A case of hair loss induced by carbamazepine]

We report a 52 year-old man presenting with an acute considerable hair loss induced by carbamazepine (CBZ). The remarkable scalp hair loss started within a week after CBZ administration. There was no evidence of dermatitis or allergic reaction, or other cause for the hair loss. The serum concentration of CBZ was 8.6 microg/ml (therapeutic range 8-12 microg/ml). CBZ was discontinued, and the hair loss stopped within several days with new hair growth. Medication-induced hair loss is an occasional adverse effect of many drugs used for neuropsychological diseases. CBZ also induces hair loss and its frequency was reported below 2%. Only a limited number of detailed case reports describing CBZ-induced hair loss were available, and we found these cases could divide into two groups with regard to a delay in starting hair loss after administration of CBZ. In one group, the hair loss started within a week suggesting anagen effluvium and in another it started after two or three months suggesting telogen effluvium. This finding suggests the causative mechanism of CBZ-induced hair loss is not unitary.     

A case of corticobasal degeneration presenting with visual hallucination]

We report a case of corticobasal degeneration (CBD) presenting with visual hallucination. A 65-year-old woman showed clumsiness of the left hand. Clinical symptoms slowly progressed to include rigidity, which was left side dominant, limb-kinetic apraxia of the left hand, disorder of construction and dressing, unilateral spatial neglect, cortical sensory loss and alien limb phenomenon. Cranial MRI showed atrophy of the parietal and medial aspect of the frontal lobes, which was more severe on the right than on the left. SPECT images showed hypoperfusion in the parietal, frontal and temporal lobes, which were similarly more severe on the right than on the left. We diagnosed the patient as having CBD based on the clinical symptoms. Two years' later, she developed recurrent visual hallucinations that were typically well formed and detailed. Since patients with CBD generally do not experience visual hallucination, this case is considered the very rare and indicates the possibility that visual hallucination may be one of the clinical symptoms of CBD.     

Renovascular hypertension: a unique cause of unilateral focal segmental glomerulosclerosis.

A 48-year-old man presented with malignant hypertension and massive proteinuria. Renal angiography showed complete obstruction of the left renal artery and 99mTc-mercaptoacetylglycine (MAG3) renography showed a nonfunctioning left kidney. Percutaneous transluminal renal angioplasty of the left renal artery was unsuccessful; hence, the patient underwent left nephrectomy because of uncontrolled hypertension and proteinuria. Histological examination of a right kidney specimen revealed lesions of focal segmental glomerulosclerosis with benign nephrosclerosis. In contrast, histology of the left kidney showed typical ischemic kidney with hypertrophy of arteriolar smooth muscle cells. The patient responded favorably to the nephrectomy, as his blood pressure and urinary protein dramatically decreased with no antihypertensive medication. This case illustrates the heterogeneous effect of the renin-angiotensin system on either kidney in patients with renovascular hypertension due to unilateral renal artery stenosis.     

Effects of pulsatile cardiopulmonary bypass on the renin-angiotensin-aldosterone system following open heart surgery

The effects of pulsatile cardiopulmonary bypass on the renin-angiotensin-aldosterone system and tissue metabolism, especially those which occur soon after surgery, were studied in 26 patients who required total cardiopulmonary bypass for longer than 60 minutes. These patients comprised 11 who underwent open heart surgery utilizing nonpulsatile cardiopulmonary bypass (Group I) and 15 who underwent open heart surgery utilizing pulsatile cardiopulmonary bypass (Group II). Plasma angiotensin II and serum aldosterene levels were significantly increased one and 5 hours postoperatively in Group I when compared with the preoperative values, whereas no significant elevations were observed in Group II. Plasma angiotensin II and serum aldosterone levels one hour postoperatively in Group II were significantly lower than those in Group I. Lactate levels in the arterial blood were significantly elevated, one and 5 hours postoperatively in both Groups I and II. Moreover, no significant difference was observed in the lactate levels between Groups I and II, one hour postoperatively. In the nonpulsatile group (Group I), plasma angiotensin II levels one hour postoperatively were correlated significantly with the duration of total cardiopulmonary bypass. In conclusion, pulsatile cardiopulmonary bypass offers significant advantages in terms of lower plasma angiotensin II and serum aldosterone levels, when compared with nonpulsatile cardiopulmonary bypass soon after open heart surgery requiring total cardiopulmonary bypass for longer than 60 minutes, however, it does not offer a definite advantage for tissue metabolism.     

Changes in left ventricular function during exercise after lung resection--study with a nuclear stethoscope]

In 29 cases undergoing lung resection, effects of the surgery on left ventricular function were investigated indirectly with a Nuclear Stethoscope. Various parameters were measured following an exercise load before and after surgery. There were significant decreases in post-operative resting levels of stroke volume (SV) (p < 0.001), end-diastolic volume (EDV) (p < 0.001), ejection fraction (EF) (p < 0.05) and ejection rate (ER) (p < 0.001) and significant increase in heart rate (HR) (p < 0.001) when compared to pre-operative resting levels. Neither filling rate (FR) nor cardiac output (CO) showed significant difference. At maximum exercise load, there were significant decreases in post-operative EDV (p < 0.005), SV (p < 0.005), ER (p < 0.001) and FR (p < 0.005), but no significant differences were detected in HR and EF; consequently, there was a significant decrease in CO (p < 0.005). Ratio of the levels at maximum load to those at resting of each parameter did not show significant difference between before and after operation with regard to any parameters except CO and FR which showed significant decrease (p < 0.005 and p < 0.001, respectively). Effects of the surgery on left ventricular function were studied according to amount of lung resection. In 13 cases where more than two lobes were resected, similar significant differences to those mentioned above were found in all parameters except EF. In cases where a single lobe was resected, only ER and FR showed similar tendency to that described above. Effects of the surgery on left ventricular function were also studied according to age of patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

