The Importance of STAT6 in a Schwannoma-like Grade III Solitary Fibrous Tumor/Hemangiopericytoma Located in the Cerebellopontine Angle and Meckel's Cave.

BACKGROUND: Hemangiopericytoma (HPC) is a rare mesenchymal tumor of the brain that occurs in the central nervous system as a solitary fibrous tumor. Surgical treatment of HPC is known to be beneficial, but results on the role of complete resection and adjuvant radiation are conflicting. However, it is often difficult to detect a central nervous system solitary fibrous tumor/HPC before surgery. We describe a presumed left trigeminal schwannoma that was histopathologically shown to be an HPC. CASE DESCRIPTION: A 65-year-old man presented with paresthesia of the second and third branches of the left trigeminal nerve. Magnetic resonance imaging showed a tumoral lesion in the left cerebellopontine angle and Meckel's cave. We suspected a schwannoma and performed surgery, which resulted in only a partial resection because of tumor bleeding and unexpected intraoperative histologic findings. We could not achieve a definitive diagnosis. However, we observed local recurrence and disseminated lesions 5 and 6.5 years later, respectively. We performed a second surgery and were able to definitively diagnose the lesion as a grade III HPC based on the positive expression of STAT6 during immunostaining. CONCLUSIONS: As solitary fibrous tumor/HPC requires gross total resection for effective resolution, it is imperative to consider it in the differential diagnoses of similar tumors. If an unusual pathologic image is found, we recommend rapid immunostaining for STAT6 to reach a definitive conclusion regarding the tumor type. This case highlights the importance of considering HPC when screening or diagnosing central nervous system lesions, especially in this rare location.

Radiation-Induced Spinal Cord Cavernous Malformations Associated with Medulloblastoma: Case Report and Review of the Literature.

BACKGROUND: Radiation-induced spinal cord cavernous malformations (CMs) are rare pathologies compared with radiation-induced cerebral CMs. We present a case of a radiation-induced spinal cord CM developed 31 years after radiation therapy for medulloblastoma. CASE DESCRIPTION: A 37-year-old man developed a symptomatic spinal hemorrhagic lesion 31 years after radiation therapy for medulloblastoma. Magnetic resonance imaging revealed an intramedullary cystic lesion with a fluid-fluid level in the C7 area. Surgery was performed leading to an unclear diagnosis. Two years later, the patient had a relapse and underwent a second operation, allowing a definitive diagnosis of radiation-induced spinal cord CM. This is believed to be the second case of de novo intramedullary CM formation following spinal radiation therapy for medulloblastoma. CONCLUSIONS: Radiation-induced spinal cord CMs should be recognized as a possible late adverse effect in patients treated with radiation therapy for medulloblastoma.

[Recurrent Hiccups Caused by Malposition of the Peritoneal Catheter of a Lumboperitoneal Shunt: A Case Report].

A number of rare and unpredictable shunt-related complications after shunt placement to treat hydrocephalus have been described. Here a 78-year-old man who underwent lumboperitoneal (LP) shunt placement presented postoperatively with recurrent hiccups. Abdominal radiography and computed tomography performed at 7 days postoperative revealed that a peritoneal catheter had migrated into the upper abdominal cavity and contacted the diaphragm. The patient underwent LP shunt revision, during which the catheter was pulled back and repositioned within the lower abdominal cavity. The hiccups ceased completely. To our knowledge, the only other report of a similar complication was published in the 1980s. Here we describe a case in which a peritoneal catheter from an LP shunt migrated into the upper abdominal cavity and irritated the diaphragm, causing recurrent hiccups.

Scedosporium aurantiacum brain abscess after near-drowning in a survivor of a tsunami in Japan.

Many victims of the tsunami that occurred following the Great East Japan Earthquake on March 11, 2011 developed systemic disorders owing to aspiration pneumonia. Herein, we report a case of tsunami lung wherein Scedosporium aurantiacum was detected in the respiratory tract. A magnetic resonance image of the patient's head confirmed multiple brain abscesses and lateral right ventricle enlargement. In this case report, we describe a potential refractory multidrug-resistant infection following a tsunami disaster.

