Dissociation of Sleep Stages Between the Two Hemispheres in a Case With Unilateral

A case with an astrocytoma in the right basal ganglia, suspected of having originated from the posterior ventro-lateral part of the thalamus, without any clinical findings indicating severe internal hydrocephalus and cortical damage, showed dissociation of sleep stages between the two hemispheres, i.e., the affected side always fell earlier into deeper stages of sleep and was more difficult to arouse by sonic stimulations than the other side. It is assumed that this bilateral dissociation with ipsilateral deactivation is due to the severe unilateral reduction of EEG activating influences from the brain stem and a possible functional damage to the interthalamic commissures. This finding can be explained sufficiently by recent theories based on experimental results in animals. The clinical value of this finding is also discussed in this paper.     

The value of combined99mTc-Sn-colloid and99mTc-RBC scintigraphy in the evaluation of a wandering spleen

Wandering spleen is the term commonly applied to splenic hypermobility that results from laxity or maldevelopment of its suspensory ligaments. It comes to medical attention usually as an abdominal mass, or when the spleen undergoes torsion. Diagnosis on clinical grounds alone is rarely made, and ultrasonography, CT and MRI findings have no specific characteristics for this condition.^99mTc-labeled colloid taken up by the spleen may provide a specific diagnosis. We report a case of wandering spleen, in which the preoperative diagnosis was made on the basis of sequential liverspleen scintigraphy with^99mTc-Sn-colloid and blood-pool scintigraphy with^99mTc-RBC. This is a rare case, in which hypermobility was assessed by sequential^99mTc-Sn-colloid scintigraphy, and to our knowledge, is the first case in which^99mTc-RBC scintigraphy provided useful information on splenic blood volume and its location.     

Dilatation of the temporal horn in subarachnoid haemorrhage

Summary CT studies of 50 patients with spontaneous subarachnoid haemorrhage (SAH) and 100 randomly selected patients were reviewed with regard to the size of the frontal and temporal horns of the lateral ventricles. The temporal horn was classified into four grades, based on the size of its posterior portion at the level of the midbrain. The horn was clearly visible in 66% of patients with SAH, but in only 2% of controls. In the SAH group, the temporal horn tended to dilate sooner than the frontal horn after haemorrhage and could be seen clearly in a larger proportion of patients. Thus, assessment of the size of the temporal horn appears to be a simple and sensitive method for assessing ventricular dilatation. In addition, dilatation of the temporal horn may prove to be an important indirect sign suggesting SAH in patients in whom no high density clot is seen on CT.     

Anti-HIV-1 protease activity of lanostane triterpenes from the vietnamese mushroom Ganoderma colossum

Four new lanostane triterpenes, colossolactone V (1), colossolactone VI (2), colossolactone VII (3), and colossolactone VIII (4), were isolated from the fruiting bodies of the Vietnamese mushroom Ganoderma colossum, together with the known compound colossolactone E (5). The structures of 1- 4 were assigned on the basis of spectroscopic evidence, and their absolute configurations were determined by CD spectroscopy and the Mosher ester method. Compounds 1- 5, as well as two previously isolated compounds [schisanlactone A (6) and colossolactone G (7)] from the same mushroom, were evaluated for inhibition of HIV-1 protease, with IC 50 values for the most potent compounds ranging from 5 to 13 microg/mL.     

The Internal Biliary Fistula – Reappraisal of Incidence,Type, Diagnosis and Management of 33 Consecutive Cases

To reevaluate the current features of spontaneous internal biliary fistulas, we reviewed 1,929 consecutive patients who had been treated for biliary tract diseases during the recent 12-year period. Thirty-three patients had internal biliary fistulas and the incidence was 1.9%. Of 33 patients, 20 were women and 13 were men with the average age 63 years, and their mean duration of illness was 4 years. A total of 37 fistulas were found and the most common type was choledochoduodenal (62%), followed by cholecystoduodenal (19%), cholecystocholedochal (11%) and cholecystocolonic (8%) fistulas. Internal biliary fistulas of thirty-one patients were caused by biliary stones and those of two patients by malignant tumors. All of the 17 bile samples examined were bacteria positive and the majority of calculi were brown pigment stones. All of the choledochoduodenal fistulas were correctly diagnosed by endoscopic retrograde cholangiography. In 14 patients with cholecystoenteric or cholecystocholedochal fistulas, direct evidence of the internal fistula was obtained only in 7 patients (50%) preoperatively. Pneumobilia, a small atrophic gallbladder adherent to the neighboring organs and a history of spontaneous disappearance of jaundice in elderly patients may indicate the presence of a cholecystoentric fistula. Since the preoperative diagnostic rate for internal biliary fistula involving the gallbladder is still low, care is necessary before and at the time of surgery especially during laparoscopic cholecystectomy for elderly patients with cholelithiasis.