A Case of Pseudoaneurysm of the Superficial Temporal Artery Causing a Massive Subcutaneous Hematoma after Craniotomy.

We present a case of a ruptured pseudoaneurysm of the superficial temporal artery (STA) after surgery for intracranial hemorrhage. To our knowledge, only three similar cases have been reported. A 47-year-old man underwent left frontal craniotomy for a left frontal subcortical hematoma. The left STA was not identified during the surgery, and no STA bleeding was observed. The postoperative course was uneventful for 20 days, until the patient experienced a left-side headache and noticed a subcutaneous mass. The mass increase in size within 1 hour and arterial hemorrhage was observed through a tear in the wound. Findings on subsequent contrast computed tomography were consistent with a ruptured pseudoaneurysm arising from the left STA. Emergency evacuation of the hematoma and STA ligation were performed. Pathological findings were consistent with a pseudoaneurysm. STA pseudoaneurysms occasionally grow rapidly and can cause massive hematoma. Surgeons should carefully monitor for evidence of a pseudoaneurysm after craniotomy, even in the absence of intraoperative bleeding from the STA.

Evaluation of Oral Mucosal Lesions Using the IllumiScan® Fluorescence Visualisation Device: Distinguishing Squamous Cell Carcinoma.

We evaluated whether fluorescence intensity (FI) and its coefficient of variation (CV) can be used to diagnose squamous cell carcinoma (SCC) through IllumiScan®, an oral mucosa fluorescence visualisation (FV) device. Overall, 190 patients with oral mucosal lesions (OMLs; SCC, 59; non-SCC OMLs, 131) and 49 patients with normal oral mucosa (NOM) were enrolled between January 2019 and March 2021. The FI of the images was analysed using image analysis software. After establishing regions of interest for SCC, non-SCC, and NOM, the average FI, standard deviation (SD), and CV were compared. There was a significant difference in the average FI for all pairs of comparisons. The SD was not significantly different between the SCC and NOM groups (p = 0.07). The CV differed significantly for NOM (p < 0.001) and non-SCC groups (p < 0.001) relative to the SCC group but was not different between NOM and non-SCC groups (p = 0.15). Univariate analysis of SCC and non-SCC groups showed significant differences for all factors, except age. However, multivariate analysis showed a significant intergroup difference only in the CV (p = 0.038). Therefore, analysing the CV in FV images of OML may be useful for the diagnosis of oral cancer.

Occipital condyle fracture caused by minor head trauma.

Background: Occipital condyle fractures (OCF) are commonly identified in patients suffering from severe craniocerebral trauma. Here, we present a 57-year-old male whose computed tomography (CT)-documented atlanto-occipital dislocation (AOD), due to just minor trauma was successfully managed with bracing alone. Case Description: A 57-year-old male presented with the right upper neck pain following a motor vehicle accident. The screening cervical CT scan revealed a fracture of the right occipital condyle, while the subsequent dynamic X-rays showed no instability or AOD. The patient was treated with a hard cervical collar, and over the next 6 months, remained asymptomatic. The 6-month repeat craniocervical CT scan additionally confirmed spontaneous fusion at the fracture site. Conclusion: Patients who have sustained even mild craniocervical trauma may develop AOD attributed to an OCF. It is critical to screen these patients early with CT and X-ray studies so they can be successfully managed with bracing alone, and avoid the need for surgery to address the delayed onset of instability.

Exposure to 60 Hz magnetic field can affect membrane proteins and membrane potential in human cancer cells.

The experimental data support the hypothesis that extremely low frequency magnetic field (ELF-MF) can affect cell membranes. Since our previous studies suggested that MF changes the permeability of cell membrane, in this study we focused on the cell membrane and investigated the effect of 60 Hz, 50 mT MF on the membrane potential and membrane proteins. The membrane potentials of three cultured human cancer cell lines, A549, MES-SA, and MES-SA/Dx5, were increased by exposure to ELF-MF. When exposed to MF and an anticancer drug, changes in the membrane potentials were detected in A549 and MES-SA cells, but not in the multi drug-resistant cells, MES-SA/Dx5. We examined whether MF has an influence on the membrane proteins extracted from cultured A549 cells, using DiBAC4(3) dye enhanced fluorescence binding to a hydrophobic site. The increase in fluorescence observed following MF exposure for 10 min indicated that the structure of the hydrophobic site on the membrane proteins changed and became more likely to bind the probe dye. A decrease in fluorescence was detected following exposure to MF for 240 min. These results indicated that 60 Hz, 50 mT MF causes changes in the membrane potential of cultured cancer cells and the conformation of membrane proteins extracted from cultured cancer cells, and has different effects depending on the exposure time.

Dietary selenium deficiency or selenomethionine excess drastically alters organ selenium contents without altering the expression of most selenoproteins in mice.

Selenium is an essential trace element, and its deficiency can cause cardiomyopathy, arrhythmias and increased susceptibility to infection. Such clinical symptoms are considered primarily attributed to decreased expression of some of the 25 selenocysteine-containing selenoproteins in humans. Conversely, a selenium-excessive diet can cause acute poisoning and chronic symptoms with unknown mechanisms. To reveal the impact of selenium deficiency and excess on selenoprotein expression in vivo, mice (that possess 24 selenoproteins) were fed with selenium-deficient or selenomethionine-excessive diets for up to 4 weeks, and the expression levels of nine representative selenoproteins [glutathione peroxidase (Gpx) 1/2/3/4, thioredoxin reductase 1/2, deiodinase 1, and selenoprotein P/S] were measured in 10 organs (brain, heart, liver, lung, kidney, pancreas, spleen, testis, skeletal muscle and thymus). We observed a time-dependent decrease in the selenium content of most organs (except testis) of selenium-deficient mice but not in the expression levels of the nine selenoproteins, with the exceptions of Gpx1/2 in the heart/liver/kidney/pancreas/spleen and Gpx3 in the pancreas/spleen. Serum lipid peroxidation levels were up-regulated in response to Se deficiency because of the decreased expression/activity of Gpx3, a plasma-type Gpx. In contrast, a time-dependent increase was observed in the selenium content of all organs but not the expression levels of the nine selenoproteins in most organs of selenomethionine-excessive mice; however, markedly elevated protein-bound selenium levels were observed in the liver/kidney. These results suggest that the systemic response to selenium deficiency and selenomethionine excess involves the down-regulation of some selenoproteins such as Gpx1/Gpx3 and up-regulation of selenium-containing proteins (not selenoproteins), respectively.

[Unusual visual impairments in a case of MPO-ANCA associated hypertrophic pachymeningitis].

We report a 79-year-old man presenting MPO-ANCA associated hypertrophic pachymeningitis and bilateral visual impairment. Two years before, microscopic hematuria and positive MPO-ANCA were indicated, then oral steroids and cyclophosphamide were given as systemic vasculitis. On admission, lateral hemianopsia in the right visual field was documented. Some weeks after admission, he complained of a left-hand side headache, and the visual impairment of a right eye. Brain MRI detected thick dura matter with abnormal enhancement predominantly on the left side of the basal temporal lobe and a tumor-like lesion at the sphenoid sinus near the right cavernous sinus. Multiple scotomas in the left visual field were compatible with ischemic changes caused by MPO-ANCA related vasculitis. On the other hand, the hemianopsia in his right eye was related with a tumor-like lesion. The visual problems showed a favorable response to the steroid pulse therapy. ANCA-positive cases can demonstrate various symptoms including intra-/extra-cranial involvement. Thus, thorough clinical workup is needed to determine the actual site of the lesion when cranial nerve involvement is observed in MPO-ANCA positive hypertrophic pachymeningitis.