Left Diaphragmatic Hernia Complicated by Perforation of an Intrathoracic Gastric Ulcer into the Aorta: Report of a Case

(Received for publication on Apr. 6, 1998; accepted on May 27, 1999)     

Change in plasma viral load, and viral DNA and mRNA burdens, in peripheral blood mononuclear cells from patients infected with HIV-1

OBJECTIVES: To clarify the virological state of human immunodeficiency virus (HIV)-1-infected patients, we compared the plasma HIV-1 RNA copy number (plasma viral load (VL)), viral DNA and mRNA burdens in peripheral blood mononuclear cells (PBMCs), and the other clinical predictors. METHODS: One hundred and thirty-one samples of PBMCs and plasma from 26 patients infected with HIV-1 were obtained during 20 consecutive months for the measurement of VL, viral DNA and mRNA burdens, and CD4 positive (CD4+) cells count. The quantitative polymerase chain reaction (PCR) method with detection by solid phase DNA was utilized for the assay of VL, viral DNA and mRNA burdens. RESULTS: Eighty-six VL, 101 viral mRNA and 129 viral DNA out of 131 samples were detected. There was a significant positive correlation between VL and the viral mRNA burden (r = 0.600, P < or = 0.001), and between VL and the viral DNA burden (r = 0.368, P < or = 0.001). Focused on individuals, the viral mRNA burdens varied in a manner relatively dependent on VL when both values were detectable. However, viral DNA burdens varied relatively independently of VL and the viral mRNA burdens. In six patients the viral mRNA burden was detectable and changed even if the VL was undetectable throughout the observation period. CONCLUSIONS: Both viral DNA and viral mRNA burdens still showed detectable changes even when the VLs became undetectable in most patients. The measurement of viral mRNA or DNA burdens may be clinically available to identify viral replication when VL is undetectable.     

FDG accumulation in aortic walls

A 65-year-old woman with no symptoms underwent whole-body F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) for cancer screening. FDG accumulation was detected incidentally in her arterial walls, including the aortic wall. She had no history of inflammatory or cardiovascular disease. Although accumulation of FDG is well recognized in the aortic wall when vasculitis is present, this patient showed no symptoms of active vasculitis during the 22-month follow-up period after the PET study. The aortic wall might be a site where FDG accumulates physiologically in elderly persons.     

Foggy scintillation counting technique.

A new "foggy scintillator" was developed for the measurement of low-energy beta-emitters in air. By the use of an ultrasonic wave generator, a liquid scintillator can be converted into the "foggy scintillator". In order to obtain reasonable detection efficiency, it is necessary to prepare a liquid scintillator with a very high concentration of the first solute (PPO). The foggy scintillation counting technique avoids the trouble of the sample preparation usually necessary for the measurement of radionuclides in air, since the radionuclide in the air can be measured directly.     

Evaluation of adhesive tape containing lidocaine using current perception threshold measurement

Lidocaine adhesive tape (Penles; Wyeth Lederle Japan, Ltd, Tokyo, Japan) is placed for pain relief prior to puncturing a vein with a needle. We investigated the optimal time interval from application of Penles to vein puncture by measuring current perception threshold (CPT) levels with a Neurometer, by which it was possible to measure the extent of nerve block in a non-invasive and quantitative manner with 3 electrical stimulus rates (2000 Hz, 250 Hz, and 5 Hz). Penles was applied to the dorsum of volunteers' hands for 1, 2, 4, 6 and 12 hours before measuring CPT levels. With a stimulation rate of 2000 Hz and 250 Hz, CPT, levels were found to increase 4 hours after the Penles application, while peak CPT levels for 5 Hz stimulation were observed from 6 to 12 hours after application. However, CPT levels tended to decrease 12 hours after application, regardless of the stimulus rate. From the result, we conclude that Penles provides maximum benefit when applied 6 hours prior to vein puncture.     

