Cerebral blood flow abnormalities with central sparing on arterial spin labeling in mild encephalopathy associated with excitotoxicity: a case report.

BACKGROUND: Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) and mild encephalopathy associated with excitotoxicity (MEEX) are the most frequent acute encephalopathies in pediatric patients in Japan. AESD typically presents with biphasic seizures and delayed reduced diffusion in the subcortical area, called bright tree appearance (BTA), on radiological examination. In patients with AESD, arterial spin labeling (ASL) shows decreased cerebral blood flow (CBF) in the hyperacute stage and increased CBF in the acute stage, suggesting the usefulness of ASL for the early diagnosis of AESD. Additionally, proton magnetic resonance spectroscopy (MRS) shows elevated glutamate (Glu) and glutamine (Gln) in AESD. MEEX is a group of mild encephalopathies with transient elevation of Gln on MRS similar to that in AESD; however, MEEX does not include any clinical biphasic course or abnormalities, including BTA on diffusion-weighted imaging. Although the usefulness of ASL for AESD has been reported, there are no reports for patients with MEEX. In this study, we report our experience with a 4-year-old girl diagnosed with MEEX who showed unique findings on ASL. CASE PRESENTATION: The patient was a 4-year-old girl admitted to the emergency room with febrile status epilepticus. Considering the possibility of AESD, vitamin therapy was initiated. ASL-MR imaging (MRI) of the brain performed on the second day showed increased blood flow in the frontal, temporal, and occipital regions with spared central sulcus, which indicated AESD with central sparing. The patient was diagnosed with AESD, and the treatment included pulse steroid therapy and immunoglobulin therapy from day 3. The patient remained mildly unconscious but gradually became conscious by day 7 with no seizures. Brain MRI performed on day 8 did not show any characteristic AESD findings, such as BTA. Furthermore, MRS showed elevated Gln, which, along with the clinical course, led to the diagnosis of MEEX. The patient was discharged on day 16 without obvious sequelae. CONCLUSIONS: ASL may be useful in the early diagnosis of MEEX as well as AESD, facilitating early intervention.

Urine alkalization improves the problems of pain and sleep in hypersensitive bladder syndrome.

OBJECTIVE: To investigate the efficacy of urine alkalization therapy using citrates in patients with hypersensitive bladder syndrome. METHODS: A total of 76 patients with urinary frequency were assessed for their symptoms using a 2-day voiding diary as well as the urine pH at each voiding during the screening period. Their symptoms were also assessed by pain score, King's health questionnaire, and O'Leary-Sant symptom and problem index scores. Finally, 50 patients were evaluated for changes in symptoms after oral treatment with citrates for 2-4 weeks after the screening period. RESULTS: After the treatment, significant increases in the urine pH (from 5.8 ± 0.4 to 6.3 ± 0.4; increment of 0.5 ± 0.4; P < 0.01), and significant decreases in the number of micturitions per day (from 14.5 ± 6.5 to 13.5 ± 5.9; P = 0.02) and the number of episodes of pain/discomfort per day (from 7.8 ± 6.8 to 6.1 ± 7.1; P = 0.02) were observed. In the King's health questionnaire, the sleep/energy domain score was significantly improved (from 60.0 ± 25.0 to 50.3 ± 29.6; P < 0.01). In a subgroup analysis based on urine pH (urine pH <6.2 and ≥6.2), significant improvements in the voiding symptoms, the sleep/energy domain score and the O'Leary-Sant problem index were observed in the group with urine pH of ≥6.2. There were statistically significant differences between the subgroups in the volume per voiding, maximum volume per voiding and the problem index. In addition, the subgroup, in which patients had pain in the screening period, showed statistically significant improvements in the number of micturitions per day, episodes of pain/discomfort per day, the sleep/energy domain score and the problem index. CONCLUSIONS: Urine alkalization therapy is likely to be effective in the treatment for hypersensitive bladder syndrome.

New cystoscopic diagnosis for interstitial cystitis/painful bladder syndrome using narrow-band imaging system.

