Risk Factors for Complications Associated with Peripherally Inserted Central Catheters During Induction Chemotherapy for Acute Myeloid Leukemia

Objective Peripherally inserted central catheters (PICCs) are widely used in patients with hematologic malignancies. However, the risks of PICC-related complications during chemotherapy for acute myeloid leukemia (AML) are not fully understood. Methods We conducted a retrospective review of 128 adult patients with AML who received induction therapy by way of PICC insertion between 2012 and 2019. Results The median duration of PICC insertion was 30 days. The incidence rate of catheter-related bloodstream infection (CRBSI) was 2.4% at 30 days, and women were more likely to suffer from CRBSI than men. Local reactions at the insertion site were observed in 56 patients; however, these events did not predict CRBSI. The incidence rates of catheter-related thrombosis (CRT) were 1.6% at 30 days. Obesity put patients at an increased risk for CRT. Unexpected PICC removal occurred in 59 patients, and women were at a higher risk of catheter removal than men. Conclusion Low PICC-related complication rates, possibly associated with high rates of catheter removal, were observed during intensive chemotherapy for AML. Women and obese patients require careful monitoring of their PICC. Procedures to achieve appropriate PICC removal without increasing the complication rate need to be considered.     

An autopsy case of argyrophilic grain dementia with abundant neurofibrillary tangles]

We reported an autopsy case of "senile dementia" showing neuropathologically abundant neurofibrillary tangles(NFT) and argyrophilic grains(AG) without senile plaques. A Japanese woman developed memory disturbance when she was 70 years old. The patient was hospitalized at age 80 and a cranial CT scan revealed bilateral mild atrophy of the temporal lobes and mild enlargement of the lateral ventricle, especially in the inferior horn. She died at the age of 80. Autopsy showed that her brain weighted 1220 g. Numerous NFT were found in the entorhinal (trans-entorhinal) region, subiculm, CA1-CA4, dentate gyrus, amygdala, nucleus basalis of Meynert, substantia nigra, and locus coeruleus. Furthermore, numerous AG were seen in the temporal lobe(T3, T4), amygdala, prominently in the basolateral nuclei. Obvious neuronal loss with gliosis was noted in the temporal lobes, including the hipocampal regions. Few senile plaques was detected in temporal lobe(T4). Sarkosyl-insoluble tau extracted from the temporal lobe consisted predominantly of four-repeat tau isoforms. To our knowledge, this is the first report of argyrophilic grain dementia complicated with tangle only dementia.     

Morphometrical reappraisal of motor neuron system of Pick's disease and amyotrophic lateral sclerosis with dementia

The conventional concept of Pick's disease does not distinguish Pick's disease with Pick bodies (Pick body disease, PBD) from Pick's disease without Pick bodies [lobar atrophy without Pick bodies, LA-PB(-)]. Recently, intraneuronal ubiquitin-positive inclusions (ub-inclusions), which are thought to be a hallmark of amyotrophic lateral sclerosis with dementia (ALS-D), have been found also in LA-PB(-). We reconfirmed that ub-inclusions are consistently detected in LA-PB(-) as well as ALS-D. Subsequently, morphometric evaluation for involvement of the upper and lower motor neuron systems were performed in seven cases each of PBD, LA-PB(-), ALS-D and controls. As an indicator of upper motor neuron involvement, the total number of axons through the pyramis of the medulla oblongata was employed and for lower motor neuron involvement, the number of hypoglossal neurons per unit area was calculated. In LA-PB(-), axons of the pyramidal tract were significantly reduced in comparison to PBD and controls, while the lower motor neurons were preserved. Contrary to LA-PB(-), ALS-D revealed significant reduction of hypoglossal neurons but its pyramidal tract tends to be relatively preserved. These results seem to indicate that LA-PB(-) and ALS-D belong to the same spectrum and consist of subgroups with ub-inclusions and involvement of motor neuron system in common. The involvement of the upper motor neuron system is emphasized in LA-PB(-), while ALS-D accentuates the lower motor neuron system. However, the border between the two group is not always clear and there are patients who can not be definitively classified.     

