Intradural extramedullary ganglioneuroma associated with multiple hamartoma syndrome

A 51-year-old woman presented with a rare completely intradural and extramedullary spinal ganglioneuroma associated with multiple hamartoma syndrome and manifesting as complaints of neck pain and dizziness persisting for 8 months. Magnetic resonance imaging of the spinal cord revealed an intradural extramedullary lesion at the C1 level. She underwent right suboccipital craniectomy and C1-2 hemilaminectomy to remove the tumor. Histological examination confirmed ganglioneuroma. She also suffered from multiple facial trichilemmomas, thyroid goiter, multiple polyposis of the gastrointestinal tract, and pulmonary hamartoma indicating multiple hamartoma syndrome. These benign neoplasms were treated conservatively.     

A simple oscillometric technique for determining new indices of arterial distensibility.

Recently, oscillometric devices have been developed that can measure blood pressure in the extremities and analyze pulse volume record. On the basis of the extremity pulse volume record, these devices can automatically determine three types of simply measured pulse wave velocity (PWV) (brachial PWV: heart to right upper arm; R-PWV: right upper arm-right ankle; and L-PWV: right upper arm-left ankle). The percent mean pulse volume record (%MPVR=the height that bisects the area of the pulse volume record/pulse pressure X100), a quantitative index of right brachial pulse volume record, can also be determined. To evaluate the usefulness of these new indices, we studied 1,067 consecutive subjects undergoing health checkups (648 men, 419 women; mean age, 50 +/- 9 years). In both sexes, age correlated positively with simply measured PWVs (men, brachial PWV: r=0.46, p<0.0001; R-PWV: r=0.46, p<0.0001; L-PWV: r=0.47, p<0.0001; women, brachial PWV: r=0.37, p<0.0001; R-PWV: r=0.47, p<0.0001; L-PWV: r=0.48, p<0.0001) and correlated negatively with %MPVR (men: r=-0.40, p<0.0001; women: r=-0.45, p<0.0001). Simply measured PWVs and %MPVR were significantly correlated with mean blood pressure. In a separate group of 60 patients, simply measured PWVs correlated positively with carotid PWV (heart to carotid) derived from an elastic vessel (brachial PWV: r=0.76, p<0.0001; R-PWV: r=0.43, p<0.01; L-PWV: r=0.43, p<0.01). %MPVR correlated negatively with carotid PWV (r=-0.35, p<0.01). In conclusion, simply measured PWVs and %MPVR are easier to determine than conventional PWV and may be useful as new indices of age-related changes in arterial distensibility.     

A case report of left upper lobectomy for lung cancer performed on an aged man of 90 year old]

A 90-year-old man was admitted to our hospital because of the dyspnea on exertion and an abnormal shadow of the chest. The examinations revealed pulmonary adenocarcinoma (bronchioloalveolar cell type) of the left S3 with clinical classification of stage I. Spirometry showed severe obstructive lung dysfunction (VC 2.05 l, % VC 75.2%, FEV1.0 0.72 l, FEV1.0% 39.3%). Walking exercise in the ward and the stairs as well as instrumental physiotherapy (Triflow) partially improved his respiratory function. Left upper lobectomy and lymphnode dissection were performed. On the 3rd postoperative day the patient developed mild delirium which disappeared in a few days. He was discharged from the hospital 62 days after the operation.     

Repair of an aortoiliac aneurysm associated with chronic disseminated intravascular coagulopathy

We report herein an unusual case of a 77 year old man who developed chronic disseminated intravascular coagulopathy (DIC) caused by an aortoiliac aneurysm. After preoperative heparin therapy, the aneurysm was successfully replaced with a prosthetic graft despite heavy blood loss. Moreover, the infusion of platelet concentrate and autotransfusion proved helpful during the operation and his hypofibrinogenemia and thrombocytopenia became normalized immediately after surgery. Thus, although preoperative heparin therapy can help control DIC, surgical repair of the aneurysm is the definitive treatment in this kind of case.     

