THE EFFECT OF CHLORDIAZEPOXIDE AND PETHIDINE, ALONE AND IN COMBINATION, ON THE RESPIRATORY RESPONSE TO CARBON DIOXIDE

The respiratory effects following the intravenous administrationof chlordiazepoxide (1 mg/kg) and pethidine (0.5 mg/kg), bothalone and as a mixture, were studied by means of carbon dioxidestimulus-response curves. Eight healthy adult volunteers demonstratedno statistically significant respiratory depression after receivingchlordiazepoxide. Pethidine alone caused depression for 2 hours,and in combination with chlordiazepoxide the duration was prolongedto 4 hours (the duration of the study period). ^*Preliminary presentation of these data was made at the 40thAnniversary Congress, Section of Anes-thesiology, Pan-AmericanMedical Association, May 1, 1965, Miami Beach, Florida. Present address: Karolinska Institute, Thoracic Clinic, Stockholm,Sweden.     

Four Cases of T-Cell Malignancy in Childhood

Four cases of T-cell malignancy in childhood are reported. Inthe two older boys (seven [Case 1] and eight [Case 2] yearsold) the disease began as leukemia without a clinically detectablemediastinal mass. However, thymic involvement was found at autopsyin Case 1. Tumor cells of both patients had a rosetteformingcapacity with sheep erythrocytes (ERFC), high terminal deoxynucleotidyltransferase (TdT) activity and a positive acid phosphatase (AcPase)reaction. These findings suggest that the tumor cells of Cases1 and 2 originated from thymic T lymphocytes. The two younger patients (two [Case 3] and three [Case 4] yearsold) had cervical lymphadenopathy with mediastinal mass at onset,followed by leukemic change. The youngest patient (Case 3) lackedERFC and the AcPase reaction, but had C3 Receptor (C3-R), humanT-lymphocyte antigen (HLTA) and TdT activity. These findingsindicate that the tumor cells of Case 3 are compatible withearly thymic T lymphocytes. Tumor cells of Case 4 had ERFC,C3-R, HTLA, and slightly increased TdT activity. These findingssuggest that the tumor cells of Case 4 originated from thymicT lymphocytes. Only one patient has maintained an initial complete remissionfor more than one year. The three others relapsed or had a leukemicconversion within 12 months of the initial remission and twodied within 13 months. This indicates that childhood T-cellmalignancies have a poor prognosis.     

Effects of short duration morning bright light in healthy elderly subjects. I:Subjective feeling and ophthalmological examinations

Abstract Seven aged subjects aged 61–78 years were exposed to 6000 lx bright light for 30 min during morning hours at their homes for 1 week. Visual analog scale was recorded before bedtime and after rising to assess subjective feelings. Ophthalmological examinations were made before and after light exposure, to exclude pre-existing ocular disorders and to detect ocular damage. Furthermore, ocular fatigue was self-evaluated immediately before and after exposure. Visual analog scale results indicated that alertness reduced significantly before bedtime. Ophthalmological abnormalities were not found after exposure. These findings suggest that short duration morning bright light exposure reduces night-time vigilance.     

Usefulness of the Noncontact Mapping System to Elucidate the Conduction Property for the Treatment of Common Atrial Flutter

Background: The functional role of the cavotricuspid isthmus (CTI) for common atrial flutter (cAFL) remains to be elucidated. In the present study, we examined whether the EnSite system (St. Jude Medical, St. Paul, MN, USA), a noncontact mapping system, is useful to evaluate the conduction properties of CTI to minimize radiofrequency (RF) ablation applications for cAFL. Methods: We enrolled 22 consecutive patients with cAFL (64.1 ± 9.5 years old, M/F 21/1) treated with the EnSite system and examined the conduction properties during cAFL and during atrial pacing. In addition, the effectiveness of the system was evaluated in comparison with the conventional ablation group (67 ± 8.9 years old, n = 15, M/F 13/2). Result: In 11 out of the 22 patients, CTI block line was achieved by fewer RF applications on a presumed single activation pathway which the EnSite system showed (point ablation [PA] group), and the remaining 11 patients needed additional linear ablation (additional ablation [AA] group). The number of RF applications in the PA group was significantly smaller than that in the conventional group. During the lower lateral right atrial pacing at a cycle length of 600 ms, the CV of the CTI in the PA group was smaller compared to that in the AA group (1.36 ± 0.61 vs 2.17 ± 0.66 m/s, P < 0.05), although the CV during cAFL (averaged cycle length 245 ± 34 ms) was not different in both groups. Conclusions: These results indicate that targeting the presumed single line identified by EnSite could be an optional therapy for cAFL RF ablation, and diverse conduction properties in CTI are related to the success rate of this procedure. (PACE 2012;35:1464–1471)     

