Mild encephalitis/encephalopathy with a reversible splenial lesion: evaluation by diffusion tensor imaging. Two case reports

Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a clinico-radiological syndrome with a very particular clinical course. Three patients with MERS were evaluated by various sequences of magnetic resonance imaging with diffusion tensor imaging. Initial diffusion-weighted imaging showed reduction in the apparent diffusion coefficient values in the lesions, which completely resolved with the elimination of symptoms. However, diffusion anisotropy of the lesions showed no remarkable abnormalities in the early or delayed phases. These results may indicate that white matter architecture is preserved in both early and delayed phases in MERS.     

Evaluation of the efficacy of venous thromboembolism prophylaxis guideline implementation in Japan

Purpose  

In Japan, the incidence of venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), has been relatively low; however, the incidence has recently been increasing. Since April 2004, we have developed an original computer-linked VTE prophylaxis in order to decrease the incidence of in-hospital VTE. Our objective has been to evaluate the efficacy of the VTE prophylaxis guideline.     

Expression and localization of insulin-like growth factor binding proteins in normal and proteinuric kidney glomeruli

Aim: Insulin‐like growth factor I (IGF‐I) acts on target cells in an endocrine and/or local manner through the IGF‐I receptor (IGF‐IR), and its actions are modulated by multiple IGF binding proteins (IGFBP). To elucidate the roles of local IGFBP in kidney glomeruli, the expression and localization of their genes were examined and compared with normal and proteinuric kidney glomeruli. Methods: A cDNA microarray database (MAd‐761) was constructed using human kidney glomeruli and cortices. The gene expression levels of IGF‐I, IGF‐1R and IGFBP (1–10) were examined in glomeruli and cortices by polymerase chain reaction (PCR) and in situ hybridization (ISH), and the expression levels of IGFBP that were abundantly found in the glomerulus were compared between normal and proteinuric kidneys in rats and humans. Results: IGFBP‐2, ‐7 and ‐8 were demonstrated to be abundantly and preferentially expressed in the glomerulus. In PCR, the expression levels of the IGFBP‐2, ‐7, ‐8 and ‐10 genes in glomeruli were shown to have more than doubled compared with their levels in the cortices. In ISH, the IGFBP‐2, ‐7, ‐8 and ‐10 genes were found to be localized in glomerular cells including podocytes, and their increased expression was observed in inflammatory glomeruli. IGF‐I gene expression was localized in glomerular podocytes, whereas the IGF‐IR gene was expressed in glomerular podocytes and cortical tubular cells. In nephrotic rats, the expression of the IGFBP‐10 gene was increased in glomerular podocytes; however, the expression levels of IGFBP‐2, ‐7 and ‐8 did not change. Conclusion: IGFBP‐2, ‐7, ‐8 and ‐10 are produced by normal and injured glomerular podocytes and may regulate local IGF‐I actions in podocytes and/or cortical tubular cells in the kidney.     

Impact of ethnic conflict on the nutritional status and quality of life of suburban villagers in the Solomon Islands

This paper describes the health and nutritional status and quality of life (QOL) of suburban villagers in the Solomon Islands 3 y after the 1998-2003 ethnic conflict. Cross-sectional data were obtained from a small community located 50 km east of the capital city (n=206, 87 adults and 119 children). A health survey involving urine analysis, anthropometry, and blood pressure measurements was conducted to assess health and nutritional status and child growth. Simultaneously, 57 non-randomly selected adults participated in the QOL questionnaire survey. Results of anthropometry show that participants had good health and nutritional status (mean BMIs: 22.8 and 21.7 for men and women, respectively) and 73% of boys and 83% of girls were judged `normal body size' based on their BMI values. Urinalysis revealed that 88% of the participants were healthy and indicated that they consumed considerable amounts of purchased food such as rice and tinned meat. These findings suggest that the population's lifestyle had essentially recovered from the ethnic conflict. However, possible consequences of the ethnic conflict on the QOL scores were observed in the environmental domain. This study found a positive association between body fat and QOL. This could be interpreted in terms of the traditionally positive view of large bodies in the South Pacific and as resulting from unstable social conditions prevailing after the ethnic conflict.     