Time-course of Toll-like receptor 2 expression, as a predictor of recurrence in patients with bacterial infectious diseases

The clinical course of bacterial infectious diseases is often variable, especially in elderly patients. Thus, new biological markers have been sought to predict the disease outcome. Recent studies have revealed that Toll-like receptor (TLR) 2 and/or TLR4 on circulating monocytes are significantly up-regulated in bacterial infections. However, the lack of reliable quantification methods hampers extensive study on the modulation of these molecules in response to the patient's clinical condition. In this study, we developed a new quantitative flow cytometric analysis system for TLR2. We then carried out a longitudinal study on TLR2 expression levels on monocytes from patients suffering from bacterial infectious diseases during and after antibiotic treatment. The clinical outcome divided 37 patients into 'cure' (n = 24) and 'recurrence' (n = 13) groups. A significant difference between the two groups was recognized in the TLR2 levels just after antibiotic treatment (antibody-binding sites/cell, 4395 +/- 784 versus 5794 +/- 1484, P < 0.001). The risk of recurrence was associated significantly with TLR2 (P < 0.001), but not C-reactive protein (P = 0.351) levels assayed during the first remission. Furthermore, antibiotic effectiveness was associated inversely with TLR2 levels during antibiotic administration (P < 0.001). Taken together, TLR2 expression levels on monocytes provide critical information for planning treatment against bacterial infectious diseases.     

Clinicopathological study of early cancer-like advanced gastric cancer

We had clinicopathologically studied early cancer-like advanced gastric cancer in relation to peptic ulcer (UI). Early cancer-like advanced cancers with the difficulty to distinguish from early gastric cancer were selected for materials. Result were as followed: 1) Early cancer-like advanced cancers were consisted of 133 lesions, of which 128 lesions (96.2%) had peptic ulcer in cancerous lesion (73 lesions were active stage and 55 lesions were scarring stage). 2) Early cancer-like advanced cancers were 17.0% in all advanced gastric cancers. Proper muscle cancer (in which depth of cancerous invasion is up to proper muscle coat) was more common in early cancer-like advanced cancers than in Borrmann type advanced cancers. 3) Early cancer-like advanced cancers with peptic ulcer showed wide intramucosal cancerous infiltration. Thus, average of maximum diameter was 51.8 mm. 4) Those ulcer were commonly reaching to proper muscle coat or subserosa. Submucosal fibrosis was prominent and scattered proliferation of tumor cells were often seen within fibrosis. 5) Extent of cancerous infiltration in mucosa was more wide than that in submucosa. The above findings have led us to consider that early cancer-like advanced cancers have grown because of high degree submucosal fibrosis by the deep ulcerations due to "malignant cycle".     

Angled interventricular septum on echocardiography: Anatomic anomaly or technical artifact?

An acutely angled interventricular septum has been reported to constitute a distinct two-dimensional echocardiographic geometric pattern that may permit a false M-mode echocardiographic recording of asymmetric septal hypertrophy. In light of experience suggesting that the angle between the aortic root and interventricular septum varied with the intercostal space of the transducer, 45 subjects were prospectively studied by two-dimensional and M-mode echocardiography. Parasternal long- and short-axis views were obtained from two to four intercostal spaces in each subject. Two-dimensional echographic cursor-generated M-mode echocardiograms were obtained from the long-axis views; interventricular septal and left ventricular posterior wall thickness was measured from both the two-dimensional and M-mode echocardiograms. On two-dimensional echocardiography, the angle between the aortic root and septum became more acute as a progressively lower intercostal space was used (p less than 0.001). Although no change in septal thickness was apparent, the septal thickness significantly increased as a progressively lower intercostal space was used. On M-mode echocardiography, 21 subjects (47%) demonstrated asymmetric septal hypertrophy (septal/posterior wall thickness ratio greater than 1.3) from at least one intercostal space, but this was confirmed by the two-dimensional technique in only 4 subjects (9%). Thus, a two-dimensional echocardiographic recording of an angled interventricular septum can be produced by positioning the transducer in a low intercostal space, and caution must be used in the interpretation of asymmetric septal hypertrophy on M-mode echocardiograms. Two-dimensional echocardiography is a useful means of identifying subjects with apparent asymmetric septal hypertrophy that often may be the result of a technical artifact.     