A case of central retinal artery occlusion after anterior posterior fusion of the lumbar spine

We report a case of central retinal artery occlusion after anterior-posterior fusion of the lumbar spine. The patient suddenly lost his vision of the right eye in the ICU just after the end of long procedure for anterior-posterior fusion of the lumbar spine. The patient was diagnosed as having central retinal artery occlusion, and treated successfully with treatments including immediate administration of urokinase and PGE1, stellate ganglion block, and hyperbaric oxygen therapy. The patient was discharged from the hospital on the 54th postoperative day with adequate vision to drive a car. Central retinal artery occlusion is a rare but very serious complication during and after supine surgery with prone position. It is very important for us to be aware of its possible occurrence. We have to diagnose and treat, as soon as possible, the vision loss after the spine surgery.     

A case report of total repair in a 71-year-old patient with tetralogy of Fallot

A 71-year-old male is presented as ever the oldest patient of tetralogy of Fallot who underwent successful radical surgery. Heart murmur was pointed out at the age of 10 years. The patient consulted us because of dyspnea and cough, and was noted to have cyanosis and clubbing fingers. Polycythemia was also detected by hemoglobin of 20.8 g/dl and hematocrit of 58.4%, and a low PaO2 of 48.5 mmHg at room temperature was pointed out. Preoperative echocardiography and cardiac catheterization indicated a ventricular septal defect, overriding of the aorta, and right ventricular outflow tract stenosis with a pressure gradient of 115 mmHg between the right ventricle and the main pulmonary artery. Under cardiopulmonary bypass, the ventricular septal defect was closed with a dacron patch and the right ventricular outflow tract was enlarged by a patch of collagen-coated vascular graft with a commissurotomy of the pulmonary valve. Postoperatively, cyanosis disappeared and the pressure gradient was decreased to 26 mmHg.     

Comparison of granisetron, droperidol, and metoclopramide for prevention of postoperative vomiting in children with a history of motion sickness undergoing tonsillectomy

BACKGROUND/PURPOSE: A history of motion sickness is one of the patient-related factors associated with postoperative vomiting (POV). This study was undertaken to compare the efficacy of granisetron, droperidol, and metoclopramide for the prevention of POV after tonsillectomy in children with a history of motion sickness. METHODS: In a prospective, randomized, double-blinded trial, 90 pediatric patients, aged 4 to 10 years, received granisetron, 40 microg/kg; droperidol, 50 microg/kg; or metoclopramide, 0.25 mg/kg (n = 30 of each) intravenously after an inhalation induction of anesthesia. Emetic episodes and safety assessments were performed during the first 24 hours after anesthesia. RESULTS: Twenty-two of 30 patients (73%) who had received granisetron were emesis free during the first 24 hours after surgery as compared with 7 of 30 (23%) who had received droperidol (P <.05) or 6 of 30 (20%) who had received metoclopramide (P <.05). No clinically serious adverse events were observed in any of the groups. CONCLUSION: Prophylactic therapy with granisetron is superior to droperidol or metoclopramide for the prevention of POV after tonsillectomy in children with a history of motion sickness.     

P16INK4Gene Mutations Are Relatively Frequent in Ampullary Carcinomas

A high incidence of gene mutations or deletions of P16INK4, a cell cycle regulator which inhibits the activity of cyclin-dependent kinase 4/cyclin D complex and blocks the Gl-to-S transition, has been reported in pancreato-biliary tract cancers. In order to investigate P16INK4 gene alterations in sporadic ampullary carcinomas, 17 sporadic ampullary carcinomas were examined. After histological diagnosis, DNA samples extracted separately from both cancerous and normal paraffin-embedded tissues were investigated. Loss of heterozygosity (LOH) was investigated utilizing 3 microsatellite markers on 9p21-22, and a mutationsl analysis was performed by cloning and sequencing. LOH was observed in 3 cases (17.6%) and somatic mutations with retention of heterozygosity were found in 7 cases (41.2%). Of note was that two mutations resulted in truncated incomplete proteins and one was a point mutation at the consensus site in the conserved ankyrin repeats, which would be crucial for function. Although two-hit inactivation was not evident in any of the mutation cases and further investigation would be needed to elucidate the role of altered p16INK4 , these results suggest that the pl6INK4 gene mutations are relatively frequent and its inactivation might be important in ampnllary carcinogenesis.