Evaluation of a high-speed but low-throughput RT-qPCR system for detection of SARS-CoV-2.

With the emergence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), a high-speed and convenient detection technology should be at the forefront of medical care worldwide. This study evaluated the usefulness of GeneSoC, a compact, high-speed reciprocal flow quantitative reverse transcription polymerase chain reaction system, for the detection of SARS-CoV-2. The results support the use of this system for the rapid identification of SARS-CoV-2. This approach can contribute to the strategic selection of initial management strategies for patients with COVID-19.

Displacement of central sulcus in cerebral arteriovenous malformation situated in the peri-motor cortex as assessed by magnetoencephalographic study.

BACKGROUND: Intra-operative monitoring of the position of the central sulcus (CS) is indispensable to properly treat a peri-motor cortex lesion. Noninvasive preoperative studies for identification of CS are also needed for choosing the optimal operative procedure. Magneto-encephalography (MEG) has recently been introduced for non-invasive preoperative investigation and cortical functional mapping. METHODS: Stereotactic mapping of functional CS anatomy was performed preoperatively on 13 subjects using somatosensory evoked fields with MRI-linked whole head MEG system. All subjects had a left sided peri-motor cortex lesion with diagnoses including the following conditions: three arteriovenous malformations (AVM), seven gliomas, three meningiomas. FINDINGS: Functional CS in supratentorial brain tumor and parietal AVM cases corresponded with anatomical CS identified by MRI. But the AVM cases in whom the nidus was situated within the peri-motor cortex showed discrepancies between anatomical CS and functional CS. INTERPRETATION: Careful consideration of the operative procedure combined with non-invasive cortical functional mapping is needed to optimally treat AVM and congenital brain lesions situated in the anatomical peri-motor cortex.

[A case of delayed subrachnoid hemorrhage from vertebrobasilar artery dissecting aneurysm].

We report a case of delayed subarachnoid hemorrhage (SAH) from a vertebrobasilar artery dissecting aneurysm (VBA-DA). The patient was a healthy 32-year-old woman with a sudden onset of severe occipitalgia. Next day, her headache improved gradually, and she consulted with our department. Although we initially suspected that she was suffering from SAH, neurological findings, CT, and cerebrospinal fluid examination did not reveal any abnormal conditions, including SAH. Therefore, she was treated conservatively with analgesics. Twelve days after the initial onset of the headache, she was admitted because of severe re-attack of headache, rt. hemiparesis with rt. oculomotor nerve palsy and loss of consciousness. CT revealed moderate SAH and cerebral angiograms showed VBA-DA. After the cerebral angiography, bleeding reoccurred two times and she lost her life. We present the case, review the literature and discuss the relationship between presenting symptom of headache and non-hemorrhagic VBA-DA. A few cases of non-hemorrhagic VBA-DA have been reported in the literature in which the only presenting symptom was headache, followed by delayed SAH from non-hemorrhagic dissecting aneurysm. Consequently, we concluded that her initial symptom of headache was due to dissection of vertebrobasilar artery, and that SAH was due to delayed hemorrhage of non-hemorrhagic VBA-DA. Even when neurological findings, CT and cerebrospinal fluid examination reveal no abnormalities in the early stage after the sudden onset of headache, especially in the occiptal or nuchal regions, non-hemorrhagic VBA-DA, which has a risk of fatal hemorrhage, cannot be ruled out with certainty. Therefore, MRI, MRA, three-dimensional CT, or cerebral angiography should be performed in such cases.

[A case of subarachnoid hemorrhage complaining of deafness].

