Toxic epidermal necrolysis with severe hyperbilirubinemia: Complete re‐epithelialization after bilirubin reduction therapies

Toxic epidermal necrolysis is a life‐threatening skin disorder, and its mortality rate is estimated to be approximately 20–30%. It is characterized that more than 30% of the skin surface is eroded, however, skin lesions are usually re‐epithelialized within 2–3 weeks. Previously, we reported a fatal case of toxic epidermal necrolysis with hyperbilirubinemia, and more than 60% of body surface areas had been eroded for 9 weeks. For the reason of delayed re‐epithelialization, we hypothesized that hyperbilirubinemia was the culprit because bilirubin damaged cultured keratinocytes in vitro. In this case, we had an opportunity to treat another case of toxic epidermal necrolysis with severe hyperbilirubinemia. In order to reduce serum bilirubin levels, we performed bilirubin adsorption therapies, and skin lesions were successfully re‐epithelialized within 4 weeks. Though further studies are required, we considered that bilirubin adsorption therapies are worth trying for toxic epidermal necrolysis with hyperbilirubinemia, especially for the cases suffering from delayed re‐epithelialization.     

Laparoscopic removal of a retroperitoneal extralobar pulmonary sequestration in an adult

A 41-year-old male patient presented with dull left flank pain. A computed tomography (CT) showed a subdiaphragmatic retroperitoneal extra-adrenal mass. A magnetic resonance image demonstrated it was hypointense on T1 weighted and hyperintense on T2. Serum analyses for adrenal hormones revealed no abnormality. [I131]metaiodo-benzylguanidene scintigraphy showed no abnormal uptake. The patient underwent laparoscopic removal to manage the symptoms and to make a pathological diagnosis, which was an extralobar pulmonary sequestration. Another congenital lung malformation was not detected on chest CT scan. The symptom was relieved postoperatively.     

Histological evaluation of alveolar ridge augmentation using injectable calcium phosphate bone cement in dogs

Summary  Alveolar ridge augmentation is an important procedure to restore tooth loss. Several types of graft materials have been used for augmenting the alveolar ridge. An injectable calcium phosphate cement (CPC) has been applied to periodontal bone defects and has shown favourable results. Thus, this CPC may work as an effective graft material for alveolar ridge augmentation. The aim of this study was to evaluate the effectiveness of the CPC for large-scaled (about 7 × 8 × 6 mm) ridge augmentation in dogs. Alveolar ridge defects were created bilaterally in the maxilla of six beagle dogs. The CPC was applied to one of the bilateral maxillary defects. The untreated defect on the contralateral side served as control. The animals were sacrificed at 6 months after surgery and decalcified histological specimens of the alveolar ridge were prepared histometrically and evaluated under a light microscope. Newly formed and reconstructed alveolar ridges covering the CPC were observed in all experimental sites. In the control sites, only slight newly bone formation was observed. Histomorphometrical analysis indicated that the CPC grafted group exhibited significantly ( P  = 0·0001) increased area and height in new bone formation compared with those of the control group. The results indicate that the CPC appears to be an effective material for alveolar ridge augmentation and may act as a space maintainer to conduct new bone formation.     

Argyria and convulsive seizures caused by ingestion of silver in a patient with schizophrenia

Abstract The case study of a schizophrenic patient with argyria which resulted from the chronic and excessive ingestion of antismoking pills contain silver, is presented. Convulsive seizures developed after the patient had been addicted to the pills for 40 years. An extremely high concentration of silver was detected in serum. This case provides support for the hypothesis that silver may cause convulsive seizures as a result of systemic poisoning.     

Relationship between solvent inhalation and antisocial behavior: Special emphasis on two types of violence seen in solvent abusers

Abstract Organic solvent inhalation is a serious problem among youths in Japan. It induces physical and mental disorders, and is related closely to crime and delinquency. The relationship between solvent inhalation and antisocial behavior was investigated in 75 youths. The subjects were divided into three groups according to the level of violent behavior and the time of appearance: a non-violent group, a late-onset group (violence occurred after the start of inhalation) and an early-onset group (violence had occurred before the start of inhalation). Various parameters were compared among the groups. The late-onset group showed the following characteristics: (i) the frequency of inhalation was high, and many subjects experienced hallucinations and mood changes caused by inhalation; (ii) the family environment was characterized by conflict; and (iii) the subjects had strong psychological conflicts and showed dissociative coping with frustration. The violence, psychological conflict and dissociation in this group were found to be related to the inhalation, with familial conflict as a background. The violence in the early-onset group was considered to be the manifestation of a violent personality as the frequency of inhalation and the incidence of mental symptoms were both low. The subjects in this group showed weak psychological conflict and tended to be demanding of others when attempting to cope with frustration. Two types of violent behaviors in the teenagers who inhaled solvents were identified. The violence of solvent inhalers should be managed according to the type.     

