An early MRI change following reversible hypoxic brain injury. A case report.

We describe a patient who suffered reversible hypoxic brain injury. The initial MRI taken 3.5 hours after asphyxiation showed an abnormal lesion on DWI, but he recovered completely from coma. The presence of cytotoxic edema in the acute stage may not necessarily indicate a poor prognosis.

Deafness induced up-regulation of GluR2/3 and NR1 in the spiral ganglion cells of the rat cochlea.

Expressions of AMPA (GluR2, GluR3, and GluR4) and NMDA (NR1 and NR2) glutamate receptors in the spiral ganglion cells of the cochlea were analyzed both at protein and mRNA levels in control and deaf rats between week 0 (P14) and week 8 (P70) after deafness induced by a daily injection of kanamycin at P0-P14. In the deaf rats, significant up-regulations of GluR2, GluR3, and NR1 in the surviving spiral ganglion cells were observed, while expressions of GluR4 and NR2 were fairly constant. In contrast, in the control rats, the expressions of all these glutamate receptor subtypes were stable. These results suggest that drastic alterations in the diversity of GluR2/GluR3/NR1 receptor complexes in the surviving spiral ganglion cells, which result in alterations in Ca2+ permeability, may contribute to the deafness-related alterations in the structure and function of the cochlea.

Epidural block with mepivacaine before surgery reduces long-term post-thoracotomy pain.

PURPOSE: To examine the effect of continuous epidural block initiated before thoracic surgery upon early and long-term postoperative pain. METHODS: In a double-blind study, 70 patients scheduled for thoracic surgery under general anesthesia were assigned randomly to receive continuous epidural block with mepivacaine 1.5% initiated either 20 min before surgical incision (Pre group) or at completion of surgery (Post group). In both groups the initial dose was 4 ml, followed by a continuous infusion at 4 ml x hr(-1) until 72 hr after operation. Indomethacin suppositories, 50 mg, were administered on request as supplementary analgesics. Visual analogue scale at rest was assessed four hours after operation, and then every 24 hr after operation on postoperative days 1 through 7, and also days 14 and 30. At three and six months after operation, all patients were interviewed by telephone with respect to postoperative pain. The most severe pain was assessed using modified numerical rating scale. RESULTS: By a visual analogue scale, postoperative pain was less in the Pre group than in the Post group at four hours, two and three days after operation (P < 0.05). By a numerical rating scale six months after operation, pain was less in the Pre group than in the Post group (P = 0.015). The percentage of pain-free patients was higher in the Pre group than in the Post group at three (P = 0.035) and six (P = 0.0086) months after operation. CONCLUSION: Continuous epidural block initiated prior to surgery may reduce long-term post-thoracotomy pain.

Three novel connexin26 gene mutations in autosomal recessive non-syndromic deafness.

Since the first identification of an association between mutations in the connexin26 (Cx26) gene and autosomal recessive non-syndromic deafness it has been shown that several mutations in this gene cause recessive, sporadic, and dominant non-syndromic deafness. Three novel mutations in the Cx26 gene were identified in four of 20 Japanese families with autosomal recessive non-syndromic deafness. Seven of 40 chromosomes contained a 233delC allele, while Tyr136Stop (408C-->A) and Gly45Glu (134G-->A) were detected in two of 40 chromosomes, respectively. These mutations were not found in chromosomes in cases of sporadic congenital deafness (0/60) or in control groups (0/100). This indicates that 27.5% (11/40 chromosomes) of cases of autosomal recessive non-syndromic deafness among the Japanese are caused by mutations in the Cx26 gene.

Intraoperative irradiation after surgery for locally recurrent rectal cancer.

PURPOSE: This study retrospectively evaluated the effects of intraoperative electron beam irradiation on patients with locally recurrent (pelvic) rectal cancer. METHODS: From November 1, 1975, to December 31, 1997, 51 patients underwent surgery for locally recurrent rectal or rectosigmoid cancer, and 27 patients received intraoperative electron beam irradiation. The intraoperative electron beam irradiation dose was 15 to 30 Gy. Kaplan-Meier survival estimates at three and five years were analyzed for the 47 patients who recovered postoperatively. RESULTS: Statistically significant factors related to survival included intraoperative electron beam irradiation vs. no intraoperative electron beam irradiation (P=0.0007), amount of residual tumor (slight vs. gross; P=0.0022), and symptom status (P=0.0024). Factors not associated with survival included distant metastases at reoperation, type of surgery for the recurrent tumor, external beam irradiation, pathologic grade, age, and gender. Surgical resection without intraoperative electron beam irradiation resulted in three-year and five-year survival rates of 5 and 0 percent, respectively. For patients who received intraoperative electron beam irradiation, the three-year survival rate was 43 percent and five-year survival rate was 21 percent. Intraoperative electron beam irradiation was a statistically significant factor related to survival in patients with and without distant metastasis (P=0.04 and P=0.0035, respectively), with slight residual tumor (P=0.0003), or with palliative surgery (P=0.0276). CONCLUSION: The trends seen in resection with intraoperative electron beam irradiation are encouraging with regard to improvements in survival as compared with studies not using intraoperative electron beam irradiation treatment.

