Long esophageal myotomy with a fundic patch procedure for treating diffuse esophageal spasm: Report of a case

A diagnosis of diffuse esophageal spasm (DES) based on radiological and manometric studies was made in a 70-year-old man who presented with severe dysphagia, vomiting, and spontaneous chest pain. The manometric studies revealed a simultaneous onset of high amplitude contractions and a hypertensive lower esophageal sphincter (LES) that was well relaxed in response to deglutition, in contrast to the incomplete relaxation seen in achalasia. Because his dysphagia was so severe and did not respond to pneumatic dilatation, the patient was treated by a long esophageal myotomy with a full thickness incision through the LES and mucosa, adding a Thal-Hatafuku procedure. The patient made a good postoperative recovery and has since been eating normally without any further dysphagia or chest pain. Good manometric and radiological results have been obtained in this patient during 5 years of follow-up.     

MRI findings in patients with spastic cerebral palsy. I: correlation with gestational age at birth

The authors studied MR images of the brain in 152 patients, aged 1 to 19 years (mean 3.3), who had spastic cerebral palsy (CP) and were attending two hospitals in Japan in 1993 and 1994. The relation was studied between the patients' gestational age at birth and their MRI findings, including the severity of periventricular leukomalacia (PVL) seen on MRI. In 119 of these patients, the CP was thought to be due to acquired, destructive brain injury. PVL was seen in 90 and posthemorrhagic porencephaly in 11. These preterm-type brain injuries were observed often in patients who had been born preterm but were also seen in those born at term. Full-term-type border-zone infarct, bilateral basal ganglia-thalamic lesion, subcortical leukomalacia, and multicystic encephalomalacia were seen in 9,14,7, and 3 patients, respectively; these term-type brain injuries were observed only in patients born at or near term. Of the patients with PVL, 90% had been born preterm. Severe PVL was common in the patients whose gestational ages at birth were between 25 and 32 weeks; all patients with PVL who had been born at term had only mild PVL. The authors concluded that MRI findings for patients with spastic CP are closely correlated with gestational age.     

Questionnaire survey on the understanding of epilepsy among non-medical persons

Background: A questionnaire survey was conducted on the understanding of epilepsy and febrile seizures in preschool teachers, public health nurses, and parents or caregivers of children with epilepsy.
Methods: The survey was performed in three different sites at different dates. The participants were 16 preschool teachers, 25 public health nurses, and 34 parents or caregivers of children with epilepsy.
Results: Seventy-seven percent of the participants thought that epilepsy was not always untreatable. Sixty-seven percent of the participants thought that epilepsy was not a hereditary disease. Sixty-one percent of the participants considered that repetitive seizures cause brain damage, and 93% of them thought that patients with epilepsy must be treated. Seventy-six percent of the participants thought that febrile seizures evolve into epilepsy if left untreated. Seventy-seven percent of the participants considered that vaccination can be performed in patients with epilepsy or febrile seizures, and 89% of them thought that swimming should not be forbidden in patients with epilepsy or febrile seizures. There was no significant difference in the answers with regard to the positions of the participants except in one question.
Conclusions: The present questionnaire survey provided some information on the understanding of epilepsy among non-medical persons. A nationwide public survey is needed to clarify the problems in the public understanding of epilepsy.     

Analysis of amino acid sequences of penicillin-binding protein 2 in clinical isolates of <Emphasis Type="Italic">Neisseria gonorrhoeae</Emphasis> with reduced susceptibility to cefixime and ceftriaxone

Neisseria gonorrhoeae strains with reduced susceptibility to cefixime and ceftriaxone, with minimum inhibitory concentrations (MICs) of cefixime of 0.125-0.25 microg/ml and ceftriaxone of 0.031-0.125 microg/ml, were isolated from male urethritis patients in Tokyo, Japan, in 2006. The amino acid sequences of PenA, penicillin-binding protein 2, in these strains were of two types: PenA mosaic and nonmosaic strains. In the PenA mosaic strain, some regions in the transpeptidase-encoding domain in PenA were similar to those of Neisseria perflava/sicca, Neisseria cinerea, Neisseria flavescens, Neisseria polysaccharea, and Neisseria meningitidis. In the PenA nonmosaic strain, there was a mutation of Ala-501 to Val in PenA. In addition, we performed homology modeling of PenA wild-type and mosaic strains and compared them. The results of the modeling studies suggested that reduced susceptibility to cephems such as cefixime and ceftriaxone is due to a conformational alteration of the beta-lactam-binding pocket. These results also indicated that the mosaic structures and the above point mutation in PenA make a major contribution to the reduced susceptibility to cephem antibiotics.     

Protective effect of S-allylcysteine against cyclophosphamide-induced bladder hemorrhagic cystitis in mice

S-Allylcysteine (SAC), an organosulfur compound of aged garlic extract (AGE) regulates the thiol status of the cell and scavenges free radicals. Depletion of thiols along with free radical generation has been implicated in cyclophosphamide (CP)-induced urotoxicity. We studied modulatory effect of SAC on CP-induced urotoxicity in mice focusing on hemorrhagic cystitis (HC). SAC (150 and 300 mg kg⁻¹) was administered in CP treated animals (200 mg kg⁻¹) and bladder was observed for histological and biochemical changes. CP treatment caused a marked increase in the lumen exudates, edema, vasodilation and HC in lamina propia in the bladder. These changes were accompanied by increase in lipid peroxidation (LPO), and decrease in reduced glutathione (GSH) and activities of antioxidant enzymes. SAC not only showed protection in tissue histology but also improved the decreased activities of antioxidant enzymes. SAC treatment also reduced LPO and increased GSH levels. Although SAC treatment did not ensure full recovery, the marked improvement in histology and antioxidants of bladder suggests that it has a significant modulatory effect on CP-induced urotoxicity. Since decrease in antioxidant level is the major cause of CP urotoxicity, the protective effect of SAC deserves its further exploration involving laboratory and clinical investigations.     

Development of Blood Extraction System for Health Monitoring System

We focus on research to develop a compact human blood sampling device used for the Self Monitoring of Blood Glucose (SMBG). The SMBG comprises: (1) an indentation system using a shape memory alloy (SMA) actuator to force a microneedle through the skin; (2) a micro electrical pumping system to extract blood using a bimorph type piezoelectric microactuator; (3) a biosensor using an enzyme such as glucose oxidase (GOx) to detect and evaluate the amount of glucose in extracted blood. A titanium microneedle the same size as a female mosquito's labium (60 μm outer diameter, 25 μm inner diameter) was produced by the sputter deposition method. The mechanical design of the device was based upon the mosquito's blood sampling mechanism. The blood extraction system worked well. We measured the performance of the principal components: the indentation load for a microneedle of external diameter 100 μm was found to be 0.1 N. The pumping system has an extraction speed of about 2 μl/min for whole blood. This is similar to that achieved by the mosquito.     

Congenital cytomegalovirus infection diagnosed by polymerase chain reaction with the use of preserved umbilical cord

We report a patient with congenital cytomegalovirus infection diagnosed retrospectively by real time polymerase chain reaction with the use of a preserved umbilical cord. The patient had mild developmental delay without apparent hearing loss at the diagnosis. Congenital cytomegalovirus infection was suspected on the basis of magnetic resonance imaging that showed abnormal signal intensities in the gray-white matter junction.