ASPLENIA AND POLYSPLENIA SYNDROME

This report described the morphological characteristics of seven cases of asplenia syndrome and three of polysplenia syndrome. Each syndrome has been characterized by a tendency for symmetric development of normally asymmetric organs, with varying degrees of cardiovascular anomalies. These latter anomalies are usually present in asplenia syndrome to a greater extent than in polysplenia syndrome. While, as observed in our material, the conotruncal anomalies were present more commonly in cases with asplenia, and absence of inferior vena cava with azygos continuation was seen specifically in all the cases with polysplenia. This evidence implied the presence of some pathogenetic distinction between the two syndromes. ACTA PATHOL. JPN. 32: 505∼511, 1982.     

Pediatric oncologic emergencies: Clinical and imaging review for pediatricians

Children with cancer are at increased risk of life‐threatening emergencies, either from the cancer itself or related to the cancer treatment. These conditions need to be assessed and treated as early as possible to minimize morbidity and mortality. Cardiothoracic emergencies encompass a variety of pathologies, including pericardial effusion and cardiac tamponade, massive hemoptysis, superior vena cava syndrome, pulmonary embolism, and pneumonia. Abdominal emergencies include bowel obstruction, intussusception, perforation, tumor rupture, intestinal graft‐versus‐host disease, acute pancreatitis, neutropenic colitis, and obstructive uropathy. Radiology plays a vital role in the diagnosis of these emergencies. We here review the clinical features and imaging in pediatric patients with oncologic emergencies, including a review of recently published studies. Key radiological images are presented to highlight the radiological approach to diagnosis. Pediatricians, pediatric surgeons, and pediatric radiologists need to work together to arrive at the correct diagnosis and to ensure prompt and appropriate treatment strategies.     

Comparative pharmaceutical evaluation of brand and generic clobetasone butyrate ointments

In the present study, we performed comprehensive pharmaceutical evaluation among an original clobetasone butyrate (CLB) ointment product and three generic products. Although spherocrystal images were observed under a polarizing microscope for only Kindavate^®, the original product, distribution of active and inactive ingredients was chemically equivalent between the original and generic medicine by the attenuated total reflection infrared spectroscopy. These results suggest that the spherocrystals observed in Kindavate^® are composed of hydrocarbon. On GC/MS, it was revealed that linear alkanes having 25–27 carbon atoms are densely present in Sun White^®, the base used in Kindavate^®. On the other hand, linear alkanes having 22–31 carbon atoms were broadly distributed in most other white petrolatums. In the CLB ointment products, the distribution equivalent of linear alkane to Sun White^® was observed only in Kindavate^®. Thus, the GC/MS method is extremely useful for identification of white petrolatum used in the ointment.     

Septicemia due to Vibrio cholerae serogroup non-O1/non-O139 strain in a cirrhotic patient

We describe a case of non-O1/ non-O139?Vibrio cholerae septicemia in a 65-year-old male patient with alcoholic liver cirrhosis. He was admitted due to septic shock from non-O1/ non-O139 V. cholerae. An intravenous empiric antibiotic, ceftriaxone sodium hydrate, was administered together with amikacin sulfate, gamma globulin and dopamine. He was discharged feeling well 17?days after admission. Poor host defense mechanisms as seen in cirrhotic patients seem to be a determinant for systemic infection of non-O1/ non-O139 V. cholerae. Such patients should be warned and educated against eating raw or undercooked seafood to avoid the occurrence of non-O1/non-O139 V. cholerae septicemia.     

Retrospective study of teeth with a poor prognosis following non-surgical periodontal treatment

Aim: The aim of this retrospective study was to assess teeth with a poor prognosis and the proximal periodontium of adjacent teeth, and to identify the risk factors associated with the loss of teeth with a poor prognosis following non-surgical periodontal treatment.
Material and Methods: Teeth with a poor prognosis ( n =113), teeth adjacent to those of poor prognosis ( n =105) and non-adjacent teeth ( n =51) were evaluated in 25 non-smoking patients who had received supportive periodontal treatment for 5–16 years following non-surgical periodontal treatment at a university hospital.
Results: Probing pocket depth (PPD), percentage of alveolar bone loss, presence of tooth mobility and bleeding on probing in all teeth improved significantly after treatment. Logistic regression analysis showed that loss of teeth with a poor prognosis depended on the initial deepest PPD, tooth mobility and multi-rooted tooth.
Conclusions: Teeth with a poor prognosis did not affect the proximal periodontium of the adjacent teeth, and progression of periodontal disease in these teeth and adjacent teeth can be prevented by non-surgical periodontal treatment in non-smokers. The risk factors for loss of teeth with a poor prognosis were the initial deepest PPD, tooth mobility and multi-rooted tooth.     