A 3-hydroxy-3-methylglutaryl co-enzyme A reductase inhibitor reduces hypertensive nephrosclerosis in stroke-prone spontaneously hypertensive rats

BACKGROUND: Recent studies suggest that 3-hydroxy-3-methylglutaryl co-enzyme A reductase inhibitors (statins) exert their protective effects against cardiovascular diseases independently of their cholesterol-decreasing effects. OBJECTIVE: To clarify the effect of a statin on hypertensive nephrosclerosis. METHODS: We treated stroke-prone spontaneously hypertensive rats (spSHRs) chronically, starting at the age of 4 weeks, with cerivastatin (2 mg/kg per day by gavage) or vehicle. Physiological parameters, plasma chemistry and urine protein excretion were analysed. At 14 weeks of age, the rats had their kidneys removed for use in assays. RESULTS: Compared with vehicle treatment, statin treatment reduced proteinuria and renal injury independently of blood pressure and cholesterol concentrations in spSHRs. Although expression of adhesion molecules and infiltration of inflammatory cells were not different whether or not cerivastatin treatment was used, renal fibrosis was significantly reduced in statin-treated spSHRs. We also found that expression of transforming growth factor-beta1 in kidneys was significantly inhibited in statin-treated spSHRs. CONCLUSION: Cerivastatin prevents or retards hypertension-induced renal injury via inhibition of renal fibrosis and proteinuria. These results show the potential of statins as protective tools against proteinuric renal diseases, independent of their cholesterol-decreasing effects.     

Trans-tympanic silicone plug insertion for chronic patulous Eustachian tube

CONCLUSION: Trans-tympanic insertion of a new silicone plug seems to be useful for controlling the distressing symptoms of patients with a chronic patulous Eustachian tube (PET). OBJECTIVE: To evaluate the effectiveness of a new silicone plug for blocking the isthmus of a PET in patients whose symptoms were resistant to other therapies for > 6 months. MATERIAL AND METHODS: The silicone plug (total length 23-25 mm; tip diameter 1.0-2.0 mm) was inserted in 44 ears of 37 patients with chronic PET. It was inserted through the tympanic orifice of the ET to obstruct the isthmus of the tube via an incision in the anterosuperior portion of the tympanic membrane. RESULTS: Insertion of the plug was possible in all except two ears, in which it failed because of a narrow tympanic orifice of the ET. In 11 ears of 10 patients, the plug was replaced by a larger one using the same approach to improve efficacy. Of the 42 ears in which the silicone plug was successfully inserted, 30 (71.4%) achieved relief from symptoms of PET without additional treatment. In > 60% of these cases, the symptoms of PET were well controlled with an aerated middle ear. The follow-up period ranged from 6 to 68 months (mean 38.9 months).     

MRI reveals fetus in fetu in the mediastinum

Fetus in fetu is an extremely rare condition in which a fetiform calcified mass is contained within the newborn or infant, often in the retroperitoneal cavity. We report a case of a fetus in fetu in the posterior mediastinum of a newborn. The prospective diagnosis was made by fetal US and MRI and confirmed by postnatal plain radiograph, CT and MRI.     

Expression of BRI,the normal precursor of the amyloid protein of familial British dementia,in human brain

Familial British dementia (FBD) is characterized neuropathologically by deposition of a unique amyloid-forming protein, ABri. It is a fragment of an abnormal form of a precursor protein, BRI. In FBD, BRI is elongated by 11 amino acids due to a point mutation that prevents recognition of the normal stop codon. We have investigated the expression of normal BRI in non-FBD cases. Three antibodies were raised against sequences of BRI and were used for immunoblotting and immunohistochemistry. Each of these antibodies detected a band at approximately 35 kDa by Western blotting. In postmortem human brain tissues, BRI was detected as fine granules in the neuronal cytoplasm. Pyramidal neurons in CA3 and CA4 of the hippocampus as well as Purkinje cells in the cerebellar cortex were most intensely stained for BRI. Such a distribution of neurons strongly expressing BRI parallels the reported occurrence of ABri deposits in patients with FBD. In pathological cases, BRI was detected in dystrophic neurites in senile plaques, around lesions in ischemic cases, in torpedo and glumose changes in the cerebellum, Lewy neurites, ballooned neurons, and neurons generally in hypoxic cases. These results suggest that BRI is transported in neuronal processes and is possibly involved in some role in nerve terminals. While a physiological role of BRI in brain remains to be determined, the behavior of BRI in diverse brain lesions appears to be somewhat analogous to that of amyloid precursor protein, which is the source of the -amyloid protein of Alzheimers disease.     