Further evidence of local ganglioside-dependent amyloid beta-protein assembly in brain

We investigated the molecular mechanism underlying the region-specific deposition of amyloid beta-protein in brains affected with Alzheimer's disease or cerebral amyloid angiopathy. Here, we show that a hereditary variant-type ('Iowa') amyloid beta-protein, which predominantly deposits in the cerebral vessel wall similar to Dutch and Italian-type amyloid beta-proteins, preferably assembles in the presence of GM3 ganglioside. On the basis of our previous findings that first, cerebrovascular smooth muscle cells that provide favorable sites for these variant-type amyloid beta-proteins exclusively express GM3 ganglioside, and second, Dutch and Italian-type amyloid beta-proteins also require GM3 ganglioside for their assembly, our results provide further evidence that local gangliosides play a crucial role in the region-specific amyloid beta-protein deposition in the brain.     

Role of glycosphingolipids and therapeutic perspectives on Alzheimer's disease

Alzheimer's disease (AD) is a devastating neurodegenerative disorder dividing into two forms, early onset familial and late onset sporadic forms. Early onset genetic cases (familial AD (FAD)) constitute about 10% of all AD cases. Heretofore, highly fibrillinogenic and pathological Abeta peptide formation is regarded as the fundamental molecular basis for this disorder. Recent enormous efforts to find out a pathogenesis, however, have revealed that this disorder has a multiplicity of causes such as glycosphingolipids abnormalities, impairment of neurotrophin signaling, protein trafficking, and protein turnover. Most of these aspects were disclosed by the studies on FAD-related presenilin. In this review, we will focus on the current knowledge of many abnormal aspects of cellular lipids, especially glycosphingolipids other than a pathogenic Abeta production caused by the mutant presenilins as a model system. Moreover, we will discuss how these glycosphingolipids abnormalities cause the pathological conditions found in this disorder.     

Ambulatory Anesthesia for Children Undergoing Laser Treatment

Purpose Since 1993, we have performed laser surgery for cutaneous lesions, such as simple hemangioma and nevus of Ota, in children under ambulatory anesthesia. Although we anticipate that the numbers of patients treated under ambulatory anesthesia will increase, few reports detail the procedures involved and their perioperative management. We describe this method of anesthesia and discuss its limitations, and future issues. Methods To date, we have performed laser treatment on 633 pediatric patients under ambulatory anesthesia. The mean age of the children was 3.6 ± 1.9 years and their mean weight was 16.4 ± 4.7 kg. The lesions treated included simple hemangioma, nevus of Ota, nevus pigmentosus, nevus spilus, and ectopic Mongolian spots. Anesthesia is induced with oxygen, nitrous oxide, and sevoflurane; then an intravenous cannula is inserted under spontaneous respiration. Anesthesia is maintained with assisted ventilation using a mask. Children are not intubated unless a mask cannot be used because the lesion is on the face or back. Results No serious peri- or postoperative complications were encountered and there were no serious adverse reactions to anesthesia. With the exception of one child who was admitted overnight for a low-grade fever, all were released from hospital within a few hours. Conclusion Ambulatory anesthesia can be performed safely using oxygen, nitrous oxide, and sevoflurane for the laser treatment of cutaneous lesions in pediatric patients.     

Intraperitoneal Rupture of the Ureter as a Cause of Generalized Peritonitis: Report of a Case

We report a rare case of generalized peritonitis caused by nontraumatic, intraperitoneal rupture of the ureter. An 80-year-old woman with a history of bilateral vesicoureteral reflux and long-term urethral indwelling catheter drainage presented with a very distended abdomen. Computed tomography showed massive ascites and intraperitoneal free gas. We performed an emergency laparotomy, assuming a gastrointestinal perforation; but could not find a cause of generalized peritonitis. Postoperatively, she presented with anuria and massive peritoneal drainage. The findings of a cystogram confirmed intraperitoneal ureteral rupture. She was managed successfully with ureteral stenting. The diagnosis of this condition requires a high degree of clinical suspicion, along with radiographic evidence and peritoneal fluid analysis. Image-guided interventions play a crucial role in the management of ureteral urine leaks after a correct diagnosis has been made.