ABSTRACT
A new Nd:YAG laser Thomson scattering (TS) system has been developed to explore the mechanism of high-beta plasma formation in the RT-1 device. The TS system is designed to measure electron temperatures (Te) from 10 eV to 50 keV and electron densities (ne) of more than 1.0 × 1017 m-3. To measure at the low-density limit, the receiving optics views the long scattering length (60 mm) using a bright optical system with both a large collection window (260-mm diameter) and large collection lenses (300-mm diameter, a solid angle of â¼68 × 10-3 str). The scattered light of the 1.2-J Nd:YAG laser (repetition frequency: 10 Hz) is detected with a scattering angle of 90° and is transferred via a set of lenses and an optical fiber bundle to a polychromator. After Raman scattering measurement for the optical alignment and an absolute calibration, we successfully measured Te = 72.2 eV and ne = 0.43 × 1016 m-3 for the coil-supported case and Te = 79.2 eV and ne = 1.28 × 1016 m-3 for the coil-levitated case near the inner edge in the magnetospheric plasmas.
ABSTRACT
A coherence-imaging spectroscopy (CIS) technique was developed to investigate plasma confinement in a dipole system that imitates a planetary magnetosphere. Optical interference generated using birefringent crystals enables two-dimensional Doppler spectroscopy to measure ion temperatures and flow velocities in plasmas. CIS covers the entire dynamics of the pole areas as well as of the core and edge areas on a dipole confinement device. The two-dimensional visualization of these quantities in the magnetospheric-plasma device RT-1 was demonstrated using CIS.
ABSTRACT
Primary invasive mold infection of the oral cavity is a rare but serious complication in immunocompromised hosts. We report a case of fatal Trichoderma longibrachiatum stomatitis in a 66-year-old female patient with malignant lymphoma. The infection rapidly disseminated from the oral mucosa to the lungs during neutropenia. Despite intensive antifungal therapy with amphotericin B and itraconazole, there was a fatal progression of the condition. While Trichoderma species have been recognized to be pathogenic in profoundly immunosuppressed hosts, this is the first report of the primary oral focus causing a fatal infection.
Subject(s)
Immunocompromised Host , Lymphoma, B-Cell/drug therapy , Lymphoma, Large B-Cell, Diffuse/drug therapy , Mycoses/microbiology , Neutropenia/etiology , Stomatitis/microbiology , Trichoderma , Aged , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Disease Progression , Fatal Outcome , Female , Gingivitis, Necrotizing Ulcerative/microbiology , Humans , Itraconazole/therapeutic use , Lung Diseases, Fungal/microbiology , Opportunistic Infections/microbiologyABSTRACT
An 8-year retrospective analysis of invasive Aspergillus stomatitis in neutropenic patients with acute leukemia was performed to characterize the epidemiology and clinical features of the infection. Twelve cases of invasive Aspergillus stomatitis were identified with both clinicohistological and microbiological evidence, and the majority of cases were caused by Aspergillus flavus (10 [83%] of 12 patients). The infection was strongly suspected when a neutropenic patient developed persistent fever without a known source, symptoms of gingival pain and facial swelling, and a solitary ulcerating lesion of mucogingiva covered with a gray necrotic pseudomembrane. Aspergillus stomatitis was diagnosed a median 23 days after admission. In all 12 patients, the diagnosis was made during the period of neutropenia. Ten patients (83%) were treated with amphotericin B and surgery and survived with recovery of neutrophils. Two patients died, and disseminated aspergillosis was identified in 1 patient.
Subject(s)
Aspergillosis/complications , Aspergillus flavus , Leukemia/complications , Stomatitis/complications , Acute Disease , Adult , Aged , Aspergillosis/microbiology , Female , Humans , Leukemia/microbiology , Male , Middle Aged , Retrospective Studies , Stomatitis/microbiologyABSTRACT
A patient is presented with a large pituitary adenoma that was successfully treated with a Le Fort I osteotomy in combination with mandibulotomy.
