Efficacy of percutaneous endoscopic gastro-jejunostomy (PEG-J) decompression therapy for patients with chronic intestinal pseudo-obstruction (CIPO).

BACKGROUNDS: Chronic intestinal pseudo-obstruction (CIPO) is an intractable rare digestive disease manifesting persistent small bowel distension without any mechanical cause. Intestinal decompression is a key treatment, but conventional method including a trans-nasal small intestinal tube is invasive and painful. Therefore, a less invasive and tolerable new decompression method is urgently desired. We conducted a pilot study and assessed the efficacy and safety of percutaneous endoscopic gastro-jejunostomy (PEG-J) decompression therapy in CIPO patients. METHODS: Seven definitive CIPO patients (2 males and 5 females) were enrolled. All patients received PEG-J decompression therapy. The number of days with any abdominal symptoms in a month (NODASIM), body mass index (BMI), serum albumin level (Alb), and small intestinal volume before and after PEG-J were compared in all patients. RESULTS: Percutaneous endoscopic gastro-jejunostomy was well tolerated and oral intake improved in all patients. NODASIM has significantly decreased (24.3 vs 9.3 days/months) and BMI/Alb have significantly increased (14.9 vs 17.2 kg/m2 and 2.6 vs 3.8 g/dL, respectively), whereas total volume of the small intestine has not significantly reduced (4.05 vs 2.59 L, P=.18). Reflux esophagitis and chemical dermatitis were observed in one case but was successfully treated conservatively. CONCLUSIONS & INFERENCES: Percutaneous endoscopic gastro-jejunostomy decompression therapy can contribute greatly to improvement of abdominal symptoms and nutritional status in CIPO patients. Although sufficient attention should be paid to acid reflux symptoms, PEG-J has the potential to be a non-invasive novel decompression therapy for CIPO available at home. However, accumulation of more CIPO patients and long-term observation are needed (UMIN000017574).

Biosurfactants of MEL-A increase gene transfection mediated by cationic liposomes.

Many microorganisms growing on water-insoluble substrates have been known to produce surface-active compounds called biosurfactants. Although biosurfactants have received increasing attention due to their special properties, there has been no information available until now of a role for them with regard to gene transfection. Thus, we studied here the effects of biosurfactants on gene transfection by cationic liposomes with a cationic cholesterol derivative. Our results showed clearly that a biosurfactant of mannosylerythritol lipid A (MEL-A) increased dramatically the efficiency of gene transfection mediated by cationic liposomes with a cationic cholesterol derivative. Among them, the liposomes with a cationic cholesterol derivative, cholesteryl-3 beta-carboxyamindoethylene-N-hydroxyethylamine (I), were much more effective for gene transfection than the liposomes with DC-Chol (cholesteryl-3 beta-oxycarboxyamidoethylenedimethylamine) or liposomes without MEL-A in various cultured cells. This demonstrates that this new finding has great potential in the experiment of gene transfection and gene therapy mediated by nonviral vectors such as cationic liposomes.

A rare case of hamartoma in the lateral ventricle: case report.

BACKGROUND: Intraventricular manifestation of a hamartoma is an unusual clinical entity. CASE DESCRIPTION: A 12-year-old girl was admitted with complaints of dizziness and head heaviness. Computed tomography and T1-weighted magnetic resonance imaging (MRI) demonstrated an isodensity or isointensity mass lesion with cystic component in the right lateral ventricle, which showed relatively high signal intensity on T2-weighted MRI and lacked contrast enhancement. Histopathologic examination on the surgically removed specimens using glial fibrillary acidic protein, Klüver-Barrera, Bodian stainings, bromouridine labeling index, and MIB-1 immunohistochemical staining confirmed that the tumor had glial and neuronal components and low proliferative potentiality. CONCLUSION: This case is the first report of intraventricular hamartoma, although some reports on intracranial hamartoma located in areas other than the hypothalamus have been published. The radiologic findings, including relatively high signal intensity on T2-weighted MRI and absence of contrast enhancement, may be suggestive of the diagnosis of intraventricular hamartoma; however, the specific stainings for glial and neuronal cells and proliferative evaluation are essential to the precise diagnosis of hamartoma. Clinical manifestation of hamartoma in the ventricular system, though rare, should be kept in mind.

Malignant brain stem hyperthermia caused by brain stem hemorrhage.

BACKGROUND: We report two cases of brain stem hemorrhage characterized by severe hyperthermia, rhabdomyolysis, acute renal failure, and a rapidly fatal course. METHODS: A 55-year-old man and a 65-year-old man were admitted with coma-producing brain stem hemorrhage accompanied by hyperthermia. Both underwent ventricular drainage. RESULTS: Within 1 day of onset, both patients developed hyperthermia of over 41 degrees C, increased serum creatine phosphokinase (CPK) level indicating rhabdomyolysis, and acute renal failure. One patient died on the second day and the other on the third day after onset despite supportive treatment. CONCLUSIONS: These cases of brain stem hemorrhage with fulminant hyperthermia should be distinguished from those with simple hyperthermia. They may represent a kind of malignant hyperthermia, in which case dantrolene sodium might be beneficial. Monitoring serum CPK levels would be of help in making the diagnosis early in the course.