Direct effects of carbon monoxide on cardiac function

Summary The direct effects of carbon monoxide (CO) on cardiac function were investigated in hemoglobin-free living rabbits treated with perfluorochemical blood substitutes. After exchange transfusion with a perfluorochemical emulsion, the erythrocyte count was below 10 x 10⁴/mm³ in each animal. Gas mixtures of oxygen with 5%, 10%, and 20% of CO or nitrogen were administered via a respirator. The results showed that the cardiac effects of CO and nitrogen were significantly different as regards changes in arterial pressure, pulse pressure, heart rate, and the product of heart rate and systolic arterial pressure in spite of the same oxygen tension in the inhaled gases. It was concluded that there was a direct effect of CO not mediated by hemoglobin.     

Relationship of upper body obesity to menstrual disorders

BACKGROUND: The purpose of the present study was to investigate the relative contribution of upper and lower body obesity to obesity-related menstrual disorders. METHODS: Women with polycystic ovary syndrome (PCOS) were excluded from the study. Eighty-three obese women with a body mass index (BMI, Wt/Ht2) of more than 25 kg/m2 were classified into two groups according to their menstrual status: one with menstrual disorders (n = 39; mean age +/- standard deviation, 31.6 +/- 4.9 years) and the other group (controls) with regular menstruation (n = 44; 32.2 +/- 4.4 years). Age, age at menarche, height, weight, and BMI were recorded. Trunk fat mass, leg fat mass, the ratio of trunk to leg fat mass amount (trunk-leg fat ratio), body fat mass, and the percentage of body fat were measured by whole-body scanning with dual-energy X-ray absorptiometry. Baseline characteristics and anthropometric variables were compared between the two groups. RESULTS: Trunk-leg fat ratio in women with menstrual disorders was 1.48 +/- 0.29, which was significantly higher than that in controls (1.25 +/- 0.38, p < 0.01). Trunk fat mass was also significantly higher in women with menstrual disorders than in controls (14.9 +/- 4.1 kg vs. 12.9 +/- 3.8 kg, p < 0.05). However, BMI, percentage of body fat, body fat mass, and leg fat mass did not differ between the two groups. Age, age at menarche, height, and weight did not differ between the two groups. CONCLUSION: Upper body, but not lower body, obesity is associated with menstrual disorders.     

Connexin-associated deafness and speech perception outcome of cochlear implantation

OBJECTIVE: To compare performance after cochlear implantation in children with mutations in connexin (Cx) 26 (GJB2) or Cx30 (GJB6) and children with deafness of unknown etiology. DESIGN: Genetic analysis and speech perception evaluation was performed in the children with and without Cx mutations who had undergone cochlear implantation. Speech perception performance was retrospectively analyzed 6, 12, 24, 36, and 48 months after implantation. Test material was selected according to the child's age and cognitive and language abilities. SETTING: The study took place at speech and hearing and genetic centers of a hospital in the central part of Israel and the genetics departments of 3 additional centrally located hospitals. PATIENTS: A total of 30 children who had undergone cochlear implantation were selected for the study, with control patients matched according to age at implantation, duration of implant use, and mode of communication. There was no evidence for additional disabilities or handicaps in either group. MAIN OUTCOME MEASURES: Speech perception measurements included a questionnaire, as well as closed and open-set tests. RESULTS: Overall, the 2 groups showed significant improvement in speech perception results after implantation. Four years after implantation, both groups achieved mean open-set speech perception scores of approximately 60%, 75%, and 90% for monosyllabic, 2 syllables, and words in sentences tests, respectively. CONCLUSIONS: There were no apparent differences in speech perception performance after implantation between the children with Cx mutations and children with deafness of unknown etiology. These data have important implications as a prognostic indicator when counseling candidates for cochlear implantation.     

Splenic marginal zone lymphoma associated with antiphospholipid antibodies

A 61-year-old woman experienced a high fever with anemia and APTT prolongation after suffering a herpes zoster virus infection. Physical examination revealed a large splenomegaly without lymphadenopathy. Laboratory evaluations were positive for lupus anticoagulant (LA) and monoclonal IgM-kappa protein. LA was associated with the presence of anti-beta2GPI antibody, anti-cardiolipin antibody, and anti-prothrombin antibody. Moreover, the results of factors IX, XI, and XII assays and CRP and FDP-E were disturbed. A splenectomy was performed, and a splenic marginal zone lymphoma (SMZL) was diagnosed. All hematological findings rapidly recovered after the splenectomy. No thrombotic events occurred after the splenectomy even though thrombosis prophylaxis was not performed. The clinical course suggested that the SMZL-producing antibody induced immunological abnormalities in the labolatory tests. Since the patient suffered disease progression soon after the splenectomy, an autologous peripheral stem cell transplantation with rituximab administration was performed.     

Needlescopic surgery for left-sided colorectal cancer

Purpose

Laparoscopic surgery has become the standard for colorectal cancers, but more minimally invasive surgery is continuously pursued. In June 2011, our institution started needlescopic surgery (NS). The aims of this study are to describe this technique and to investigate its feasibility for left-sided colorectal cancer surgery.