A 64-year-old female came to our department because of a sudden onset of bilateral deafness 2 days before. She had sudden onset of mild headache, nausea and vomiting 9 days before, but was diagnosed as food poisoning by her home doctor. Her symptoms disappeared on the following day. Neurological examination revealed bilateral deafness, right facial palsy of central type and very slight neck stiffness. CT showed inconspicuous subarachnoid hemorrhage, but lumber puncture revealed definite subarachnoid hemorrhage. Another important finding of CT was old left temporal lobe infarction. Cerebral angiography detected right middle cerebral artery aneurysm at the trifurcation and moderate cerebral vasospasm of the right M2 portion. Neck clipping was successfully performed, but small size of right temporal lobe infarction was found on postoperative CT, which was due to cerebral vasospasm. Postoperative MRI showed bilateral temporal lobe infarction, especially including bilateral auditory cortex. This finding suggests that her deafness was cortical in origin.

Distribution of PNP 14 (beta-synuclein) in neuroendocrine tissues: localization in Sertoli cells.

Phosphoneuroprotein (PNP 14) is abundant in the central nervous system and is localized at nerve endings but not in synaptic vesicles. In this study, we examined the presence of PNP 14 in various endocrine tissues of the rat. PNP 14 was not detected in the endocrine cells of the intestine, testes, or adrenal gland, but it was present in axon terminals in both the medulla of the adrenal gland and the anterior pituitary gland. When testes were stained with PNP 14-specific antibodies by an indirect immunofluorescence method, PNP 14 was found in Sertoli cells of the testes, associated with fibrillar structures. PNP 14 was also detected in cultured Sertoli cells with a fibrillar pattern in the cytoplasm and around the nuclei. The fibrillar structure did not resemble actin stress fibers, microtubules, or intermediate filaments. The amount of PNP 14 in the testis changed with development. It increased markedly during the first 4 weeks after birth and then decreased. During the first 4 weeks after birth, spermatogonia undergo two rounds of meiosis. It is possible, therefore, that PNP 14 might be a factor related to meiosis.

[Preventive effect of intracisternal methylprednisolone on symptomatic vasospasm after aneurysmal subarachnoid hemorrhage].

A series of 103 patients with ruptured cerebral aneurysms were treated by intracranial irrigation, after aneurysmal clipping, with pH 8.0 Hartmann solution containing 1 mg/ml of methylprednisolone sodium succinate, during operation. Postoperatively, 5 ml/day of the solution was also injected until day 14, percutaneously through an Ommaya reservoir into the cisterns around the clipped aneurysm. Six (5.7%) of the 103 patients suffered symptomatic vasospasm postoperatively. The Glasgow Outcome Scale at discharge of all patients indicated good recovery, Moderately disabled, Severely disabled and Vegetative state in 74 (72%), 18 (17%), 9 (9%) and 2 (2%) patients respectively. As a complication, subdural effusion was noticed in 17 (17%) patients, without any influence on outcome at all.

Efficacy of steroid hormone in solution for intracranial irrigation during aneurysmal surgery for prevention of the vasospasm syndrome.

A series of 55 patients with ruptured cerebral aneurysms were treated with moderate removal of subarachnoid clot followed by intracranial irrigation with pH 8.0 Hartmann solution containing 1 mg/ml of methylpredonisolone sodium succinate after the aneurysmal clipping during early (before day 3) operation. Six (11%) of the 55 patients suffered vasospasm syndrome postoperatively. The clinical results are significantly better than a series of 68 patients operated on and treated before day 3 by intracranial irrigation with Hartmann solution (pH 8.0) only. The possible preventive effect of direct intracranial administration of steroid hormone is discussed.

Impairment of anti-platelet-aggregating activity of endothelial cells after experimental subarachnoid hemorrhage.