Performance monitoring during sleep inertia after a 1‐h daytime nap

Performance monitoring is an essential function involved in the correction of errors. Deterioration of this function may result in serious accidents. This function is reflected in two event‐related potential (ERP) components that occur after erroneous responses, specifically the error‐related negativity/error negativity (ERN/Ne) and error positivity (Pe). The ERN/Ne is thought to be associated with error detection, while the Pe is thought to reflect motivational significance or recognition of errors. Using these ERP components, some studies have shown that sleepiness resulting from extended wakefulness may cause a decline in error‐monitoring function. However, the effects of sleep inertia have not yet been explored. In this study, we examined the effects of sleep inertia immediately after a 1‐h daytime nap on error‐monitoring function as expressed through the ERN/Ne and Pe. Nine healthy young adults participated in two different experimental conditions (nap and rest). Participants performed the arrow‐orientation task before and immediately after a 1‐h nap or rest period. Immediately after the nap, participants reported an increased effort to perform the task and tended to estimate their performance as better, despite no objective difference in actual performance between the two conditions. ERN/Ne amplitude showed no difference between the conditions; however, the amplitude of the Pe was reduced following the nap. These results suggest that individuals can detect their own error responses, but the motivational significance ascribed to these errors might be diminished during the sleep inertia experienced after a 1‐h nap. This decline might lead to overestimation of their performance.     

Comparison of Symptomatic Vasospasm after Surgical Clipping and Endovascular Coiling

Vasospasm, initial neurological damage, rebleeding, and periprocedural complications are associated prognostic factors for clinical outcomes after aneurysmal subarachnoid hemorrhage (SAH). In this study, factors related to delayed ischemic neurological deficit (DIND) are evaluated using data from our institute for the last 18 years. Data from 2001 to 2018 of patients with aneurysmal SAH who underwent surgical clipping (SC) or endovascular coiling (EC) within 7 days of onset were retrospectively analyzed. Cases of mortality within 5 days after treatment were excluded. Multivariate analysis was used to identify the risk factors for DIND. In total, 840 cases of SAH were assessed; among these cases, 384 (45.7%) and 456 (54.3%) were treated with SC and EC, respectively. The frequency of DIND in the EC group was significantly less than that in the SC group (11.8% vs. 17.7%; p = 0.016). In the results of multivariate analysis, internal carotid artery (ICA) aneurysm and hemorrhagic complications were the risk factors for DIND. Cilostazol administration and EC were significant factors for vasospasm prevention after aneurysmal SAH (odds ratio of ICA aneurysm: 1.59, hemorrhagic complications: 1.76, SC: 1.51, and cilostazol administration: 0.51, respectively). Cilostazol administration was also a significant factor in patients who were treated with EC. ICA aneurysm, treatment strategy, hemorrhagic complications, and cilostazol administration were associated with DIND. Oral administration of cilostazol and avoiding hemorrhagic complications were effective in DIND prevention. If both treatments are available for ruptured aneurysms, clinicians should choose EC on the basis of its ability to prevent DIND.     

Successfully Treated Isolated Posterior Spinal Artery Aneurysm Causing Intracranial Subarachnoid Hemorrhage: Case Report

There are very few published reports of rupture of an isolated posterior spinal artery (PSA) aneurysm, and consequently the optimal therapeutic strategy is debatable. An 84-year-old man presented with sudden onset of restlessness and disorientation. Neuroradiological imaging showed an intracranial subarachnoid hemorrhage (SAH) with no visible intracranial vascular lesion. Spinal magnetic resonance imaging (MRI) detected a localized subarachnoid hematoma at Th10–11. Both contrast-enhanced spinal computed tomography and enhanced MRI and magnetic resonance angiography revealed an area of enhancement within the hematoma. Superselective angiography of the left Th12 intercostal artery demonstrated a faintly enhanced spot in the venous phase. Thirteen days after the onset of symptoms, a small fusiform aneurysm situated on the radiculopial artery was resected. The patient''s postoperative course was uneventful and he was eventually discharged in an ambulatory condition. To our knowledge, this 84-year-old man is the oldest reported case of surgical management of a ruptured isolated PSA aneurysm. This case illustrates both the validity and efficacy of this therapeutic approach.     

Detection of herpes simplex viral DNA in Kaposi's varicelliform eruption using in situ hybridization method

Herpes simplex viral DNA was detected in biopsy specimens obtained from four patients with Kaposi's varicelliform eruption using an in situ hybridization technique with btotinylated complementary DNA probes. Herpes simplex viral DNA was consistently found almost exclusively in the nuclei of giant cells and balloon cells in vesicles during day 2, 5 and 7 of the disease. In the nuclei, the viral DNA staining pattern was granular or agglomerate. No positive staining was observed in the cytoplasm.     

HYPERMINERALOCORTICISM WITHOUT ELEVATION OF PLASMA ALDOSTERONE: DEOXYCORTICOSTERONE-PRODUCING ADRENAL ADENOMA AND HYPERPLASIA

Two female patients were admitted for evaluation of hypertension and hypokalaemia. Plasma renin activity was suppressed and plasma aldosterone levels were within the normal value in a 52-year-old woman and below the normal value in the other patient, a 62-year-old woman. Plasma 11-deoxycorticosterone (DOC) levels were as high as 1.13 and 1.47 nmol/l, respectively. Adrenal scintigram and abdominal CT scan clearly showed a right adrenal tumour in the 52-year-old woman. After adrenalectomy plasma DOC level decreased to the normal level of 0.12 nmol/l, and her blood pressure and serum potassium became normal. Abdominal CT scan revealed no finding of adrenal tumour in the older woman. These results indicate that these two patients had hypermineralocorticism with elevation of plasma DOC. One patient had a DOC-producing adrenal adenoma, and the other probably had bilateral adrenal hyperplasia.