Butterfly needle tap and suction (BTS) technique: a treatment for recurrent chronic subdural hematoma after burr hole craniostomy.

BACKGROUND: In this study, we propose a butterfly needle tap and suction (BTS) technique for recurrent chronic subdural hematoma (CSDH) as an alternative to reoperation with burr hole craniostomy (BHC) and investigate its efficacy and safety. The procedure involves percutaneous puncture through the burr hole created during the previous surgery and subsequent hematoma evacuation using a butterfly needle. METHODS: This retrospective study included patients who underwent BTS for CSDH at Ogaki Municipal Hospital between January 2017 and December 2020. The follow-up CT scans were reviewed after several weeks. We evaluated the number of percutaneous punctures required to resolve CSDH during the BTS technique, the volume of the evacuated hematoma, and procedure-related complications. RESULTS: Twenty-six patients were enrolled in the study, 21 of whom achieved resolution of the hematoma using punctures with the BTS technique alone (mean, 2.2 ± 1.5). Five patients had a recurrence of hematoma after one or more punctures during the BTS technique, and they underwent reoperation with BHC according to the surgeon's decision or patient requests. Among the 55 punctures, 43.0 ± 16.0 ml of hematoma was evacuated per puncture. The evacuated hematoma volume was 41.9 ± 16.4 ml in the BTS-alone group and 49.4 ± 12.9 ml in the reoperation group, with no significant difference (p = 0.25). Three patients complained of a headache during the puncture procedure, and no other complications, including intracranial hemorrhage or infection, were reported therein. CONCLUSIONS: The BTS technique is an effective alternative to reoperation with BHC.

Deep-Sea Phylogeographic Structure Shaped by Paleoenvironmental Changes and Ongoing Ocean Currents Around the Sea of Japan in a Crangonid Shrimp, Argis lar.

The deep-sea crangonid shrimp, Argis lar, is a highly abundant species from the northern Pacific Ocean. We investigated its phylogeographic and demographic structure across the species' extensive range, using mitochondrial DNA sequence variation to evaluate the impact of deep-sea paleoenvironmental dynamics in the Sea of Japan on population histories. The haplotype network detected three distinct lineages with allopatric isolation, which roughly corresponded to the Sea of Japan (Lineage A), the northwestern Pacific off the Japanese Archipelago (Lineage B), and the Bering Sea/Gulf of Alaska (Lineage C). Lineage A showed relatively low haplotype and nucleotide diversity, a significantly negative value of Tajima's D, and a star-shaped network, suggesting that anoxic bottom-water in the Sea of Japan over the last glacial period may have brought about a reduction in the Sea of Japan population. Furthermore, unexpectedly, the distributions of Lineage A and B were closely related to the pathways of the two ocean currents, especially along the Sanriku Coast. This result indicated that A. lar could disperse across shallow straits through the ocean current, despite their deep-sea adult habitat. Bayesian inference of divergence time revealed that A. lar separated into three lineages approximately 1 million years before present (BP) in the Pleistocene, and then had been influenced by deep-sea paleoenvironmental change in the Sea of Japan during the last glacial period, followed by a more recent larval dispersal with the ocean current since ca. 6 kilo years BP.

Analyses of optical rays in KTN optical beam deflectors for device design.

The potassium tantalate niobate (KTN) optical beam deflector is an electro-optic deflector without any moving parts that works at frequencies higher than 200 kHz. In this paper, we discuss the performance parameters of this deflector. Optical beams are bent by the spatial distribution of the refractive index in the KTN crystal block used in this deflector. In addition to the deflection function, the index distribution operates as a cylindrical convex lens. Therefore, the deflector is often used with glass cylindrical lenses to cancel out the lens function. We analyzed optical rays curving in the block based on the graded index lens theory. We describe the way in which performance parameters, such as the deflection angle, change, depending on both the choice of the compensating lenses and the parameters of the KTN block, namely its size and charge density. We concentrate especially on methods designed to improve the resolvable spot number, which is the most important figure of merit for optical deflectors. One way to achieve improvement is to input a collimated beam or a slightly converging beam into the KTN block.

A Case of Recurrence of Benign Convexity Primary Intraosseous Meningioma.

