Simple classification of carotid bifurcation: is it possible to predict twisted carotid artery during carotid endarterectomy?

Background: The internal carotid artery (ICA) usually runs posterolaterally to the external carotid artery (ECA), but occasionally we encounter the twisted carotid bifurcation, a variant in which the ICA courses medially to the ECA during carotid endarterectomy (CEA). Prediction of this anomaly in the preoperative evaluation is mandatory, although descriptions in the literature are limited. We reviewed the clinical features of patients who underwent CEA and analyzed preoperative cerebral angiography, especially the anteroposterior (AP) view to determine whether it could be a predictive modality. Methods: In 58 consecutive CEA cases, we simply classified them into three groups; type 1 (the ICA runs laterally and the ECA runs medially), type 2 (the ICA and ECA run to overlap each other), and type 3 (the ICA runs medially and the ECA runs laterally), based on the findings of AP view of cerebral angiography. We compared the clinical features and intraoperative findings of these groups. Results: Of 58 cases, types 1–3 were 24, 30, and four cases, respectively. Twisted carotid bifurcations were recognized in seven cases (12.4 %), including three cases in type 2 and four in type 3, and all twisted cases were found on the right side. Twisted carotids and right-sided lesion were significantly frequent in type 3, but no statistical differences of coexisting diseases were recognized among the three groups. CEAs of twisted carotid bifurcations were performed successfully with correction of the carotid position in three and as it was in four cases. Conclusions: Twisted carotid bifurcations were observed during operation in 10 % in type 2 and 100 % in type 3. CEA of twisted carotid bifurcations can be performed safely with or without correction of the carotid position. AP view of cerebral angiography could be useful for preoperative evaluation. © 2016 Springer-Verlag WienEmbargo Period 12 month

グリオーマ幹細胞に特異的に発現する分子の探索と治療標的分子としての妥当性評価

金沢大学医薬保健研究域医学系Tumor initiating cellで機能する分子としてNotchが抽出された。本研究では、膠芽腫患者由来の幹細胞株を使用し、Notchを阻害する分子標的薬剤MRK003 (MRK)の効果を評価した。使用した3種類の細胞株にはNotch1、2の発現が認められた。MRKによってNotchシグナルは阻害された。MRKの下流シグナルであるAKTシグナルが強く阻害された幹細胞株は低濃度のMRKにより細胞増殖、Sphere形成能が高度に低下し、AKTシグナル阻害が不変であった幹細胞株に対するMRKの効果は乏しかった。以上より、MRKはAKTシグナル阻害程度によって効果が異なることが示唆された。Notch was selected as an important signaling molecule for cancer stem/initiating cells to maintain stemness, induce cell proliferation and regulate apoptosis. Notch signal inhibition by γ-secretase inhibitor may be effective strategy for the treatment of cancer stem/initiating cells. We analyzed 3 patient’s derived GBM stem-like cells with treatment by MRK003, a novel clinically available γ-secretase inhibitor. Notch 1 and 2 were expressed in all cells. MRK003 suppressed Notch signaling in all cells. Akt signaling which is downstream of Notch was strongly inhibited in two species of cells. These cells showed strong effect of MRK in terms of inhibition of proliferation and sphere formation. On the contrary, the cell without alteration of Akt signaling by MRK showed low effect of MRK. Taken together, the effect of MRK003 may depend on the inhibition of Akt pathway.研究課題/領域番号:25861262, 研究期間(年度):2013-04-01 – 2015-03-3

Duplicated middle cerebral artery associated with aneurysm at M1/M2 bifurcation: a case report

Abstract Background A duplicated middle cerebral artery arises from the internal carotid artery and supplies blood to the middle cerebral artery territory. A duplicated middle cerebral artery is sometimes associated with an intracranial aneurysm. Most aneurysms associated with duplicated middle cerebral artery are located at the origin of the duplicated middle cerebral artery. An aneurysm located at the distal middle cerebral artery is not common. Case presentation We encountered a 62-year-old Asian man with duplicated middle cerebral artery associated with aneurysms at the M1/M2 junction of the duplicated middle cerebral artery and top of the internal carotid artery. Conclusions In cases of duplicated middle cerebral artery, association with a distal aneurysm on the duplicated middle cerebral artery is rare. However, the aneurysm may be formed on the thicker middle cerebral artery due to hemodynamic stress

Anaplastic Meningioma With Extremely Rapid Recurrence [Case Report]

A 62-year-old woman presented with an uncommon case of anaplastic meningioma manifesting as recent memory disturbance. Magnetic resonance imaging revealed a mass located in the right temporal lobe. She became unconscious because of uncal herniation and underwent urgent surgery. The tumor was completely resected, except for a lesion tightly attached to arteries. Histological examination indicated the presence of anaplastic meningioma with an extremely high MIB-1 labeling index (70%). After 43 days, the patient developed local recurrence and dissemination in the left temporal lobe. The exceptionally high MIB-1 labeling index corresponded with a short tumor doubling time (8.2 days). Whole-brain irradiation and linear accelerator surgery for disseminated lesions were performed, and the tumor growth halted. Although meningiomas rarely show malignant behavior, corresponding to World Health Organization grade III, it is necessary to consider malignant behavior when treating meningiomas