A case of sub wakefulness syndrome

Abstract We report a patient, a 30-year-old male Japanese-Brazilian migrant construction worker, suffering from excessive daytime sleepiness for at least 6 months. Electroencephalogram recordings during his waking states showed that 10-Hz and 60-µV alpha activity was present prominently in the occipital regions. From the multiple sleep latency test, it was found that stages 1–2 NREM sleep episodes appeared repetitively without any REM episodes, and that the mean sleep latency was 10.2 min. These findings support the diagnosis that this patient suffers from subwakefulness syndrome.     

Relation between serum hepatitis C virus-RNA levels and efficacy of interferon-β therapy

We performed two courses of interferon-β (IFN-β) to a child with chronic hepatitis C. A complete response was not obtained by the first interferon treatment, however, the results of the second treatment differed from those of the first. Hepatitis C virus (HCV)-RNA remained negative and both aspartate aminotransferase and alanine aminotransferase levels remained normal after completion of the second course. From these results we estimated that HCV-RNA levels before IFN therapy could be significantly associated with the efficacy of this treatment. The serum level of HCV-RNA was 10⁶ copies/50 μL before the first treatment, but was 10³ copies/50 μL before the second course. We conclude that IFN therapy to children with hepatitis C should always be directed at providing a cure. Even if the clinical effects of the first course are minimal decreasing quantities of HCV-RNA still offer hope for cure by subsequent readministration.     

Renal Cell Carcinoma in a Solitary Kidney Treated by Partial Nephrectomy --Case Report and Review of Japanese Literature

Renal cell carcinoma in a solitary kidney is rather rare. Wepresent a case of this condition occurring in a 50-year-oldman. He was treated by partial nephrectomy and temporary hemodialysisfor postoperative acute renal failure. Perusal of the literaturereveals that in situ partial nephrectomy, if possible, seemsto be a reasonable treatment of choice for renal cell carcinomain a solitary kidney. This is the fifth case ever reported inJapan.     

Empirical analysis of content of support in regional intractable disease consultation

Aim: The purpose of this research is to study the content of support provided by nurses who were employed in a regional intractable disease consultation project. Methods: The content of support was classified using records of 943 consultations with intractable disease patients and their families conducted over a 5 year period in a regional intractable disease consultation project in one prefecture of Japan as the subject of analysis. The number of recording units in respective categories was compared. Results: A total of 1276 recording units were extracted from the data and organized into two major categories, eight minor categories, and 24 subcategories. The major category [Support for problem solving by patients' and their families' own efforts] comprised four minor categories, which have the aims of respect of the independence of the patient and patient's family and support for the solution of problems. The major category [Coordination with support division] comprised four minor categories, as support for problems which are difficult for the patient and their family to solve. Conclusion: The distinctive features of regional intractable disease consultations conducted by nurses are support from the combined viewpoints of medical care and everyday life, specialized support based on the features of the patient's disease, and coordination with close support persons. In education for nurses who are to be employed in this field, it is necessary to develop competence in responding to the specialized support needs of intractable diseases and coordination of support persons.     

A novel branching pattern of the superior mesenteric artery found in the bullfrog (Rana catesbeiana) amphibian

The branching and distribution patterns of the superior mesenteric artery were studied in 10 adult bullfrogs ( Rana catesbeiana ) after injection of coloured latex solution into the vasculature. The abdominal digestive organs in the bullfrog were mainly supplied by the coeliac artery and the superior mesenteric artery, both of which arose as a common trunk, the coeliacomesenteric artery, from the abdominal aorta. The coeliac artery supplied the stomach, liver, gallbladder and the pancreas, whereas the first branch of the superior mesenteric artery was the splenic artery with other branches supplying the greater part of intestine. The apex of the intestinal loop was defined as the region supplied by the trunk of the superior mesenteric artery, and its intestinal branches constituted a 'nested formation' which had the following characteristics. (1) The branches of the trunk were distributed to both sides of the apex, and the distribution regions of younger branches were located more distant from the apex than those of older branches. (2) Two branches directed towards both sides of the trunk frequently made a common stem arising from the trunk. The second branch of the superior mesenteric artery constituted a secondary trunk and its distribution region could be defined as a secondary apex, since 1 of its branches also constituted a nested formation which was distributed to both sides of the primary and secondary apices. The intestinal branches of the superior mesenteric artery were divided into 4 types on the basis of their pattern of branching and course. It is suggested that the nested formation of the superior mesenteric artery in the bullfrog is a remnant of the vascular pattern of the tadpole, which possesses a double spiral mode of intestinal convolution, probably supplied by arteries with the nested formation in a latent form.     

