Asymptomatic Acute Cerebral Infarction in a Patient with Hemoglobin Köln.

Congenital hemoglobin disorders typically present as hemolytic anemia, but there are also numerous reports of thrombotic complications in these diseases, suggesting an associated hypercoagulative state. In hemoglobin Köln, the most common type of unstable hemoglobinopathy worldwide, there have not been many reports of such thrombotic phenomena. We herein describe the case of a patient with hemoglobin Köln demonstrating acute cerebral infarction. His father, who also had hemolytic anemia, presumably hemoglobin Köln, had a history of cerebral infarction. This case suggests that hemoglobin Köln, among other congenital hemoglobin disorders, may be a precipitating factor of thrombotic events.

Clinical effects of polymyxin B-immobilized fiber column direct hemoperfusion for severe bacterial meningitis: A series of 10 cases.

Our results suggest a possible role for Polymyxin B-immobilized fiber column direct hemoperfusion in combination with standard therapy in the rapid improvement of impaired consciousness in patients with severe bacterial meningitis.

Intranuclear coccidiosis caused by Cyclospora spp. in calves.

Intranuclear coccidiosis in 3 calves is described. Two calves with no genetic relationship were kept in the same pen, and the third calf was on another farm. The animals suffered from watery diarrhea or severe emaciation. Histologic examination showed epithelial desquamation (cases 1 and 2) or atrophy (case 3) of the jejunal villi. Coccidial meronts or merozoites were present in the nuclei of the majority of villus epithelial cells. There were rare intranuclear macrogametocytes, macrogametes, microgametocytes, microgametes, and oocysts in cases 1 and 2, but these were more easily observed in case 3. Parasite 18S ribosomal RNA sequences from case 1 showed 99.5% sequence identity with Cyclospora sp. Guangzhou 1, which has been found in fecal samples of cattle from China. In addition to the molecular results in one of the cases, the fact that the microgametocytes and oocysts were noticeably smaller in size than those of Eimeria alabamensis in all cases indicates the close association between Cyclospora and the 3 cases described herein.

[Streptococcus pneumoniae meningitis treated successfully with polymyxin B-immobilized fiber therapy: a case report].

A-61-year old man was admitted to our hospital with fever and severe disturbance of consciousness. He was diagnosed with Streptococcus pneumoniae meningitis on the basis of cerebrospinal fluid (CSF) analysis and urinary antigen detection by immunochromatography. Although he was treated with dexamethasone and antibiotics, his general status worsened as systemic inflammatory response syndrome (SIRS), disseminated intravascular coagulation (DIC), and status epileptics developed. Following treatment with polymyxin B-immobilized fiber therapy (PMX), which can also absorb bacteria-derived toxic substances, he recovered from DIC and SIRS, and disturbance of consciousness improved immediately. In addition, the concentration of several CSF cytokines--IL-1, IL-2, and TNF-α--was decreased. The present case suggests that PMX is a good option for severe bacterial meningitis.

Steroid-responsive focal epilepsy with focal dystonia accompanied by glutamate receptor delta2 antibody.

This report describes a rare case presenting with focal epilepsy and focal dystonia associated with glutamate receptor δ2 antibody. The patient was a 47-year-old male patient with neurosyphilis. He presented with an intractable focal seizure spreading from the right arm, with dystonia of the left leg. The IgG antibody of glutamate receptor δ2 was detected. Ictal and interictal SPECT suggested focal epilepsy in the left frontal cortex. Antibiotic and antiepileptic drugs were ineffective, although steroid pulse therapy effectively diminished the patient's symptoms. Inflammatory mechanisms may have contributed to this disorder.

Recurrent spinal cord attacks in a patient with a limited form of neuromyelitis optica.

This report describes the case of a 71-year-old woman with a limited form of neuromyelitis optica (NMO) who had a longitudinally extensive spinal cord lesion from the fourth to the tenth thoracic vertebrae. Up to age 75, she had four subsequent recurrences of the myelitis within the same spinal cord area but with no optic neuritis. Anti-AQP4 antibody was seropositive. Recurrence within the same spinal cord area might be a characteristic clinical finding in NMO spectrum disorders. For such patients, examination for anti-AQP4 antibody might be necessary for the diagnosis and therapy of this disorder.