Continuous midazolam infusion for refractory nonconvulsive status epilepticus in children

We examined efficacy of continuous midazolam (MDL) infusion in seven episodes of refractory nonconvulsive status epilepticus (NCSE) in five children. Diagnosis included Lennox-Gastaut syndrome (two cases), and symptomatic generalized epilepsy, ring chromosome 20 syndrome, and epilepsy with continuous spike-waves during slow-wave sleep (one case each). One patient with Lennox-Gastaut syndrome and another with ring chromosome 20 syndrome had two episodes of NCSE. MDL was given as an initial bolus of 0.15 to 0.3 mg/kg, followed by continuous intravenous infusion at 0.1 to 0.2 mg/kg/hr. The infusion rate was increased slowly by 0.1 mg/kg/hr every 0.5 to 1.0 hr, up to 0.4 mg/kg/hr or until NCSE was controlled. The electroencephalogram, vital signs, blood pressure, and oxygen saturation were monitored during therapy. Electrical status epilepticus was abolished within a few hours in five of the seven episodes, and two patients could maintain wakefulness, oral intake, and bowel and bladder control throughout the continuous infusion. In one patient in whom NCSE recurred, it then remained uncontrolled even at a maximum dose. Serious complications such as respiratory depression or hypotension were not observed. Continuous intravenous infusion of MDL was effective and safe for NCSE in children, and can be used as firstline therapy for this condition.     

Application of ET-Kyoto solution in clinical lung transplantation

We have developed a new organ preservation solution called extracellular-type trehalose-containing Kyoto (ET-Kyoto) solution. ET-Kyoto solution has been applied in clinical lung transplantation. The patient was a 49-year-old woman with diffuse panbronchiolitis. She underwent bilateral lobar lung transplantation from living donors. Each lobe was flushed with ET-Kyoto solution. After reperfusion, PaO(2) with inhalation of 100% oxygen was more than 500 Torr. Posttransplantation course was uneventful. Despite the relatively short ischemic time of this case report, ET-Kyoto solution may be feasible and safely applied in clinical lung transplantation.     

A case of giant thyroid tumor with tracheal stenosis

A 61-year-old female underwent resection of a giant thyroid tumor, and tracheal stenosis ensued. She had cough, dyspnea, and palpitation in the supine position. The giant thyroid tumor was of the size of 11 x 12 cm and the diameter of trachea was 8 x 6 mm at 3.5 cm below the vocal cord, at which point the trachea was the narrowest on cervical computed tomography. The peak expiratory flow rate from the flow-volume curve was 2.94 l x sec(-1) (% predicted value 55.2%) in the upright position. We were concerned about difficult airway management. Oro-tracheal intubation with an armored tube (ID 7.5 mm) was performed after intravenous midazolam 2 mg and fentanyl 50 microg, 4% lidocaine spray 2 ml with oxygen 6 l x min(-1) inhalation keeping spontaneous breathing and consciousness. Anesthesia was induced and maintained with intravenous propofol, fentany, vecuronium and nitrous oxide in oxygen to keep the bispectral index between 40 and 60. The extracted thyroid tumor was 620 g in weight. A careful preoperative evaluation of the airway using ultrasonography, CT, MRI, laryngoscopy, bronchoscopy and respiratory function test, especially peak expiratory flow rate of the flow-volume curve is important in such a case of a giant thyroid tumor. Intubation under conscious sedation with midazolam and fentanyl is useful for a patient with a giant thyroid tumor and tracheal stenosis.     

Endovascular treatment of dural sinus malformation with arteriovenous shunt in a low birth weight neonate--case report

A boy was born at 36 weeks gestation weighing 2,135 g, with a prenatal diagnosis of dural sinus malformation with arteriovenous shunts. Congestive heart failure and anuria at birth prompted emergency intervention. Transfemoral-transvenous coil embolization was performed on day 1, resulting in partial occlusion of the huge venous pouch with a total length of 2,355 cm of detachable coils. Transarterial glue embolization on days 7, 23, and 42 was required due to persistent heart failure. Transarterial embolization was performed by common carotid puncture because the transfemoral route could not be used due to the small size and compromised blood flow of the femoral artery. Transarterial embolization reduced the arteriovenous shunts markedly and resulted in clinical improvement. Early treatment of a high flow dural arteriovenous fistula in a low birth weight neonate can achieve an excellent result with an acceptable neurological outcome.     

Fish, long-chain n-3 polyunsaturated fatty acids, and risk of colorectal cancer in middle-aged Japanese: the JPHC study

Although long-chain n-3 polyunsaturated fatty acids (Ln-3 PUFA), which are abundant in fish, have shown protective effects on colorectal cancer in laboratory studies, epidemiological studies to date have not been consistent. We evaluated the relationship of consumption of fish and Ln-3 PUFA to the colon and rectal cancer risk in the two cohorts of the Japan Public Health Center-based prospective study of 42,525 men and 46,133 women. Dietary and other exposure data were obtained between 1990 and 1994. Through December 1999, 705 cases of colon and rectal cancer were documented. When data from the two cohorts were pooled, multivariable relative risks (RRs) for the highest quartile compared with the lowest quartile of fish consumption were 1.07 (95% confidence interval, CI = 0.77-1.48) for colon cancer and 0.95 (95% CI = 0.63-1.43) for rectal cancer with no dose-risk trend. RRs for the highest quartile compared with the lowest quartile of eicosapentaenoic acid consumption were 1.05 (95% CI = 0.76-1.46) for colon cancer and 0.91 (95% CI = 0.60-1.38) for rectal cancer with no dose-risk trend. This study does not support the role of fish and Ln-3 PUFA in the etiology of colon and rectal cancer in this population whose fish consumption was high and the variation in Ln-3 PUFA consumption was large.     

Crystal structure of the Pyrococcus horikoshii DNA primase-UTP complex: implications for the mechanism of primer synthesis

BACKGROUND: In chromosomal DNA replication, DNA primase initiates the synthesis of a dinucleotide on a single-stranded template DNA, and elongates it to form a primer RNA for the replicative DNA polymerase. Although the apo-structure of an archaeal primase has been reported, the mechanism of primer synthesis by the eukaryotic-type primase still remains to be elucidated. RESULTS: In this study, we present the crystal structure of the eukaryotic-type DNA primase from the hyperthermophilic archaeon (Pyrococcus horikoshii) with the uridine 5'-triphosphate (UTP). In the present primase-UTP complex, the primase binds the triphosphate moiety of the UTP at the active site, which includes Asp95, Asp97, and Asp280, the essential residues for the nucleotidyl transfer reaction. CONCLUSION: The nucleotide binding geometry in this complex explains the previous biochemical analyses of the eukaryotic primase. Based on the complex structure, we constructed a model between the DNA primase and a primer/template DNA for the primer synthesis. This model facilitates the comprehension of the reported features of DNA primase.