Evidence of Bone Resorption-Stimulating Factor in Adult T-Cell Leukemia

Adult T-cell leukemia (ATL) is known to be frequently accompaniedby hypercalcemia, but the mechanisms responsible for hypercalcemiain this disorder are not fully understood. We have recentlyexperienced two male patients (25 and 36 yr old) with ATL diagnosedfrom typical leukemic cells with grooved and folded nucleus,surface marker, anti-ATLA antibody etc. Serum calcium levelsof these patients were 16.4 and 21.4 mg/dl, respectively, withno radiological evidence of bone destruction. Peripheral bloodleukemic lymphocytes from these patients were purified by theFicoll-Hypaque method and cultured at a concentration of 1.5x 10⁶ cells/ml for 3 days on F-10 medium supplemented with 10%fetal calf serum. The supernatant fluids from the cell cultureswere bioassayed for bone resorption-stimulating activity (BRSA)by an assay based on the release of ⁴⁵Ca from prelabeled fetalmouse forearm bones in organ culture according to Raisz's method.The supernatant fluid of cultures from both patients which showedmarked BRSA was nondialyzable through a dialysis membrane witha molecular weight cutoff of 3500. Parathyroid hormone and prostaglandinswere not detectable in the supernatant fluids of the leukemiccell cultures. In one patient, BRSA was measured twice and foundto be decreased to a normal level when the patient was in hematologicalremission with a normal calcium level (8.3 mg/dl). These resultssuggest that the hypercalcemia observed in patients with ATLis due, in part, to a bone resorptionstimulating factor whichis produced by leukemic T-cell lymphocytes.     

Human parvovirus B19-induced aplastic crisis in iron deficiency anemia

Human parvovirus B19 (HPVB19) infects and replicates in erythroid progenitor cells. Its specific cytotoxic effect on these cells results in aplastic crises in patients with congenital hemolytic anemias. Aplastic crisis due to HPVB19 infection in a healthy girl revealed occult iron deficiency anemia. The condition is characterized by a high serum iron level in the aplastic phase and rapid recovery after administration of iron. Temporary HPVB19-induced red blood cell aplasia could occur in patients with other anemias, particularly those with non-inherited form of hemolysis.     

Hormonal function after ovarian transposition to the abdominal subcutaneous fat tissue

We previously reported a new technique for ovarian transposition to the abdominal subcutaneous fat tissue (OTAFT) following hysterectomy. The purpose of this study is to assess the hormonal function after OTAFT. From 1993 to 2000, OTAFT was performed in 27 patients (group A). Forty-two women underwent hysterectomy and retained ovaries without transposition (group B). In 19 cases, bilateral oophorectomy with hysterectomy was performed, and they received a hormone replacement therapy (HRT) (group C). Serum follicle-stimulating hormone (FSH) level of patients was monitored every 2-12 months, and the time of menopause (defined as FSH >40 mIU/mL two times consecutively) was determined in groups A and B. After a median follow-up of 65 months, cumulative ovarian survival did not show significant difference between group A and group B (HR = 0.52, 95% CI = 0.17-1.16; P= 0.10). In patients who were 40 years old or younger, ovarian function declined significantly in group A compared to group B (HR = 0.29, 95% CI = 0.02-0.91; P= 0.04). However, FSH level of postmenopausal patients in group A was not different from FSH level of patients in group C, but FSH level of postmenopausal patients in group B was significantly higher than FSH level of patients in group C (P= 0.002). Although the procedure of OTAFT may somewhat affect the ovarian function, the transposed ovary in postmenopausal women presumably still secrete a small amount of estrogen which is equivalent to an estrogen level by HRT.     

高分子聚合体表面润湿性研究模型的建立

目的:利用低温等离子体轰击法建立高分子聚合体表面润湿性研究模型.方法:使用氧低温等离子体轰击六甲基二硅氧烷薄膜聚合体表面,测定表面接触角,建立轰击时间-表面接触角曲线,建立线型回归方程.观察在不同介质中保存时材料表面接触角的变化情况.结果:经过氧等离子体轰击后,六甲基二硅氧烷薄膜聚合体表面接触角明显下降,与处理时间呈现负相关性.在空气中保存时,表面接触角随时间逐渐上升,0度接触角表面24 h后上升为20°左右,而在双蒸水中保存的表面接触角基本保持不变.结论:氧等离子体轰击法能可控性地改变六甲基二硅氧烷薄膜聚合体表面润湿性,处理后的表面在水中接触角保持稳定,该方法可以用来建立表面润湿性研究模型.     

Effects of aging on behavioral symptoms in Alzheimer's disease

Aim:  The aim of the present study was to evaluate the relationship between aging and the behavioral and psychological symptoms of dementia (BPSD) in patients with Alzheimer's disease (AD).
Methods:  Eligible subjects were consecutively referred AD patients with BPSD. According to patient age at the time of the test, the AD patient group ( n  = 79, whole AD group (WADG)) was divided into two groups: a relative older group (OG) in the whole AD group (WAD) (age at the time of test was 81 years or more, n  = 40) and a relative younger group (YG) in the WAD (age at the time of test was below 81 years, n  = 39). A comparison was made of the demographic data (sex difference, educational level and severity of dementia), cognitive functions and BPSD between the groups. BPSD was evaluated using the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD). The factor analysis of BPSD was conducted in the WADG as well as in the OG and YG.
Results:  Sex difference, educational level, severity of dementia and cognitive functions were not different; however, the total score of the BEHAVE-AD symptom domain in diurnal rhythm was significantly higher in the OG than in the YG (Student's t -test: P  < 0.05). Factor analysis showed that psychosis was the first factor in the OG, but was the third factor in the YG and that the psychotic symptoms were caused by anxieties and phobias in the OG.
Conclusion:  From these results, we found that the effects of aging on the BPSD in AD were characterized by diurnal rhythm disturbance and psychosis.