EXPERIMENTAL STUDY ON HEMORRHAGE IN THE BRAIN STEM INDUCED BY AN INTRACRANIAL SPACE OCCUPYING LESION

Increased intracranial pressure was experimentally produced in dogs by inserting a rubber balloon epidurally in the left temporal region and then inflating the balloon with water. The animals were killed after a set interval and the hemorrhagic lesion in the brain stem examined in detail. 1. The hemorrhagic lesions in the brain stem could be microscopically classified into three types; arterial, venous and capillary. Massive hemorrhagic lesion was also observed in some animals. 2. Arterial hemorrhage was distributed mostly in the area supplied by the thalamo-perforating artery in the diencephalon and in the area supplied by the paramedian branches of the basilar artery in the lower brain stem. Venous hemorrhage was found mostly in the region of the terminal vein and basal vein in the diencephalon and in the region of the basilar vein in the lower brain stem. Capillary hemorrhage was extensive and the distribution corresponded approximately with that of venous hemorrhage but also in part with that of arterial lesions. 3. A relation was apparent between the hemorrhagic lesion in the brain stem and the amount of water instilled into the rubber balloon, which could be correlated to intracranial pressure. Capillary hemorrhage was observed in most cases in which over 3.5 ml of water was instilled. With instillation of 4.0 ml of water, all types of hemorrhage were observed profusely but venos hemorrhage predominated. With instillation of more than 4.5 ml of water, arterial hemorrhage was dominant. 4. The relation between the hemorrhagic lesions and the survival time after procedure was studied in the animals which had died naturally. Capillary hemorrhage was observed in almost all the animals irregardless of the survival time. Both arterial and venous hemorrhage were observed abundantly in animals which survived for over 10 hours. Arterial hemorrhage, in particular, was dominant in the cases which died within 12 hours and the venous type was dominant in the case surviving over 12 hours.     

Importance of recall and follow-up screening for chronic hepatitis C in children receiving blood products prior to 1990 in Japan

The objective was to detect chronic hepatitis C virus infection in recipients of blood products using retrospective analysis by recall and enrollment of recipients. 226 patients who received blood products for open heart surgery from January 1983 to June 1992 were examined for HCV antibody by using a second generation assay and liver function test. 22 (14%) of the 161 patients who received blood products before November 1989 had detectable HCV antibody, but none of the 65 recipients receiving blood products after 1990, the year the Japanese blood bank began to screen for HCV-antibody. Abnormal alanine aminotransferase (ALT) levels, more than 25 iu/L, during the chronic phase of HCV infection was recognized in nine of 22 (41%) seropositive patients. The liver function test and second generation HCV antibody in the serum are effective markers to screen for chronic hepatitis C in blood product recipients transfused before 1990.     

AN ANALYSIS OF EVOKED ELECTROMYOGRAM FROM ORBICULARIS OCULI IN PATIENTS WITH MYASTHENIA GRAVIS

Evoked electromyograms of the orbicularis oculi muscle with repeated stimulation given at frequencies of 5, 10, 20, 50 and 100 c/s were examined in myasthenia gravis; and the following results were obtained. 1. In the normal subject, the amplitude of M-waves showed almost no change by stimulation at frequencies of 5 and 10 c/s, and a mild gradual increase by stimulation at a frequency of 20 c/s. On stimulation with 50 and 100 c/s, the amplitude of M-waves showed a marked gradual increase and maintained nearly the peak value after a maximum had been reached. 2. In a total of 23 patients with myasthenia gravis, the amplitude of M-waves showed several specific changes against the stimulation frequencies employed. The patterns of the amplitude of M-waves appearing with each frequency were classified into 3 types: Type I, which showed an initial gradual decrease in amplitude with all the stimulation frequencies employed, was observed in 13 patients (56.5%). Type II, which showed an initial gradual decrease at frequencies of 5 c/s and 10 c/s, but a gradual increase followed by gradual decrease at frequencies of 50 and 100 c/s, was observed in 8 patients (34.8%). Type III, which showed no obvious difference from the pattern of the normal curve with stimulation given at not more than 50 c/s but a gradual increase followed by gradual decrease at a frequency of 100c/s, was observed in 2 patients (8.7%). 3. No distinct differences were noted in other neuromuscular diseases taken as control, as compared with the normal.     

