Liver abscess secondary to ventriculoperitoneal shunt

Liver abscess is a rare complication following the ventriculoperitoneal (V-P) shunt operation. There has been only one case reported in the literature. We present a case of liver abscess developed about 3 months after V-P shunt operation. A 31-year-old female was admitted to our hospital in comatose condition due to second bleeding from an aneurysm of the right internal carotid artery on January 1, 1984. Obliteration of the aneurysm was performed on the following day. She received V-P shunt operation for the marked hydrocephalus on February 4, but she developed low spinal fluid pressure syndrome. She was able to walk by herself after the replacement of shunt valve on March 4. In the middle of April, she suffered from abdominal pain with a pyrexia for about 5 days. On May 13, a new peritoneal tube was placed in another part of the peritoneal cavity because of the recurrence of hydrocephalus. On the following day, she developed severe abdominal and back pains with a high fever. Abdominal CT scans and ultrasonogram were performed on May 22, showing a well-defined, cystic mass lesion in the liver and the peritoneal tube lying just beneath the mass lesion. Approximately 100 ml of white creamy pus was aspirated from the cystic mass by ultrasound-guided percutaneous puncture, and a 8.3 French pigtail nephrostomy catheter was left in place for 9 days until purulent drainage stopped. Microbiologic examination demonstrated staphylococcus epidermidis in the cerebrospinal fluid (CSF) from the shunt tube but was negative in the abscess fluid. The ventricular fluid was drained externally with the V-P shunt tube for a while, but the new ventricular drainage was instituted because of continuous positive cultures in the CSF from the shunt tube. Thereafter, the cultures of the CSF became negative and ventriculoatrial (V-A) shunt operation was performed on July 2. Postoperative course was uneventful. It is considered that the formation of the liver abscess seems to be caused by the focal injury to the liver surface by the insidiously infected peritoneal tube with St. epidermidis, and by the decrease in systemic resistance to infection. Percutaneous aspiration and drainage under the guidance of abdominal computed tomography or ultrasonography are very useful and efficient for the diagnosis and the treatment of liver abscess. When patients show signs of infection to the V-P shunt, we should remove the shunting system and place a new external ventricular drainage, and institute a V-A shunt after confirming negative cultures of the CSF.     

Immunohistochemical study of microtubule-associated protein 2 and ubiquitin in chronically aluminum-intoxicated rabbit brain

Summary Experimental neurofibrillary change was produced in rabbit brains by daily subcutaneous aluminum tartrate injection for 40 days. The production of experimental neurofibrillary changes was confirmed by immunostaining with antibodies against neurofilament triplet proteins and the brain tissue was studied immunohistochemically with antibodies against microtubule-associated protein (MAP) 2 and ubiquitin. The hippocampal neurons of the chronically aluminum-intoxicated rabbit brain showed diminished staining of dendrites by anti-MAP2 antibody. The length of anti-MAP2-positive dendrites in hippocampus was significantly shorter than that of the control brain. In the cortex somata of a subset of pyramidal neurons were intensively stained by anti-MAP2 antibody, while the MAP2 immunoreactivity of distal dendrites was diminished. The immunostaining by anti-ubiquitin antibody revealed the positive staining of the neurons bearing experimental neurofibrillary changes in the lower brain stem nuclei. It is speculated that MAP2 dislocation and ubiquitination are accompanying phenomena of the production of experimental neurofibrillary changes in chronically aluminum-intoxicated rabbit brains.Supported in part by grants from Ministry of Education of Japan and the Sandoz Gerontological Research Foundation     

Clinical evaluation of indium-111-labeled leukocyte imaging in bone infection

In-111-oxine-labeled leukocyte imaging was performed on twenty-one patients suspected of having bone infection. Nine of eleven cases (82%) were diagnosed as having active infection as demonstrated by abnormal accumulation of In-111-labeled leukocytes at the site of infection. There are two false negative (18%) cases. Two cases without active infection showed abnormal uptake. Four cases revealed cold defects on the scintigraphy. Marked uptake of radiotracer was noted not only in the case of acute osteomyelitis with acute septicaemia but also in the case with persistent chronic active osteomyelitis. It was observed that for precise evaluation of the test results it was equally important to compare the imaging findings with physical signs and laboratory investigations. It is concluded that In-111-oxine-labeled leukocyte imaging is a useful tool for the evaluation of the progression of bone infection.     

