Intracranial hypertension in a boy with Mycoplasma pneumoniae infection: the first report

We describe a 7-y-old boy who developed idiopathic intracranial hypertension (IIH) during the convalescent phase of Mycoplasma pneumoniae (M. pneumoniae) infection. Anti-M. pneumoniae antibody and cold hemagglutinin titer were extremely high during his course, and corticosteroid administration was noticeably effective. It supports an immunopathological mechanism for his intracranial hypertension.     

The clinical outcome and quality of life following minimally invasive direct coronary artery bypass surgery

BACKGROUND: Minimally invasive direct coronary artery bypass (MIDCAB) through a limited anterior small thoracotomy has been shown to be a promising technique of surgical treatment for single or double vessel disease. Little is known about the Health-Related Quality Of Life (HRQOL) in this group of patients. METHODS: The records of 75 consecutive patients who underwent MIDCAB procedure at Harefield Hospital between April 2000 and January 2002 were reviewed retrospectively. HRQOL assessment was planned in a cross-sectional design. Patients were contacted by telephone to conduct a semi-structured interview and were sent two questionnaires: the Short Form health survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS). RESULTS: There was no in-hospital death. Patients stayed in the Intensive Therapy Unit (ITU) for 11.56 +/- 4.55 hours and stayed in hospital for 3 +/- 2.34 days. None of the study patients had perioperative myocardial infarction (MI) or neurological complications including permanent and transient strokes. We were able to contact all the 75 patients by telephone and they also completed the SF-36 and HADS. The SF-36 scores were compared to an age-matched group of normal British people. The MIDCAB group had an excellent general health perception compared to the normal group (p < 0.001), but similar scores otherwise. The HADS scores showed that only 1 patient (1.3%) had mild depression, 5 patients (6.7%) had mild anxiety, and 2 patients (2.6%) had moderate anxiety. CONCLUSION: MIDCAB is a safe surgical treatment and provides excellent clinical and HRQOL outcomes.     

Human urocortin 2, a corticotropin-releasing factor (CRF)2 agonist, and ovine CRF, a CRF1 agonist, differentially alter feeding and motor activity

Two corticotropin-releasing factor (CRF) receptor families have been identified (CRF1 and CRF2). Whereas anxiogenic-like roles for the CRF1 receptor have been identified, behavioral functions of the CRF2 receptor remain obscure. Urocortin 2 (Ucn 2), a CRF-related peptide that selectively binds CRF2 receptors, was recently identified and recognized for its central anorectic properties. The present study tested the hypothesis that the anorexigenic mode of action of Ucn 2 differed from that of ovine CRF (oCRF), a preferential CRF1 receptor agonist. The behavioral effects of intracerebroventricular administration of Ucn 2 were compared with those of oCRF in nondeprived male Wistar rats (n=102). Ucn 2 reduced 6-h food and water intake at doses that did not induce visceral illness (0.1, 1, and 10 microg), as indicated by kaolin intake. Ucn 2 retained its potent anorectic activity in rats receiving a highly palatable cafeteria diet, preferentially reducing intake of carbohydrate (CHO)-rich items while sparing intake of mixed-fat/CHO items. In contrast to Ucn 2, oCRF (10 microg) suppressed 6-h intake of cafeteria diet-fed rats without regard to macronutrient composition. Rather, oCRF most potently suppressed intake of preferred food items. Whereas oCRF had short-onset motor-activating effects, Ucn 2 had nondose-dependent, delayed-onset motor-suppressing effects. Thus, central infusion of a CRF2 receptor agonist suppressed intake of both bland and palatable diets without inducing behavioral arousal or malaise, and the profile of anorexigenic effects qualitatively differed from those of a CRF1 receptor agonist. The results suggest the existence of distinct forms of CRF1- and CRF2-mediated anorexia.     

Relationship between newborn size and mother's blood cadmium levels, Toyama, Japan

The effect of blood cadmium (Cd), which reflects not only Cd body burden but also recent Cd exposure and communicates with fetal blood in the placenta, on newborn size at birth was investigated. Blood Cd of 55 mothers from Toyama, Japan, at 30-32 gestational weeks was measured using a flameless atomic absorption spectrophotometer. The relationship between blood Cd and newborn size was analyzed after adjustment for gestational age and maternal build. A significant inverse correlation was found between infant height and maternal blood Cd. After adjustment for gestational age and maternal weight at 30-32 gestational weeks, the significant inverse relationship between maternal blood Cd and infant height was shown using the multiple regression analysis. Newborn size might be influenced by maternal blood Cd levels to which infants may be exposed during gestation.     

The R(-)-enantiomer of efonidipine blocks T-type but not L-type calcium current in guinea pig ventricular myocardium

In guinea pig ventricular cardiomyocytes, the R(-)-enantiomer of efonidipine concentration-dependently blocked T-type Ca2+ current with 85% inhibition at 1 microM. In contrast, R(-)-efonidipine (1 microM) had no effect on the L-type Ca2+ current and Ca2+ transient in cardiomyocytes and contractile force in papillary muscles. Thus, R(-)-efonidipine is a highly selective blocker of the T-type Ca2+ current in native myocardia.     