[A patient with systemic scleroderma showing improvement during long-term hemodialysis after renal crisis].

A 68-year-old man experienced systemic pruritus since he was 63 years old, and systemic sclerosis and skin pigmentation were observed when he was 64. When he developed dyspnea the same year, he was admitted and SSc was diagnosed on the basis of the clinical and skin biopsy findings, lung fibrosis on X-P and TBLB findings. At 65, his dyspnea reappeared along with elevated blood pressure, acute renal failure and lung congestion, and he was diagnosed as having a scleroderma renal crisis (SRC) from the clinical and renal biopsy findings. Hemodialysis was started because he showed mental disturbance, and this and other acute symptoms were subsequently reduced. As he showed no recovery from his renal failure, the patient has been maintained on hemodialysis for over four years now. In the meantime, his sclerosis has improved and antinuclear antibody almost disappeared. Hemodialysis appears to be the most likely reason for his improvement, although spontaneous remission, D-penicillamine and angiotensin converting enzyme (ACE) inhibitor therapy may also have contributed, considering the short period and the small amount of drugs given until improvement.

CD95 (Fas) may control the expansion of activated T cells after elimination of bacteria in murine listeriosis.

CD95 (Fas) is known to mediate activation-induced T-cell death by apoptosis. To understand the role of CD95 during the course of bacterial infection, we examined the kinetics of alphabeta and gammadelta T cells in the peritoneal cavities and livers of 5-week-old CD95-defective MRL/lpr mice after an intraperitoneal infection with Listeria monocytogenes. The number of bacteria in the spleen decreased to an undetectable level by day 10 after infection with 7 x 10(3) Listeria cells similar to the number in MRL/+/+ mice. The number of alphabeta T cells expressing CD44 and CD95 reached a maximum in the peritoneal cavity on day 6 after listerial infection and thereafter decreased gradually in MRL/+/+ mice, whereas CD44+ alphabeta T cells without CD95 expression continued to increase throughout the course of listerial infection in MRL/lpr mice. Freshly isolated T cells from MRL/+/+ mice infected with L. monocytogenes 10 days previously showed DNA fragmentation with apoptosis, whereas such fragmentation was not prominent in T cells from infected MRL/lpr mice. In correlation with the increased number of CD44+ alphabeta T cells, Listeria-specific T-cell proliferation of peritoneal exudate cells was significantly greater in MRL/lpr mice than in MRL/+/+ mice on day 10 after listerial infection. In contrast to alphabeta T cells, gammadelta T cells increased in number only transiently in the peritoneal cavity and liver after listerial infection in both MRL/lpr mice and MRL/+/+ mice. These results suggest that CD95-mediated cell death with apoptosis may be involved in termination of the alphabeta-T-cell-mediated immune response after the battle against L. monocytogenes has been won, whereas gammadelta T cells may undergo apoptosis independently of CD95 during the course of listerial infection.

[Information processing deficits in depression in terms of event-related potentials: in comparison with schizophrenics and normal controls].

