Fundamental and clinical studies on ceftazidime in pediatric surgery

Fundamental and clinical studies of ceftazidime (CAZ) were performed in pediatric surgery. The results obtained were summarized below. Serum and urinary levels of CAZ were measured in 5 patients following injection (CAZ: 10 or 20 mg/kg, intravenous bolus injection). Highest levels in serum were observed within 30 minutes, 30.4 micrograms/ml and 49.5-62.9 micrograms/ml with 10 mg/kg and 20 mg/kg doses, respectively. Then serum levels of CAZ decreased gradually except in 1 case with a metabolic disease, and serum half-lives (T 1/2) were 1.19-1.88 hours for the high doses. The highest levels in urine were observed in 0-2 hours, and the urinary recovery rate was 59-100%. The bile levels were also measured in 3 patients who underwent radical operations of congenital biliary atresia (CBA). Highest levels of CAZ in bile, 4.47-9.66 micrograms/ml, were noted in 0-2 or 2-4 hours following injection. Recovery rates for 8 hours were 0.11, 0.17 and 0.20% for the 3 patients. The CAZ was administrated to 7 patients for prophylaxis of the postoperative infection (5 cases) or to treat ascending cholangitis in CBA (2 cases). Clinical results were good in 4, fair in 1, poor in 1 and unknown in 1. No clinical and laboratory side effect due to the administration of CAZ was observed. It is concluded that CAZ is a safe and effective antibiotic in pediatric surgery.     

Onset of vecuronium neuromuscular blockade at the hand with an arterio-venous shunt

Purpose

To evaluate the onset of vecuronium neuromuscular blockade in the hand with an arteno-venous shunt for haemodialysis.

Methods

In 15 adult patients receiving haemodialysis for renal failure the onset of vecuronium-induced neuromuscular blockade after 0.08 mg·kg^?1 vecuroniumiv was measured. Using train-of-four mechanomyographic monitoring, the force of contraction of the adductor pollicis of both hands with and without arteno-venous shunt was measured simultaneously.

Results

The times from the injection to the first depression of twitch response (latent onset) and 95% twitch depression (onset) in the hand with and without arteno-venous shunt were114.7 ± 33.4 and 218.7 ± 59.9 and 117.3 ± 34.3 and 208.7 ± 60.9 sec respectively. No difference in the onset of vecuronium neuromuscular blockade in the hand an arterio-venous shunt was demonstrated.

Conclusion

The presence of an artenovenous fistula does not modify the onset on neuromuscular blockade. Either arm can be used to monitor onset of neuromuscular blockade in chronic renal failure patients with an arterio-venous shunt in the hand for haemodialysis     

Dermoscopic features of ocular and extraocular sebaceous carcinomas

Sebaceous carcinomas are rare but potentially fatal malignant adenocarcinomas with varying degrees of sebaceous differentiation. Several dermoscopic findings of extraocular sebaceous carcinomas have been reported; however, there are no previous reports of ocular sebaceous carcinomas detected using dermoscopy. We present a case of ocular sebaceous carcinomas showing specific findings from dermoscopy, and describe the common dermoscopic characteristics. In our cases and a review of cases in the literature, we noted that polymorphous vessels and yellowish areas were observed in all eight cases. Thus, we consider that dermoscopic findings of polymorphous vessels with yellow backgrounds suggest sebaceous carcinoma.     

Effect of heel pressure pad attached to ankle-foot orthosis on the energy conversion efficiency in post-stroke hemiplegic gait

[Purpose] This study aimed to analyze the effect of heel pads in ankle-foot orthoses on dynamic motion aspects of gait in stroke patients from the viewpoint of energy conversion efficiency. [Subjects] Fourteen chronic stroke patients who were ambulatory and had lower extremity motor function categorized as Brunnstrom stage IV participated in the study. [Methods] A three-dimensional motion analysis system was used to assess the effect of heel pad intervention on dynamic motion gait parameters using a single-system A-B-A design. [Results] The results showed that a heel pad attached to the ankle-foot orthosis caused significant retention of the center-of-pressure at the heel during the heel rocker function and significant increase in the dorsiflexion moment and the height of the center of gravity. [Conclusion] The present study showed that a heel pad attached to the calcaneal region of an ankle-foot orthosis caused slight retention of the center-of-pressure at the heel during the heel rocker function along with center of gravity elevation in the stance phase and improved the energy conversion efficiency, especially on the non-paretic side.Key words: Heel pad, Three-dimensional motion analysis, Hemiplegic gait     

Gastric adenocarcinoma coexisting with a reddish semipedunculated polyp arising from <Emphasis Type="Italic">Helicobacter pylori</Emphasis>-negative normal gastric mucosa: a report of two cases

We experienced two cases of adenocarcinoma coexisting with a hyperplastic polyp arising from Helicobacter pylori-negative normal gastric mucosa. The first case was of a 59-year-old man. Esophagogastroduodenoscopy revealed a protruding lesion measuring 4 mm in diameter on the greater curvature of the middle gastric body. The second case was of a 47-year-old man. Esophagogastroduodenoscopy showed a protruding lesion measuring 5 mm located at the greater curvature of the upper gastric body. The absence of atrophic changes in the entire gastric mucosa was confirmed endoscopically in both cases. Multiple H. pylori tests were all negative. Endoscopically, these protruding lesions appeared as reddish, semipedunculated polyps. Hyperplastic polyps were suspected based on white light endoscopic findings. Magnified endoscopy with narrow band imaging could not predict the coexistence of cancer. However, histopathological examination of the resected specimen revealed focal cancer at the surface of the gastric hyperplastic polyps. Considering the possibility that cancer may be coexisting in polyps, when reddish polyps are detected in H. pylori-negative normal gastric mucosa, it is important to perform a biopsy, or a careful follow-up endoscopy.     

Carcinoma of the cystic duct remnant with direct colonic invasion

Carcinoma of the cystic duct remnant is extremely rare, and only five cases have been reported previously in the English literature. We present another case of carcinoma of the cystic duct remnant and review the literature. A 62-yr-old woman was diagnosed as having hilar cholangiocarcinoma and transverse colon cancer. However, at laparotomy, the center of the tumor mass was in the cystic duct remnant with contiguous colonic invasion. The pathology of the surgical specimen confirmed carcinoma of the cystic duct remnant. The diagnosis of carcinoma of the cystic duct remnant was made using Ozden's new criteria.