Mode of Imaging Study and Endovascular Therapy for a Large Ischemic Core: Insights From the RESCUE-Japan LIMIT / 대한뇌졸중학회지

Background@#and Purpose Differences in measurement of the extent of acute ischemic stroke using the Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) by non-contrast computed tomography (CT-ASPECTS stratum) and diffusion-weighted imaging (DWI-ASPECTS stratum) may impact the efficacy of endovascular therapy (EVT) in patients with a large ischemic core. @*Methods@#The RESCUE-Japan LIMIT (Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism Japan–Large IscheMIc core Trial) was a multicenter, open-label, randomized clinical trial that evaluated the efficacy and safety of EVT in patients with ASPECTS of 3–5. CT-ASPECTS was prioritized when both CT-ASPECTS and DWI-ASPECTS were measured. The effects of EVT on the modified Rankin Scale (mRS) score at 90 days were assessed separately for each stratum. @*Results@#Among 183 patients, 112 (EVT group, 53; No-EVT group, 59) were in the CT-ASPECTS stratum and 71 (EVT group, 40; No-EVT group, 31) in the DWI-ASPECTS stratum. The common odds ratio (OR) (95% confidence interval) of the EVT group for one scale shift of the mRS score toward 0 was 1.29 (0.65–2.54) compared to the No-EVT group in CT-ASPECTS stratum, and 6.15 (2.46–16.3) in DWI-ASPECTS stratum with significant interaction between treatment assignment and mode of imaging study (P=0.002). There were significant interactions in the improvement of the National Institutes of Health Stroke Scale score at 48 hours (CT-ASPECTS stratum: OR, 1.95; DWIASPECTS stratum: OR, 14.5; interaction P=0.035) and mortality at 90 days (CT-ASPECTS stratum: OR, 2.07; DWI-ASPECTS stratum: OR, 0.23; interaction P=0.008). @*Conclusion@#Patients with ASPECTS of 3–5 on MRI benefitted more from EVT than those with ASPECTS of 3–5 on CT.

5-Aminosalicylic acid aggravates colitis mimicking exacerbation of ulcerative colitis

Ulcerative colitis (UC) is one of the major clinical phenotypes of inflammatory bowel diseases. Although 5-aminosalicylic acid (5-ASA) is widely used for UC and its efficacy and safety have been demonstrated, a few patients paradoxically develop a severe exacerbation of colitis by 5-ASA administration. It is crucial to know clinical features including endoscopic findings in this condition for making a correct diagnosis and a prompt decision to withdraw the medication. Here, we report case series with UC exacerbated by 5-ASA. Medical records of 8 UC patients experiencing an exacerbation of colitis after induction of 5-ASA that was improved by the withdrawal of 5-ASA but also re-aggravated by dose increase or re-administration of 5-ASA were reviewed. The patients were newly diagnosed with UC, started 5-ASA and developed an exacerbation in approximately 2 to 3 weeks. They did not appear to have systemic allergic reactions. Seven of the 8 patients had a high fever. Three of 5 patients who undertook total colonoscopy showed right-side-dominant colitis. These findings suggest clinical characteristics in this condition. Further assessment of clinical and endoscopic features in more cases is necessary for establishing diagnostic criteria and understanding underlying mechanisms in those cases where 5-ASA aggravates the colitis.

Usefulness of three-phase bone scintigraphy and SPECT/CT for the diagnosis of bone lesions of systemic sarcoidosis

We report a three-phase bone scintigraphy for the diagnosis of a peripheral bone lesion caused by systemic sarcoidosis. A 32-year-old man with suspected osteomyelitis of the right forefinger underwent three-phase bone scintigraphy with Tc-99m hydroxymethylene diphosphonate [HMDP] and single-photon emission computed tomography/computed tomography [SPECT/CT]. The lesion was rich in blood flow according to flow study and blood pool study on bone scintigraphy, and was associated with an osteolytic change on SPECT/CT imaging performed 3 hours after injection of a radioisotope [RI]. Whole-body bone scintigraphy indicated multiple high levels of abnormal RI accumulation. The findings of the three-phase bone scintigraphy and SPECT/CT suggested the presence of systemic sarcoidosis; however, a subsequent 18Ffluorodeoxyglucose positron emission tomography/CT [FDG-PET/CT] could not exclude the possibility of multiple metastases from testicular tumors. Therefore, testicular enucleation was performed, and the pathological examination confirmed the presence of sarcoidosis

Subcutaneous extravasation of Sr-89: usefulness of bremsstrahlung imaging in confirming Sr-89 extravasation and in the decision making for the choice of treatment strategies for local radiation injuries caused by Sr-89 extravasation

