Sudden death in a youth. A case of quadricuspid aortic valve with isolation of origin of left coronary artery.

A youth of 16 years of age died suddenly and quite unexpectedly while walking to school. The necropsy disclosed a quadricuspid aortic valve with complete isolation of the left coronary artery by an adherent aortic valve cusp. The left ventricular myocardium showed subendocardial contraction band necrosis suggesting that critical ischaemia had triggered a state of hypercontraction, in keeping with ventricular fibrillation as the immediate cause of death. The site of the anomaly in the aortic root showed dysplasia of the aortic wall and the affected valve cusp, histologically similar to the changes that characterise supravalvar aortic stenosis. The findings suggest a developmental anomaly, possibly a forme fruste of supravalvar aortic stenosis, rather than a postnatally acquired condition.     

Attitudes of Japanese nursing personnel toward patients who have attempted suicide

Objective

The aim of this study was to examine the attitudes among Japanese nurses together with their perceived need for training in relation to understanding the nature of suicidal behavior and preventive strategies.

Methods

The Understanding Suicidal Patients scale together with additional questions reflecting training and the psychiatric treatment of suicide attempters were administered.

Results

A total of 323 nurses attended this study. Overall, the nurses thought patients who attempted suicide were not treated well. The nurses who worked in the psychiatric unit or had the experience in psychiatric nursing had more favorable attitudes toward suicidal patients and viewed themselves as having more relevant skill training in dealing with suicidal patients than those who did not. The nurses who worked at emergency care/intensive care unit were less likely to understand suicidal patients, and were less inclined to be sympathetic and to verbally interact with suicidal patients concerning their problems. The nurses who have confidence in the psychiatric care of suicidal patients, confidence in their own skills, and have a need for more training had the more positive attitudes.

Conclusions

The results suggest that less favorable attitudes may to some extent be the result of lack of knowledge regarding suicidal patients. Future studies should focus on the evaluation of educational experiences on attitudes and skill acquisition of nurses.     

Selection Criteria for Kidney Laterality in Retroperitoneoscopic Living Donor Nephrectomy and the Usefulness of Pretransplant Intervention

Objectives

To evaluate the selection criteria for kidney laterality and the usefulness of pretransplant intervention in living donor nephrectomy.

Severe Neonatal Nemaline Myopathy—Histological and Histochemical Studies of Respiratory Muscles—

The histological and histochemical findings in the respiratory muscles of a patient with severe neonatal nemaline myopathy are described. The patient suffered from frequent pneumonia associated with vomiting due to gastroesophageal reflux and died at 3 months from respiratory failure. The diaphragm was moderately involved and the intercostal muscles mildly involved. Core/targetoid structures were observed in the diaphragm and intercostal muscles.     

Alteration of histological gastritis after cure of Helicobacter pylori infection

BACKGROUND: It is still disputed whether gastric atrophy or intestinal metaplasia improves after the cure of Helicobacter pylori infection. AIM: To clarify the histological changes after the cure of H. pylori infection through a literature survey. METHODS: Fifty-one selected reports from 1066 relevant articles were reviewed. The extracted data were pooled according to histological parameters of gastritis based on the (updated) Sydney system. RESULTS: Activity improved more rapidly than inflammation. Eleven of 25 reports described significant improvement of atrophy. Atrophy was not improved in one of four studies with a large sample size (> 100 samples) and in two of five studies with a long follow-up period (> 12 months), suggesting that disagreement between the studies was not totally due to sample size or follow-up period. Methodological flaws, such as patient selection, and statistical analysis based on the assumption that atrophy improves continuously and generally in all patients might be responsible for the inconsistent results. Four of 28 studies described significant improvement of intestinal metaplasia [corrected]. CONCLUSIONS: Activity and inflammation were improved after the cure of H. pylori infection. Atrophy did not improve generally among all patients, but improved in certain patients. Improvement of intestinal metaplasia was difficult to analyse due to methodological problems including statistical power.     

Ependymal cell reactions in spinal cord segments after compression injury in adult rat

Recently, it has been suggested that neural stem cells and neural progenitor cells exist in the ependyma that forms the central canal of the spinal cord. In this study, we produced various degrees of thoracic cord injury in adult rats using an NYU-weight-drop device, assessed the degree of recovery of lower limb motor function based on a locomotor rating scale, and analyzed the kinetics of ependymal cell proliferation and differentiation by proliferating cell nuclear antigen (PCNA), nestin, glial fibrillary acidic protein (GFAP), or GAP-43 immunostaining. The results showed that the time course of the ependymal cell proliferation and differentiation reactions differed according to the severity of injury, and that the responses occurred not only in the neighborhood of the injury but in the entire spinal cord. An increase in the locomotor rating score was related to an increase in the number of PCNA-positive cells, and the differentiation of ependymal cells into reactive astrocytes was involved in injury repair. No apoptotic cells in the ependyma were detectable by the TUNEL method. These results indicate that the ependymal cells of the spinal central canal are themselves multipotent, can divide and proliferate according to the severity of injury, and differentiate into reactive astrocytes within the ependyma without undergoing apoptosis or cell death.     

Responses of hepatic glucose output to noxious mechanical stimulation of the skin in anaesthetised rats

Responses of hepatic glucose output (HGO) to noxious mechanical stimulation of different skin areas were investigated in anaesthetised rats with central nervous system intact or acutely spinalized at the thoracic 1-2 (T1-T2) level by focusing on the involvement of the sympathetic and parasympathetic nerves in the responses of HGO. We measured HGO with a microdialysis probe implanted into the left lateral lobe of the liver. Pinching was applied to bilateral skin areas of the abdomen and hindlimb for 10 min. Atropine was injected in order to block the action of the parasympathetic nerves, whereas phentolamine and propranolol were injected in order to block the action of the sympathetic nerves. The HGO started to increase immediately after the cessation of pinching of the abdomen and the hindlimb, and lasted for 30 min. The increase of HGO was observed during stimulus period in animals pretreated with atropine, and totally abolished in animals pretreated with phentolamine and propranolol. The responses of HGO to abdominal pinching, but not to hindlimb pinching, remained after spinal cord transection at the T1-T2 level. The present results suggest that HGO is regulated as a reflex response via both sympathetic and parasympathetic nerves by noxious mechanical stimulation of the skin. Furthermore, it was shown that relative contribution of the spinal and supraspinal organization to the somato-HGO responses was dependent on the skin areas stimulated.