A refractory case of dermatomyositis complicated with multiple brain abscesses

We describe a 48‐year‐old woman with dermatomyositis complicated with interstitial pneumonia. The pulmonary lesion was refractory; however, several therapeutic regimens such as steriod pulse therapy or gamma globulin and cyclophosphamide, resolved the situation. Later she developed multiple brain abscesses thought to be responsible for immune depression; prolonged antimycotic therapy brought dramatic improvement. Brain abscess is a rare complication in such immuno‐compromised cases; attention should be given to the possibility of deep mycosis, especially brain abscess.     

Periodic stupor-like states in progressive supranuclear palsy

Four patients with progressive supranuclear palsy presented with various psychiatric symptoms. Periodic stupor‐like states due to fluctuations of consciousness were observed in all four cases. Magnetic resonance imaging showed severe dilatation of the third ventricle suggesting atrophy of the thalami. Neuropathological examination in one of the cases confirmed severe fibrillary gliosis in the intralaminar thalamic nucleus. So far, few studies have focused on periodic stupor‐like states observed in progressive supranuclear palsy patients. From our cases and from the literature, we postulate that the lesions in the intralaminar thalamic nuclei may have close relevance to the stupor‐like states seen in progressive supranuclear palsy patients.     

Newborn hearing screening in a single private Japanese obstetric hospital

BACKGROUND: Hearing loss is one of the most common abnormalities present at birth. The authors examined the frequency of newborn hearing disturbance at a single obstetric hospital to exclude technical varieties or varieties of subjects which are inevitable in multiple institutional cooperative studies. METHODS: The newborns were examined with an automated auditory brainstem response screener, the ALGO 2e, on day 4 post-partum. This Screener uses 35 dB near hearing level click stimuli and provides a PASS/REFER result that requires no interpretation. The PASS result is accepted as adequate evidence of hearing and REFER result as required further diagnostic testing to determine hearing status. Screenings of REFER outcomes were repeated at 1 month of age. Comparisons were made of the results and the Japanese multiple institutional trials by Mann-Whitney U-test. RESULTS: The authors screened 8979 out of 13 494 neonates born from July 1999 to October 2004. The neonates with unilateral or bilateral REFER outcomes were 37 cases (0.41% of the total examined) on day 4, and 31 cases (0.35%) at 1 month of age. Five of the 31 neonates had PASS outcomes at 6 months of age. Among the 31 REFER neonates, eight (25.8%) had otolaryngeal complications. CONCLUSION: In the present study, screening results at 1 month of age resembled the final diagnosis obtained at 6 months of age; out of 31 REFER cases, 26 cases were diagnosed with hearing loss. In contrast, in the multiple institutional study, both unilateral and bilateral REFER rates were much higher than the rates of final hearing loss. Concerning the final diagnoses of bilateral hearing loss, the authors' results (0.10%) and the multiple institutional studies' results (0.05% in low-risk and 2.19% in high-risk neonates) were comparable to the results reported in the USA. To expand the newborn hearing screening program, it is crucial that authority and institutions concerned promote the development of a national or prefecture-based early hearing loss identification and intervention network.     

Spread of subarachnoid hyperbaric amethocaine in adolescents

We have compared the spread of subarachnoid hyperbaric amethocainein adolescents with that in adults. Amethocaine 8 mg in 2 mlof 10% glucose was injected through a 25-gauge spinal needleinserted at the L3-4 interspace in 21 adolescents aged 12–16yr and in 111 adults aged 17–82yr. Although we found nodifferences in height, weight or body mass index between theadolescents and adults, maximum spread of analgesia was significantlyhigher in the adolescents (median T3 (range T4–C5)) thanin the adults (T4 (T9–C7)). We conclude that subarachnoidinjection of hyperbaric amethocaine produces an unexpectedlyhigher level of analgesia in adolescents than in adults.     