Effect of cilnidipine on L- and T-type calcium currents in guinea pig ventricle and action potential in rabbit sinoatrial node

Cilnidipine, a dihydropyridine Ca(2+) channel antagonist, is known to have inhibitory effects on both L- and N-type Ca(2+) currents. In the present study, we examined the effect of cilnidipine on myocardial L- and T-type Ca(2+) currents and sinoatrial node action potential configuration. In voltage clamped guinea pig ventricular myocytes, cilnidipine concentration-dependently decreased L- and T-type Ca(2+) currents. In rabbit sinoatrial node tissue, cilnidipine increased cycle length through reduction of phase 4 depolarization slope. In conclusion, cilnidipine has inhibitory effects on T-type Ca(2+) current, which may contribute to its negative chronotropic potency.     

Receptor-like protein tyrosine phosphatase zeta/RPTP beta is expressed on tangentially aligned neurons in early mouse neocortex

Protein tyrosine phosphatase zeta (PTPzeta)/RPTPbeta is a chondroitin sulfate proteoglycan predominantly expressed in the brain. In this study, we examined immunohistochemical localisation of PTPzeta in the mouse telencephalon from embryonic day 9.5 (E9.5) to E15.5. During E10.5-E12.5, immunoreactivities for PTPzeta are specifically observed on the tangentially aligned neurons at the preplate (PP) of the neocortex, as well as on the neurons at the mantle layer (ML) of the ganglionic eminences (GEs). Likewise, neurons immunoreactive for CR50, a marker for Cajal-Retzius neurons, are aligned from the ML of the ganglionic eminences to the PP of the neocortex and co-express PTPzeta. During E13.5-E15.5, PTPzeta-positive neurons are present at the subplate (SP) as well as at the marginal zone (MZ) of the neocortex. These results indicate that PTPzeta is a useful marker for early-generated neocortical neurons in mice: Cajal-Retzius neurons as well as the subplate neurons.     

Significance and usefulness of corticospinal motor evoked potential monitoring for lesions adjacent to primary motor cortex]

This study evaluated the usefulness of intraoperative corticospinal motor evoked potential (MEP) monitoring in preventing postoperative motor deficits, and whether this procedure contributed to surgery on intrinsic brain lesions in the vicinity of the motor area. The subjects were 45 patients with brain tumors located in and around the primary motor area. MEP was recorded through the cervical epidural electrodes in response to stimulation of the motor cortex. The amplitude of D-response of MEP was compared at the beginning and at the end of surgery. Then MEP changes were divided into five groups; "increase", "no change", "diminish", "decrease" and "disappear". We used the DeJong classification for qualitative analysis of motor function, and reviewed these findings in relation to the change in MEP. It was possible to record MEP when the preoperative motor weakness was DeJong 3 or better. There was no postoperative motor deficit when the MEP amplitude was preserved at better than 50% of a control amplitude. If the amplitude decreased to less than 50%, motor deficits were encoutered. When MEP amplitude increased during the surgery, preoperative motor weakness was improved after the surgery. It is concluded that there is little possibility of causing motor deficits even if tumor removal is aggressively pursued, as long as the amplitude of D-response remains at 50% or more of the baseline. This monitoring procedure is expected to improve the overall surgical results in patients with intrinsic brain tumors around the motor area.     

A tube-fed liquid formula diet containing dietary fiber increased stool weight in bed-ridden elderly patients

OBJECTIVE: The number of bedridden elderly patients who need a liquid diet has been increasing. We evaluated the usefulness of a tube-fed liquid diet containing cellulose and oligosaccharide for elderly bedridden patients. METHODS: Twenty-two elderly bedridden patients were given a liquid diet containing cellulose and lafinose for 4 wk. Parameters associated with blood and stool weight were measured during this period. RESULTS: Stool weight increased by 32.0 g in men and 8.8 g in women at 2 wk and remained at these weights up to 4 wk (P < 0.05 before and after 2 wk, 3 wk, and 4 wk in men, and P < 0.05 before and after 3 wk in women). Body weight increased in men (0.5 kg) and women (0.7 kg) 15 d after starting the diet and then remained at these values up to 29 d thereafter, and statistically significant differences were not seen. There were no changes in nutritional parameters such as total protein. CONCLUSION: No significant changes were observed in the general condition of elderly patients, with the exception of a positive increase in fecal weight, by 30-d supplementation of a liquid diet containing cellulose and lafinose.     

Contrast-enhanced MRA for investigation of cerebral arteriovenous malformations

We evaluated contrast-enhanced MRA (enhanced 3-D fast gradient-echo [efgre3d] with spectral inversion recovery) for identification of 15 intracranial arteriovenous malformations (AVMs) in 14 patients. Demonstration of the feeding arteries was classified as good for 16 examinations on maximum-intensity projections and multiprojection volume reconstruction images. The nidus was seen well in all patients. Definition of the draining veins was good or fair except for one poor result. Therapeutic effects were clearly demonstrated in three follow-up series. Contrast-enhanced MRA using efgre3d is useful for delineation of AVMs and for follow-up after treatment.