Curative resection of gastric cancer: Limitation of peritoneal lavage cytology in predicting the outcome

Patients with stage T3N0～2M0 gastric carcinoma (n = 108) were studied for relevant prognostic factors. Peritoneal lavage cytology (PLC) was performed in all. In univariate analysis, 5-year survival rates were better with smaller serosal invasion (diameter <3.0 cm vs. ≥3.0 cm, 61% vs. 37%, P < 0.05) and fewer metastatic nodes (≤5 vs. ≥6, 57% vs. 29%, P < 0.05). In multivariate analyses, only these two factors were significant. The predictive value of PLC was not shown in both univariate and multivariate analyses. Peritoneal recurrence occured in 14 (22%) of 77 patients with negative PLC, and in 3 (18%) of 17 with positive PLC, the difference being not significant. Our results indicate that PLC is insensitive in predicting the development of peritoneal recurrence. Its role in the estimation of survival is limited, as many will die of visceral or locoregional recurrence if not of peritoneal dissemination.     

Blood pressure changes following extracorporeal shock wave lithotripsy for urolithiasis.

Hypertension after extracorporeal shock wave lithotripsy (ESWL) has been a controversial subject. Changes in blood pressure were studied in 262 patients (mean age 47.8 years) 18.6 months after ESWL. According to World Health Organization criteria the number of patients who showed a decrease exceeded those who showed an increase in blood pressure. The patients who have been on antihypertensive therapy showed a significantly greater decrease in blood pressure than those without medication. Of 192 normotensive patients diastolic pressure increased 1.2 mm. Hg and 2 (1.0%) had hypertension 18.4 months after ESWL. Annualized increase in diastolic pressure and new onset of hypertension were calculated to be 0.78 mm. Hg and 0.65%, respectively. Significant elevation of diastolic pressure was noted in the patients who received a larger number of shock waves. Blood pressure should be carefully followed after ESWL especially in patients who have been treated by a greater number of shock waves.     

Japanese guidelines for the management of herpes simplex encephalitis; comparison with those from the International Management Herpes Forum]

Herpes simplex encephalitis (HSE) is still recognized as a severe sporadic encephalitis, although the mortality and morbidity rates have been decreased to 10% and 30%, respectively. This disease is diagnosed using clinical symptoms, CSF, EEG, CT, MRI, and virologic tests such as polymerase chain reaction (PCR) or enzyme immunosorbent assay (EIA). Early diagnosis and treatment are essential for HSE. However, the early symptoms of this disease are various, and the laboratory diagnostic criteria are unclear to the non-specialist. In 2005, Japanese guidelines for the management of HSE have been issued via two sets of Workshops at the Japanese Neuroinfectious Disease Congress. The diagnostic and therapeutic criteria were discussed in comparison with those from the International Management Herpes Forum (IMHF) in 2004. For a definitive diagnosis, CSF PCR for herpes simplex virus (HSV) is recommended, and the detection rate has been reported to be 60 to 80% within the 7th day of the illness. In the IMHF, the PCR method has also been the primary method for early diagnosis and for monitoring the therapy. Further, quantitative real-time PCR has become available for measuring the effectiveness of aciclovir therapy. To measure HSV antibody levels, complement antibody (CF), neutralizing antibody (NT), or enzyme-linked immunosorbent assay (ELISA or EIA) are available. Significant elevation of EIA IgG or intrathecal HSV antibody production should be shown, although these antibody responses often appear two weeks after the onset of HSE. Regarding anti-herpesvirus drugs, in both Japanese and IMHF guidelines aciclovir is consistent with the first choice, and it is recommended that its administration would be started as soon as HSE is suspected on the basis of clinical pictures, CT * MRI, EEG, or CSF findings. However, antiviral therapy may be discontinued if a negative CSF HSV PCR is obtained at > 72 hours after onset. A recent Japanese study shows the efficacy of a combination therapy of aciclovir and corticosteroid for this disease. Further prospective investigation is expected.     

Intravitreal injection of 0.3 ml of SF6 gas for persistent subfoveal fluid after scleral buckling for rhegmatogenous retinal detachment

Purpose  To determine the efficacy of intravitreal injection of sulphur hexafluoride (SF6) gas for reducing persistent subfoveal fluid after scleral buckling surgery for macula-off rhegmatogenous retinal detachments. Methods  We injected 0.3 ml of SF6 gas into the vitreous cavity of two eyes of two patients with persistent macular retinal detachment 3 and 5 months after successful scleral buckling. Optical coherence tomography was performed before and after surgery. Results  Subfoveal fluid was displaced peripheral to the fovea immediately after gas injection and the fluid was absorbed gradually in both eyes. Conclusions  Persistent subfoveal fluid after scleral buckling may be treated with intravitreal SF6 gas injection. The authors have no proprietary interest in any aspect of this report