Cold-Induced Salt Intake in Mice and Catecholamine, Renin and Thermogenesis Mechanisms

Cold induces increased intake of salt in mice. To examine involvement of renin and catecholamines, male ICR mice were exposed to cold (7–9°C; 6 h/day; 4 days), and half of them were allowed to choose between water and 0·9% NaCl. Plasma renin activity (PRA) and catecholamine concentrations in plasma, adrenal gland, kidney, brown adipose tissue (BAT) and brain were examined in three phases: for 9 h before exposure to cold, during 6 h of cold exposure and for 9 h after the exposure. The amount of salt intake from NaCl solution and from food, PRA and noradrenaline (NE) concentrations in kidney and medulla oblongata were higher during cold and the 9 h after exposure to cold than during the 9 h before the exposure. These results are consistent with the suggestion that cold-induced catecholamine metabolism enhanced activity in the renin–angiotensin system, which played an important role in the arousal of salt appetite. During cold exposure, concentrations of NE and dopamine in BAT were higher in mice with access to NaCl solution than those without NaCl to drink. These results suggest that cold-induced salt intake enhanced non-shivering thermogenesis, and are consistent with our previous report that high salt intake helped to maintain colonic temperature under cold exposure.     

Experience with Percutaneous Electronic Choledochoscopy

Experience with percutaneous choledochoscopy using a prototype electronic choledochoscope (Pentax ECN-1530) is presented herein. This electronic endoscope is 5.3 mm in outside diameter at the tip and has a forceps channel 2.0 mm in diameter. The outside diameter is 0.4 mm larger, while the forceps channel diameter is 0.2 mm smaller, than that of the conventional fiberoptic choledochoscope (FCN-15X) produced by the same company. Although the new electronic choledochoscope could be inserted through a 16 Fr in size fistula, we considered an 18 Fr fistula to be preferable for insertion without resistance. Various types of accessory equipment for endoscopic treatment, such as an electrohydraulic Shockwave lithotriptor (EHL) and an Nd-YAG laser, could be used without difficulty. The electronic choledochoscope was useful for examining bile duct carcinoma invasion to the hepatic side and evaluating the efficacy of various multi-modal treatments, as it provided observation of the bile duct mucosa in great detail due to a very clear dynamic image. Moreover, endoscopic treatment was also greatly facilitated because it provided a clear view on a large, bright monitor screen for the surgeons. We therefore believe that this new electronic choledochoscope is very useful for the accurate diagnosis and treatment of biliary diseases.     

Elucidation of chemical compounds responsible for foot malodour

Short-chain fatty acids from the socks and feet of subjects either with strong foot odour or with weak or no foot odour were extracted with ethyl ether, and then analysed by gas chromatography/mass spectrometry (GC/MS). Short chain fatty acids were found in greater amounts from those subjects with strong foot odour. Iso-valeric acid was present in all the subjects with foot odour but was not detected in those without. Olfactory evaluations of the various short-chain fatty acid solutions were in agreement with the GC/MS analyses. By incubating sweat and lipid from subjects with strong foot odour, we succeeded in reproducing the foot malodour. GC/MS analyses of reproduced foot odour revealed that short-chain fatty acids were present in a similar composition to that found in vivo.     

Cutaneous endometriosis in the umbilical region: The usefulness of CD10 in identifying the interstitium of ectopic endometriosis

Endometriosis is a condition in which endometrium or endometrium‐like tissue grows in areas other than the endometrium and is often found within the pelvis such as in the uterus or ovary, but occasionally develops ectopically in the skin. In this paper, we report a case of cutaneous endometriosis in the umbilical region found in a 37‐year‐old woman with no history of pregnancy. The lesion was a brown, firm and elastic nodule, 9 mm × 7 mm in size, and caused bleeding as well as pain which increased during menstruation. Histopathological findings revealed that there were small and large glandular cavity structures in the dermis and the edematous interstitium around it. On immunohistochemical staining for estrogen and progesterone receptors, the cellular nuclei of glandular cavity walls were mainly found to be positive for both, and cells in the edematous interstitium around the glandular cavity were positive for CD10. Consequently, we diagnosed this case as cutaneous endometriosis in the umbilical region. CD10 was initially described as a tumor‐specific antigen found in acute lymphoblastic leukemia. Recently, the usefulness of CD10 in diagnosing endometriosis in addition to various types of lymphoma or blood cancer has been confirmed, and in our case it also proved to be as useful as estrogen receptor or progesterone receptor in the definitive diagnosis of endometriosis.