Methods

From June 2011 to June 2013, 105 sigmoid colon and upper/middle rectal cancer patients underwent NS in our institution, involving one 5-mm port and three 3-mm ports, with the exception of an umbilical 12-mm port. A 10-mm scope is used through the umbilical 12-mm port, which will be extended to a small skin incision for specimen extraction. After dissection of the left colon, a 5-mm scope is inserted through the right lower 5-mm port and a linear stapler is inserted through the umbilical 12-mm port for rectal transection. The specimen is then extracted through umbilical incision, and the anastomosis is carried out by the double-staple technique.

Results

TNM staging is stage 0/I/II/III/IV?=?0/31/32/31/11. Fifty-one patients underwent sigmoidectomy and 54 patients underwent anterior resection. There was no conversion to open surgery, but one patient required a change to a 5-mm port from one of the 3-mm ports. Mean operating time was 193 min and mean estimated blood loss was 12 ml. There were ten (9 %) postoperative complications: two anastomotic leaks requiring reoperation, two anastomotic hemorrhages, and one wound infection. There was no mortality.

Conclusions

NS for left-sided colorectal cancer was a technically and oncologically feasible technique for selected patients.     

Role of posterior parietal cortex in reaching movements in humans: Clinical implication for ‘optic ataxia’

Objective

To clarify the spatio-temporal profile of cortical activity related to reaching movement in the posterior parietal cortex (PPC) in humans.

Methods

Four patients with intractable partial epilepsy who underwent subdural electrode implantation were studied as a part of pre-surgical evaluation. We investigated the Bereitschaftspotential (BP) associated with reaching and correlated the findings with the effect of electrical stimulation of the same cortical area.

Results

BPs specific for reaching, as compared with BPs for simple movements by the hand or arm contralateral to the implanted hemisphere, were recognized in all patients, mainly around the intraparietal sulcus (IPS), the superior parietal lobule (SPL) and the precuneus. BPs near the IPS had the earlier onset than BPs in the SPL. Electrical stimulation of a part of the PPC, where the reach-specific BPs were recorded, selectively impaired reaching.

Conclusions

Intracranial BP recording and cortical electrical stimulation delineated human reach-related areas in the PPC.

Significance

The present study for the first time by direct cortical recording in humans demonstrates that parts of the cortices around the IPS and SPL play a crucial role in visually-guided reaching.     

Pulmonary hemorrhage induced by epileptic seizure

We report a 35-year-old man who presented with pulmonary hemorrhage induced by an epileptic seizure. He had experienced recurrent episodes of massive hemoptysis after epileptic seizures since the age of 28 years. He was admitted to Kyoto University Hospital with massive hemoptysis and hypoxia after an epileptic seizure of a few minutes' duration. Radiographic signs of infiltrations and hemorrhagic bronchoalveolar lavage fluid were observed. He was intubated and successfully treated with anti-epilepsy drugs and corticosteroids. Epileptic seizures may have induced increased pulmonary vascular permeability and structural damage to the blood-gas barrier, which may have caused pulmonary hemorrhage. Pulmonary hemorrhage could be in the list of differential diagnoses of hemoptysis in patients with epilepsy.     

Persistent frequent subclinical seizures and memory impairment after clinical remission in smoldering limbic encephalitis

Aim. To delineate a possible correlation between clinical course and EEG abnormalities in non‐infectious “smoldering” limbic encephalitis. Methods. Long‐term clinical data, including video‐EEG monitoring records, were analysed in two patients. Results. The two patients were positive for anti‐voltage‐gated potassium channel complex antibody and unspecified antineuronal antibody, respectively. The latter patient had small cell lung carcinoma. Both patients had memory impairment and clinical seizures. EEG showed frequent subclinical seizure patterns in the bilateral temporal regions. Subclinical seizure patterns and memory impairment persisted over one to two years after clinical seizure remission. Therapy (prednisolone and chemoradiation in the two patients, respectively) resulted in decreased occurrence of subclinical seizure patterns and memory improvement. Conclusions. EEG seizure patterns may persist years after clinical seizure remission in “smoldering” limbic encephalitis and lead to memory impairment.     

Genome‐wide approach to identify second gene targets for malignant rhabdoid tumors using high‐density oligonucleotide microarrays

Malignant rhabdoid tumor (MRT) is a rare and highly lethal cancer that mainly affects infants and young children. The majority of MRT are characterized by loss of function of SMARCB1 on chromosome 22q11.2. However, little is known about genetic changes other than SMARCB1 alterations that are responsible for the development and/or progression of MRT. To explore additional gene targets in MRT, we analyzed 21 MRT specimens (12 fresh tumors and 9 MRT‐derived cell lines) using high‐density single nucleotide polymorphism genotyping microarrays. Although MRT genomes are characterized by common 22q11.2 deletions, affecting the SMARCB1 locus with a frequency of 95.2% (20/21 specimens), other genetic changes have been less frequent. Of the 20 specimens with deletions of 22q11.2, eight specimens showed uniparental disomy of the SMARCB1 locus with homozygous deletions or gene mutations. High‐resolution analysis also disclosed the recurrent hemizygous/homozygous deletions of 7q35–q36.1, involving the CNTNAP2 locus in three specimens. Mutations analysis of CNTNAP2 showed a novel R157C missense mutation in a primary case, and methylation analysis showed recurrent hypermethylation of CNTNAP2 in three of nine cell lines. These results demonstrated that CNTNAP2 is one of the additional gene targets, other than SMARCB1, in MRT.