Nitroglycerin to relax the uterus during cesarean delivery for the low birthweight baby

BACKGROUND: The uterus at premature birth being thick and sensitive, we applied nitroglycerin (NTG) to relax the uterus during cesarean delivery for the low birthweight baby. METHODS: Twelve parturients of impending premature birth and nine of severe intoxication were included. General anesthesia was induced with thiamylal, and maintained with 5% inhaled sevoflurane. NTG was injected in an intermittent dose of 500 microg. The relative hardness of the uterus at delivery was evaluated by obstetricians in four ranks of categories. RESULTS: The mean gestation period was 27.4 weeks (24 weeks at the minimum-33 weeks at the maximum) and the mean birthweight was 986 g (561-1518 g). The mean time elapsed from induction of anesthesia to delivery was 8.3 min (2-14 min) while NTG was injected for the mean 1.8 times that reflected a total dose of 900 microg (500-1500 microg). The mean endtidal concentration of sevoflurane at delivery reached 3.8% (3.4-4.3%). The uterus was evaluated as "very soft" in 15 out of 21 cases, and all babies were extracted easily without injury through the lower J-shaped section of the uterus. The mean Apgar score was 2.9 points at 1 minute and 6.3 points at 5 minutes. No adverse effect of NTG on the mothers or babies was noticed. CONCLUSIONS: NTG relaxes the uterus effectively and facilitates cesarean delivery for the low birthweight baby.     

An intestinal volvulus caused by multiple magnet ingestion: an unexpected risk in children

It has been reported that ingested magnets can cause intestinal fistula formation or perforation, leading to intestinal obstruction. However, there are no previous case reports that magnet ingestion additionally caused an intestinal volvulus. We report herein the case of a 1-year-old boy in whom the ingested magnets caused a volvulus of part of the small intestine leading to the resection of the necrotic portion. We think that if more than one magnet is found as a foreign body in the intestine, they should be removed immediately by laparotomy. Clinicians who care for children should be aware of this unexpected risk.     

The potent role of graft-derived NKR-P1+TCRalphabeta+ T (NKT) cells in the spontaneous acceptance of rat liver allografts

BACKGROUND: The mechanism involved in the spontaneous acceptance of liver allografts in some rat strain combinations remains unclear. Immunoregulatory NKR-P1TCRalphabetaT (NKT) cells primarily produce IL-4 and IFN-gamma, and enhance the polarization of immune responses to Th2 and Th1, respectively. The aim of this study was to clarify the role of graft-derived NKT cells in inducing the spontaneous acceptance of rat orthotopic liver transplantation (OLTx) METHODS: The experimental groups were divided as follows: Group 1, BN to LEW "low responder (acceptor)" combination; Group 2, DA to LEW "high responder (rejector)" combination; na?ve BN (Group 3) or LEW recipients (Group 4) with liver allografts from irradiated BN donors. The recipients had liver allografts from irradiated donors reconstituted from the following cell populations 24 hr before harvesting, spleen cells (SPCs, Group 5), IgSPCs (Group 6), IgNKR-P1SPCs (Group 7), and IgTCRabSPCs (Group 8) RESULTS: In Group 1, the percent of graft-derived NKT cells harvested on day 7 posttransplant were significantly higher than in Group 2. In the case of BN liver allografts that had been irradiated and reconstituted with cell populations including NKT cells (Groups 5 and 6), the mean graft survival (MST) was extended to 39.2+/-5.7 and 38.8+/-8.0 days, respectively. In contrast, when NKT cells were excluded (Groups 7 and 8), the grafts were acutely rejected within MST of 17.8+/-4.0 and 18.8+/-7.7 days, respectively. The concentrations of IL-10 and TGF-beta, but not IL-4 in IgGICs culture supernatants were predominant in the acceptor, whereas those with IFN-gamma predominated in the rejector. CONCLUSIONS: Graft-derived NKT cells might be responsible for spontaneous acceptance in the rat OLTx.     

Multiple spontaneous dissecting aneurysms of the anterior cerebral and vertebral arteries

A 50-year-old woman presented with rare multiple dissecting aneurysms that appeared first in the anterior cerebral artery (ACA) and shortly afterwards in the vertebral artery (VA). She initially suffered sudden motor weakness in the left lower limb due to acute brain infarction. Angiography revealed diffuse string sign in the right ACA. Conservative treatment resulted in resolution of the deficits. Follow-up angiography performed 1 year later revealed recovery of the ACA stenosis. Fourteen days later, she complained of sudden headache and became comatose. Computed tomography showed diffuse subarachnoid hemorrhage. Angiography revealed a new right VA dissecting aneurysm involving the posterior inferior cerebellar artery (PICA). The orifice of the dissection was not apparent in the operative field and the dissection extended to the median. The patient underwent extracranial right VA ligation, clipping of the proximal PICA, and revascularization between the right occipital artery and distal PICA. Her postoperative course was uneventful and she was discharged without neurological deficits. VA dissecting aneurysms involving the PICA without evident orifice or extending over the median can be treated by extracranial ligation with clipping of the PICA, followed by revascularization.     

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).     

