol-type diterpenes (prostratin Q (4) and 12-O-n-deca-2,4,6-trienoyl-phorbol-(13)-acetate (7)) were isolated as Nurr1 activating compounds from the D. genkwa extract. Consistent with their higher Nurr1 activating activity, compounds 1, 4, 5, and 7 exhibited higher inhibitory activity on lipopolysaccharide (LPS)-induced nitric oxide (NO) production in murine microglial BV-2 cells with an IC50 (µM) of 1-2, which was 15-30 times more potent than that of minocycline (29.9 µM), a well-known anti-neuroinflammatory agent. Additionally, these diterpenes reduced expression and transcription of LPS-induced pro-inflammatory cytokines in BV-2 cells. Thus, the daphnane-type and phorbol-type diterpenes had anti-neuroinflammatory activity with Nurr1 activation and could be responsible for the anti-PD effect of the roots and stems of D. genkwa.

Surgery versus Conservative Treatment for Spontaneous Supratentorial Intracerebral Hemorrhage in Spot Sign Positive Patients.

OBJECTIVE: An advantage of surgical treatment over conservative treatment of spontaneous intracerebral hemorrhage (ICH) is controversial. Recent reports suggest that contrast extravasations on CT angiography (CTA) might serve as a crucial predictor of hematoma expansion and mortality. The purpose of this study was aimed at investigating the efficacy of surgical treatment in patients with spot sign positive ICH. METHODS: We used our institutional medical data search system to identify all adult patients who admitted for treatment of ICH between January 1, 2007 and January 31, 2012. Patients were classified two groups into a surgical group (n=27) and a conservative treatment group (n=28). Admission criteria were the following: age 20-79 years, spontaneous supratentorial ICH, Glasgow Coma Score Ranging from 9 to 14, ICH volume ≥20 mL, and treatment within 24 hours. RESULTS: Fifty-five patients were analyzed. There was no significant difference in the ICU stay between the conservative treatment group (7.36±3.66 days) and the surgical treatment group (6.93±2.20 days; p=0.950). There was a significant difference in the in-hospital stay between the conservative treatment group (13.93±8.87 days) and the surgical treatment group (20.33±6.37 days; p=0.001). Overall mortality at day 90 after ICH was 36.4%; this included 16 of 28 patients (57.1%) in the conservative group and 4 of 27 patients (14.8%) in the surgical group. In univariate analysis, there was a positive effect of the surgical treatment in reducing mortality at 90 days (p=0.002), Glasgow Outcome Scale (GOS) at 90-day (p=0.006), and modified Rankin Scale (mRS) at 90-day (p=0.023). In multivariate logistic analysis, there was a significant difference in mortality (odds ratio, 0.211; 95% confidence interval, 0.049-0.906; p=0.036) between the groups at 90-day follow-up. However, there was no significant difference in GOS (odds ratio, 0.371; 95% confidence interval, 0.031-4.446; p=0.434) and mRS (odds ratio, 1.041; 95% confidence interval, 0.086-12.637; p=0.975) between the groups at 90-day follow-up. CONCLUSION: In this study of surgical treatment of supratentorial ICH in patients with spot sign positive in CTA was associated with less mortality despite of long duration of in-hospital stay. We failed to show that clinical outcome benefit of surgical treatment compared with conservative treatment in patients with spot sign positive ICH.

Long-term outcome of surgical treatment of patients with intractable epilepsy associated with schizencephaly.