Meningiomas originating within the bones of the skull are rare and have been reported as primary intraosseous meningiomas (PIOM). Moreover, PIOMs with a skull base location or malignant pathology are predisposed to recurrence; however, recurrence is quite rare among PIOMs characterized by a convexity location and benign pathology. Here, we present a case of extensive recurrence of a convex intraosseous meningioma with benign pathology. A 72-year-old woman presented with a headache to our hospital. Gd contrast-enhanced magnetic resonance imaging revealed an enhanced tumor in the left frontal to the parietal region extending through the calvarial bone and invading the subdural space and subcutaneous tissue. Skull radiograph and computed tomography identified a remarkable osteolytic change in the lesion. Macroscopic complete resection (MCR) of the tumor and the surrounding tissues was performed. The tumor was histopathologically diagnosed as a transitional meningioma (World Health Organization grade 1). Seven years after the surgery, the patient presented with dysarthria, and the recurrence of the tumor was identified as massive lesions extending through the calvarial bone to the orbital bone, partially protruding into the brain and scalp. MCR was performed again, with the reconstruction of the skull for an extensive calvarial area using a titanium plate. This case is unique due to the extensiveness of the recurrent tumor and its rarity. Here, we report the details of the clinical course and discuss the characteristics of this case.

Association of infective endocarditis caused by Abiotrophia defectiva with mycotic aneurysm formation: A case report and the review of the literature.

A 74-year-old woman with a history of mitral valve prolapse with mitral regurgitation was transferred to our hospital due to infective endocarditis. Blood culture revealed Abiotrophia defectiva which is known as a nutritional variant streptococcus. Transesophageal echocardiography revealed posterior leaflet (P2) prolapse due to rupture of tendon chordae with severe mitral regurgitation and vegetation on posterior leaflet. Magnetic resonance imaging (MRI) revealed multiple infarction lesions in left temporal lobe and parietal lobe and mycotic aneurysm formation of right middle cerebral artery. Because A. defectiva cannot be cultured on non-supplemented media, their prevalence may be underreported. Learning objective: A number of causative microorganisms of infective endocarditis have been identified. Streptococci and staphylococci account for 80 % of cases of infective endocarditis. Abiotrophia defectiva does not grow in ordinary growth media and its prevalence may be underreported. It is important to know A. defectiva causes infective endocarditis with mycotic aneurysm formation.

Geographical distributions of mitochondrial DNA lineages reflect ancient directions of river flow: a case study of the Japanese freshwater shrimp Neocaridina denticulata denticulata (Decapoda: Atyidae).

The mitochondrial DNA phylogeographical structure of the freshwater atyid shrimp Neocaridina denticulata denticulata was investigated near the Yura and Kako Rivers in western Japan. To assess the biological significance of drainage evolution, fragments of 390 base pairs (bp) extending from the NADH dehydrogenase subunit 2 gene to the tryptophan transfer RNA gene were sequenced for 246 specimens from twenty locations. The phylogenetic tree detected two distinct clades corresponding to the region along the Sea of Japan and Seto Inland Sea, respectively. Geographical mapping of the two clades well reflected the river capture, in which the upper reaches of the Yura River draining into the Sea of Japan had been captured from the Kako River into the Seto Inland Sea. The clear pattern of mitochondrial DNA distribution may be accounted for by the ecological characteristics of species that minimize passive downstream drift, local adaptation, and mountain topography.

Acute coronary syndrome due to native coronary occlusion proximal to a patent bypass graft: a case report.

BACKGROUND: Primary percutaneous coronary intervention (PCI) for acute coronary syndrome has significantly contributed to improvements in overall outcomes. However, clinical challenges exist when performing urgent PCI for patients with a history of coronary artery bypass grafting (CABG). CASE SUMMARY: An 83-year-old man with a history of CABG presented with an inferior ST-elevation myocardial infarction (STEMI). Emergent coronary angiography showed an occlusion of the right coronary artery that had been previously grafted with the right gastroepiploic artery. Primary PCI for the native coronary artery was performed on the assumption that the bypass graft had been occluded. We were unable to attain angiographic antegrade flow after balloon angioplasty, and intravascular ultrasound revealed a ruptured plaque with a thrombus proximally and a patent bypass graft with complete recanalization distally. These findings suggested that the plaque rupture with resultant thrombus formation proximal to the anastomosis eventually overlay the patent bypass graft. Subsequent stent implantation covering only the culprit site with a residual stenosis proximal to the anastomosis was performed, resulting in good patency of both the native coronary artery and bypass graft for more than 3 years. DISCUSSION: This is the first documented case of a patient with STEMI due to proximal native coronary artery occlusion with a thrombus overlying a patent bypass graft. Intravascular ultrasound was helpful to recognize the distal patency and guide optimal stent implantation. This case illustrates the complexity of treating a patient with a history of CABG and the importance of a multifaceted approach in such an urgent situation.

S(N)2' reaction of organozinc reagents activated by catalytic tBu-P4 base in the presence of LiCl.