Hematopoietic stem cell and marrow stromal cell for spinal cord injury in mice

We compared the effects of hematopoietic stem cell and marrow stromal cell transplantation for spinal cord injury in mice. From green fluorescent protein transgenic mouse bone marrow, lineage-negative, c-kit- and Sca-1-positive cells were sorted as hematopoietic stem cells and plastic-adherent cells were cultured as marrow stromal cells. One week after injury, hematopoietic stem cells or marrow stromal cells were injected into the lesioned site. Functional recovery was assessed and immunohistochemistry was performed. In the hematopoietic stem cell group, a portion of green fluorescent protein-positive cells expressed glial marker. In the marrow stem cell group, a number of green fluorescent protein and fibronectin-double positive cells were observed. No significant difference was observed in the recovery between both groups. Both hematopoietic stem cells and marrow stromal cells have the potential to restore the injured spinal cord and to promote functional recovery.     

Stress-reductive effects of information disclosure to medical and psychiatric patients

Informed consent has become a central part of medical decision-making. It is based on disclosure of medical information to support patients' rights for autonomous decision-making from a legal point of view. However, information disclosure may also benefit patients. Research indicates that information disclosure reduces stress among patients and that the more patients desire relevant information, the more stress-reductive information disclosure may be. In psychiatry, too, studies have shown that educating psychiatric patients may not necessarily reduce compliance or increase relapse rate. These findings are in line with patients' desires and their legal right to know their own medical matters. It has long been believed that patients, be they psychiatric or non-psychiatric, should be protected and not given information that would potentially cause distress or harm to them. However, patient's competency may be a function of the physicians' efforts to make patients understand necessary information. Therefore, a patient's right to give informed consent leads to a physician's duty to disclose individually tailored information understandable to patients.     

Diffusion-weighted imaging of radiation-induced brain injury for differentiation from tumor recurrence

BACKGROUND AND PURPOSE: Differentiation between tumor recurrence and treatment-related brain injury is often difficult with conventional MRI. We hypothesized that the diffusion-weighted imaging (DWI) could help differentiate these 2 conditions, because water diffusion may be greater for necrotic tissues in the treatment-related brain injury than for tumor tissues in recurrence. Our aim was to analyze whether DWI findings of recurrent tumor are distinct from those of radiation necrosis. METHODS: Seventeen patients were examined prospectively. Two readers assessed the images by consensus for homogeneity and signal intensity of the lesions. Five regions of interest were drawn within the lesions on trace DWI images and apparent diffusion coefficient (ADC) maps. The minimal, maximal, and mean values of each lesion were compared between the 2 groups. Findings in 12 of 17 patients were verified histologically by surgery or biopsy; the diagnoses in the remaining 5 patients were made on the basis of follow-up MRI findings and clinical follow-up. RESULTS: There were a total of 20 lesions; 12 lesions were due to radiation necrosis and 8 lesions to tumor recurrence. In the radiation necrosis group, 8 lesions had marked hypointensity. In the recurrence group, however, no marked hypointensity was seen. The maximal ADC values within each lesion were significantly smaller for the recurrence group than for the necrosis group (P = .039). CONCLUSION: Radiation necrosis usually showed heterogeneity on DWI images and often included spotty, marked hypointensity. Significant difference was found in the maximal ADC values between radiation necrosis and tumor recurrence. DWI was useful in differentiating recurrent neoplasm from radiation necrosis.     

Quantitative evaluation of measurement accuracy for three-dimensional angiography system using various phantoms

PURPOSE: The purpose of this study was to evaluate the spatial resolution and accuracy of three-dimensional (3D) distance measurements performed with 3D angiography using various phantoms. MATERIALS AND METHODS: With a 3D angiography system, digital images with a 512 x 512 matrix were obtained with the C-arm sweep, which rotates at a speed of 30 degrees/second. A 3D comb phantom was designed to assess spatial resolution and artifacts at 3D angiography and consisted of six combs with different pitches: 0.5 mm, 0.6 mm, 0.7 mm, 0.8 mm, 0.9 mm, and 1.0 mm. Frame rate, field of view (FOV) size, reconstruction matrix, and direction of the phantom were changed. In order to investigate the accuracy of 3D distance measurements, aneurysm phantoms and stenosis phantoms were used. Aneurysm phantoms simulated intracranial saccular aneurysms and parent arteries; 2-mm- or 4-mm-inner-diameter cylinder and five different spheres (diameter: 10, 7, 5, 3, 2 mm) were used. Stenosis phantoms were designed to simulate intracranial steno-occlusive diseases; the nonpulsatile phantoms were made of four cylinders (diameter: 3.0, 3.6, 4.0, 5.0 mm) that had areas of 50% and 75% stenosis. The dimensions of the spheres and cylinders were measured on magnified multiplanar reconstruction (MPR) images. RESULTS: The pitch of the 0.5 mm comb phantom was identified clearly on 3D images reconstructed with a frame rate of 30 frame/sec and 512(3) reconstruction mode. In any reconstruction matrixes and any angles of the phantom, the resolution and artifacts worsened when frame rates were decreased. With regard to the angle of the phantom to the axis of rotational angiography, spatial resolution and artifacts worsened with increase in angle. Spatial resolution and artifacts were better with a FOV of 7 x 7 inch than with one of 9 x 9 inch. All spheres on the aneurysm phantom were clearly demonstrated at any angle; measurement error of sphere size was 0.3 mm or less for 512(3) reconstruction. In 512(3) reconstruction, the error of percent stenosis was 3% or less except for a cylinder diameter of 3.0 mm and 5% for a cylinder diameter of 3.0 mm. CONCLUSION: Spatial resolution of the reconstructed 3D images in this system was 0.5 mm or less. Measurement error of sphere size was 0.3 mm or less when 512(3) reconstruction was used. When using proper imaging parameters and postprocessing methods, measurements of aneurysm size and percent stenosis on the reconstructed 3D angiograms were substantially reliable.