OBJECTIVES: Diagnosing the bladder lesions associated with interstitial cystitis/painful bladder syndrome (IC/PBS) is sometimes difficult for general urologists. We therefore aimed to develop an IC/PBS diagnosis method using a cystoscope with a narrow-band imaging (NBI) system that can detect mucosal angiogenic lesions. METHODS: Fifty-two subjects suspected of having IC between October 2006 and June 2007 were included in this study. There were 49 women and three men, ranging in age from 19 through 85 with an average age of 59. First, conventional cystoscopy under spinal anesthesia was performed to examine the ulcerative lesions by a urological specialist. Then, other health care professionals made a separate observation of capillary-rich areas of the superficial layer of the bladder mucosa by cystoscopy with the NBI system. RESULTS: Among the 52 patients, 37 cases were found to have ulcers by conventional cystoscopy, which were also recognized as capillary-rich brownish areas using the NBI system (100% accuracy); 13 cases were found to have NBI-positive areas without ulcer, which were coincided with those with petechial hemorrhages and glomerulations following subsequent hydrodistention; and two cases of normal mucosa were detected. Furthermore, six cases of bladder cancer (carcinoma in situ) were detected by biopsies that were obtained from the ulcerative lesions positively identified by NBI cystoscopy. CONCLUSIONS: Examining the urinary bladder mucosa with a flexible cystoscope with the NBI system makes it possible to easily detect ulcers of bladder mucosa and areas with angiogenesis. Therefore, it is considered that the use of a flexible cystoscope with the NBI system is highly practical for the IC/PBS diagnosis.

[One-year experience of Men's Outpatient Health Care Unit without specifying the category of disease].

The Men's Outpatient Health Care Unit was established in April 2006 in Kyoto City Hospital. In this outpatient unit, medical services are provided to males of all ages and with any category of complaints. For patients' privacy, the unit is situated on a different floor from the other outpatient ward, and all-male staff handles from reservation to examination. Furthermore, each patient is given 30 minutes to provide enough time for counseling and examination. To our knowledge, this system was established for the first time in Japan. During the first one year, a total of 106 new patients visited this ward with a large variety of chief complaints : sexual dysfunction, urinary disorder, consultation for aging male, consultation for size and shape of the penis, and so forth. Over 25% of patients disinclined against visiting the conventional urological ward. Furthermore, over 25% of patients revealed that they were hesitant to see female staffs including clerks and nurses. Although more facilities in Japan are recently providing gender-specific medical services, most of them are directed to the female gender. Our experience of this health care system suggested that male-specific gender medicine should become more widespread and cover various categories of diseases.

Echogenicity in transrectal ultrasound is determined by sound speed of prostate tissue components.

Typically, conventional transrectal ultrasound (TRUS) imaging of the cancer tissue is hypoechoic in echo texture. However, TRUS does not reliably distinguish between cancerous and non-cancerous tissue in the prostate. In the present study, sound speed of prostate needle biopsy specimens were measured by ultrasound speed microscope (USM) to construct a database for interpreting clinical TRUS images. Biopsy specimens were formalin-fixed and sectioned approximately 5 µm in thickness. They were mounted on glass slides without cover slips. The ultrasonic transducer with the central frequency of 120 MHz was mechanically scanned over the specimen to measure sound speed distribution. Echo intensity of TRUS images were qualitatively classified into three categories; hyperechoic, iso-echoic and hypoechoic areas. Sound speed was 1596.9 ± 28.2 m/s in hyperechoic, 1571.2 ± 35.8 m/s in iso-echoic and 1562.6 ± 35.1 m/s in hypoechoic area, respectively. However, echo intensity showed no significant relationship to malignancy of prostatic tissue. Echo intensity of TRUS is significantly affected with tissue components and USM findings would provide important information for interpretation of TRUS images.

Ultrasonic tissue characterization of prostate biopsy tissues by ultrasound speed microscope.

Ultrasound speed microscope was developed for quantitative measurement of ultrasonic parameters of soft tissues. The system can measure the ultrasonic attenuation and sound speed in the tissue using fast Fourier transform of a single pulsed wave instead of burst waves used in conventional acoustic microscopy. Prostate biopsy tissues were formalin-fixed and sectioned approximately 5-6 µm in thickness. They were mounted on glass slides without cover slips. The ultrasonic transducer was mechanically scanned over the specimen. Attenuation was 1.42 ± 0.08 dB/mm and the sound speed was 1584 ± 12 m/s in prostatic cancer while both values were 1.86 ± 0.14 dB/mm and 1614 ± 30 m/s in normal prostate. The basic measurements of ultrasonic properties would help understanding the interpretation of clinical echography in diagnosis of prostate cancer.