A male patient in his 20s presented at our clinic with pain caused by bone metastases of the primitive neuroectodermal tumor, and Sr-89 was administrated to palliate the pain. After receiving the injection, the patient complained of a slight burning pain at the catheterized area. Slight reddening and small circular swelling [diameter, 0.5 cm] were observed at the catheterized area. Sr-89 extravasation was suspected. To estimate the amount of subcutaneous Sr-89 leakage, bremsstrahlung imaging was immediately performed. We speculated that the skin-absorbed dose from the subcutaneous Sr-89 leakage was 1.78 Gy. The mildest clinical sign of local radiation injury was erythema. The received dose was higher than 3 Gy, and the time of onset was from 2 to 3 weeks. In our patient, local radiation injuries [LRIs] did not occur. Though requiring further verification, subsequent bremsstrahlung imaging and estimation of the skin-absorbed dose from the subcutaneous Sr-89 leakage are useful in confirming Sr-89 extravasation and in the decision making for the choice of treatment strategies for LRIs caused by Sr-89 extravasation

Successful Pain Control in Cancer Patient on Palliative Therapy by Partial Opioid Rotation / 日本農村医学会雑誌

  Our palliative care team intervened in a patient with sciatica resulting from metastasis to sacral bone after surgery for rectal cancer. Rapid pain control and a change in the route of rescue drug administration from the stoma were needed. Partial opioid rotation was performed. The dose of 25.2 mg in 72 hours in a transdermal fentanyl patch decreased to 16.8 mg in 72 hours, and the dose of 3.6mg in an hour by continuous intravenous injection of morphine was added. The change in the rescue root to intravenous administration by a patient-controlled analgesia pump gave the patient relief from his pain. He was able to attend his daughter's wedding. His family were all pleased with the relief provided. The advantages of this partial opioid rotation are summed up in the following three points: (1) The required time is relatively short; (2) It can be expedient for analgesia due to the addition of different opioids; and (3) The partial opioid rotation produces fewer adverse effects than a full opioid rotation. Adjustment of the amount of drugs for pain relief in cancer patients is important with the situations of the patient and the family taken into consideration fully.

Ultrastructural analysis of low-threshold mechanoreceptive vibrissa afferent boutons in the cat trigeminal caudal nucleus / 대한해부학회지

Ultrastructural parameters related to synaptic release and their correlation with synaptic connectivity were analyzed in the low-threshold mechanoreceptive vibrissa afferent boutons in laminae III and IV of the trigeminal caudal nucleus (Vc). Rapidly adapting vibrissa afferents were intra-axonally labeled, and quantitative ultrastructural analyses with serial sections were performed on the labeled boutons and their presynaptic endings (p-endings). The volume of the labeled boutons was widely distributed from small to large ones (0.8~12.3 microm3), whereas the p-endings were small and uniform in size. The volume of the labeled boutons was positively correlated with the ultrastructural parameters such as mitochondrial volume (correlation coefficient, r=0.96), active zone area (r=0.82) and apposed surface area (r=0.79). Vesicle density (r=-0.18) showed little correlation to the volume of labeled boutons, suggesting that the total vesicle number of a bouton is proportional to its volume. In addition, the bouton volume was positively correlated with the number of p-endings (r=0.52) and with the number of dendrites postsynaptic to the labeled bouton (r=0.83). These findings suggest that low-threshold mechanoreception conveyed through vibrissa afferents is processed in a bouton size-dependent manner in the Vc, which may contribute to the sensory-motor function of laminae III/IV in Vc.

Research of PSC (Phenomenon of the Propagated Sensation along Channels), Locations and Clinical Effects of the Meridian Point in Japan and China / 全日本鍼灸学会雑誌

