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Masanori Sato, Namio Kodama, Tatsuya Sasaki and Mamoru Ohta

✓ Olfactory evoked potentials (OEPs), obtained by electrical stimulation of the olfactory mucosa, were recorded in dogs and humans to develop an objective method for evaluating olfactory functions.

In dogs, OEPs were recorded from the olfactory tract and the scalp. The latency of the first negative peak was approximately 40 msec. A response was not obtained after stimulation of the nasal mucosa and disappeared after sectioning of the olfactory nerve. With increasing frequencies of repetitive stimulation, the amplitude was reduced, suggesting that the response was synaptically mediated. These results demonstrate that evoked potentials from the olfactory tract and the scalp following electrical stimulation of the olfactory mucosa originate specifically from the olfactory system.

In humans, a stimulating electrode with a soft catheter was fixed on the olfactory mucosa. The OEPs from the olfactory tract, recorded with a negative peak of approximately 27 msec, had similar characteristics to OEPs found in dogs. The OEPs from the olfactory tract in humans also originate specifically from the olfactory system. The authors postulate that OEPs obtained by electrical stimulation of the olfactory mucosa may prove useful for intraoperative monitoring of olfactory functions.

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Masanori Sato, Noriko Kubota, Yoshihiko Katsuyama, Yota Suzuki, Yosuke Miyairi, Kisei Minami and Masashi Kasai

Mycoplasma hominis is a rare causative pathogen for surgical site infections after neurosurgical procedures. This organism lacks a cell wall, rendering it undetectable by Gram staining and making it resistant to beta-lactam antibiotics. In addition, some special techniques are required to identify this organism. Thus, it is very difficult to diagnose infections caused by this pathogen. Here, the authors report a pediatric case of M. hominis ventriculoperitoneal shunt (VPS) infection with central nervous system involvement for which beta-lactam antibiotics were not effective and Gram staining revealed no pathogens. Because few cases have been described that involve the treatment of M. hominis infection after neurosurgery, in this case the patient's serum and CSF were monitored for antibiotic drug concentrations. Successful treatment of the infection was achieved after approximately 6 weeks of administration of clindamycin and ciprofloxacin antibiotics in addition to external ventricular drain revision and subsequent VPS replacement. When beta-lactam antibiotics are ineffective and when Gram staining cannot detect the responsible pathogens, it is important to consider M. hominis as the atypical pathogen.

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Masato Matsumoto, Masanori Sato, Masayuki Nakano, Yuji Endo, Youichi Watanabe, Tatsuya Sasaki, Kyouichi Suzuki and Namio Kodama

Object. The aim of this study was to assess whether aneurysm surgery can be performed in patients with ruptured cerebral aneurysms by using three-dimensional computerized tomography (3D-CT) angiography alone, without conventional catheter angiography.

Methods. In a previous study, 60 patients with subarachnoid hemorrhage (SAH) from ruptured aneurysms were prospectively evaluated using both 3D-CT and conventional angiography, which resulted in a 100% accuracy for 3D-CT angiography in the diagnosis of ruptured aneurysms, and a 96% accuracy in the identification of associated unruptured aneurysms. The results led the authors to consider replacing conventional angiography with 3D-CT angiography for use in diagnosing ruptured aneurysms, and to perform surgery aided by 3D-CT angiography alone without conventional angiography. Based on the results, 100 consecutive patients with SAH who had undergone surgery in the acute stage based on 3D-CT angiography findings have been studied since December 1996. One hundred ruptured aneurysms, including 41 associated unruptured lesions, were detected using 3D-CT angiography. In seven of 100 ruptured aneurysms, which included four dissecting vertebral artery aneurysms, two basilar artery (BA) tip aneurysms, and one BA—superior cerebellar artery aneurysm, 3D-CT angiography was followed by conventional angiography to acquire diagnostic confirmation or information about the vein of Labbé, which was needed to guide the surgical approach for BA tip aneurysms. All of the ruptured aneurysms were confirmed at surgery and treated successfully. Ninety-three patients who underwent operation with the aid of 3D-CT angiography only had no complications related to the lack of information gathered by conventional angiography. The 3D-CT angiography studies provided the authors with the aneurysm location as well as surgically important information on the configuration of its sac and neck, the presence of calcification in the aneurysm wall, and its relationship to the adjacent vessels and bone structures.

Conclusions The authors believe that 3D-CT angiography can replace conventional angiography in the diagnosis of ruptured aneurysms and that surgery can be performed in almost all acutely ruptured aneurysms by using only 3D-CT angiography without conventional angiography.

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Ryuhei Kitai, Kazufumi Sato, Toshihiko Kubota, Masanori Kabuto, Hirokazu Kawano, Hidenori Kobayashi and Tetsuro Tsuji

✓ Extranodal sinus histiocytosis with massive lymphadenopathy involving the meninges is a rare clinical entity. The authors describe the unusual case of an occipital meningeal lesion in a 25-year-old man in whom they found inflammation of the occipital lobe mimicking lymphoplasmacyte-rich meningioma. The clinical similarities and differences are discussed.

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Takao Nakagawa, Toshihiko Kubota, Masanori Kabuto, Kazufumi Sato, Hirokazu Kawano, Taro Hayakawa and Yasunori Okada

✓ The role of matrix metalloproteinases (MMP's) and their inhibitor, tissue inhibitor of metalloproteinases-1 (TIMP-1), in human brain tumor invasion was investigated. Gelatinolytic activity was assayed via gelatin zymography, and four MMP's (MMP-1, MMP-2, MMP-3, and MMP-9) and TIMP-1 were immunolocalized in human brain tumors and in normal brain tissues using monoclonal antibodies. The tissue was surgically removed from 44 patients: glioblastoma (five cases), anaplastic astrocytoma (six cases), astrocytoma (four cases), metastatic tumor (six cases), neurinoma (10 cases), meningioma (10 cases), and normal brain tissue (three cases). Glioblastomas, anaplastic astrocytomas, and metastatic tumors showed high gelatinolytic activity and positive immunostaining for MMP's; TIMP-1 was also expressed in these tumors, but some tumor cells were negative for the antibody. Astrocytomas had low gelatinolytic activity and the tumor cells showed no immunoreactivity for MMP's and TIMP-1. Although neurinomas and meningiomas had only moderate proteinase activity and exhibited positive immunoreactivity for MMP-9, intense expression of TIMP-1 was simultaneously observed in these tumor cells. These findings suggest that MMP's play an important role in human brain tumor invasion, probably due to an imbalance between the production of MMP's and TIMP-1 by the tumor cells.