BACKGROUND AND PURPOSE: Serial changes of anti-platelet-aggregating activity in the endothelial cells after experimental subarachnoid hemorrhage were studied in 30 feline two-hemorrhage models. METHODS: One hour or 2, 4, 7, or 14 days after mimic subarachnoid hemorrhage, ADP (40 mg/kg) was infused into the basilar artery via the right vertebral artery to activate circulating platelets. Immediately after ADP infusion, the basilar artery was fixed by intra-arterial perfusion with 1.5% glutaraldehyde in 0.1 mol/L phosphate buffer and was removed. The luminal surface was examined under a scanning electron microscope. RESULTS: One hour after subarachnoid hemorrhage, no platelets adhered or aggregated on the luminal surface. However, 4 to 7 days after subarachnoid hemorrhage, many platelets were observed adhering or aggregating on the luminal surface. CONCLUSIONS: These findings suggest the impairment of anti-platelet-aggregating activity of endothelial cells after subarachnoid hemorrhage. This impairment may be involved in inducing cerebral ischemia during cerebral vasospasm by causing platelet adhesion and aggregation.

[Two cases of well-known syndrome due to midbrain-brain stem hemorrhage--Weber's syndrome and one and a half syndrome].

Two cases of well-known syndrome due to midbrain-brain stem hemorrhage without having a history of hypertension were reported. Case 1 is a 62-year-old female, presenting Weber's syndrome due to midbrain hemorrhage and diagnosed as Moyamoya disease angiographically. Case 2 is a 24-year-old-male, presenting One and a half syndrome due to brain stem hemorrhage from a brain stem cavernous angioma, which was diagnosed angiographically and by magnetic resonance imaging (MRI). Left hemiparesis seen in case 1 had improved by conservative therapy but no improvement could be obtained in the oculomotor nerve palsy. In case 2, hematoma was aspirated surgically for the purpose of decompression and his neurological symptoms improved markedly. Their pathogenesis and pathophysiology were also discussed.

[Two cases of failure of a programmable pressure valve].

Two cases of a programmable pressure valve trouble are reported. Case #1 was that of a 49-year-old male who had received a ventriculoperitoneal shunt (VPS) using a Sophy programmable pressure valve (Model S3) after the removal of the fourth ventricle ependymoma. After the VPS, the patient went through several episodes of complaining of headache due to the spontaneous movement of the rotor from the high pressure position to the medium or low pressure position. The symptom had disappeared after exchanging the valve for a new one and by setting the valve pressure at high. Examination of the removed valve revealed that the bending-degree of the spring tip was insufficient, and that the opening pressures at the medium and high pressure positions were both lower than the desired range. Case #2 was that of a 62-year-old female who had received a VPS for normal pressure hydrocephalus using a Sophy programmable pressure valve (Model S3) with the valve pressure set a high. However, her symptoms did not improve, so an attempt was made to change the valve pressure from the high pressure position to the medium pressure position with a ring magnet. But the rotor could not be moved. The valve was exchanged and the valve pressure was set at medium, and the symptoms of the patient improved postoperatively. Examination of the removed valve revealed that the movement of the rotor with a ring magnet was not able to be carried out smoothly.(ABSTRACT TRUNCATED AT 250 WORDS)

[P3 portion aneurysm of the posterior cerebral artery; a case report].

A case was reported of surgically treated saccular aneurysm located at the right posterior temporoparietooccipital artery junction (P3 portion of PCA). An aneurysm of this portion is said to be rare, and only 7 cases have been described so far. A 74-year-old female was transferred to our clinic, after 3, 5 months of sustaining aneurysmal rupture, for surgical treatment. The patient had been treated conservatively because of her severe condition in the early stage. She was in nearly apallic state with left hemiparesis at the time of admission to our clinic. During the acute stage of her illness, moderate hematoma in the right ambient cistern without hydrocephalus, and an aneurysm at P3 portion of the right posterior cerebral artery with marked arteriosclerosis were delineated by CT, and by right vertebral angiography respectively. However, in the CT taken 3, 5 months after the onset, moderate hydrocephalus and a low density area in the right internal capsule were detected. Aneurysmal neck clipping was performed using the right posterior subtemporal approach, without any deformity of the parent arteries. Occlusion of the right parietooccipital artery occurred, however, probably on the 2nd postoperative day. Despite the newly developed left homonymous hemianopsia, general condition, including consciousness level, improved postoperatively particularly after the ventriculo-peritoneal shunt was carried out.