The role of tumor necrosis factor-α and interferon-γ in regulating angiomotin-like protein 1 expression in lung microvascular endothelial cells.

BACKGROUND: Angiogenesis in the alveolar septa is thought be a critical factor in pulmonary emphysema. Angiomotin-like protein 1 (AmotL1) is involved in angiogenesis via regulating endothelial cell function. However, the role of AmotL1 in the pathogenesis of pulmonary emphysema has not been elucidated. The objective of this study is to evaluate the expression of AmotL1 in lung tissues from a murine model with emphysema, as well as from patients with chronic obstructive pulmonary disease (COPD). Furthermore, we analyzed the regulation of AmotL1 expression by TNF-α and IFN-γ in endothelial cells in vitro. METHODS: Nrf2 knockout mice were exposed to cigarette smoke (CS) for 4 weeks, and the down-regulated genes affecting vascularity in the whole lung were identified by microarray analysis. This analysis revealed that the mRNA expression of AmotL1 decreased in response to CS when compared with air exposure. To confirm the protein levels that were indicated in the microarray data, we determined the expression of AmotL1 in lung tissues obtained from patients with COPD and also determined the expression of AmotL1, NFκB and IκBα in cultured normal human lung microvascular endothelial cells (HLMVECs) that were stimulated by TNF-α and IFN-γ. RESULTS: We found that the number of AmotL1-positive vessels decreased in the emphysema lungs compared with the normal and bronchial asthmatic lungs. IFN-γ pretreatment diminished the TNF-α-induced AmotL1 in the cultured HLMVECs by blocking the degradation of IκBα. CONCLUSIONS: These results suggested that IFN-γ exhibits anti-angiogenesis effects by regulating the expression of TNF-α-induced AmotL1 via NFκB in emphysema lungs.

Multiple Scedosporium apiospermum abscesses in a woman survivor of a tsunami in northeastern Japan: a case report.

INTRODUCTION: Scedosporium apiospermum is increasingly recognized as a cause of localized and disseminated mycotic infections in near-drowning victims. CASE PRESENTATION: We report the case of a 59-year-old Japanese woman who was a survivor of a tsunami in northeastern Japan and who had lung and brain abscesses caused by S. apiospermum. Initially, an aspergillus infection was suspected, so she was treated with micafungin. However, computed tomography scans of her chest revealed lung abscesses, and magnetic resonance images demonstrated multiple abscesses in her brain. S. apiospermum was cultured from her bronchoalveolar lavage fluid, and antimycotic therapy with voriconazole was initiated. Since she developed an increase in the frequency of premature ventricular contractions, an adverse drug reaction to the voriconazole was suspected. She was started on a treatment of a combination of low-dose voriconazole and liposomal amphotericin B. After combination therapy, further computed tomography scans of the chest and magnetic resonance images of her brain showed a demarcation of abscesses. CONCLUSIONS: Voriconazole appeared to have a successful record in treating scedosporiosis after a near drowning but, owing to several adverse effects, may possibly not be recommended. Thus, a combination treatment of low-dose voriconazole and liposomal amphotericin B may be a safe and effective treatment for an S. apiospermum infection. Even though a diagnosis of scedosporiosis may be difficult, a fast and correct etiological diagnosis could improve the patient's chance of recovery in any case.

Firing patterns of micturition-related neurons in the pontine storage centre in cats.

The pontine storage centre (PSC) and the pontine micturition centre (PMC) are known to be critical for urinary filling and emptying, respectively. In the present study, firing patterns of 45 neurons in the PSC area where electrical stimulation induced inhibition of the micturition reflex were analyzed in 20 male decerebrated and paralyzed cats. The electrically determined PSC area was widespread in the dorsolateral pontine reticular formation (P0-P4), ventrolateral to the PMC. Four major types of neurons were detected according to urinary storage/micturition cycles: tonic storage neurons (38%), phasic storage neurons (40%), tonic micturition neurons (9%) and phasic micturition neurons (13%). These four types of neurons were intermingled in the PSC. However, the tonic and phasic micturition neurons tended to be located within a limited area (P2-P3). These neurons were further classified into augmenting, constant and decrementing firing patterns. Some increased their firing prior to the storage/micturition phase initiation. Such preceding pattern was more frequently found in the tonic neurons than in the phasic neurons. In conclusion, the PSC neurons with diverse heterogeneous discharge patterns suggest that these neurons may organize a complex neuronal circuitry, which is critical in the neural control of the urinary continence.