The Research Committee for the Meridian Point held its third workshop at the 57th Annual Meeting of the Japan Society Acupuncture and Moxibustion in Kyoto. Evaluations and reports were presented on two topics.<BR><BR>The first topic:Study of PSC in Japan and China.<BR> 1) Literature search on PSC in China (Wang):A literature search on major studies on PSC in China since 1979 was conducted. The report introduces the definition, characteristics and the mechanism of PSC development together with meridian phenomena.<BR><BR> 2) PSC in reference to the ryodoraku (Morikawa):Development of the reactive ryodo point in patients under hemodialysis or those who have had a total gastrectomy and the cases in which reactive ryodo points or needle sensation developed when specific regions were stimulated were reported. The relationship between reactive ryodo points and PSC was examined. <BR><BR> 3) The mechanism by which PSC develops (Yamada):Neurotransmitter substances are released from sensory nerve endings during acupuncture stimulation. Absorbed by lymphatic vessels, these substances stimulate the smooth muscle of these vessels, thus causing the PSC. Based on factors such as transmission velocity and inhibitory factors, the mechanism by which PSC develops was investigated.<BR><BR>The second topic:Specific locations of meridian points and clinical effects of the meridian point.<BR> 1) Anatomical regions for GB 30 huantiao (Ozaki and Matsuoka):In establishing the international standard for the meridian points under the guidance of WHO, both Chinese and Japanese proposals were listed for GB 30. The clinical effects-presumably emanating from the subcutaneous structure when acupuncture stimuli are applied to these points in a direction perpendicular to the body surface-were comparatively evaluated. <BR><BR> 2) Transition in the regions and main effects of GB 30 (Sakaguchi):As stated above, both Japanese and Chinese definitions were cited in establishing the international standard for GB 30 under the guidance of WHO. By quoting the classic literature from China and Japan, changes in the regions and main effects of GB 30 were comparatively evaluated.

An Anatomical and Clinical Examination of Meridian and Meridian Point / 全日本鍼灸学会雑誌

Six members of the Research Committee for the Meridian Point (former Committee for the Meridian Point) reported on three themes regarding meridian and acupuncture point at Workshop II of the 54th Science Rally of The Japan Society of Acupuncture and Moxibustion held in Fukuoka.<BR>1st theme : Anatomical examination of the meridian and meridian point.<BR>1) Anatomic structure showing path and meridian running. (Kenji Matsuoka) : Similarity of meridian pathway and course of nerve and blood vessels in cadaver.<BR>2) Gross anatomical study of meridian and acupuncture point in upper limbs (Kansho Yamada) : Doctoral study of Katsuyosi Toyoda, former Nagoya City University School of Medicine researcher and Yamada's study (Relation between running of meridian & acupuncture point and subdermal nerve & blood vessels) were reported.<BR>2nd theme : Study of acupuncture safety depth in Japan and China.<BR>1) Research and progress situation of acupuncture safety depth in China. (WANG Cai Yuan) : Data of Yan Zhenguo, professor of anatomy at Shanghai University of Traditional Chinese Medicine, an authority on the study of acupuncture safety depth and progress situation of recent study of acupuncture safety depth in China.<BR>2) Retrospective study of acupuncture safety depth (Tomofumi Ozaki) : Study of acupuncture safety depth published by Ozaki to date and comparative study alongside Prof. Yan Zhenguo data.<BR>3rd theme : Examination of clinical effect of a few meridian points.<BR>1) Acupuncture clinical effect using a few meridian points (Syunji Sakaguchi) : Paper research and analysis of acupuncture clinical effects using 1-4 meridian points of Japana Centra Revuo Medicina.<BR>2) Inflence on skin energizing current by various acupuncture stimulation of LI4 (Gokoku) (Kazuhiro Morikawa) : Influence on the amount of skin energizing current by acupuncture stimulation, direct current electricity stimulation and stimulation of electroacupuncture to LI4.

A Consideration of Safely Applying Acupuncture of the Meridian Point (Gaohuang, Koko, BL43) based on Dissection of a Cadaver, and Clinical Findings and CT Radiographic Findings in Vivo / 全日本鍼灸学会雑誌

Acupuncture to Gaohuang carries a risk of causing pneumothorax because it reaches the lungs at deep portion. This study was designed to consider a safe depth for acupuncture to Gaohuang.<BR>1) We inserted a needle to Gaohuang on both sides of a cadaver to examine the location of the needle tip and measure the distance from the body surface of the left Gaohuang to the pleura. The tip was located at the fifth intercostal region on both sides, and the distance was 44 mm with a rib thickness of 10 mm. 2) Using 104 students, we inserted a needle to the left Gaohuang until the tip reached the rib, and measured the distance between the bodysurface and rib. The minimal distance was 14 mm. 3) We inserted a needle to Gaohuang on both sides of two males and took CT-radiographs to examine the location of the needle tip and measure the distance from the body surface of Gaohuang to the pleura. In a man of standard body size, the needle reached the rib on the left and the intercostal region on the right. The thickness of the left rib was 10.9 mm, and the distance from body surface to pleura was 33.6 mm on the left and 28.4 mm on the right. In a man of thin body size, the needle reached the rib on both sides, with the rib thickness was 9.8 mm on the left and 8.8 mm on the right. The distance from body surface to pleura was 29.4 mm on the left and 31.8 mm on the right. The above results showed that needle insertion within 19 mm (the minimal value of the measured distance between the body surface and rib + the half thickness of the rib) is safe.