Limitation of angiography to identify the culprit plaque in acute myocardial infarction with coronary total occlusion utility of coronary plaque temperature measurement to identify the culprit plaque.

OBJECTIVES: The purpose of this study was to test the hypothesis that the maximal temperature (Tmax) site, as measured by thermal wire, coincides with the culprit plaque by intravascular ultrasound (IVUS) in patients with acute myocardial infarction (AMI). BACKGROUND: Subsequent thrombosis developing to the proximal region from the site of plaque rupture or erosion can potentially complicate the ability of coronary angiography to identify the accurate culprit plaque in patients with coronary total occlusion. METHODS: In 45 consecutive patients with a first anterior AMI, the Tmax site by thermal wire and the culprit plaque by IVUS were evaluated in the left anterior descending coronary artery (LAD). RESULTS: Twenty-five patients had LAD total occlusion, and the remaining 20 had LAD reperfusion. In both groups of patients, the Tmax site was significantly more distal to the angiographically most stenotic site or occlusive site (reperfusion: mean distance [MD] = 1.1 mm distal, 95% confidence interval [CI] 0.3 to 1.9 mm, p = 0.01; total occlusion: MD = 8.8 mm distal, 95% CI 8.0 to 9.6 mm, p < 0.0001). The culprit plaques by IVUS approximately coincided with those by angiography or thermal wire in patients with reperfusion. However, the angiographic occlusive site was significantly more proximal to the culprit plaque by IVUS (MD = 9.2 mm, 95% CI 7.9 to 10.6 mm, p < 0.0001), but the Tmax site coincided with the culprit plaque by IVUS (MD = 0.3 mm distal, 95% CI 0.3 mm proximal to 1.0 mm distal, p = 0.293) in patients with total occlusion. CONCLUSIONS: Temperature measurement of coronary plaque enables accurate localization of the culprit plaque in AMI with coronary total occlusion.     

Effects of glucose abnormalities on in-hospital outcome after coronary intervention for acute myocardial infarction.

BACKGROUND: The effects of glucose abnormalities on outcomes after percutaneous coronary intervention (PCI) remain unclear. We examined the association between glucose abnormalities and in-hospital outcome in patients undergoing PCI for acute myocardial infarction (AMI). METHODS AND RESULTS: A total of 849 patients with AMI who were admitted within 12 h after symptom onset and underwent emergency PCI were classified according to the presence or absence of admission hyperglycemia, defined as a blood glucose level on admission of >11 mmol/L and whether they had a history of diabetes mellitus: group 1 (n = 504), non-diabetic patients without admission hyperglycemia; group 2 (n = 111), diabetic patients without admission hyperglycemia; group 3 (n = 87), non-diabetic patients with admission hyperglycemia; and group 4 (n = 147), diabetic patients with admission hyperglycemia. Among groups 1, 2, 3 and 4, in-hospital mortality was 2.6, 2.7, 11.5 and 8.8%, respectively (p < 0.01). Multivariate analysis showed that compared with group 1 patients, the odds ratio (95%confidence interval) for in-hospital mortality among those in groups 2, 3, and 4 were 0.80 (0.24-2.60, p = 0.708), 2.29 (1.10-5.49, p = 0.039), and 2.14 (1.14-4.69, p = 0.048), respectively. CONCLUSIONS: In-patients undergoing PCI for AMI, admission hyperglycemia, irrespective of the presence or absence of diabetes, is associated with increased in-hospital mortality, whereas diabetes without admission hyperglycemia is not.