Assessment of the Accuracy and Errors of Head-Up Display by an Optical Neuronavigation System in Brain Tumor Surgery.

BACKGROUND: A head-up display (HUD) in which navigational information is projected into the microscope view may enable surgeons to perform operations more efficiently. Projecting depictions of both tumor and important intracranial structures on the HUD may facilitate safe surgery. OBJECTIVE: To investigate accuracy and errors regarding important intracranial structures, errors due to brain shifts, and preservation rates for important intracranial structures. METHODS: A total of 184 surgeries in 172 patients were performed using this operation system. Postoperatively, we determined accuracy and errors for actual structures and virtual reality on the HUD and performed statistical analyses. RESULTS: Preresection accuracy for important intracranial structures was highest for the internal carotid artery (ICA; 90.4%) and lowest for the posterior inferior cerebellar artery (53.6%). Differences between pre- and postresection accuracy were greatest, in descending order, for the cortical vein ( P < .0001), V4 segment of vertebral artery ( P < .0001), and anterior inferior cerebellar artery ( P = .00780), whereas differences between pre- and postresection errors were smallest for the cranial nerve V ( P = .500), middle cerebral artery ( P = .0313), and ICA ( P = .0313). Cases of poor preresection accuracy and large differences in pre- to postresection accuracy were seen in the prone position. CONCLUSION: A reliable surgical resection rate was achieved using the HUD, and reliable preservation of important intracranial structures was also possible. Accuracy was concluded to be within an acceptable range.

[Epidemiological Investigation of Patients in Persistent Vegetative States in Aomori, Japan].

The actual number and condition of Japanese patients in persistent vegetative states have not yet been fully understood. The aim of this study is to investigate the epidemiology of patients in persistent vegetative states in the Aomori prefecture. We sent questionnaires regarding gender, age, cause of persistent vegetative state, and residence of patient to all medical institutions in the Aomori prefecture (n=682). Two hundreds and seventeen institutions (31.8%) replied to the questionnaire, and eleven hundred ninety-eight patients(Male/Female=381/817) were included. Patients over 80 years-old were the most common (63.4%), and cerebrovascular stroke was the major cause (64.4%) of persistent vegetative state. Nursing homes (48.1%) and hospitals (34.6%) were the main care institutions. Population based analysis revealed that 869 persistent vegetative state patients per million were cared for in the Aomori prefecture. This result was twice as many as was previously reported in Miyagi prefecture. The number of patients in persistent vegetative states will increase in the future, due to an increasing elderly population and a high incidence of stroke in this demographic. We therefore predict that increased medical and administrative support will be required in the future.

Diastereomers of lithospermic acid and lithospermic acid B from Monarda fistulosa and Lithospermum erythrorhizon.

Monardic acids A (1) and B (2), which are (7R,8R) diastereomers of lithospermic acid (LA) and lithospermic acid B, respectively, were isolated from Monarda fistulosa. A (7S,8R) isomer (3) of LA was also isolated from this plant, and a (7R,8S) isomer (7) of LA was obtained from Lithospermum erythrorhizon. The absolute configuration of 1 was confirmed by analysis of its hydrolysates, 7-epiblechnic acid and 2R-3-(3,4-dihydroxyphenyl)-2-hydroxypropanoic acid. The configuration in the dihydrobenzofuran moieties of 2, 3, and 7 was extrapolated by using the phenylglycine methyl ester method and a Cotton effect at approximately 250-260 nm in their electronic circular dichroism spectra. Diastereomers (1-3 and 7) displayed moderate hyaluronidase inhibitory and histamine release inhibitory activities.