Three-dimensional computed tomography imaging in the sitting position for the diagnosis of patulous eustachian tube.

OBJECTIVE: Computed tomography (CT) in the sitting position was useful for detecting patulous Eustachian tube (ET). STUDY DESIGN: Retrospective. SETTING: Tertiary referral center. PATIENTS: Eighty-seven patients divided into two groups. The patulous ET group consisted of 111 ears of 67 patients with patulous ET. The control group consisted of 30 ears of 20 patients without symptoms characteristic of patulous ET or abnormal findings in ET function tests. MAIN OUTCOME MEASURES: CT was performed under the resting condition and during Valsalva maneuver (Valsalva condition). The multiplanar reconstruction technique was used to reconstruct 1-mm-thick gapless images parallel to and perpendicular to the ET long axis. The open tubal distance (OTD) and average ET-gram were examined. RESULTS: The OTD was significantly longer in the patulous ET group than in the control group under both resting and Valsalva conditions (both p < 0.001). The OTD was also significantly longer under the Valsalva condition than under the resting condition in both groups (p < 0.01 in the patulous ET group, p < 0.001 in the control group). The average ET-gram showed an occlusive zone in the cartilaginous portion medial to the isthmus under both the resting and Valsalva conditions in the control group (n = 30). However, the occlusive zone could not be observed under either the resting or Valsalva conditions in the patulous ET group (n = 111). Completely patent (open) ET was observed with continuous hyperlucency from the pharyngeal to the tympanic orifices in 88 of 111 patients in the patulous ET group, but in none of the control group, indicative of 100% specificity. CONCLUSION: Computed tomography in the sitting position employing Valsalva maneuver is useful for the diagnosis of patulous ET.     

Pick-body-like inclusions in corticobasal degeneration differ from Pick bodies in Pick's disease

In corticobasal degeneration (CBD), tau-positive cytoplasmic inclusions resembling Pick bodies (PBs) appear in the cerebral cortex. Tau immunoreactivity in PBs is expressed mainly on filamentous elements, whereas that of PB-like inclusions in CBD is expressed on granules, which are densely packed mainly in the periphery of inclusions. PBs are clearly detectable by conventional Bodian silver impregnation but negative for the Gallyas-Braak (G-B) method and for PS262, which recognizes phosphorylation at Ser 262 of the entire tau sequence. Almost all PBs are negative for Ex10, which recognizes 4-repeat tau specifically. In contrast to PBs, PB-like inclusions in CBD could not be detected by the Bodian method, but were positive for the G-B method, PS262 and Ex10. In summary, PBs and PB-like inclusions exhibit distinct differences. These results are useful for the argument of an overlap between PiD and CBD as well as discussion of the phenotypic resemblance of PB-like inclusions bearing types of FTDP-17 to Pick's disease.     

Effects of contralateral noise on the measurement of auditory threshold

It is well known that sound presented in the contralateral ear can elicit the activity of the olivocochlear (OC) efferent. In the present study, the effects of the addition of contralateral noise on the psychophysical measurements of auditory thresholds were investigated in human subjects with normal hearing. The results obtained in the present study indicate that the addition of contralateral noise at a level of only 20 or 30 dB sound pressure level (SPL) may cause a significant elevation of the auditory threshold in the mid-frequency area (usually 2-3 dB). When the level of contralateral noise was elevated, the elevation of the auditory threshold tended to be larger and the affected frequency area became wider. Although other factors that elevate the auditory thresholds, such as cross-talk effects and the acoustic reflex of the middle ear muscles, may be involved in the above-mentioned paradigm, especially when higher levels of contralateral noise are used, it is important to know the degree of OC-mediated threshold elevation in usual audiometric measurement.