BACKGROUND: Schizencephaly is a developmental anomaly of the brain that is sometimes associated with intractable seizures. Patients that suffer from medically refractory seizures may be considered for surgical treatment. METHOD: Five patients with intractable epilepsy associated with schizencephaly were studied. Evaluation methods included medical history assessment, neurological examination, magnetic resonance imaging (MRI) with three-dimensional (3D) surface rendering, positron emission tomography (PET), video-electroencephalogram (EEG) monitoring with surface electrodes and subdural grid electrodes, sodium amobarbital test, and neuropsychological assessments. Topectomy was performed close to the schizencephalic cleft in two patients, and at an area distant from the cleft in one under the guidance of electrocorticography (ECoG). Temporal lobectomy was performed in two patients. RESULTS: MRI revealed unilateral schizencephaly in all five patients. Video-EEG monitoring recorded simple partial seizures in two patients and complex partial seizures in three patients. The epileptogenic zone was localized close to the schizencephalic cleft in two patients, distant to the cleft in one patient, and in the temporal lobe in two patients. Postoperatively, one of two patients with temporal lobectomy and one of three patients with topectomy were seizure-free at 1-year follow-up. Three patients experienced marked seizure reduction but were not seizure-free at 1 year; however, at the follow-up periods of 2.5 years and 6.5 years, two of these three patients were seizure free. One patient who underwent temporal lobectomy began to have very brief losses of consciousness lasting 1-3 s (3-4 times per year). Neurological complications included temporary upper monoparesis in one and hemiparesis in one. CONCLUSIONS: The abnormal cortex lining schizencephalic clefts and cortical tissues near the cleft may be epileptogenic. Areas distant to the cleft may also be the source of seizures. Careful evaluation should be performed to define the epileptogenic zone in patients with intractable epilepsy associated with schizencephaly, and meticulous resection of the epileptogenic zone can lead to good seizure control.

Multiple gamma knife radiosurgery for multiple metachronous brain metastases associated with lung cancer : survival time.

OBJECTIVE: We compared the survival time between patients with multiple gamma knife radiosurgery (GKRS) and patients with a single GKRS plus whole brain radiation therapy (WBRT), in patients with multiple metachronous brain metastases from lung cancer. METHODS: From May 2006 to July 2010, we analyzed 31 patients out of 112 patients who showed multiple metachronous brain metastases. 20 out of 31 patients underwent multiple GKRS (group A) and 11 patients underwent a single GKRS plus WBRT (group B). We compared the survival time between group A and B. Kaplan-Meier method and Cox proportional hazards were used to analyze relationship between survival and 1) the number of lesions in each patient, 2) the average volume of lesions in each patient, 3) the number of repeated GKRS, and 4) the interval of development of new lesions, respectively. RESULTS: Median survival time was 18 months (range 6-50 months) in group A and 6 months (range 3-18 months) in group B. Only the average volume of individual lesion (over 10 cc) was negatively related with survival time according to Kaplan-Meier method. Cox-proportional hazard ratio of each variable was 1.1559 for the number of lesions, 1.0005 for the average volume of lesions, 0.0894 for the numbers of repeated GKRS, and 0.5970 for the interval of development of new lesions. CONCLUSION: This study showed extended survival time in group A compared with group B. Our result supports that multiple GKRS is of value in extending the survival time in patients with multiple metachronous brain metastases, and that the number of the lesions and the frequency of development of new lesions are not an obstacle in treating patients with GKRS.

Malignant transformation of an epidermoid cyst in the cerebellopontine angle.

Intracranial squamous cell carcinoma is extremely rare, with most of the cases arising from malignant transformation of an epidermoid or a dermoid cyst. The patient presented with facial weakness. Initial magnetic resonance imaging revealed a mass in the right cerebellopontine angle. A subtotal resection was performed via right retrosigmoid suboccipital approach. Histopathological findings were consistent with an epidermoid tumor. Five months later, the patient underwent gamma knife radiosurgery due to highly probable recurrent epidermoid tumor. Two years after, the patient's neurological deficit had been newly developed, and follow-up magnetic resonance imaging demonstrated a large contrast-enhancing tumor in the left cerebellopontine angle, which compressed the brainstem. After resection of the tumor, histopathological examinations revealed a squamous cell carcinoma probably arising from an underlying epidermoid cyst. We report a case of an epidermoid tumor in the cerebellopontine angle that transformed into a squamous cell carcinoma.

Independent predictors for recurrence of chronic subdural hematoma.