[Disproportionately large communicating fourth ventricle with bilateral exotropia: report of two cases].

Two cases of disproportionately large communicating fourth ventricle (DLCFV) accompanied by consciousness disturbance and bilateral exotropia are reported. Case #1 was a 21-year-old male who suffered from consciousness disturbance and bilateral exotropia due to malfunction of the ventriculoperitoneal shunt (VPS) which had previously been operated on twice for a left parietal arteriovenous malformation, which had caused ventricular hemorrhage several times. The last hemorrhage was massive and made ventricular casting, including the fourth ventricle. Both bilateral exotropia and the fourth ventricular dilatation were well controlled by the reconstruction of the VPS. Case #2 was a 66-year-old female, semicomatous because of massive subarachnoid hemorrhage with ventricular casting hematoma due to rupture of the right middle cerebral aneurysm. Though an improvement of the consciousness disturbance was obtained by continuous ventricular drainage (CVD), bilateral exotropia and consciousness deterioration appeared after lumboperitoneal shunt followed by the removal of the CVD. Another CVD was then carried out and some improvement was obtained again. However, the same symptoms appeared again after the VPS, followed by the removal of the CVD. The patient finally died despite a third CVD. Autopsy revealed a markedly dilated fourth ventricle and massive subarachnoid clots particularly around the foramen of Magendie and Luschka. The pathogenesis of DLCFV and bilateral exotropia are also discussed.

[Cyst formation of meningioma: report of two cases and review of literature].

Cystic meningioma is rare and said to account for 1 to 2% of all types of meningioma. Here we report two cases of cystic meningioma. Case 1 is a 25-year-old man. He had suffered from sporadic epileptic seizure for about two years until the first CT was performed. It revealed a large cystic lesion at the right parietal region in touch with the midline structure. A nodular high density area was delineated in the contrast enhanced CT on the medial wall of the cyst. He showed no neurological abnormality at all. Case 2 is a 56-year-old female who had been complaining of memory disturbance, and an episode of sudden dizziness followed by a syncope that lasted for a few minutes. Neurological examination revealed slight right hemiparesis, right homonymous hemianopsia and left papilledema. A large cystic lesion was delineated at the temporal region in the plain CT, and no positively enhanced region could be found in the contrast enhanced CT. After surgical removal of the tumors, both cases were identified as cases of meningioma. They were diagnosed histopathologically as a fibroblastic meningioma and a meningotheliomatous meningioma respectively. The wall of the cyst consisted of the cortical surface per se in both cases. Preoperative diagnosis of such cases and the mechanism by which the cyst is formed were also discussed.

[Subependymoma of the septum pellucidum. MRI features and its usefulness in planning surgery].

A 61-year-old female was referred because of headache and gait disturbance. A computed tomography (CT) scan revealed a midline isodense mass lesion. The limit of the tumor was equivocal even after administration of contrast medium. Magnetic resonance imaging (MRI) study, however, clearly showed the relationship between the tumor and the surrounding structures, such as the corpus callosum, the ventricular cavities. The tumor had originated from the region of the septum pellucidum and positioned just beneath the corpus callosum from the genu to the splenium with the roof of the third ventricle pushed downward. The tumor was totally extirpated via the interhemispheric paratranscallosal route. The tumor was typical subependymoma. The post-operative course was uneventful. Transient psychiatric disturbance and inability to retain recent memory were observed and the former subsided in several weeks. CT and MRI characteristics of subependymoma are summarized and the usefulness of MRI to locate tumors and to plan proper surgical approaches are emphasized.

A simple self-retaining cerebral retractor. Technical note.

A flexible copper spatula, usually used by us as retractor in brain surgery, was easily converted to become self-retaining without any other apparatus, by a simple minor modification.