The tBu-P4 base was found to be an excellent catalyst for the activation of organozinc reagents. The base was used to promote the S(N)2' reaction of alpha,beta-unsaturated esters bearing a gamma-chloride in the reactions with various organozinc reagents in the presence of LiCl. The reactions proceeded in high yield with excellent chemo-and regioselectivity. The role of LiCl appears to be the activation of the gamma-chloride of the alpha,beta-unsaturated esters, which was confirmed by NMR spectroscopic study.

Right hemi-reconstruction of the left atrium using two equine pericardial patches for recurrent malignant fibrous histiocytoma: report of a case.

We report a case of recurrent malignant fibrous histiocytoma (MFH) in the left atrium, treated by removal of the tumor and the right half of the left atrium, which was reconstructed with two equine pericardial patches. Postoperative echocardiography showed patent right pulmonary veins and a properly shaped left atrium. The patient survived for 3 years after the operation with no cardiac symptoms.

A Rare Case of Pericardial Effusion in a Patient with Silicosis.

Silicosis is an occupational lung disorder caused by inhalation of silica dust. It not only causes respiratory disorders but also affects other organs. We report an extremely rare case of silicosis complicated by pericarditis in an 83-year-old male. He had been working as a coal miner and was diagnosed with silicosis at the age of 63. Because he had experienced repeated pericardial effusions, he was referred for a surgical pericardial biopsy to elucidate the cause of his repeated pericardial effusion and to perform pericardial fenestration. Thoracoscopic surgery was performed. The pericardium was resected, and a drain was placed in the left thoracic cavity. Histopathological examination revealed the pericardial degeneration due to silicosis, suggesting that pericarditis and pericardial effusion are related to silicosis. The operation was successful, and he experienced no recurrence of pericardial effusion at the 7-month follow-up.

Obstructive shock with mediastinal hematoma caused by chest compressions after successful primary percutaneous coronary intervention.

A 75-year-old man with a history of hypertension was transferred to our hospital due to pulseless ventricular tachycardia. When return of spontaneous circulation was achieved, an electrocardiogram showed ST elevation in V1-4 leads. Successuful primary percutaneous coronary intervention was performed. However, on the next day, the patient's systolic blood pressure dropped to 60 mmHg despite using high-dose inotropic agents. Echocardiography and chest computed tomography revealed large mediastinal hematoma. A diagnosis of obstructive shock caused by massive mediastinal hematoma was made. Emergency surgical evacuation of hematoma and hemostasis was successfully performed. .

Left Ventricular Pseudo-aneurysm with Ventricular Septal Rupture Due to Anterior ST-segment Elevation Myocardial Infarction.

We report a case with the simultaneous occurrence of pseudo-aneurysm of the left ventricle and ventricular septal rupture, which was successfully surgically repaired. A 77-year-old woman with a history of aortic valve replacement and coronary bypass graft presented to our clinic due to chest pain. She was diagnosed with anterior ST-segment elevation myocardial infarction (STEMI) based on an electrocardiogram. Echocardiography revealed pseudo-aneurysm of the left ventricle and ventricular septal rupture. Coronary angiography revealed 99% stenosis with delayed contrast filling in the mid left anterior descending artery. Surgical repair with a bovine pericardium patch was performed, and the postoperative course was uneventful.

Activation of organozinc reagents with t-Bu-P4 base for transition metal-free catalytic SN2' reaction.

The t-Bu-P4 base was found to be an excellent catalyst for activating organozinc reagents and was used to promote the S(N)2' reaction of alpha,beta-unsaturated esters bearing a gamma-chloride using various organozinc reagents: these reactions proceeded in high yields with excellent chemo-and regioselectivity.

Preoperative advanced left ventricular remodeling predisposes to recurrence of ischemic mitral regurgitation with less reverse remodeling.

