A case of posterior reversible leukoencephalopathy syndrome caused by fibromuscular dysplasia.

A 23-year-old woman presented with disturbance of consciousness and seizure. Her blood pressure was remarkably high, and brain magnetic resonance imaging (MRI) showed high-intensity T2 signals in the bilateral basal ganglia, corpus callosum, cerebral white matter, and cortex. With the administration of angiotensin II receptor blocker, the symptoms and MRI findings improved, along with normalization of blood pressure, and a diagnosis of posterior reversible leukoencephalopathy syndrome (PRES) was made. Plasma renin activity was high, and the right kidney was severely atrophic. Results from renal and adrenal vein sampling revealed renal vascular hypertension derived from the right renal artery stenosis. The right kidney was then removed by laparoscopic nephrectomy. Pathological examination of the kidney confirmed the diagnosis of fibromuscular dysplasia (FMD). In juvenile-onset encephalitis/encephalopathy, PRES due to FMD should be included in the differential diagnosis.

Rostrocaudal thickness on sagittal diffusion-weighted imaging as a predictor of motor deficits in an acute isolated pontine infarction.

BACKGROUND: The relationship between infarct dimensions and neurologic severity in patients with acute pontine infarctions remains unclear. This study aimed to clarify the morphometric predictive value of magnetic resonance imaging for motor deficits in pontine infarction. METHODS: Nineteen patients with an acute pontine infarction (12 males and 7 females, 70.6 ± 13.5 years [mean age ± SD]) had ventrodorsal length and rostrocaudal thickness and width retrospectively measured as parameters of infarct size on axial and sagittal diffusion-weighted imaging (DWI). Each patient's functional score (FS) based on Brunnstrom scale (upper limb, hand, and lower limb) was assessed. The functional score of bulbar symptoms was coded as follows: 2, none; 1, dysarthria or dysphasia; and 0, both. The mean FS was compared with each infarct size parameter and the patients' clinical features. RESULTS: Rostrocaudal thickness on sagittal DWI was the parameter most closely correlated with FS (Spearman rank correlation coefficient (rs) = -.474, P = .040). However, there is apparently no association between FS and infarct size with correction for age. FS was most severe in patients with an atherothrombotic infarction; it was mildest in patients with a lacunar infarction (value of K [Kruskal-Wallis] = 9.0, P = .015). CONCLUSIONS: The branch orifices of the pontine paramedian arteries could be narrowed by atheromatous plaques within the basilar artery. These atheromatous lesions involving multiple branching paramedian arteries probably cause rostrocaudally thick infarctions. A pontine infarction extending rostrocaudally along the corticospinal tract may cause severe motor impairments.

Formation of octacalcium phosphates with co-incorporated succinate and suberate ions.

Octacalcium phosphates (OCPs) co-incorporated with various molar ratios of succinate and suberate ions were synthesized by wet processing. The interplanar spacings of the (100) planes (d(100)) of OCPs formed in the presence of succinic acid (Suc) or suberic acid (Sub) were larger than those of OCPs formed without addition of a dicarboxylic acid to the reaction solvent. The increases in the interplanar spacings of the (100) planes were caused by substitution of HPO(4)(2-) by dicarboxylate ions. The OCPs with co-incorporated succinate and suberate ions, i.e. solid solutions of OCP with incorporated Suc and Sub, were formed by reactions in the presence of Suc and Sub. When the Suc/(Suc + Sub) values in the starting compositions were in the range 0.45-1.0, Suc was preferentially incorporated into the OCP. In contrast, when the Sub/(Suc + Sub) values in the starting compositions were in the range 0.60-1.0, Sub was preferentially incorporated into the OCP crystals.

[Leak of anesthetic gases inside the anesthesia machine].

We experienced the leak of anesthetic gases inside the anesthesia machine in spite of performing the leak test before its use. After induction of anesthesia, a laryngeal mask airway was inserted and the patient was ventilated manually. At the beginning we could not find any signs of machine troubles. High airway pressure occurred immediately after switching to the mechanical ventilation. Because we could not detect the details of the machine trouble, tidal volume was set lower and the surgery was continued. After surgery, we found a crack in a fresh gas circuit valve. We have to check the anesthesia machine regularly and know its duration of use.

Gene expression patterns of pro-opiomelanocortin-processing enzymes PC1 and PC2 during postnatal development of rat corticotrophs.

We examined the expression and localization of the prohormone convertases, PC1 and PC2, in the anterior pituitary cells of developing rats by a double staining procedure using in situ RT-PCR and an immunofluorescence technique. In the adult, both PC1 mRNA and PC2 mRNA were expressed in corticotrophs, gonadotrophs, thyrotrophs, and mammotrophs. These cells, except for corticotrophs, had previously been considered to be ones in which proprotein processing does not take place, but both PC1 and PC2 may be necessary to process other proteins, such as granin family proteins, having proteolytic cleavage sites and located in secretory granules of the above trophs. In addition, no PC1 or PC2 mRNA was expressed in somatotrophs, which is consistent with the fact that somatotrophs do not contain these granins. In addition, 7B2 mRNA was expressed in these PC2-positive trophs, suggesting that there is a functional relationship between PC2 and 7B2 proteins. We found that alpha-MSH was expressed in the corticotrophs of the postnatal rat and that the number of alpha-MSH-immunopositive corticotrophs decreased as development proceeded. Because the changes in the pattern of POMC processing are considered to depend on the relative expression levels of PC1 and PC2, PC1 and PC2 mRNAs were examined in corticotrophs during postnatal development. We found a decrease in the number of PC2 mRNA-positive cells, which coincided with one in the number of alpha-MSH-immunopositive corticotrophs, as postnatal development proceeded. Our present data demonstrate that the alpha-MSH production varies directly in accordance with the expression of PC2. We also discuss the possible significance of alpha-MSH production during the postnatal period.