Early detection of brain damages in status epilepticus using apparent diffusion coefficient mapping]

We report two patients of status epilepticus, in which detailed brain magnetic resonance image (MRI) studies were performed. In one patient apparent diffusion coefficient (ADC) increased in the right temporopareital regions in the acute phase. This patient finally has good clinical course without neurological deficits, and abnormal findings on MRI also disappeared. In another patient ADC increased in the similar regions in the acute phase, and an MRI demonstrated cortical laminar necrosis on T1-weighted scans in the same regions in the posticteric phase about 3 months later. The patient had a poorer prognosis with moderate dementia. It has been demonstrated that increased ADC reflects extracellular edema, while decreased ADC indicates cytotoxic edema. ADC mapping appears to be useful for predicting the reversibility of brain damages due to status epilepticus.     

Left Atrial ball thrombi without mitral valve disease treated by surgical removal

We describe two patients with free-floating left atrial ball thrombi with no evidence of cardiac disease except atrial fibrillation. One patient had experienced an embolic stroke, and the second patient had a history of stroke and peripheral thromboembolism. In each patient, the thrombi, which were not visible on transthoracic echocardiography, were detected by transesophageal echocardiography. Each patient underwent successful surgical removal using cardiopulmonary bypass.     

Percutaneous bare Z-stent implantation as an alternative to surgery for acute aortic dissection with visceral ischemia.

We describe a case of Stanford type B acute aortic dissection causing visceral ischemia. An aortogram showed an hourglass-like narrowing of the true lumen at the diaphragm with a 60 mm Hg pressure gradient. Placement of a self-expanding metallic Z-stent under intravascular ultrasound guidance restored blood flow to the viscera.     

Specific notch in early expiration region of a flow-volume curve in a case of Mounier-Kuhn syndrome]

A 75-year-old man presented at our hospital for evaluation of a chronic cough and sputa. Radiographic examination showed enlargement of the trachea and main bronchi. On chest radiography, the transverse diameter of the trachea was 39 mm at the level of the third thoracic spine. On bronchoscopy, the trachea and main bronchi were dilated on inspiration and were completely collapsed on expiration. A 3-D CT examination showed the trachea and main bronchi dilated, and the cartilage of the trachea and bronchi distorted. In pulmonary function testing, this disorder is characterized by the appearance of a specific notch in the early phase of expiration on the flow-volume curve.     

Effects of repeated sauna treatment on ventricular arrhythmias in patients with chronic heart failure.

BACKGROUND: The aim of the present study was to determine whether repeated 60 degrees C sauna treatment improves cardiac arrhythmias in chronic heart failure (CHF) patients, because ventricular arrhythmias are an important therapeutic target in CHF. METHODS AND RESULTS: Thirty patients (59+/-3 years) with New York Heart Association functional class II or III CHF and at least 200 premature ventricular contractions (PVCs)/24 h assessed by 24-h Holter recordings were studied. They were randomized into sauna-treated (n=20) or non-treated (n=10) groups. The sauna-treated group underwent a 2-week program of a daily 60 degrees C far infrared-ray dry sauna for 15 min, followed by 30 min bed rest with blankets, for 5 days per week. Patients in the non-treated group had bed rest in a temperature-controlled room (24 degrees C) for 45 min. The total numbers of PVCs/24 h in the sauna-treated group decreased compared with the non-treated group [848+/-415 vs 3,097+/-1,033/24 h, p<0.01]. Heart rate variability (SDNN, standard deviation of normal-to-normal beat interval) increased [142+/-10 (n=16) vs 112+/-11 ms (n=8), p<0.05] and plasma brain natriuretic peptide concentrations decreased [229+/-54 vs 419+/-110 pg/ml, p<0.05] in the sauna-treated group compared with the non-treated group. CONCLUSION: Repeated sauna treatment improves ventricular arrhythmias in patients with CHF.     

Definitive chemoradiotherapy with docetaxel,cisplatin, and 5-fluorouracil (DCF-R) for advanced cervical esophageal cancer

Background

Recently, definitive chemoradiotherapy (dCRT) has become one of the essential treatment strategies for esophageal squamous cell carcinoma (ESCC) and has been especially gaining prevalence for cervical ESCC to preserve the larynx. Our department recently introduced dCRT concomitant with docetaxel, cisplatin, and 5-fluorouracil (DCF-R) for treating advanced cervical ESCC. This study aims to assess the safety and outcomes of DCF-R in patients with advanced cervical ESCC.

Methods

We retrospectively assessed 11 patients with advanced cervical ESCC (clinical stage: II–IV, including T4b and/or M1 lymph node) who received DCF-R as the first-line treatment between December 2010 and February 2015.

Results

Our patient cohort comprised 8 males and 3 females (median age 68 years; range 54–76 years). The pretreatment clinical stage included stage II (1), stage III (7), and stage IV (3) cases [including 3 patients with T4b (2 trachea and 1 thyroid) and 3 patients with M1 lymph node]. We attained complete response (CR) in 10 patients and stable disease in 1 patient. Of 10 patients with CR, 5 experienced recurrence and 5 continued exhibiting CR. Furthermore, grade 3 or more adverse events included leucopenia (91%), neutropenia (91%), febrile neutropenia (45%), and pharyngeal pain (55%). While the 2-year overall survival rate was 72%, the 2-year recurrent-free survival rate was 64%, respectively.

Conclusions

DCF-R treatment for advanced cervical esophageal cancer could be completed by the careful administration; although a strong blood toxicity might occur, this treatment may provide the chance to obtain favorable prognosis with larynx preservation.

     

Amylase levels in bile in patients with a morphologically normal pancreaticobiliary ductal arrangement

Background We investigated the presence of occult pancreaticobiliary reflux in patients with a morphologically normal pancreaticobiliary ductal arrangement by measuring biliary amylase levels and compared histopathological findings of the gallbladder between groups with high and low biliary amylase levels. Methods In 178 patients with a normal pancreaticobiliary ductal arrangement who had undergone endoscopic retrograde cholangiopancreatography (ERCP), we sampled bile from the bile duct and measured amylase levels. Then we compared clinical features and histological findings of the gallbladder between high (HALG) and low amylase level groups (LALG). Results A high biliary amylase level was observed in 25.8% (46/178) of the patients. The prevalence of a high biliary amylase level was high in patients with gallbladder carcinoma (40%) and in those with choledocholithiasis (28.4%). The level of amylase in bile was high in patients with gallbladder carcinoma, adenomyomatosis of the gallbladder, and chronic cholecystitis. A strong correlation between the levels of amylase and lipase in bile and the dominance of amylase of pancreatic origin in bile were confirmed by isozyme analysis. Thickening of the gallbladder mucosa was a significant manifestation in HALG. Histological examination of the gallbladder mucosa showed that incidences of metaplastic change and atypical epithelium and Ki67-LI in were higher in HALG than in LALG. Conclusions Occult pancreaticobiliary reflux is observed in a considerable number of ERCP candidates. Those who show an extremely high biliary amylase level, at least, may be at high risk for biliary malignancies.     

Spatial and transmural properties of the reentrant ventricular tachycardia circuit in arrhythmogenic right ventricular cardiomyopathy: Simultaneous epicardial and endocardial recordings

1. Download : Download high-res image (308KB)
2. Download : Download full-size image