A case of emphysematous pyelonephritis in a patient with rheumatoid arthritis taking corticosteroid and low‐dose methotrexate

Rheumatoid arthritis (RA) is a systemic autoimmune disease that is characterized by chronic synovial inflammation. Patients with RA have increased risk of infection; this is related to RA itself or the adverse effects of medication. In this report, we describe a case of emphysematous pyelonephritis in a patient with RA associated with AA amyloidosis and steroid‐induced diabetes mellitus who was taking corticosteroid and low‐dose methotrexate.     

Xanthogranulomatous pyelonephritis with a renocolic fistula caused by a parapelvic cyst

Fistula formation between the upper urinary tract and bowel is an uncommon complication in urogenital diseases. We present a rare case of focal xanthogranulomatous pyelonephritis with a renocolic fistula. This is the first case where a parapelvic cyst obstructs the caliceal outflow and leads to the formation of a renocolic fistula in renal inflammatory disease. It is difficult to make a preoperative diagnosis of focal xanthogranulomatous pyelonephritis with widespread involvement that is caused by non-calculous urinary tract obstruction.     

Changes in sleep patterns during He-O2 saturation dives

Abstract During simulated hyperbaric saturation diving experiments of He-02 mixture at the depths of 150, 180 and 230 m the standard polysomnography of four divers, as well as their subjective feelings of fatigue, were recorded for 268 nights. In all three diving conditions, during the bottom period and the decompression period, wakes after sleep onset and Stage 1 sleep increased while Stage 4 sleep decreased. In deeper diving conditions stage 4 sleep tended to decrease and subjective feelings of fatigue increased. When the results are considered it can be assumed that the deeper the diving depths, the increased sleep disturbances and fatigue. However, it is believed that a fundamental sleep pattern will be maintained.     

Chronological changes in brain MRI, SPECT, and EEG in neurosarcoidosis with stroke-like episodes

Abstract  Neurosarcoidosis with recurrent stroke-like episodes has been reported only rarely in the literature. We repeatedly measured brain magnetic resonance images (MRI), SPECT, and electroencephalograms (EEG) in a 32-year-old male patient with this condition. In the acute stage of the episodes, he showed semi-coma followed by severe dysphasia; left-frontal EEG delta wave activities and left-sided hyperperfusion SPECT were noted. Gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA) MRI findings were aggravated diffusely in the convalescent stage of the disease rather than in the acute stage. The EEG and SPECT findings were clearly reflective of an early stage of acute encephalomeningitis caused by the neurosarcoidosis, and thus are more useful than MRI for evaluation of the acute inflammatory process in this condition.     

Predictive factors in eradicating hepatitis C virus using a relatively small dose of interferon

Interferon (IFN) can reduce hepatitis C virus load and even eliminate the virus in 30-40% of patients. Several predictive factors for eradication of the virus have been reported and a higher dose of IFN tends to result in elimination of the virus. However, a small dose of IFN sometimes is as effective as a large dose in eradicating the virus. The predictive factors for such a response are not well established. We retrospectively analysed 50 patients with chronic hepatitis C who were treated with relatively small amounts of IFN (equal or less than 252 million units). Eleven patients were responders (elimination of hepatitis C virus (HCV) and normalization of alanine amino transferase (ALT) for at least 6 months), but the remaining 39 were non-responders. Multivariate analysis showed that the pretreatment viral load and total dose of IFN per kilogram of bodyweight were significant predictive factors of response to therapy. We also assessed the amino acid substitutions in the IFN sensitivity determining region (ISDR), NS5A codon 2209-2248, of HCV in serum samples obtained from 31 patients with HCV genotype 1 b. The presence of more than one amino acid substitution in the ISDR tended to correlate with HCV genotype lb elimination. As IFN is expensive and has a number of serious side effects, our study suggests that the optimal dose of IFN may vary from one patient to another and that more stringent criteria should be used to select the optimal dose for therapy.