Testosterone inhibits immunoglobulin production by human peripheral blood mononuclear cells

We studied the in vitro effect of testosterone on spontaneous immunoglobulin production by human peripheral blood mononuclear cells (PBMC). Testosterone inhibited IgG and IgM production by PBMC both from males and females. The inhibitory effect of testosterone was revealed at doses more than 1 nm, increased dose-dependently, and reached a plateau at 100 nm. At doses <1000 nm, testosterone did not reduce cell viability. Testosterone treatment reduced IgG production by 59.0% and that of IgM by 61.3% compared with control. Immunoglobulin production by B cells was also suppressed by testosterone, though the magnitude of the suppressive effect on B cells was lower than that on whole PBMC; testosterone-induced decrease of IgG production compared with control was 26.9% and that of IgM was 24.9%. Exogenous IL-6 partially restored the impaired immunoglobulin production of testosterone-treated PBMC; IgG production in testosterone culture was increased by IL-6 from 35.6% to 66.5% of control and that of IgM was also increased from 38.9% to 71.2%, respectively. Testosterone treatment reduced IL-6 production of monocytes by 78.4% compared with control, but neither affected that of T cells or B cells. These results suggest that testosterone may suppress immunoglobulin production of human PBMC directly by inhibiting B cell activity and indirectly by reducing IL-6 production of monocytes. It is thus indicated that this hormone may have protective and therapeutic effects on human autoimmune diseases.     

Epidural air associated with spontaneous pneumomediastinum in children: Uncommon complication?

BACKGROUND: The purpose of the present study was to evaluate the incidence of epidural air associated with spontaneous pneumomediastinum in children. METHODS: The subjects consisted of 25 boys and 17 girls with an age range of 3-14 years (mean age: 8.5 years) who underwent chest computed tomography (CT) for evaluation of spontaneous pneumomediastinum. The CT scans and medical records were reviewed retrospectively. RESULTS: Of the 42 patients, four (9.5%) had intraspinal air on CT. The air was interpreted as epidural in every patient. The small number of patients with epidural air meant that there was no significant difference in age, gender, or clinical manifestations between groups with and without epidural air. Subcutaneous emphysema was identified in all four patients with epidural air versus 18 out of 38 patients (47%) without epidural air. The patients with epidural air did not have any neurologic symptoms. Irrespective of the presence or absence of epidural air, every patient had a favorable outcome without any serious complications. CONCLUSION: In patients with spontaneous pneumomediastinum, epidural air may be more common than was previously realized. It is suggested that an air leak may spread from the mediastinum into the epidural space via the cervical fascial planes and neural foramina.     

The diagnostic value of kappa/lambda ratios determined by flow cytometric analysis of biopsy specimens in B‐cell lymphoma

Flow cytometry (FC) is widely utilized in the diagnosis of lymphoma and the light chain ratio (LCR) is especially useful in the diagnosis of B‐cell malignancy. In this study we analysed, retrospectively, the predictive value of the LCR in the diagnosis of B‐cell lymphoma in 105 consecutive patients with persistent lymph node enlargement or extranodal masses who underwent biopsy. We used a receiver‐operating characteristic curve to establish a LCR threshold value of 2.0. The specificity, sensitivity, positive and negative predictive values were 92.3%, 73.1%, 90% and 77%, respectively. We concluded that determination of LCR is a useful adjunct to pathological diagnosis.