Successful percutaneous closure of a coronary artery fistula with a detachable balloon

Precutaneous transcatheter closure technique of a coronary artery fistula with a detachable balloon was performed for a 14 year old male student. Complete closure of the fistula without any complications was confirmed by angiography after the procedure. When the patient underwent a second angiography 6 months after the closure, it was confirmed that the position of the balloon had not changed, that the interruption of the flow of the fistula had been maintained and that the diameter of the left coronary artery and the fistula were reduced. Percutaneous closure technique using a detachable balloon may become the primary treatment for a coronary artery fistula in place of surgical ligation.     

Enteric pathogens in severe forms of acute gastroenteritis in Ghanaian children

Diarrheal disease is the major cause of childhood morbidity in developing countries. Although malnutrition is known as a risk factor for severe gastroenteritis, the role of enteric pathogens in the clinical severity is unclear. The present study was conducted in well nourished Ghanaian preschool children during a 3 month period of the rainy season to assess the relationship between enteric pathogens and severe gastroenteritis. Two hundred and twenty-five children with acute gastroenteritis and 64 age-matched control children were prospectively examined for the severity of dehydration and enteric pathogens in their stools. Of the 225 children with gastroenteritis, 69.8% (157/225) had mild dehydration and 30.2% (68/225) had severe dehydration. Bacteria were similarly isolated in stool samples from children with mild and severe dehydration and controls. Rotavirus accounted for 20.6% of children with severe dehydration and was more often isolated in stools from patients with severe dehydration than those from controls. Furthermore, the mixed infections associated with rotavirus and bacteria were more often found in patients with severe dehydration than those with mild dehydration or controls. Parasites were similarly found at low incidences among the three groups. The present study implied that rotavirus was more responsible for severe gastroenteritis than bacteria or parasites. However, factors other than enteric pathogens must be sought in a considerable number of severe cases. A large scale study throughout a year is recommended to obtain more precise information that would reflect the seasonal variation of rotavirus infections.     

Prevalence of Alzheimer's disease with diabetes in the Japanese population

Background:  The aim of the present study was to estimate the prevalence of impaired cognitive function and Alzheimer's disease (AD) in diabetic subjects from Japan.
Methods:  In the present study, 386 Japanese diabetic subjects aged more than 50 years were initially screened with the 'brief screening test' for AD, and were diagnosed with AD and vascular dementia (VaD) according to the criteria of the NINCDS-ADRDA and the NINDS-AIREN. We compared the prevalence of dementia in diabetic patients with that in ordinary subjects, and analyzed the association of the status of diabetes with dementia including AD and VaD.
Results:  Forty-six (11.9%) patients were diagnosed with dementia, including 13 (3.4%) patients with AD and nine (2.3%) patients with VaD. Of the 221 subjects aged more than 65 years, 39 (17.6%) patients had dementia, including 13 (5.9%) patients with AD and eight (3.6%) patients with VaD. Compared with ordinary subjects, the prevalence of dementia in the present study was more frequent than the prevalence of dementia for the general population in almost each age group examined. There was also a greater prevalence of AD and VaD in subjects aged over 65 years in the present study. In the present study, AD subjects had significantly higher levels of fasting plasma glucose (FPG; 247.5 ± 116.3 mg/dL; P  < 0.05) and glycosylated hemoglobin (HbA1c; 8.8 ± 1.9%; P  < 0.01) compared with non-demented subjects. In AD patients, the odds ratios of FPG and HbA1c were also significantly higher (1.02 and 2.07, respectively; both P  < 0.01).
Conclusion:  The present study shows that diabetes can be associated with impaired cognitive function, particularly AD, in Japanese subjects.     

Effect of varicella zoster virus antigen-antibody complexes on hydrogen peroxide generation by human polymorphonuclear leukocytes

Hydrogen peroxide (H₂O₂) generation by human polymorphonuclear leukocytes (PMN) incubated with varicella zoster virus (VZV) antigen was studied by cytofluorography. Hydrogen peroxide generation was detected in the presence of VZV-seropositive sera. When seropositive sera were heat-inactivated, H₂O₂ generation was reduced. When PMN were pre-incubated with Leu-1 1b, a monoclonal antibody to the Fc receptor on PMN, H₂O₂ generation was also reduced. These results suggest that VZV antigen-antibody-complement complexes induce H₂O₂ generation by PMN after these complexes attach to Fc receptors on PMN.     

Phase I and Preliminary Phase II Studies on Aclacinomycin A in Patients with Acute Leukemia

Eight patients with acute nonlymphocytic leukemia (ANLL) andfive patients with acute lymphocytic leukemia were treated withaclacinomycin A. It was given daily by one-hour infusion indoses ranging from 0.33 to 0.70 mg/kg for seven to 20 days withoutother antileukemic agents. Two patients with ANLL achieved completeremission and one with ANLL achieved partial remission. Itsmajor toxic effects were myelosuppression and gastrointestinalsymptoms.     

A vesicular variant of bullous pemphigoid with autoantibodies against unidentified 205- and 150-kDa proteins at the basement membrane zone

Summary We describe a 75-year-old man who developed a vesicular variant of bullous pemphigoid with a distinctive result of immunoblot analysis. Characteristic symptoms consisted of vesiculopapular eruptions with erythematous patches on the arms and legs, many of which fused to form irregularly outlined areas of erythema varying in size. Direct immunofluorescence revealed a linear deposition of IgG at the basement membrane zone of the skin, and indirect immunofluorescence detected circulating IgG autoantibodies at a titre of 1: 160. which reacted with the antigens located on the epidermal side of skin split with 1 mol/L, NaCI. Immunoblot analysis using epidermal extracts demonstrated the presence of IgG antibodies directed to 150, 205, 240 and 280 kDa proteins as well as to the 180kDa bullous pemphigoid antigen (BPAG2). All antibodies eluted from nitrocellulose membrane imprints of individual bands with molecular weights of 150, 180 and 205 kDa were found by indirect immunofluorescence to react with the basement membrane zone, whereas those elutcd from the bands with molecular weights of 240 and 280 kDa did not. These findings suggest that antibodies directed not only to the 180kDa BPAG2, but also to 150 and 205 kDa proteins, are involved in the pathogenesis of bulla formation in this patient.     

Recurrence of Thymoma with Appearance of Myasthenia Gravis 18 Years after Surgery: A Case Report

A 59-year-old woman was admitted to the hospital because ofrecurrence of thymoma with appearance of myasthenia gravis 18years after excision of an invasive thymoma. Recurrence wasobserved in the anterior mediastinum, right pleura, pericardiumand left supraclavicular lymph node. Hashimoto's thyroiditis,vitiligo vulgaris and leukopenia were also seen. After creationof a pericardial window for pericardial effusion, she receivedvincristine, then carbazilquinone intravenously as single chemotherapeuticagents based on the chemosensitivity by clonogenic assay ofthe supraclavicular tumor, but response was not achieved. Atone and a half years after radiotherapy to the mediastinum,she is now doing well without symptoms and is receiving a fairlylow dose of anticholinesterase medication.     

Erythropoietin-producing renal cell carcinoma in chronic hemodialysis patients: A report of two cases

Erythropoietin (EPO)-producing renal cell carcinomas in two hemodialysis patients are reported. Despite deteriorated kidney function, these patients did not manifest anemia at diagnosis and their elevated serum EPO levels rapidly returned to within the normal range after nephrectomy. Immunohistochemical staining of the resected specimens showed production of erythropoietin in the tumor cells in one case and in the lining cells of the cyst wall in the other case. Renal cell carcinoma could cause an increase of blood hematocrit level in dialysis patients.