Objective
The optimal surgical approach for a trigone meningioma is still controversial. Here, we report two patients with trigone meningioma treated successfully via an occipital inter-hemispheric ...and trans-cortical approach in the lateral semi-prone position.
Clinical presentation
A 53-year-old woman was admitted to a local hospital with sudden transient dizziness and vomiting. The CT brain scan demonstrated a right intra-ventricular tumour. She was therefore transferred to our hospital for surgical treatment. The other patient was a 67-year-old woman who was admitted to a local hospital after a traffic accident and a CT brain scan revealed an incidental right intra-ventricular tumour. After referral to our hospital, periodic MRI examinations revealed gradual tumour enlargement within a one-year period. Neither of the patients had any neurological deficits, including in the visual fields.
Intervention
The head of each patient was positioned so that the tumour-containing right ventricle was oriented downwards and laterally. An occipital inter-hemispheric approach was performed and using a navigation system, the tumour was identified about 1 cm in depth from the cortical surface. After the medial part of the tumour was debulked, the posterior and then the anterior choroidal blood supplies to the tumour were identified. Occlusion of these vessels achieved tumour haemostasis. The tumours were totally removed via a 1.5-cm cortical incision. Brain retraction was minimal because the right hemisphere was pulled down by gravity. Therefore, the para-splenial cisterns were easily accessed, resulting in early release of cerebrospinal fluid. Post-operative MRI showed complete removal of the tumour and the patients had no neurological deficits. Anti-epileptic medication was withdrawn one week after the operation.
Conclusions
The occipital inter-hemispheric fissure lacks important bridging veins. The approach used and patient positioning minimized damage to the lateral aspect of the optic radiation and the corpus callosum. Except in patients with very large trigone meningiomas, this approach is useful for decreasing the risk of post-operative hemianopsia or epilepsy, and possibly speech disturbance, even in patients with a tumour in the dominant hemisphere.
An outbreak of Klebsiella pneumoniae resistant to broad spectrum cephalosporins occurred in a hospital in the Kinki area in Japan. During 18 months, from February 1998 to July 1999, 23 strains were ...isolated from 21 patients (10 with pneumonia, 4 with urinary tract infection, 1 with sepsis, 1 with vaginosis, 1 with a wound infection, and 1 with both pneumonia and sepsis; 3 patients showed noninfective colonization with K. pneumoniae) in seven wards, including the intensive care unit. MEN-1-derived gene was detected by polymerase chain reaction from the majority of the strains. Ninety-nine strains of K. pneumoniae were isolated during this period. The isolation rate of K. pneumoniae resistant to broad spectrum cephalosporins was 21%. We distinguished three clones by pulsed-field gel electrophoresis and randomly amplified polymorphic DNA analysis, and one of them was isolated from 18 patients. The presence of an R-plasmid of more than 160 kb was confirmed by plasmid analysis, but it was not possible to obtain transconjugants from all strains. This outbreak of K. pneumoniae was immediately confirmed by genetic analysis, and it was promptly ended by the infection control procedures. This is the first hospital outbreak of MEN-1-producing K. pneumoniae in Japan.
Using the archive data of the H{sup 13}CO{sup +} (J = 1-0) line emission taken with the Nobeyama 45 m radio telescope with a spatial resolution of {approx} 0.01 pc, we have identified 68 dense cores ...in the central dense region of the {rho} Ophiuchi main cloud. The H{sup 13}CO{sup +} data also indicate that the fractional abundance of H{sup 13}CO{sup +} relative to H{sub 2} is roughly inversely proportional to the square root of the H{sub 2} column density with a mean of 1.72 x 10{sup -11}. The mean radius, FWHM line width, and LTE mass of the identified cores are estimated to be 0.045 {+-} 0.011 pc, 0.49 {+-} 0.14 km s{sup -1}, and 3.4 {+-} 3.6 M{sub sun}, respectively. The majority of the identified cores have subsonic internal motions. The virial ratio, the ratio of the virial mass to the LTE mass, tends to decrease with increasing LTE mass and about 60% of the cores have virial ratios smaller than 2, indicating that these cores are not transient structures but self-gravitating. The detailed virial analysis suggests that the surface pressure often dominates over the self-gravity and thus plays a crucial role in regulating core formation and evolution. By comparing the {rho} Oph cores with those in the Orion A molecular cloud observed with the same telescope, we found that the statistical properties of the core physical quantities are similar between the two clouds if the effect of the different spatial resolutions is corrected. The line widths of the {rho} Oph cores appear to be nearly independent of the core radii over the range of 0.01-0.1 pc and deviate upward from the Heyer and Brunt relation. This may be evidence that turbulent motions are driven by protostellar outflows in the cluster environment.
We present the results of C18O(J = 1-0) mapping observations of a 20' X 18' area in the Lynds 1204 molecular cloud associated with the Sharpless 2-140 (S140) H II region. The C18O cube ( Delta *a- ...Delta *d-v LSR) data show that there are three clumps of sizes ~1 pc in the region. Two of these have peculiar redshifted velocity components at their edges, which can be interpreted as the results of the interaction between the cloud and the Cepheus Bubble. From the C18O cube data, clumpfind identified 123 C18O cores, which have mean radius, velocity width in FWHM, and LTE mass of 0.36 ? 0.07 pc, 0.37 ? 0.09 km s--1, and 41 ? 29 M , respectively. Considering the uncertainty in the C18O abundance, all the cores in S140 are most likely to be gravitationally bound. We derived a C18O core mass function (CMF), which shows a power-law-like behavior above a turnover at 30 M . The best-fit power-law index of --2.1 ? 0.2 is quite consistent with that of the initial mass function (IMF) and the C18O CMF in the OMC-1 region as found by Ikeda & Kitamura. Kramer et al. estimated the power-law index of --1.65 in S140 from the C18O(J = 2-1) data, which is inconsistent with this study. The C18O(J = 2-1) data are spatially limited to the central part of the cloud and are likely to be biased toward high-mass cores, leading to the flatter CMF. Consequently, this study and our previous study strongly support that the power-law form of the IMF has already been determined at the density of 103-104 cm--3, traced by the C18O(J = 1-0) line.
Objective: We report a rare case of multiple unruptured cerebral aneurysms associated with persistent primitive hypoglossal artery (PPHA). Case presentation: A 70-year-old female was admitted to our ...hospital for further examination of left hearing impairment and bilateral tinnitus. 3D-CTA and cerebral angiography showed a large aneurysm at the cavernous segment of the right internal carotid artery (ICA) and a small aneurysm at the top of basilar artery associated with PPHA. The patient underwent balloon-assisted coil embolization of the large aneurysm of the right ICA and rescue stenting for the protruding coil into the right ICA. Postoperative course was uneventful. Conclusion: This is the first report of a large unruptured aneurysm at the cavernous segment of the ICA in multiple cerebral aneurysms associated with PPHA.
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