A case of facial nerve palsy caused by severe head injury treated by translabyrinthine approach.

Background: Several treatments for traumatic facial paralysis have been reported, but the role of surgery is still controversial. Case Description: A 57-year-old man was admitted to our hospital with head trauma due to a fall injury. A total body computed tomography (CT) scan showed a left frontal acute epidural hematoma associated with a left optic canal and petrous bone fractures with the disappearance of the light reflex. Hematoma removal and optic nerve decompression were performed immediately. The initial treatment was successful with complete recovery of consciousness and vision. The facial nerve paralysis (House and Brackmann scale grade 6) did not improve after medical therapy, and thus, surgical reconstruction was performed 3 months after the injury. The left hearing was lost entirely, and the facial nerve was surgically exposed from the internal auditory canal to the stylomastoid foramen through the translabyrinthine approach. The facial nerve's fracture line and damaged portion were recognized intraoperatively near the geniculate ganglion. The facial nerve was reconstructed using a greater auricular nerve graft. Functional recovery was observed at the 6-months follow-up (House and Brackmann grade 4), with significant recovery in the orbicularis oris muscle. Conclusion: Interventions tend to be delayed, but it is possible to select a treatment method of the translabyrinthine approach.

Superior sagittal sinus dural arteriovenous fistula with changes in angiographic findings associated with contiguous parasagittal meningioma: A case report.

Background: Meningioma and dural arteriovenous fistula (dAVF) located at the same site are rare. The present case demonstrated the transformation of tumor feeding vessels into the pial feeder of the dAVF over time, which may help to elucidate the pathogenesis of tumor-associated dAVF. Case Description: A 71-year-old man presented with convulsion. Magnetic resonance (MR) imaging showed a right parasagittal sinus meningioma invading the superior sagittal sinus (SSS). Bilateral external carotid angiography showed dAVF at the SSS, near the site of tumor invasion. The right internal carotid angiography showed tumor staining from the anterior cerebral artery with intra-tumor arteriovenous shunting, with stagnation of tumor blood flow, suggesting impairment of perfusion to the SSS. Four years after the initial diagnosis, the patient was admitted to hospital with status epilepticus, and MR imaging showed an enlarged tumor. Carotid angiography revealed transformation of the tumor feeders to the pial feeder of the dAVF. The findings of shunting to the SSS had intensified, and stenosis had occurred in the posterior third of the SSS. The venous return showed retrograde flow anteriorly to the SSS. The patient underwent endovascular embolization and tumor resection. The shunt had disappeared. Conclusion: This report supports the proposal that impaired venous return is an important factor in the shunt occurrence of dAVF. Neurosurgeons should consider that cases of meningioma invading the venous sinuses may be complicated by dAVF and changes may occur over time.

Autonomic dysreflexia associated with cervical spinal cord gliofibroma: case report.

BACKGROUND: Autonomic dysreflexia (AD) is an abnormal reflex of the autonomic nervous system normally observed in patients with spinal cord injury from the sixth thoracic vertebra and above. AD causes various symptoms including paroxysmal hypertension due to stimulus. Here, we report a case of recurrent AD associated with cervical spinal cord tumor. CASE PRESENTATION: The patient was a 57-year-old man. Magnetic resonance imaging revealed an intramedullary lesion in the C2, C6, and high Th12 levels. During the course of treatment, sudden loss of consciousness occurred together with abnormal paroxysmal hypertension, marked facial sweating, left upward conjugate gaze deviation, ankylosis of both upper and lower extremities, and mydriasis. Seizures repeatedly occurred, with symptoms disappearing after approximately 30 min. AD associated with cervical spinal cord tumor was diagnosed. Histological examination by tumor biopsy confirmed the diagnosis of gliofibroma. Radiotherapy was performed targeting the entire brain and spinal cord. The patient died approximately 3 months after treatment was started. CONCLUSIONS: AD is rarely associated with spinal cord tumor, and this is the first case associated with cervical spinal cord gliofibroma. AD is important to recognize, since immediate and appropriate response is required.

Deconstructive Endovascular Treatment of Ruptured Serpentine Basilar Artery Aneurysm by Mid-Basilar Occlusion.

