Lemierre syndrome complicated by bronchopleural fistula.

We present a 19-year-old woman, a case of Lemierre syndrome, who presented with fever, sore throat, and left shoulder pain. Imaging revealed a thrombus in the right internal jugular vein, multiple nodular shadows below both pleura with some cavitations, right lung necrotizing pneumonia, pyothorax, abscess in the infraspinatus muscle, and multiloculated fluid collections in the left hip joint. After inserting a chest tube and administering urokinase for the pyothorax, a bronchopleural fistula was suspected. The fistula was identified based on clinical symptoms and computed tomography scan findings. If a bronchopleural fistula is present, thoracic lavage should not be performed as it may cause complications such as contralateral pneumonia due to reflux.

Impact of interpersonal adversity in childhood on adult mental health: how much is mediated by social support and socio-economic status in Japan?

OBJECTIVES: To examine the extent to which social support and socio-economic status (SES) in adulthood mediate the impact of interpersonal adversity in childhood on adult mental health using large-scale population data in Japan. STUDY DESIGN: Cross-sectional survey. METHODS: Data were derived from the Japanese Study of Stratification, Health, Income and Neighbourhood, which was conducted from October 2010 to February 2011 in four municipalities in and around the Tokyo metropolitan area. Survey participants were community residents aged 25-50 years who were selected at random from voter registration lists. The total sample size was 3292. The self-reported experience of parental maltreatment (physical abuse and/or neglect) and bullying in school and their impacts on adult mental health (in terms of K6 = 5+, K6 = 13+ and suicide ideation) were examined using multivariate logistic models. RESULTS: Interpersonal adversity in childhood has a negative impact on adult mental health even after controlling for childhood SES. For example, the odds ratio for K6 = 5+, responding to parental maltreatment, was 2.64 (95% confidence interval 2.04-3.41). Perceived social support and adult SES mediated the impact of interpersonal adversity in childhood, but a substantial proportion of the impact was unexplained by their mediating effects; social support and adult SES only mediated 11-24% and 6-12%, respectively. It was also found that social support and adult SES (except educational attainment) did not moderate the negative impact of interpersonal adversity in childhood. CONCLUSIONS: This analysis highlighted that the impact of interpersonal adversity in childhood is relatively independent of social support and SES in adulthood. This result has clear policy implications; more focus should be placed on policies that aim to reduce incidents of childhood maltreatment and bullying per se, both of which have a long-lasting direct impact on mental health.

Intragastric migration of a ventriculoperitoneal shunt catheter.

A child developed bacterial meningitis and shunt dysfunction 2 years after the insertion of a ventriculoperitoneal shunt for posttraumatic hydrocephalus. The distal end of the shunt catheter had penetrated the gastric wall. We found no other report of intragastric shunt catheter migration with successful treatment.

Study of drug-protein binding by affinity chromatography: interaction of bovine serum albumin and salicylic acid.

The affinity chromatographic technique was used to study the interaction of bovine serum albumin and salicylic acid at 3.3 +/- 1.1 degrees. Beaded agarose gel, on which the albumin was immobilized by covalent linkage, was packed in a column as an affinity adsorbent. Frontal analysis was performed on this column to evaluate the binding parameters for the interaction. The effect of albumin immobilization on drug binding was investigated by comparing the binding parameters of two affinity adsorbents, directly coupled albumin and albumin coupled through a spacer arm. The latter mode of attachment gave binding characteristics comparable to those of the soluble albumin. The method is simple and precise. The affinity adsorbent can be used repeatedly for many months for various drugs, including those that do not diffuse through dialysis membranes.

Chylothorax following Bochdalek herniorrhaphy in an infant.

A case of chylothorax following Bochdalek herniorrhaphy in an infant is presented. To our knowledge, it is only the third case to be reported in the literature.

Urologic abnormalities in Menkes' kinky hair disease: report of three cases.

Menkes' kinky hair disease is a rare congenital disorder of copper metabolism with X-linked recessive inheritance. It is well known that it is frequently associated with urologic abnormalities. The authors experienced three such cases, but each of them was different. Multiple bladder diverticula, right vesico-ureteral reflux, and right hydronephrosis were noted on the first baby boy. In the second case, hematomas in the left kidney, pelvis, ureter and the adipose capsule, which were thought to be the abnormality of vessels, were noted in the neonatal period. In the third body, multiple bladder diverticular were noted at the age of 1 year. One year, 10 months later, a spontaneous rupture at the huge diverticulum occurred.

Recurrent perforations of viscus due to ventriculoperitoneal shunt in a hydrocephalic child.

In this report, we describe the first case of recurrent perforations of viscus due to ventriculoperitoneal shunt for the treatment of hydrocephalus. Based on our own experience and a survey of literature, we suggest that perforation of the gastrointestinal tract should be suspected in patients with ventriculoperitoneal shunt, particularly when abdominal symptoms or ventriculitis are presented. To manage this complication, at the first perforation in the present case, a fibrin sealant was effective for closure of the perforated stomach wall. At the second perforation, when laparotomy was performed, we could not find any abnormality in the abdominal cavity except for a sheath and slight omental adhesions near it.

TWEAK/Fn14 pathway promotes a T helper 2-type chronic colitis with fibrosis in mice.

Tumor necrosis factor (TNF)-like weak inducer of apoptosis (TWEAK), a TNF superfamily member, induces damage of the epithelial cells (ECs) and production of inflammatory mediaters through its receptor Fn14 in a model of acute colitis. In our current study of chronic colitis induced by repeated rectal injection of a hapten, we found that inflammation, fibrosis, and T helper 2 (Th2)-type immunity were significantly reduced in Fn14 gene knockout (KO) mice when compared with wild-type (WT) control mice. Expression of thymic stromal lymphopoietin (TSLP) was lower in Fn14 KO colon ECs than in WT ECs. TWEAK potentiates the induction of TSLP by interleukin-13 (IL-13) in colon explants from WT but not in Fn14 KO tissue. TSLP receptor KO mice exhibit milder chronic colitis, similar to that in Fn14 KO mice. TWEAK and IL-13 synergistically promote fibroblast proliferation. Thus we propose an IL-13-TWEAK/Fn14-TSLP axis as a key mechanism underlying chronic colitis with fibrosis.