Information processing deficits characteristic of remitted major depression, which may be a vulnerability marker for the disease, were examined from two aspects by means of visual event-related potentials (ERPs) obtained during simple and discriminative response tasks: 1. To clarify the difference in cognitive dysfunction between both depressives and schizophrenics in remission, we compared the ERPs in remitted depressive patients (n = 11) and remitted schizophrenic patients (n = 9) with those of age, and sex-matched controls (n = 10). 2. To clarify the influence of aging on information processing in remitted depression, ERPs in young remitted depressives (20-46 years old, n = 11) were compared with those in older remitted depressives (52-75 years old, n = 11) in contrast to young (n = 10) and older (n = 11) controls. The remitted schizophrenics showed a retardation in NA and N2 latencies and a reduction in P3 amplitude. However, P1 increased in amplitude exclusively in the remitted depressives. The effect of stimulus discrimination on N1 seen in the controls was absent in both patient groups. The results suggest that the remitted depressives had an attentional deficit in early information processing reflected on P1 and N1 potentials, while the remitted schizophrenics had an extensive cognitive dysfunction reflected on N1, NA, N2, and P3 potentials. Although the effect of stimulus discrimination on N1 was absent in both young and older remitted depressive patients, older patients showed no effects of normal aging on ERPs such as P1 increase or N1 increase during discrimination tasks. Significant interaction effects between diagnosis and aging were found by ANOVA only in the laterality of the P1 amplitude. Older remitted depressives showed an unbalanced right-predominance in P1 amplitude. These results suggest that older remitted depressives had the same early information-processing deficit seen in the young remitted depressives as well as an overactivation over the right hemisphere in the attentional mechanism, irrespective of normal aging.

Fatal subarachnoid hemorrhage from an inflammatory cavernous carotid artery aneurysm: failure of conservative treatment after early diagnosis--case report.

Inflammatory carotid artery aneurysm is a rare complication of acute paranasal sinusitis. A 50-year-old female presented with a ruptured giant carotid artery aneurysm secondary to infection of the sphenoid sinus and cavernous sinus. She had been healthy until 5 days before admission, when she developed orbital phlegmon and meningitis. She received antibiotic therapy for 10 days. Computed tomography (CT) of the brain 2 days after admission showed no abnormality. However, repeat CT on day 6 showed a round isodense mass in the suprasellar cistern suggesting a cerebral aneurysm. Twelve days after admission, she suffered a fatal subarachnoid hemorrhage. Cerebral angiography revealed a giant left cavernous carotid artery aneurysm with a very irregular shape. Autopsy found sphenoid sinusitis and osteomyelitis extending into the cavernous sinuses. Diagnosis of bacterial inflammatory aneurysms before rupture is very important. Appropriate surgical intervention should be considered if there is enlargement of the original aneurysm or appearance of a new aneurysm indicating a potentially dangerous situation.

[Reverse-tolerance phenomenon in methamphetamine-induced behavioral stereotypy and impairment of cliff avoidance reaction after subchronic methamphetamine administration in rats].

Clinical evidence of methamphetamine (MAP)-induced reverse-tolerance phenomenon is available in studies of methamphetamine psychosis. To examine the clinical relevance of the reverse-tolerance phenomenon as a model of this psychosis, two experiments were conducted using rats. In the first experiment, we examined the relationship of MAP (4 mg/kg/day)-induced reverse tolerance in behavioral stereotypy to impairment of the cliff avoidance reaction (CAR). The stereotypy scores by the method of Creese and Iversen reached a maximum at day 14, and were unchanged thereafter. Impairment of CAR appeared in 3 of 6 rats at day 21 or 28 without motor ataxia, as rated by the scoring system of Hiramatsu et al. This suggested that cognitive dysfunction reflected by CAR impairment may develop after MAP-induced reverse-tolerance phenomenon, as evaluated by the behavioral stereotyping rating scale. In the second experiment, the effect of PCP (1 mg/kg) on CAR was examined in rats pretreated with MAP (4 mg/kg/day) for 30 days. No behavioral stereotypy or CAR impairment was found in these rats for 1 hour after PCP challenge. This showed that MAP-induced reverse-tolerance did not alter sensitivity to PCP in producing behavioral stereotypy or CAR impairment.

[Progressive systemic sclerosis (PSS) and cancer--increasing coincidence rate of cancer in 67 PSS patients].

The coincidence rate of cancer and PSS has been increasing according to reports from Nippon Byori Boken Shuho (Annual of Pathological Autopsy Cases in Japan), reaching 12.3% in the most recent report. Therefore we reviewed the histories of 67 PSS patients seen at our division over an 18-year period between 1974 and 1992, and found a high coincidence rate (14.6%) of cancer, reflecting the increasing tendency reported in the Nippon Byori Boken Shuho. The most frequent type of cancer was gastrointestinal cancer, including gastric and colon cancer and duodenal carcinoid. There were no significant differences in the clinical and laboratory findings between PSS patients with cancer and those without. Twenty-six of the 67 PSS patients died. Cancer was the cause of death in four, ranking second behind respiratory failure. The reason for the increasing coincidence rate of cancer and PSS is unclear at present. However, it is very important to discover cancer in PSS patients as early as possible, since it has a marked effect on prognosis.