BACKGROUND: No clear treatment course for cerebral aneurysms in the main trunk of the basilar artery (BA) has been established thus far. CASE DESCRIPTION: A 69-year-old man with a history of hypertension presented to the emergency department with a sudden headache followed by decreased consciousness. Head computed tomography revealed a subarachnoid hemorrhage from the front of the brain stem to the basal cistern, and a lump-like dilation localized in the main trunk of the BA in the front of the midbrain. A rotated 360° large cerebral serpentine aneurysm was observed from the upper BA to the proximal part of the superior cerebellar artery. Endovascular treatment was performed under general anesthesia. To avoid a perforator infarction, short-segment parent artery embolization was performed only at the rupture point and the proximal part of the aneurysm. A magnetic resonance imaging scan 1 day after surgery revealed only microinfarction in the pons just below the embolus. The patient developed mild left hemiparesis postoperatively but soon improved and was discharged from the hospital. CONCLUSIONS: Parent vessel sacrifice carries a risk of perforator injury due to extension of thrombosis from the blind pouch into eloquent perforator vessels. Minimizing this risk requires careful evaluation of anatomy and strategic occlusion, which preserves runoff into relatively large vessels, such as the superior cerebellar artery, the anterior inferior cerebellar artery, or the penetrating branch from the blind pouch, as much as possible.

Differing Effects of Aliskiren/Amlodipine Combination and High-Dose Amlodipine Monotherapy on Ambulatory Blood Pressure and Target Organ Protection.

The aim of this study was to compare an aliskiren/amlodipine combination with high-dose amlodipine monotherapy on ambulatory blood pressure monitoring (ABPM) and organ protection. The study was a prospective, randomized, multicenter, open-label trial in elderly essential hypertensive patients. A total of 105 patients with clinic BP (CBP) ≥140/90 mm Hg with amlodipine 5 mg were randomly allocated to aliskiren (150-300 mg)/amlodipine (5 mg) (ALI/AML group, n=53) or high-dose amlodipine (10 mg) (h-dAML group, n=52) and treated for 16 weeks. Each patient's CBP, ABPM, urine albumin-to-creatinine ratio (UACR), and brachial-ankle pulse wave velocity (baPWV) were measured at baseline and at the end of the study. The ALI/AML and h-dAML groups showed similarly reduced mean 24-hour SBP, daytime SBP, nighttime SBP, and baPWV. However, UACR reduction was significantly greater in the ALI/AML group (P=.02). ALI/AML was significantly less effective in reducing early-morning BP (P=.002) and morning BP surge (P=.001) compared with h-dAML.

Identification of Ecl family genes that extend chronological lifespan in fission yeast.

In fission yeast, we identified two genes, named ecl2+ and ecl3+, that are paralogous to ecl1+, which extends the chronological lifespan. Both ecl2+ and ecl3+ extend the chronological lifespan when overexpressed as ecl1+. ecl2+ and ecl3+ encode 84- and 89-amino acid polypeptides respectively that are not annotated in the current database. The Ecl2 protein is localized mainly in the nucleus, as Ecl1. These results suggest that ecl1+, ecl2+, and ecl3+ have overlapping functions in the regulation of chronological lifespan.

[Construction and evaluation of new anti-cancer drug prescription support system to promote proper use of anticancer drugs].

In the Nagoya City University Hospital, we started an Anti-cancer drug prescription support system according to which physicians input the injection prescription order from the regimen, together with the Outpatient Oncology Unit established in May, 2007. In order to prepare the anti-cancer drug more safely, we constructed a new Anti-cancer drug preparation support system(new system) at the same time. We investigated and evaluated the time and accuracy required for the preparation between the old and new systems. In the old system, we used electronic calculators or manual methods to perform calculations in the prescription procedure. In the new system, notes are automatically printed out with the kind, amount, and extraction amount of the dissolution liquid according to the dosage of the given anti-cancer drug for the injection prescription. Therefore, even a person with little experience in the preparation can confirm the preparative procedure accurately and promptly. Moreover, this system improves the efficiency of the preparation and it is thought that the utility is high as a part of the risk management.