Long-term prognosis of patients with congestive heart failure

Factors determining prognosis in 100 patients with recent onset of congestive heart failure (CHF) were evaluated. The 1 year, 3 year, 5 year, and 10 year survival rates in the entire CHF group were 78.5%, 59.8%, 50.4% and 14.7%, respectively. No correlations between age, sex, heart rate and cardiothoracic ratio, and the cumulative survival rate were found. The prognosis of patients with CHF due to underlying coronary artery disease or primary cardiomyopathy was poor compared with that of patients with other types of heart disease. Patients whose NYHA classification was class III or VI had a significantly lower survival rate than those in class II. Patients with lower left ventricular stroke work and consecutive ventricular premature depolarization also had a significantly lower survival rate. These results suggest that functional status, underlying heart disease, left ventricular stroke work, and the presence of ventricular tachycardia provide important information regarding the long-term prognosis in patients with congestive heart failure.     

A case of angiomatous meningioma near the geniculate ganglion

A 57-year-old male was admitted with pulsatile tinnitus and hearing disturbance of the right ear and right peripheral facial palsy. Otological examination revealed a pulsatile red mass in his right ear and right conductive hearing disturbance. CT and MRI showed the mass lesion at his right middle fossa near the geniculate ganglion. Right external carotid angiogram disclosed a tumor stain fed by the middle meningeal artery. The tumor was removed via a combination of subtemporal and transmastoidal approaches. Histologically, this tumor was diagnosed as angiomatous meningioma partly with meningotheliomatous meningioma. Meningioma in this region is very rare. We discussed its clinical and radiological characteristics in comparison with chemodectoma and facial neurinoma at the geniculate ganglion.     

Washout rate in patients with hypertrophic cardiomyopathy and hypertensive cardiac hypertrophy

The present study was performed to clinically clarify the pathogenesis of hypertensive cardiac hypertrophy (HT) and hypertrophic cardiomyopathy (HCM). Exercise thallium-201 (Tl-201) myocardial scintigraphy using a bicycle ergometer was performed for controls, HT and HCM. The scintigrams were evaluated by the circumferential profile analysis. Furthermore, the changes in Tl-201 dynamics in exercise Tl-201 scintigraphy with verapamil injections were examined in these three groups. Analysis of exercise Tl-201 scintigraphy without verapamil injections showed that the initial uptake did not differ among the three groups, but the washout rate three hours after the Tl-201 injections (WR3) did differ among the three groups. Although the WR3 of HT did not differ from that of the controls, the WR3 of HCM was lower than that of the controls. The WR3 with and without verapamil were compared. Although the WR with verapamil injections equalled that without verapamil injections in the controls and HT, the WR3 with verapamil injections decreased more than did that without verapamil injections in HCM. As an index of great and rapid changes in circulation, the washout rate one hour after the Tl-201 injection (WR1) was calculated. The WR1 without verapamil did not differ among the three groups and did not differ from that with verapamil injections in each group. These results suggest that Tl-201 dynamics of HT differ from those of HCM and lowering of the WR3 in HCM may not be caused by disturbance in the microcirculation, but rather by disturbance of Tl-clearance through the cell membrane and its cytoplasm.     

Childhood liposarcoma of the eyelid--a case report

An 11-year-old girl noted a small mass on the left upper eyelid. The tumor was excised and diagnosed as round cell-type liposarcoma. In spite of intensive multimodal therapy, the tumor tended to recur, metastasizing to the central nervous system and soft tissues. The patient died of progressive disease three years after diagnosis. Features unique to this case include the ophthalmological primary site, the age at onset, the histological subtype and the mode of metastasis.