Association between activity level and changes in bodyweight in dementia patients

Introduction: Bodyweight is routinely used as an important health assessment measure in care facilities. Recently, the integrated circuit (IC) tag monitoring system became available for measuring the distance walked by patients with dementia (PsWD) over an extended period. The main objective of the present study was to examine an association between the distance walked and changes in bodyweight in PsWD. Methods: Monitoring was conducted in a semi‐acute dementia care unit in Japan between November 2006 and March 2007. All patients had been diagnosed with dementia and were able to walk independently. Demographic and food intake data were obtained from medical records. Bodyweight was measured weekly. The monitoring system calculated the distance walked. The study was approved by the Ethics Committees of Osaka University and Asakayama Hospital and written informed consent was obtained from authorized proxies. Results: In total, 23 patients were monitored. The median distance walked per day for all subjects was 1042.7 m (range 136–7781m) and the mean rate of weight change per month was ?0.1 kg (range ?1.5 to 2.4 kg). The mean food intake per day was 97 ± 5% (range 79–100%). There was a significant negative correlation between median distance walked per day and rate of weight change per month (r = ?0.52; P < 0.05). Distance walked per day was divided into three groups (<1 km, 1–2 km and ≥ 2 km), but there was no change in mean food intake between the three groups. However, PsWD who walked ≥ 2 km/day tended to have higher total Neuropsychiatric Inventory–Nursing Home Version (NPI‐NH) scores and a higher number of symptoms than those who walked < 2 km/day. The former tended to have aberrant motor activity compared with the latter. Conclusion: The present study shows that the distance walked per day seems to play a major role in weight change. Because the IC tag monitoring system can measure the distance walked accurately over an extended period, it could be used to estimate the calorie expenditure for each patient and to reduce the various risks related to weight loss.     

Gender differences in factors associated with suicidal ideation in major depression among cancer patients

Objective: Major depression is a well‐documented risk factor for suicide, and several gender differences in risk factors for suicide exist in cancer patients as well as in the general population. However, no data is available regarding gender differences in risk factors for suicide among cancer patients with major depression. Methods: We investigated the background differences between cancer patients suffering from major depression with or without suicidal ideation according to gender by analyzing the consultation data obtained for patients referred to the Psychiatry Division. Results: Among the 5431 referred patients, 329 males and 399 females were diagnosed as having major depression; among these patients with major depression, 136 (41%) males and 157 (39%) females also had suicidal ideation. A preliminary analysis showed that physical functioning and an advanced stage were potential factors that interacted significantly with gender differences regarding suicidal ideation. A final logistic regression analysis indicated that poor physical functioning and an advanced stage were significant risk factors among male patients. Conclusions: These preliminary findings suggest that gender differences in important indicators of suicidal ideation exist among cancer patients with major depression; these findings may be useful for developing strategies to prevent suicide among cancer patients. Copyright © 2009 John Wiley & Sons, Ltd.     

Successful treatment for a benign esophagorespiratory fistula with perioperative nutritional management and multistep esophageal bypass operation: a case report

A 49-year-old man was referred to our hospital for treatment of an esophagorespiratory fistula following 5-year airway stenting for stenosis of tracheal anastomosis. In consideration of the prior polysurgery and the patient’s poor general status and malnutrition, we selected multistep esophageal bypass combined with feeding enterostomy for nutritional support. Respiratory symptoms and pneumonia were rapidly improved by esophageal transection and decompression via a catheter esophagostomy. Nutritional status was also improved by enteral nutrition via a catheter gastrostomy. Four months after the esophageal transection, we conducted an esophageal bypass using an ileocolonic conduit because the right gastroepiploic artery had been used for omental reinforcement of tracheal anastomosis. The patient had no postoperative complications and was discharged 53 days after the bypass surgery. Multistep esophageal bypass including feeding enterostomy for perioperative nutritional management is a safe and useful alternative to direct closure for a critically ill patient with an esophagorespiratory fistula who is at high risk for operative mortality.