BACKGROUND: Chronic subdural hematoma is characterized by blood in the subdural space that evokes an inflammatory reaction. Numerous factors potentially associated with recurrence of chronic subdural hematoma have been reported, but these factors have not been sufficiently investigated. In this study, we evaluated the independent risk factors of recurrence. METHODS: We analyzed data for 420 patients with chronic subdural hematoma treated by the standard surgical procedure for hematoma evacuation at our institution. RESULTS: Ninety-two (21.9 %) patients experienced at least one recurrence of chronic subdural hematoma during the study period. We did not identify any significant differences between chronic subdural hematoma recurrence and current antiplatelet therapy. The recurrence rate was 7 % for the homogeneous type, 21 % for the laminar type, 38 % for the separated type, and 0 % for the trabecular type. The rate of recurrence was significantly lower in the homogeneous and trabecular type than in the laminar and separated type. We performed a multivariate logistic regression analysis and found that postoperative midline shifting (OR, 3.6; 95 % CI, 1.618-7.885; p = 0.001), diabetes mellitus (OR, 2.2; 95 % CI, 1.196-3.856; p = 0.010), history of seizure (OR, 2.6; 95 % CI, 1.210-5.430; p = 0.014), width of hematoma (OR, 2.1; 95 % CI, 1.287-3.538; p = 0.003), and anticoagulant therapy (OR, 2.7; 95 % CI, 1.424-6.960; p = 0.005) were independent risk factors for the recurrence of chronic subdural hematoma. CONCLUSIONS: We have shown that postoperative midline shifting (≥5 mm), diabetes mellitus, preoperative seizure, preoperative width of hematoma (≥20 mm), and anticoagulant therapy were independent predictors of the recurrence of chronic subdural hematoma. According to internal architecture of hematoma, the rate of recurrence was significantly lower in the homogeneous and the trabecular type than the laminar and separated type.

Hemimasticatory spasm treated with microvascular decompression of the trigeminal nerve.

Hemimasticatory spasm is a very rare disorder of the trigeminal nerve characterized by paroxysmal involuntary contraction of the jaw-closing muscles. The mechanisms leading to hemimasticatory spasm are still unclear. Recently, injection of botulinum toxin has become the treatment of choice due to its excellent results. We report a case of a successful treatment of hemimasticatory spasm via microvascular decompression of the motor branch of the trigeminal nerve.

Rapid-growing juvenile xanthogranuloma on the scalp in 18-month-old girl.

Juvenile xanthogranuloma (JXG) is an uncommon histiocytic cutaneous lesion. An 18-month-old girl visited our clinic due to rapid growing orange-yellowish lesion on scalp. Enlarging time from 1 mm to 12 mm was just 8 weeks. We excised the tumor and adjacent normal tissue. Histopathological study showed numerous eosinophils and Touton giant cells within the lesion. Immunohistochemical study revealed positive immunoreactivity for CD68 in most areas. No recurrence was seen during 12 months after resection. We report a case with rapidly growing JXG on scalp with peculiar histopathologic findings.

Surgical management of anterior cerebral artery aneurysms of the proximal (A1) segment.

OBJECTIVE: To report a series of 20 consecutive patients with aneurysms of the proximal segment (A1) of the anterior cerebral artery (ACA. METHODS: The medical records of patients who had undergone surgery for intracranial aneurysms at two institutions between January 1, 1989, and February 1, 2009, were reviewed. Mean patient age was 52.15 years (range 39-69 years). All 20 patients underwent direct surgery, with clipping or trapping, via standard pterional craniotomy. RESULTS: The incidence of A1 segment aneurysm was 0.59%. There were 16 women and 4 men, showing a strong predominance of this lesion in women. Mean aneurysm size was 6.95 mm (range 3-10 mm). Four patients (20%) had multiple aneurysms, and three patients (15%) had associated vascular anomalies. Among patients whose aneurysms originated from perforating arteries, dissection sacrificed the perforating arteries in two patients, and the perforating arteries occluded postoperatively in three patients. In the patients whose aneurysms did not originate from perforating arteries, no perforating arteries were sacrificed during dissection, and perforating arteries became occluded in two patients postoperatively. There was no statistically significant difference between the two groups of patients regarding the incidence of injury or occlusion. Clinical outcomes were as follows: good recovery in 15 (75%) patients, moderate disability in 2 (10%) patients, severe disability in 2 (10%) patients, and death in 1 (5%) patient. CONCLUSIONS: The important consideration in surgery for intracranial aneurysms is preservation of the perforating arteries, through cautious dissection around the neck or dome and avoidance of direct clip compression, even after releasing the retracted frontal lobe.

