Acute encephalopathy with bilateral thalamotegmental involvement in infants and children: imaging and pathology findings.

PURPOSE: To investigate the imaging and pathologic characteristics of acute encephalopathy with bilateral thalamotegmental involvement in infants and children. METHODS: Five Japanese children ranging in age from 11 to 29 months were studied. We performed CT imaging in all patients, 10 MR examinations in four patients, and an autopsy in one patient. RESULTS: The encephalopathy affected the thalami, brain stem tegmenta, and cerebral and cerebellar white matter. The brain of the autopsied case showed fresh necrosis and brain edema without inflammatory cell infiltration. Petechiae and congestion were demonstrated mainly in the thalamus. CT and MR images showed symmetric focal lesions in the same areas in the early phase. These lesions became more demarcated and smaller in the intermediate phase. The ventricles and cortical sulci enlarged. MR images demonstrated T1 shortening in the thalami. The prognosis was generally poor; one patient died, three patients were left with severe sequelae, and only one patient improved. CONCLUSIONS: The encephalopathy might be a postviral or postinfectious brain disorder. T1 shortening in the thalami indicated the presence of petechiae.

[Multiple cerebral infarction after treatment with cisplatin].

A 46-year-old woman with a tumor the uterine cervix who experienced cerebrovascular accident as a complication of cisplatin-based chemotherapy is presented. Five days after the eleventh cycle of cisplatin 75 mg, intravenously, she had an acute onset of mild memory disturbance and right-sided weakness. On neurological examination, pyramidal sign was discovered on the right side. MRI of the brain showed multiple infarction on the left basal ganglia. There was no evidence of coagulopathy, vascular, or endocardial disease that may have led to a cerebrovascular accident. Similar characteristics in patients previously reported suggest that thrombosis secondary to vascular endothelial injury induced by cisplatin therapy may be responsible for cerebrovascular complications.

Computed tomography of emphysema following tooth extraction.

Subcutaneous and tissue space emphysema following surgical extraction of mandibular third molars is a rare and serious complication of dental surgery. Recognition of mediastinal emphysema following surgical extraction is difficult because there are no absolute clinical symptoms and signs. We present two cases of emphysema following extraction of a lower third molar and discuss the contribution of CT to the early recognition of the presence and spatial migration of air and to clinical management.

Bronchogenic lung cyst with elevated serum type I chain related carbohydrate antigens, CA19-9, CA50 and FH-7.

A case of bronchogenic cyst of the right lung in a 30-year-old woman who had elevated serum type 1 chain related carbohydrate antigens defined by the three monoclonal antibodies, CA19-9, CA50 and FH-7, is reported. The mucinous fluid from the cystic lesion contained extraordinary high antigen levels, and immunohistochemistry revealed CA19-9 to be highly positive in the cystic wall and cyst fluid. Antigen levels returned to their normal ranges after a right lower lobectomy. This represents a rare case of bronchogenic cyst with abnormal increases in the respective carbohydrate antigens.

Chemical and chemotaxonomical studies on Dicranopteris species.

Clerodane glycosides and flavonoids in Dicranopteris pedata and three varieties of D. linearis were investigated. All the ferns contained a new glycoside, (6S,13S)-6-[6-O-acetyl-beta-D-glucopyranosyl-(1-->4)-alpha-L-rhamnopy - ranosyloxy]-13-[alpha-L-rhamnopyranosyl-(1-->4)-beta-D-fucopyra nosyloxy]- cleroda-3,14-diene, as a chemical marker of this group. Flavonoids were limited to flavonol 3-O-glycosides. The ferns and isolated flavonoids are as follows; D. pedata: afzelin, quercitrin. D. linearis var. brevis: afzelin, quercitrin. D. linearis var. tenuis: quercitrin, isoquercitrin. D. linearis var. sebastiana: astragarin, isoquercitrin, rutin, kaempferol 3-O-(4-O-p-coumaroyl-3-O-alpha-L-rhamnopyranosyl)-alpha-L-rhamn opy ranosyl- (1-->6)-beta-D-glucopyranoside.

Solution structure of a human cystatin A variant, cystatin A2-98 M65L, by NMR spectroscopy. A possible role of the interactions between the N- and C-termini to maintain the inhibitory active form of cystatin A.

The solution structure of a human cystatin A variant, cystatin A2-98 M65L, which maintains the full inhibitory activity of the wild-type protein, was determined at pH 3.8 by sD/3D heteronuclear double- and triple-resonance NMR spectroscopy. The structure is based on a total of 1343 experimental restraints, comprising 1139 distance, 154 phi and chi 1 torsion angle restraints, and 50 distance constraints for 25 backbone hydrogen bonds. A total of 15 structures was calculated using the YASAP protocol with X-PLOR, and the atomic rms distribution about the mean coordinate positions for residues 8-93 was 0.55 +/- 0.10 A for the backbone atoms and 1.05 +/- 0.11 A for all heavy atoms. The structure consists of five antiparallel beta-sheets and two short alpha-helices. Comparison with the X-ray structure of cystatin B in the papain complex shows that the conformation of the first binding loop is quite similar to that of cystatin A, with an rms deviation of 0.78 A for the backbone atoms in the 43-53 region (cystatin A numbering). The second binding loop, however, is significantly different in the two structures, with an rms deviation greater than 2 A. There are some other significant differences, especially for the N-terminal and alpha-helix regions. The overall structure of cystatin A is also compared with the recently reported NMR structure of the wild-type cystatin A (stefin A) at pH 5.5 (Martin et al., 1995) and reveals the following features. that differ in our structure from the previous one: (1) the N-terminal segment, which was unstructured in the previous report, folds over in close vicinity to the C-terminus, as revealed by the distinctive NOEs between those segments; (2) two discrete short alpha-helices linked by a type II reverse turn were found, instead of the continuous single alpha-helix with a slight kink shown in the previous structure; (3) the second binding loop, which was not well converged in the previous study at pH 5.5, is determined very well in our structure. The effect of the N-terminal truncation on the cystatin A structure was examined by comparing the 1H-15N HSQC spectrum of cystatin A2-98 with that of the cystatin A5-98 variant, which lacks the anti-papain activity, revealing significant chemical shift differences in the residual N-terminal segment and the first binding loop, together with small shifts in the other parts.(ABSTRACT TRUNCATED AT 400 WORDS)