A Pediatric Case of Septic Pulmonary Embolism Caused by Tsukamurella paurometabola.

We herein report a three-year-old boy with septic pulmonary embolism caused by Tsukamurella paurometabola bacteremia during chemotherapy for rhabdomyosarcoma. During the interval of chemotherapy, the patient was temporarily discharged with a peripherally inserted central venous catheter but was re-admitted to the hospital with a fever on the same day. A blood culture taken at the time of re-admission showed T. paurometabola. The patient had a persistent fever, and computed tomography performed on the ninth day showed septic pulmonary embolism. We stress the importance of being aware of the possibility of septic pulmonary embolism in patients with Tsukamurella bacteremia.

Annual changes in pulmonary function in combined pulmonary fibrosis and emphysema: over a 5-year follow-up.

BACKGROUND: Combined pulmonary fibrosis and emphysema (CPFE) is a unique disorder that has been previously described, and the distinct features of CPFE in comparison with chronic obstructive pulmonary disease (COPD) have been reported. However, the yearly dynamics of pulmonary function parameters in CPFE patients compared with those in COPD patients have not yet been reported. METHODS: We retrospectively enrolled patients with CPFE and COPD who had undergone pulmonary function tests more than five times during a follow-up period of more than five years. The baseline clinical characteristics and the annual changes in pulmonary function during the follow-up period in 16 stable CPFE patients were compared with those in 19 stable COPD patients. Annual changes in pulmonary function were estimated from linear regressions, with assumptions for time-dependency and linearity. We analyzed the time-dependent fluctuations in pulmonary function for the two disorders. RESULTS: Annual decreases in VC and FVC in the CPFE group were significantly higher than those in the COPD group. Annual decrease in FEV1/FVC in the COPD group was significantly higher than in the CPFE group. During the follow-up period, FEV1/FVC in the CPFE group appeared to improve because of annual decrease in FVC. Annual decreases in DLco and DLco/VA in the CPFE group were significantly higher than those in the COPD group. CONCLUSION: This is the first report showing the yearly dynamics of pulmonary function parameters in CPFE patients compared with those in COPD patients during a follow-up period of more than five years. This study revealed that the physiologic consequences of CPFE including the rate of progression of pulmonary function impairment were different from those of COPD.

Lateral inclination of the trunk and falling frequency in Parkinson's disease patients.

OBJECTIVE: To investigate clinical features of postural instability and the relationship between severity of instability and falls during daily living in patients with Parkinson's disease (PD). METHODS AND SUBJECTS: We recorded trunk movements of subjects maintaining a seated position for 2 minutes using both a force plate and a position sensor system. We compared 13 patients with falls (fallers), 7 without falls (non-fallers), and 8 age-matched normal controls. RESULTS: The tendency for the values of both lateral COP displacement and trunk displacement was to increase in 1) patients compared with controls, and 2) fallers compared to non-fallers. Among patients who showed a large value of lateral COP displacement, greater than the value of the mean plus one standard deviation of controls, 90% had lumbar scoliosis and 60% of these patients fell down more than 5 times during the one-year follow-up period. CONCLUSION: We demonstrated that PD patients who had fallen frequently tended to have a 1) lumbar scoliosis, and 2) large value of lateral COP displacement. These results suggest that the measurement of both lateral COP displacement during sitting and spinal curvature would be useful in predicting the risk of falling in PD patients.

Pure word deafness due to left subcortical lesion: neurophysiological studies of two patients.

OBJECTIVE: This study investigated the auditory processing in two patients with pure word deafness (PWD) using neurophysiological experimental methods. METHODS: We recorded the auditory brainstem response (ABR), the middle latency auditory-evoked response (MLR) and the auditory-evoked event-related potentials (ERPs) in two patients with PWD after subcortical hemorrhage in the left temporal lobe. RESULTS: Both patients showed normal response in ABR and abnormality in MLR. The latency of P300 evoked by right-ear stimulation was 51 ms longer in one patient and 26 ms longer in the other patient than that evoked by left-ear stimulation. CONCLUSIONS: Our results suggested that the prolongation of P300 latency could be caused by the deterioration of auditory stimulus processing and supported the hypothesis that the defect in auditory temporal resolution was an important factor in the development of PWD. SIGNIFICANCE: This study demonstrated that recordings of ERP with auditory-evoked response such as ABR and MLR are useful to elucidate the deterioration of auditory stimulus processing in patients with PWD.

Effects of simulated high altitude on event-related potential (P300) and auditory brain-stem responses.

OBJECTIVE: This study investigated the effect of hyobaric hypoxia on cognitive function. METHODS: We recorded the auditory brain-stem response (ABR) and auditory-evoked event-related potentials (ERP) in 7 male subjects during a rapid ascent to a simulated 4500 m altitude from their acclimatized altitude of 610 m. The amplitude and latency of each component of ABR and of ERP were assessed. RESULTS: Compared with the values at 610 m, at 4500 m the latencies of both waves I and V of ABR significantly increased, with no change in I-V interpeak latency; and the amplitude of wave I decreased, with no change in the amplitude of wave V. The increase in altitude affected neither the amplitude nor the latency of N100. The P300 latency was prolonged significantly after exposure to hypobaric-hypoxic conditions for 2h, with no significant change in amplitude. At 4500 m, the P300 latency returned to the baseline value after oxygen was inhaled. CONCLUSIONS: Our results suggest it is possible to boost cognitive processing by supplying oxygen even when auditory stimulus intensity decreases under hypobaric and hypoxic conditions, and that P300 latency is affected by hypoxic more than hypobaric conditions. SIGNIFICANCE: This study demonstrated that each component of ABR and the latency of both N100 and P300 are important to record when the effects of hypobaric hypoxia on cognitive function are investigated.

An autopsy case of chronic inflammatory demyelinating polyradiculoneuropathy with respiratory failure.

An 85-year-old Japanese woman presented with progressive symmetrical proximal and distal muscle weakness, numbness in the distal extremities, and sudden onset of hemifacial weakness. The results of laboratory studies fulfilled the American Academy of Neurology criteria for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). She died of respiratory failure after two courses of intravenous immunoglobulin treatment, each resulting in transient improvement in strength and sensory symptoms. Autopsy revealed multifocal demyelinative or axonal lesions of varying severity affecting the cranial and peripheral nerves and including the phrenic nerve. These findings suggest that the clinical phenotype of CIDP depend on distribution and severity of the anatomical lesions.

Effects of unilateral pallidotomy on voluntary movement, and simple and choice reaction times in Parkinson's disease.

We studied the effects of unilateral pallidotomy on motor execution and reaction times in patients with moderately advanced Parkinson's disease (PD). Twelve consecutive patients (7 men, 5 women; all right-handed) underwent left-side microelectrode-guided pallidotomy. In addition to clinical rating, reaction time (RT) tests and repetitive movements of the contralesional hand/arm were carried out at baseline and 2 to 3 months after surgery while patients were on optimal medical regimens (on period). The initiation time in both simple reaction time (SRT) and choice reaction time (CRT) improved significantly after pallidotomy (P < 0.05), whereas no effect was observed on the choice processing time, which was calculated by subtracting the mean value of the onset of SRT from that of CRT. Pallidotomy resulted in significant improvement of repetitive movements such as hand pronation/supination and finger-tapping (P < 0.002, P < 0.005, respectively). Improvements in RT tests and repetitive movements suggest that pallidotomy may enhance attention and motor function. These effects are probably mediated through the pallido-thalamic-cortical neural circuitry.