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Occurrence of acute middle cerebral artery occlusion with common carotid artery occlusion is rare, and its treatment may be complicated. If the approach route cannot be secured because of carotid artery occlusion, endovascular embolectomy may not be indicated. The best treatment approach for such cases remains controversial. A woman in her 70s was transferred to our hospital in ambulance following a sudden onset of dysarthria and left hemiparesis. Magnetic resonance imaging revealed an ischemic lesion in the right basal ganglia and occlusion of the right common carotid and intracranial middle cerebral arteries. Emergency embolectomy was performed for acute middle cerebral artery occlusion. Postoperative magnetic resonance imaging revealed complete recovery of the right middle cerebral artery blood flow. Emergency embolectomy can effectively treat acute middle cerebral artery occlusion with common carotid artery occlusion. Keywords: Embolectomy, Middle cerebral artery occlusion, Chronic carotid artery occlusion

Objective The current study aimed to assess the risk factors and preventive measures for valve inversion after lumboperitoneal shunt (LPS) construction. Methods The medical records of patients who were admitted to Mito Brain Heart Center from July 2015 to October 2018 were retrospectively analyzed. Next, clinical and neuroimaging data were collected from electronic medical charts and operative notes. The cause of valve reversal was investigated. In addition, a simulated shunt device was established and the efficacy of countermeasures was evaluated. Results The mean age of the participants was 69.3 (range: 46–88) years, and there were 15 men and 22 women. In total, 20 and 17 patients presented with secondary and idiopathic normal pressure hydrocephalus, respectively. Further, 8 patients had valve reversal. Conclusions The distance between the valve and spinous process was found to be significantly correlated with valve reversal. However, the condition can be prevented by fixing the tube at the nuchal ligament.

Objective Opening of mastoid air cells (MACs), a complication of lateral suboccipital craniotomy for microvascular decompression (MVD), might cause cerebrospinal fluid (CSF) leakage and meningitis. Only a few studies have investigated the association of degree of MAC development and actual opening of MACs. The present study focused on preoperative risk assessment for predicting the opening of MACs. Patients and methods The study included 204 consecutive patients who underwent MVD at our hospital between January 2014 and December 2018. We retrospectively collected clinical and neuroimaging data from electronic medical charts and discharge summaries. MACs were classified into four types according to neuroimaging data. Postoperative computed tomography (CT) was used to assess patients with and without CSF leakage into MACs. Results No CSF leakage was observed into types 1 and 2 MACs, but it was noted in 14 of 46 patients (30 %) with type 3 and 44 of 58 patients (76 %) with type 4 MACs. Opening of MACs during surgery could not be recognized in 33 (57 %). CSF rhinorrhea was noted in 1 of the 58 patients with CSF leakage into MACs and meningitis was not noted. Conclusion Patients with types 3 and 4 MACs have a high risk of CSF leakage. Complete prevention of mild symptoms, such as ear obstruction, is challenging even if opened MACs are sealed, but serious complications, such as CSF rhinorrhea and meningitis, can be avoided. For cases in which preoperative CT reveals a high risk of opening of MACs, preventive closure should be performed.

We reviewed reports about the postoperative course of hemifacial spasm (HFS) after microvascular decompression (MVD), including in our own patients, and investigated treatment for delayed resolution or recurrence of HFS. Symptoms of HFS disappear after surgery in many patients, but spasm persists postoperatively in about 10–40%. Residual spasm also gradually decreases, with rates of 1–13% at 1 year postoperatively. However, because delayed resolution is uncommon after 1 year postoperatively, the following is advised: (1) In patients with residual spasms after 1 year postoperatively (incomplete cure) or who again experience spasm ≥ 1 year postoperatively (recurrence), re-operation is recommended if the spasms are worse than before MVD. (2) When re-operation is considered, preoperative magnetic resonance imaging (MRI) findings and intraoperative videos should be reviewed to ensure that no compression due to a small artery or vein was missed, and to confirm that adhesions with the prosthesis are not causing compression. If any suspicious findings are identified, the cause must be eliminated. Moreover, because of the risk of nerve injury, decompression of the distal portion of the facial nerve should be performed only in patients in whom distal compression is strongly suspected to be the cause of symptoms. (3) Cure rates after re-operation are high, but complications such as hearing impairment and facial weakness have been reported in 10–20% of cases, so surgery must be performed with great care.

Losing surgical needles during surgery is rare and there are no clear guidelines for managing such a loss. Although it is considered ideal to search until a lost needle is found, the operation usually proceeds at the discretion of the operating surgeon. The small needles (≤5) mm sometimes used

Synopsis Eleven patients with malignant ovarian tumors were treated with cisplatin. Antitumor effects and adverse reactions were evaluated in accordance with the Koyama-Saito criteria. 1 An overall response rate of therapy where patients receiving cisplatin either as a single agent or in combination with other drugs was 54.5% (6/11). 2 Statistically significant difference in response rate was not observed between primary and recurrent tumors, nor was it seen between incomplete excision and exploratory laparotomy. 3 Side effects most frequently observed were of gastrointestinal origin and mild. Adequate hydration and diuresis helped reduce renal toxicity.