BACKGROUND AND AIM OF THE STUDY: The recurrence of ischemic mitral regurgitation (IMR) after mitral annuloplasty is a major determinant of patient survival. The study aim was to investigate, retrospectively, the characteristics of patients with postoperative recurrence of IMR. METHODS: Twenty patients who had no regurgitation immediately after mitral annuloplasty, were allocated to either recurrence (n = 8) or non-recurrence (n = 12) groups. Recurrence was defined as any interval upgrade of regurgitation. The patients' preoperative profiles and parameters of preoperative, immediate postoperative and intermediate postoperative echocardiography were compared. RESULTS: Patients with recurrence were more frequently dyspneic and had a significantly higher cardiothoracic ratio (p = 0.041) on radiologic examination. The preoperative left ventricular end-diastolic and end-systolic dimensions (p = 0.018 and 0.021), and left ventricular end-diastolic and end-systolic volumes (p = 0.038 and 0.041), and left ventricular wall motion score (p = 0.0002) were significantly greater in the recurrence group. These differences in left ventricular volume persisted at the immediate and intermediate postoperative stages. Reverse remodeling occurred at a ca. 50% lower rate in the recurrence group, and was associated with significantly smaller preoperative left ventricular dimension and volume. At intermediate follow up, the left ventricular ejection fraction was improved and significantly greater in the non-recurrence group (p = 0.024), but remained unchanged in the recurrence group. CONCLUSION: Advanced left ventricular remodeling and dilatation before surgery predispose to a recurrence of mitral regurgitation and a lesser incidence of reverse remodeling. Mitral annuloplasty alone may have a limited role in preventing the recurrence of regurgitation in the case of advanced IMR, without functional recovery.

Radical repair of cor triatriatum with partially unroofed coronary sinus and persistent left superior vena cava 35 years after operation for tetralogy of Fallot.

We report a rare case of simultaneous repair for Cor triatriatum (CT), partially unroofed coronary sinus (CS) with persistent left superior vena cava (PLSVC), moderately severe tricuspid regurgitation, and atrial flutter 35 years after radical operation for tetralogy of Fallot (TOF). A 40-year-old woman underwent patch closure of atrial septal defect as to drain blood from left SVC to right atrium (RA), excision of diaphragm in left atrium (LA), tricuspid annuloplasty, and cryoablation. Postoperative course was uneventful with successful anatomical correction.

Nucleophilic aromatic substitution using Et3SiH/cat. t-Bu-P4 as a system for nucleophile activation.

A novel type of deprotonative arylation of nucleophiles was conducted using Et(3)SiH/cat. t-Bu-P4 and the powerful S(N)Ar reactions of aryl fluorides were accomplished using alcohols and malonates as nucleophiles.

Mid-term changes of left ventricular geometry and function after Dor, SAVE, and Overlapping procedures.

BACKGROUND: The aim of this study was to investigate the mid-term changes of left ventricular (LV) geometry and function after Dor, septal anterior ventricular exclusion (SAVE), and Overlapping ventricular remodeling procedures. METHODS: Forty-three patients who underwent LV reconstruction for end-stage ischemic heart disease, were divided into three groups, undergoing Dor (n=15), SAVE (n=12), and Overlapping procedures (n=16). Coronary artery bypass grafting and mitral annuloplasty were performed concomitantly when indicated. Left ventricular diastolic and systolic dimensions (LVDd and LVDs), LV end-diastolic and end-systolic volume indexes (LVEDVI and LVESVI), LV ejection fraction (LVEF), deceleration time (DcT), sphericity index (SI), and grade of mitral regurgitation were measured on preoperative and postoperative (immediately and at intermediate-term) echocardiography. RESULTS: In the Dor group, the LVEDVI and LVESVI were significantly reduced immediately after the operation, and increased again at intermediate follow-up. The SI was significantly increased immediately after the operation and increased thereafter in a linear fashion. In the SAVE group, the DcT was significantly reduced immediately after the operation and was not improved in the later stage. In the Overlapping group, the LVEDVI and LVESVI were significantly reduced, and remained as such at intermediate follow-up. The SI was not increased and remained almost unchanged after the operation. CONCLUSION: Progression in LV sphericity after the Dor procedure and persistent reduction of the DcT after the SAVE procedure seem to be procedure-related problems. The Overlapping procedure provided significant LV volume reduction, maintaining the most elliptical LV shape with acceptable early and late mortality.

Phosphazene base-catalyzed condensation of trimethylsilylacetate with carbonyl compounds.

The t-Bu-P4 base was found to be an excellent catalyst for the condensation of trimethylsilylacetate or trimethylacetonitrile with carbonyl compounds to form functionalized alkenes and beta-enaminoesters were also synthesized by the condensation with formanilides.

Phosphazene base-promoted halogen-zinc exchange reaction of aryl iodides using diethylzinc.

The use of catalytic t-Bu-P4 base dramatically improved the performance of halogen-zinc exchange of aryl iodides, and the arylzinc derivatives were functionalized under copper-free reaction conditions.

Phosphazene base-promoted functionalization of aryltrimethylsilanes.

The activation of Ar-Si bonds in aryltrimethylsilane was investigated using a catalytic amount of t-Bu-P4 base and selective functionalizations of aryltrimethylsilanes in the absence of strong electron withdrawing groups on the aromatic rings were accomplished.