Assessment of mechanical and thermal thresholds of human C nociceptors during increases in skin sympathetic nerve activity.

OBJECTIVES: The objective of the present study is to investigate the relationship between C-fiber nociceptor sensitivity and skin sympathetic nerve activity during mental arithmetic. METHODS: Single afferent C-fibers were identified simultaneously with spontaneous postganglionic sympathetic discharges and recorded from the peroneal nerve using microneurography in 23 normal subjects. Mechanical and heat thresholds were measured by 'marking' the nociceptor with suprathreshold stimuli, causing increased latency after a subsequent threshold stimulus at rest and during mental arithmetic. Skin sympathetic nerve activity was estimated by counting the number of bursts per minute. RESULTS: Thirty-two single C-fibers were identified. Eleven had polymodal receptors (mechanical and heat sensitive), eight were only sensitive to mechanical stimuli, two were only sensitive to heat stimuli, and 11 were insensitive to both. C-fibers were selected when the ratio of skin sympathetic nerve activity during mental arithmetic to that at rest was over 1.00. In 19 selected mechanical sensitive units, average mechanical threshold was 4.86 at rest and 4.84 during mental arithmetic. In 6 selected heat sensitive units, average heat threshold was 45.0 degrees C at rest and 43.4 degrees C during mental arithmetic. However, differences were not statistically significant. CONCLUSIONS: Physiological sympathetic stimulation did not affect afferent C-fiber nociceptor sensitivity to mechanical and heat stimuli in healthy subjects.

Segmental regulation pattern of body surface temperature in the rat hindlimb.

Body surface zones or 'thermatomes', whose temperature is regulated by a single spinal segment, were investigated by thermography in the rat hindlimb. First, the spatial relation between the dermatome delineated by dye extravasation and the corresponding thermatome was investigated in rats pretreated with intravenous application of Evans blue. Electrical stimulation of the spinal nerves and sympathetic trunk segments at L3 and L5 induced a distal dominant temperature decrease. In contrast, Evans blue extravasation appeared in the medial (in L3) and lateral (in L5) paw only by electrical stimulation of the spinal nerves. Second, thermatomes L1-L5 were determined in other rats. Electrical stimulation of the sympathetic trunk segments L1-L6 produced a temperature decrease in the abdomen, hindlimb, and tail. However, the hindlimb temperature was regulated mainly by L2-L5 levels, particularly by L4 and L5. The abdomen was regulated uniformly by L1-L6, and the tail by L6. It was demonstrated that thermatomes are manifested differently from the corresponding dermatomes in the rat hindlimb.

Different patterns of dipole source localization in gelastic seizure with or without a sense of mirth.

Dipole source localization corresponding to interictal spikes were estimated using EEG dipole tracing with a realistic three-shell head model in three patients with cryptogenic gelastic epilepsy. The dipole sources in two patients, whose gelastic seizures were accompanied by a subjective feeling of mirth, were estimated in the right or left medio-basal temporal regions. In the other patient, with gelastic seizures without a sense of mirth, the dipole sources were localized in the right frontal region corresponding to the anterior cingulate. The results suggest that the neural activities in hippocampal regions are involved with the generation of gelastic seizures with a sense of mirth and those in the cingulate might be associated with the motor act of laughter.

Case-control study of calcification of the hepatic artery in chronic hemodialysis patients: comparison with the abdominal aorta and splenic artery.