Posterior arch defects of the cervical spine: a comparison between absent pedicle syndrome and spondylolysis.

BACKGROUND CONTEXT: Abnormalities of the posterior arch are rare entities that are usually found incidentally on neck radiographs. Their radiographic appearance may cause them to be confused with more serious entities such as fractures, locked facets, and tumor-induced bony erosions. It is important to distinguish these posterior arch abnormalities from the other entities because the treatment is very different. PURPOSE: Posterior arch defects of the cervical spine, including cervical spondylolysis and absent pedicle syndrome, occur rarely. In this case report, we describe three cases of posterior arch defects and present a review of the literature concerning the distinguishing features between spondylolysis and absent pedicle syndrome. STUDY DESIGN: A case report and literature review of the posterior arch defects. METHODS: Two patients are presented who developed posterior neck pain after trauma. They had no neurologic deficits, but cervical radiographs suggested that they had a traumatic injury. Cervical spine computed tomography (CT) revealed absent pedicle syndrome and they were treated conservatively. Another patient is presented who developed worsening posterior neck pain and left shoulder pain. She had no history of significant neck injury. Cervical radiographs and CT showed bilateral spondylolysis of C6 vertebra and subluxation of C6 on C7. Because her symptoms were not relieved by conservative measures, we performed anterior cervical discectomy and fusion. RESULTS: We treated two patients with absent pedicle syndrome by conservative measures and one patient with cervical spondylolyis by surgical treatment. CONCLUSIONS: Posterior arch defects were often confused with other disease entities. But, they have some distinctive features and such distinctive features may be helpful in confirming diagnosis and planning treatment. Furthermore, three-dimensional CT scan reconstruction provides comprehensive anatomic evaluation of the structures with an absent pedicle and the associated bony abnormalities.

Midline glioblastoma multiforme with bilateral symmetric cysts.

Cystic glioblastoma multiforme (GBM) is a rare disease. Its exact prevalence has not yet been reported. Also, the mechanism of cyst formation remains to be elucidated. We report a case of GBM with a large peripheral cyst. A 43-year-old woman visited our clinic with a 3-month history of severe headache, memory impairment and general weakness. T1-weighted gadolinium-enhanced magnetic resonance (MR) image revealed a midline enhanced solid mass and bilateral symmetric banana-shaped peripheral cysts. A centrally enhanced mass was measured 2x4 cm in size and both mass and cysts as 7x7 cm. Both the frontal lobe and the frontal horn were severely compressed inferiorly and posteriorly. We resected a midline solid tumor and cysts via the bilateral interhemispheric transcortical approach. Histopathologic examination revealed GBM. The patient was subsequently treated with fractionated conventional brain radiation therapy, followed by temozolomide chemotherapy. Eighteen months later, there was no tumor recurrence and no neurological deficits were noted. Our patient showed no tumor recurrence and a long survival at a long follow-up.

Effect of vagus nerve stimulation in post-traumatic epilepsy and failed epilepsy surgery : preliminary report.

OBJECTIVE: Vagus nerve stimulation (VNS) has been used in epilepsy patients refractory to standard medical treatments and unsuitable candidates for resective or disconnective surgery. In this study, we investigated the efficacy of VNS to patients who had refractory result to epilepsy surgery and patients with post-traumatic epilepsy. METHODS: We analyzed the effect of VNS in 11 patients who had undergone previous epilepsy surgery and patients with intractable post-traumatic epilepsy associated with brain injury. All patients underwent VNS implantation between October 2005 and December 2006. RESULTS: We evaluated seizure frequency before and after implantation of VNS and maximum follow up period was 24 months. In the first 6 months, 11 patients showed an average of 74.3% seizure reduction. After 12 months, 10 patients showed 85.2% seizure reduction. Eighteen months after implantation, 9 patients showed 92.4% seizure reduction and 7 patients showed 97.2% seizure reduction after 24 months. Six patients were seizure-free at this time. CONCLUSION: We conclude that the VNS is a helpful treatment modality in patients with surgically refractory epilepsy and in patients with post-traumatic epilepsy due to severe brain injury.