Ossifying fibroma arising from the zygomatic arch: A case report.

INTRODUCTION: Ossifying fibroma (OF) is a rare type of tumor characterized by fibrous tissue proliferation with cementum- or bone-like hard tissue formation. Since its first report by Montgomery in 1927, several cases of OF have been reported; however, no cases of OF arising from the zygomatic arch have been reported. Herein, we report a case of OF arising from the zygomatic arch. CLINICAL CASE SUMMARY: A 70-year-old female visited our department in February 2017 because of a gradually growing osseous protrusion in the right zygomatic region, which she was aware of since the previous 6 months. A 3.3cm×3.2-cm area of swelling was observed in the region. Computed tomography confirmed the presence of a granulated lesion on the surface of the right zygomatic arch. Accordingly, benign bone tumor was diagnosed, and tumor resection was subsequently performed. Histopathological analysis revealed irregularly arranged bone trabeculae, an increased number of fibroblasts, and collagen fibers between the bone trabeculae; accordingly, OF was diagnosed. No clinical or radiographic evidence of recurrence was observed during the 1.5-year follow-up period. DISCUSSION: A granulated lesion was present on the surface of the right zygomatic arch, and the boundary between the lesion and surrounding bone was clear. Resection of the lesion from the zygomatic arch was relatively easy. Thus, OF was diagnosed. If OF is suspected, a risk of recurrence persists; therefore, shaving the area including the bones surrounding the lesion may be necessary. Although detailed causes of OF and osteoma remain unknown, past trauma has been indicated as a common etiology. However, compared with the frequency of fractures in the zygomatic arch, the frequency of OF and osteoma is rare; thus, the etiology of OF and osteoma remains to be fully elucidated.

Ultrasound-guided supraclavicular brachial plexus block in upper limb surgery: outcomes and patient satisfaction.

We examined the outcomes and levels of patient satisfaction in 202 consecutive cases of ultrasound-guided supraclavicular brachial plexus block (SBPB) in upper limb surgery performed between September 2007 and March 2010. All blocks were performed by orthopaedic surgeons using ultrasound visualisation with a high-frequency linear probe. The probe was placed in the coronal-oblique plane in the supraclavicular fossa, and the puncture was 'in-plane' from lateral to medial. Most of the blocks were performed with 0.75% ropivacaine/1% lidocaine (1:1), with or without adrenaline in 1:200 000 dilution. In 201 patients (99.5%) the brachial plexus block permitted surgery without conversion to general anaesthesia. The mean procedure time for block was 3.9 min (2 to 12), the mean waiting time for surgery was 34.1 min (10 to 64), the mean surgical time was 75.2 min (6 to 232), and the mean duration of post-anaesthetic analgesia was 437 min (171 to 992). A total of 20 patients (10%) developed a transient Horner's syndrome. No nerve injury, pneumothorax, arterial puncture or systemic anaesthetic toxicity were recorded. Most patients (96.7%) were satisfied with ultrasound-guided SBPB. This study demonstrates the efficacy and safety of ultrasound-guided SBPB for orthopaedic surgery on the upper limb.

Cellular localization of lipocalin-type prostaglandin D synthase (beta-trace) in the central nervous system of the adult rat.

We applied high-resolution laser-scanning microscopy, electron microscopy, and non-radioactive in situ hybridization histochemistry to determine the cellular and intracellular localization of lipocalin-type prostaglandin D synthase, the major brain-derived protein component of cerebrospinal fluid, and its mRNA in leptomeninges, choroid plexus, and parenchyma of the adult rat brain. Both immunoreactivity and mRNA for prostaglandin D synthase were located in arachnoid barrier cells, arachnoid trabecular cells, and arachnoid pia mater cells. Furthermore, meningeal macrophages and perivascular microglial cells, identified by use of ED2 antibody, were immunopositive for prostaglandin D synthase. In the arachnoid trabecular cells, the immunoreactivity for prostaglandin D synthase was located in the nuclear envelope, Golgi apparatus, and secretory vesicles, indicating the active production and secretion of prostaglandin D synthase. In the meningeal macrophages, prostaglandin D synthase was not found around the nucleus but in lysosomes in the cytoplasm, pointing to an uptake of the protein from the cerebrospinal fluid. Furthermore, the existence of meningeal cyclooxygenase (COX) -1 and COX-2 was investigated by Western blot, Northern blot, and reverse transcriptase-polymerase chain reaction (RT-PCR), and the colocalization of COX-2 and prostaglandin D synthase was demonstrated in virtually all cells of the leptomeninges, choroid plexus epithelial cells, and perivascular microglial cells, suggesting that these cells synthesize prostaglandin D(2) actively. Alternatively, oligodendrocytes showed prostaglandin D synthase immunoreactivity without detectable COX-2. The localization of lipocalin-type prostaglandin D synthase in meningeal cells and its colocalization with COX-2 provide evidence for its function as a prostaglandin D(2)-producing enzyme.

[Studies on coagulase negative Staphylococci isolated from urine].

This study was conducted to invesitigate the relative frequency of Staphylocossus spp. and coagulase negative Staphylococci (CNS) isolates from urine at Juntendo University Hospital in Tokyo. The frequency of Staphylococci spp. was encountered in about 10% of the cases from 1984 to 1994 (except 1992 and 1993), and no significant annual changes were observed. The frequency of Staphylococcus aureus has been gradually increasing from 1986. The relative frequency of CNS (321 strains) from 1989 to 1994 were as follows; Staphylococcus epidermidis 36%, Staphylococcus saprophyticus 26%, Staphylococcus haemolyticus 22%, Staphylococus caprae 8%, and other CNS 8%. S. saprophyticus, most of which were isolated from female out-patients, were suggested to be the important pathogen of acute urinary tract infections. All of S. caprae were isolated from male patients. Most of S. epidermidis isolated from inpatients of urinary tracts with other bacteria.

[Antimicrobial susceptibility of coagulase negative staphylococci isolated from urine].

This study was conducted to investigate the antimicrobial susceptibilities of the strains of coagulase negative Staphylococci (CNS) isolates from urine at Juntendo University Hospital in Tokyo from 1989 to 1994. The susceptibility testing were performed according to the broth dilution method standerdized by the Japan Society of Chemotherapy. The following bacteria were tested; Staphylococcus epidermidis (59 strains), Staphylococcus haemolyticus (42 strains), Staphylococcus saprophyticus (30 strains). The antimicrobial agents tested wre as follows; Oxacillin, Cefazolin, Imipenem, Flomoxef, Gentanicin, Tobramycin, Arbekacin, Clindamycin, Tetracycline, Minicycline, Vancomycin, Sulfamethoxaxole-Trimethoprim and, Ofloxacin. 1. 100% of S. caprae, 62% of S. haemolyticus and 42% of S. epidermidis were resistant to Oxacillin. All strains of S. saprophyticus were sensitive to Oxacillin. 2. S. saprophyticus showed the highest sensitivities to all anti-microbial agents. 3. All strains of S. caprae were resistant to Tobramycin and Clindamycine. 4. Vancomycin and Arbecacin has strong antimicrobial activities to all CNS. S. saprophyticus, which is the pathogen of acute urinary tract infections, showed high sensitivities to many antimicrobial agents. On the other hand, S. haemolyticus and S. caprae, which are the predominate microorganisms of bacteriuria of inpatients, showed high resistance rates to antimicrobial agents.