BACKGROUND AND AIMS: Studies of the hepatic artery are scarce. We have observed that hepatic artery calcification is very uncommon in patients with hyperparathyroidism that expedites calcification. METHODS: Plain abdominal CT was studied in 221 patients on chronic hemodialysis. Control consisted of 442 sex- and age-matched patients with other diseases. Calcification was graded as a percentage of the entire wall circumference for the aorta, and as a percentage of the entire length of the hepatic and splenic arteries from the celiac trunk to the hilum of each organ. RESULTS: Aortic calcification was seen in 79.2% of male dialysis patients, 22.1% of controls, 74.1% of female dialysis patients and 17.3% of controls (P < 0.0001). Hepatic artery calcification was seen in only 13 dialysis patients. The degree of calcification of the abdominal aorta was correlated with the length of hemodialysis period (P = 0.008), but not with serum calcium, serum phosphate or their product. Although serum parathormone levels were not correlated with calcification, seven of eight dialysis patients with hepatic artery calcification had very high parathormone levels. CONCLUSIONS: The hepatic artery is far less frequently calcified than are the abdominal aorta and splenic artery. This may be a teleologic phenomenon of the liver.

[Symptomatological and electrophysiological study on cold paresis in juvenile muscular atrophy of distal upper extremity (Hirayama's disease)].

Patients with juvenile muscular atrophy of distal upper extremity (Hirayama's disease) often show marked weakness of the fingers occurring with exposure to cold. We term this phenomenon cold paresis. We conducted an original test to induce cold paresis (Cold Paresis Inducement Test) in 11 patients of this disease and 10 normal controls. Cold paresis was induced in 9 of 11 patients, but was not induced in the 2 patients who had the disease longer than 20 years and in all normal controls. We examined the electromyogram of abductor digiti minimi during 5 Hz and 20 Hz rate of ulnar nerve stimulation at cooling. The patients in whom cold paresis was induced exhibited a waning of amplitude of compound muscle action potential (M wave) during 20 Hz stimulation. This waning was aggravated by intravenous administration of anticholinesterase (edrohponium). We found a remarkable conduction delay of M waveform at the waning by means of waveform analysis. These results suggest that cold paresis may be caused by a conduction block of the muscle fiber membrane in re-innervating muscles after active denervation.

EEG gamma band is asymmetrically activated by location and shape memory tasks in humans.

From the viewpoint of psychology, it is thought that perception analysis of the visual world includes two information processes: global (whole) and local (part) processes. It is assumed that the global process is carried out in the right hemisphere, and the local process, in the left hemisphere. In the present study, gamma EEG band activities during location memory (LM) task, as a global form, and shape memory (SM) task, as a local form, were calculated from the temporal, parietal and occipital areas using stimuli consisting of categorical patterns of small shapes. Gamma band activity during the SM task was greater than that during the LM task. It was assumed that the SM task requires a higher memory load condition than the LM task. In terms of the laterality ratio obtained from the whole electrode array, the gamma band was significantly activated in the right hemisphere during the LM task, and in the left hemisphere during the SM task. The gamma activation in the occipital area was significantly high in the right hemisphere for both tasks. High gamma band activation was observed in the right parietal area during the LM task and in the left temporal area during the SM task. It was concluded that global and local information processes occur in the left temporal areas and in the right occipitoparietal areas, respectively. The results of this study are useful in the assessment of visual cognition deficits in patients with cerebral hemispheric lesions in the physical therapy.

Dermatomes in the rat limbs as determined by antidromic stimulation of sensory C-fibers in spinal nerves.

Dermatomes of rats from C1 to T1 (forelimb) and from T12 to S2 (hindlimb) were determined by electrical stimulation of spinal nerves following the intravenous administration of Evans blue. After stimulation of the ventral ramus of a spinal nerve, a blue spotted area presenting the maximal innervation area of the spinal nerve appeared in the skin. Maximal innervation areas generally overlapped the adjacent areas. Each digit was innervated by two to three spinal nerves. Composite dermatomes were determined where boundary lines were defined as the midline of overlapping areas. Based on the composite dermatomes, boundary lines in the rat fore- and hindlimbs were revealed to loop around the antero-posterior axis showing a V-shaped pattern in the anterior and posterior aspects and converge to the ventral and dorsal midlines of the limb. The present dermatome chart may be applied to research concerning the segmental distribution of sensory C-fibers.