Subject(s)
Adenoma/surgery , Mandible/surgery , Oral Surgical Procedures/methods , Osteotomy, Le Fort , Pituitary Neoplasms/surgery , Skull Base Neoplasms/surgery , Female , Humans , Middle AgedABSTRACT
OBJECTIVE: The aim of this study was to evaluate the relevance of in vitro antifungal susceptibility to clinical response in neutropenic patients with invasive oral aspergillosis. STUDY DESIGN: Nine isolates of Aspergillus species were obtained from invasive oral infections in 9 patients with hematologic malignancies and tested for their in vitro susceptibility to amphotericin B, fluconazole, miconazole, 5-fluorocytosine, and itraconazole. Minimal inhibitory concentration values of the 5 drugs were obtained for each fungus through use of a microdilution broth method. The patients were treated with intravenous amphotericin B (30-50 mg/day) in combination with oral 5-fluorocytosine (3000-6000 mg/day) and/or oral itraconazole (200 mg/day). RESULTS: Amphotericin B and itraconazole were found to be very active, with minimal inhibitory concentration values of 0.861 and 0.194 microg/mL, respectively. Miconazole and 5-fluorocytosine showed minimal inhibitory concentration values of 1.72 and 3.56 microg/mL, respectively. On the other hand, fluconazole FCZ showed low activity, with a minimal inhibitory concentration value in excess of 64.0 microg/mL. During neutropenia, combined antifungal chemotherapy stabilized oral aspergillosis and prevented the spread of oral lesions in 8 patients in whom neutrophil counts eventually recovered. CONCLUSIONS: The results imply that in vitro susceptibility testing may serve as an informative parameter with respect to the efficacy of these antifungals in the treatment of invasive oral aspergillosis, inducing fungal stasis until the neutrophils recover.
Subject(s)
Antifungal Agents/pharmacology , Antifungal Agents/therapeutic use , Aspergillosis/drug therapy , Aspergillus/drug effects , Mouth Diseases/microbiology , Neutropenia/complications , Adult , Aged , Amphotericin B/pharmacology , Amphotericin B/therapeutic use , Antineoplastic Agents/adverse effects , Aspergillosis/complications , Drug Combinations , Drug Evaluation , Female , Fluconazole/pharmacology , Fluconazole/therapeutic use , Flucytosine/pharmacology , Flucytosine/therapeutic use , Humans , Immunocompromised Host , Itraconazole/pharmacology , Itraconazole/therapeutic use , Leukemia/complications , Leukemia/drug therapy , Leukemia/immunology , Lymphoma/complications , Lymphoma/drug therapy , Lymphoma/immunology , Male , Miconazole/pharmacology , Miconazole/therapeutic use , Microbial Sensitivity Tests , Middle Aged , Mouth Diseases/drug therapy , Neutropenia/chemically inducedSubject(s)
Gingivitis, Necrotizing Ulcerative/diagnosis , Pseudomonas Infections/diagnosis , Sepsis/diagnosis , Female , Gingivitis, Necrotizing Ulcerative/microbiology , Humans , Leukemia, Myeloid, Acute/complications , Leukemia, Myeloid, Acute/microbiology , Middle Aged , Neutropenia/diagnosis , Neutropenia/microbiology , Pseudomonas Infections/microbiology , Pseudomonas aeruginosa/isolation & purification , Sepsis/microbiologySubject(s)
Osteotomy, Le Fort , Pituitary Neoplasms/surgery , Prolactinoma/surgery , Skull Base Neoplasms/surgery , Humans , Male , Middle AgedSubject(s)
Masseter Muscle/injuries , Myositis Ossificans/etiology , Temporal Muscle/injuries , Accidents, Occupational , Ear, External/injuries , Humans , Male , Middle Aged , Myositis Ossificans/diagnostic imaging , Myositis Ossificans/surgery , Tomography, X-Ray Computed , Trismus/etiology , Zygomatic Fractures/etiologyABSTRACT
Acromegaly in a female patient was first diagnosed after a dental examination at which time the patient complained of the inability to incise properly. An elevated serum growth hormone level and enlarged sella turcica confirmed the diagnosis of acromegaly. Based on examination of her plaster study models, it was apparent the patient had been developing a change in her dentition for years.
Subject(s)
Acromegaly/diagnosis , Malocclusion, Angle Class III/etiology , Prognathism/etiology , Acromegaly/blood , Acromegaly/etiology , Adenoma/complications , Adenoma/surgery , Adult , Female , Human Growth Hormone/blood , Humans , Pituitary Neoplasms/complications , Pituitary Neoplasms/surgery , Somatomedins/analysisSubject(s)
Bacteroides Infections/complications , Cellulitis/etiology , Diabetes Mellitus, Type 2/complications , Focal Infection, Dental/complications , Mediastinitis/etiology , Streptococcal Infections/complications , Aged , Bacteroides Infections/diagnosis , Bacteroides Infections/surgery , Cellulitis/diagnosis , Cellulitis/surgery , Combined Modality Therapy , Diabetes Mellitus, Type 2/drug therapy , Female , Focal Infection, Dental/diagnosis , Focal Infection, Dental/surgery , Humans , Mandible , Mediastinitis/diagnosis , Mediastinitis/surgery , Molar, Third , Neck , Streptococcal Infections/diagnosis , Streptococcal Infections/surgery , Tooth, Impacted/complications , Tooth, Impacted/diagnosis , Tooth, Impacted/surgeryABSTRACT
Primary invasive aspergillosis of the oral cavity is a rare but serious complication in immunocompromised patients. We report a case of gingival Aspergillus infection in a neutropenic patient with acute myelogenous leukemia, who was successfully treated by an early surgical approach in combination with antifungal medication and granulocyte colon stimulating factors.