Treatment of unclippable posterior cerebral artery (PCA) aneurysms frequently requires revascularization of the PCA, especially in cases with poor collateral circulation flow. We report on the microsurgical revascularization of the PCA territories in 3 patients having PCA aneurysms. Case 1 involved a P2 partially thrombosed large aneurysm. The patient did not tolerate temporary balloon occlusion of the PCA. Case 2 had a P2 thrombosed fusiform aneurysm. Case 3 presented a P1/2 thrombosed giant aneurysm. A balloon occlusion test (BOT) was not used in Case 2 or 3. All patients underwent direct operation with revascularization: STA-PCA bypass and trapping of the aneurysms via combined approach, with favorable outcome. We discuss these operative approaches and procedures for microsurgical revascularization.

An event-related fMRI technique was used to assess neural responses to financial reward and penalty during a simple gambling task. We attempted to determine whether brain activities are dependent on the unique context of an event sequence. Thirty-six healthy volunteers participated in the study. The task was to guess the color of the suit of a card on each trial and to respond by pressing a button. Every correct response (“win”) and incorrect response (“loss”) was associated with financial reward and penalty, respectively. The magnitude of reward or penalty in each trial did not change; however, the subjects' self-reported emotional arousal was significantly higher for the events of “the fourth win of four wins in a row” and “the fourth loss of four losses in a row.” We also found that the bilateral anterior cingulate and medial prefrontal cortices were specifically activated when the subjects experienced “the fourth win of four wins in a row” and “the fourth loss of four losses in a row. ”When the subjects experienced “a win following four losses in a row” or “a loss following four wins in a row, ”the right dorsolateral prefrontal cortex was specifically activated. Our data indicate that there exist brain activities associated with the event-sequence context in which abstract reward or penalty is received. These context-dependent activities appear to be crucial for adapting oneself to new circumstances and may account for clinical symptoms of various mental illnesses in which dysfunction of these regions has been reported.

A 66-year-old man suffered from subarachnoid hemorrhage due to the rupture of a right middle cerebral artery aneurysm that was detected by 3D-CTA. He underwent an emergent clipping operation. Incidentally, postoperative DSA demonstrated dural arteriovenous fistula in the left anterior cranial fossa, which was fed by the left anterior ethmoidal artery and drained into the superior sagittal sinus via the cortical vein of the left frontal lobe. We performed electrocoagulation and division of the fistula at the second surgery. Subsequently, he underwent a ventriculo-peritoneal shunt and was discharged without any neurological deficits. We reviewed reported cases of rare association of ruptured cerebral aneurysm and dural arteriovenous fistula in the left anterior cranial fossa.

We studied whether 8-iso-PGF2alpha, nonenzymatic arachidonyl peroxide, participated in the pathogenesis of delayed vasospasm using a canine subarachnoid hemorrhage (SAH) model. Fourteen adult mongrel dogs were divided into two groups, two-hemorrhage SAH group (n = 8) and control group (n = 6). The contents of 8-iso-PGF2alpha in CSF, the basilar artery segment, and subarachnoid clot were measured by enzyme immunoassay kit. The CSF 8-iso-PGF2alpha content on Day 7 in the SAH group was 67.9+/-29.9 pg ml(-1) (n = 8), which was significantly higher than 27.1+/-13.8 (n = 8) on Day 0 in the SAH group, and 33.2+/-14.4 pg ml(-1) (n = 5) on Day 7 in the control group. The 8-iso-PGF2alpha content in the basilar artery segment with spasm on Day 7 in the SAH group was 13.5+/-1.9 pg mg(-1) wet weight (n = 8), significantly higher than 8.7+/-1.9 (n = 6) in the control group. The 8-iso-PGF2alpha content in subarachnoid clot was 1.7+/-1.4 ng g(-1) wet weight (n = 8). Significant elevation of the 8-iso-PGF2alpha contents in the CSF and the basilar artery segment occurred on Day 7 in the SAH group. The subarachnoid clot enclosed the basilar artery on Day 7, contained a considerable amount of 8-iso-PGF2alpha. These results suggested that 8-iso-PGF2alpha could play a crucial role in the pathogenesis of the delayed cerebral vasospasm.

The temperature change in GaSb melt caused by introducing ultrasonic vibrations of 10 kHz was measured to investigate why In x Ga1-x Sb single crystals were grown under vibrations. The vibrations reduced the temperature difference near the melt surface across the radial direction, but they did not influence the temperature difference along the melt depth. The stirring of the melt by vibrations brought about the decrease of constitutional supercooling, and as a result the growth of In x Ga1-x Sb single crystals was promoted.

In order to compare the efficiencies of successive precipitation and column elution methods in compositional fractionation, mixtures of two styrene-acrylonitrile random copolymers with different chemical compositions were fractionated by the two methods by using the methyl ethyl ketone-cyclohexane system. The compositional distribution curve determined by each method was compared with the curve calculated from a theory on compositional fractionation. The value of a parameter K, which shows the efficiency of compositional fractionation, was determined to have the best agreement between the experimental and calculated curves. It was found that the column elution method is more effective than the successive precipitation method.

Paddy fields are kept in a flooded condition for at least three months during the growing period of rice plants. The chemical characteristics of soils in paddy fields, therefore, are remarkably different from these of upland fields. Many soil constituents undergo great changes during the flood period. The soil can be understood as a redox system (1, 17). Japanese workers (3) have found oxidized and reduced layers in the submerged soil, which cause the soil to lose nitrogen by nitrification of ammonium and denitrification of nitrate and/or nitrite.