Subject(s)
Aspergillosis/surgery , Gingival Diseases/microbiology , Leukemia, Myeloid, Acute/complications , Neutropenia/complications , Adult , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Aspergillosis/drug therapy , Female , Fluconazole/therapeutic use , Flucytosine/therapeutic use , Gingival Diseases/drug therapy , Gingival Diseases/surgery , Granulocyte Colony-Stimulating Factor/therapeutic use , Humans , Immunocompromised Host , Itraconazole/therapeutic useSubject(s)
Aspergillosis/etiology , Hematologic Neoplasms/complications , Immunocompromised Host , Mouth Diseases/etiology , Adult , Aged , Aspergillosis/immunology , Aspergillosis/pathology , Aspergillosis/prevention & control , Chemoprevention , Female , Humans , Itraconazole/therapeutic use , Leukemia, Biphenotypic, Acute/complications , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications , Leukemia, Myeloid, Acute/complications , Lymphoma/complications , Male , Middle Aged , Mouth Diseases/immunology , Mouth Diseases/microbiology , Mouth Diseases/pathology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complicationsABSTRACT
PURPOSE: Little is known about the characteristic macroscopic and microscopic changes that take place during the progression of oral invasive aspergillosis in immunocompromised patients. The aim of this study was to determine the relationship between the oral and histopathologic findings in these patients. Such a study would aid in understanding the early development of subsequent progression of the disease. PATIENTS AND METHODS: Twelve patients with hematologic malignancies who developed invasive oral aspergillosis were studied. The condition was divided into three stages according to the oral findings at the time biopsy procedures were performed. Tissue sections from biopsy specimens were stained with hematoxylin and eosin for histopathologic study and the findings were evaluated in relation to the oral findings. Fungal cultures of biopsy specimens were also performed to confirm the causative organisms. RESULTS: The diagnosis of oral aspergillosis was established in terms of both histologic and microbiologic evidence in all 12 patients. In the early stage (three patients), isolated areas of violaceous marginal gingiva consisted of degenerated epithelium and connective tissue infiltrated by fungal hyphae. In the advanced stage (four patients), the violaceous marginal gingiva had become transformed into gray necrotic lesions that extended to the attached gingiva. The necrotic lesions showed ulceration and were covered by a pseudomembrane containing fungal hyphae. At the base of the ulcers, connective tissue was occupied by proliferating fungal hyphae, with vascular invasion being observed. In the late stage (five patients), the ulcerated lesions had progressed, showing destruction of the alveolar bone and surrounding facial muscles, with infiltration of fungal hyphae unto the tissues. No inflammatory cellular reaction was observed until the hematologic status of the patients improved. CONCLUSION: These findings indicate that invasive oral aspergillosis has three distinctive clinicopathological stages. Recognition of the different stages of invasive Aspergillus infections is helpful for correct diagnosis of the disease.
Subject(s)
Aspergillosis/pathology , Leukemia/complications , Lymphoma, Non-Hodgkin/complications , Mouth Diseases/microbiology , Mouth Diseases/pathology , Adult , Aged , Aspergillosis/etiology , Disease Progression , Female , Humans , Immunocompromised Host , Leukemia, Biphenotypic, Acute/complications , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications , Leukemia, Myeloid, Acute/complications , Male , Middle AgedABSTRACT
The fungus Fusarium moniliforme causes fusariosis, which can be invasive and fatal in immunocompromised patients. We report a case of oral Fusarium infection in a granulocytopenic patient with acute myelogenous leukemia who developed necrotic ulceration of the gingiva, extending to the alveolar bone, but was otherwise free of any active systemic lesions. Fusarium moniliforme was identified, by histopathology and culture, to be present in the lesion and was deduced to be the causative organism for this invasive oral infection.
Subject(s)
Agranulocytosis/chemically induced , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Fusarium , Gingival Diseases/microbiology , Leukemia, Myeloid, Acute/drug therapy , Mycoses/etiology , Acute Kidney Injury/etiology , Aged , Agranulocytosis/complications , Amphotericin B/therapeutic use , Cytarabine/administration & dosage , Cytarabine/adverse effects , Epirubicin/adverse effects , Etoposide/administration & dosage , Etoposide/adverse effects , Fatal Outcome , Gingival Diseases/drug therapy , Gingival Diseases/etiology , Humans , Immunocompromised Host , Male , Maxillary Diseases/drug therapy , Maxillary Diseases/etiology , Maxillary Diseases/microbiology , Mercaptopurine/administration & dosage , Mercaptopurine/adverse effects , Mycoses/drug therapy , Necrosis , Prednisolone/administration & dosage , Prednisolone/adverse effects , Ulcer , Vindesine/administration & dosage , Vindesine/adverse effectsABSTRACT
The clinicopathologic characteristics of invasive oral aspergillosis in 16 immunocompromised patients who developed this infection during antileukemic chemotherapy are described. The primary site of the infection was the marginal gingiva, there was severe spontaneous pain, and the patients developed spiking fever and granulocytopenia. Necrotic ulceration of the gingiva rapidly extended to the contiguous mucosa, muscle, and bone. Microscopically, the necrotic tissue contained thrombotic vascular infarcts and there were hyphae that showed frequent transverse septa and dichotomous branching. The invasive organisms were not responsive to amphotericin B in the absence of remission of the leukemia and restoration of the depressed host defenses. In 15 patients who showed improvement of hematologic status, oral aspergillosis was controlled by the combination of antifungal chemotherapy and debridement of necrotic tissues.
Subject(s)
Aspergillosis/pathology , Immunocompromised Host , Leukemia/drug therapy , Mouth Diseases/pathology , Adult , Aged , Agranulocytosis/complications , Amphotericin B/therapeutic use , Aspergillosis/etiology , Aspergillosis/therapy , Female , Humans , Male , Middle Aged , Mouth Diseases/etiology , Mouth Diseases/therapy , Necrosis , Nystatin/therapeutic useABSTRACT
The conductivity of motor neurons in 26 aged females (mean age 79 years) was analyzed by the conventional conduction method and by pulsed magnetic stimulation and compared with that in 14 younger controls. In aged people, slow motor conduction velocities were found in peripheral nerves. Central motor conduction time (CMCT) in relaxed muscle was shorter in the aged people, although CMCT was normal in mildly contracted muscle. These findings coincide with the results studied in Parkinson's disease, although these subjects were not diagnosed as having Parkinson's disease. Aged people generally have an anteflexed posture, slow movements, and poor postural reflexes, and have been reported to have a decrease in the dopamine level which is relatively earlier than that of other transmitters in the basal ganglia. This may account for the present finding that aged people have neurophysiological abnormalities in CNS which are similar to those in Parkinson's disease.
Subject(s)
Aging/physiology , Motor Cortex/physiology , Motor Neurons/physiology , Neural Conduction/physiology , Adult , Aged , Aged, 80 and over , Electromyography , Evoked Potentials , Female , Humans , Magnetics , Median Nerve/physiology , Muscle Contraction , Parkinson Disease/physiopathology , Reaction Time , Ulnar Nerve/physiologyABSTRACT
A 40-year-old woman developed high fever and headache. Five days later, she was admitted because of consciousness disturbance and tremulous movements in upper extremities. The paired sera showed more than fourfold elevation in complement fixation titer to Japanese encephalitis virus. She was diagnosed as Japanese encephalitis from the clinical features and serological tests. Magnetic resonance imaging (MRI), which was performed about seven months after the onset, revealed abnormal intensity areas bilaterally in the thalamus, hippocampus, substantia nigra, globus pallidus and white matter around the lateral ventricle. Eight months after the onset, she was left with bradykinesia, disturbance of rightening reflex, emotional lability and impairment of recent memory with a long period of amnesia, including not only her illness and subsequent events but also about several years before her illness. The characteristic memory dysfunction seems to be due to disorder of bilateral hippocampus, where MRI revealed abnormal intensity areas. And disorder of medial thalamic nucleus would be related to emotional liability. The relation between the clinical features and MRI findings is also discussed.
Subject(s)
Encephalitis, Japanese/diagnosis , Adult , Affective Symptoms/etiology , Encephalitis, Japanese/complications , Female , Humans , Magnetic Resonance Imaging , Memory Disorders/etiologyABSTRACT
We reported a case of hypertrophic neuropathy of adult onset. The pathological change in the sural nerve was decreased axonal population with onion-bulb formation. On examination, there were enlarged nerve on palpation and she was found to have distal muscle atrophy, weakness and sensory loss. The deep tendon reflexes of extremities were weak. The first clinical feature of this patient was mainly polyneuropathy. The lower limbs were slightly spastic and plantar responses were extensor bilaterally. There was also sensory level at C6 level. After 1.5 years from first examination, she had shown myelopathy. Magnetic resonance imaging (MRI) of the spine showed marked thickening of the nerve roots and it revealed the compression of the spinal cord by enlarged nerve roots from C2 to C6 level. The compression syndrome of the patients with hypertrophic neuropathy was unclear at the onset in this case. MRI study of the spinal cord would be very beneficial to disclose subclinical myelopathy associated with hypertrophic neuropathy, as indicated in this report.