Three cases of 'mechanic's hands' associated with interstitial pneumonia: possible involvement with foot lesions

We describe three cases of the rare combination of lateral erythema and hyperkeratosis of the fingers that typify a condition known as 'Mechanic's Hands'. The first and the third cases were unusual in that the condition was associated with cutaneous involvement of the feet and interstitial pneumonia but not with myositis, or with only mild muscular involvement, while the second case was typical, being accompanied by myositis and detectable antibodies against histidyl transferase. We propose that Mechanic's Hands can occur in association with foot lesions and interstitial pneumonia, even if it is not accompanied by myositis.     

Two types of direction-changing positional nystagmus with neutral points

Objectives

We encountered patients who had static direction-changing positional nystagmus (DCPN) canceled at about 20-30° yaw head rotation from the supine position. This nystagmus was also canceled when the head was rotated 180° from this position. We termed these head positions neutral points. The positional nystagmus observed (except at the neutral points) was thought to occur due to a “heavy cupula” or “light cupula”. The purpose of this study was to examine DCPN with neutral points as well as the pathomechanism of this condition.

Methods

Retrospective case review of patients attending two hospitals. Sixteen patients who exhibited DCPN with neutral points were examined using an infrared camera (installed in goggles). Using this system, the vestibulo-ocular reflex (VOR) was recorded, and VOR gain was obtained. Vestibular function and the affected side were determined. In addition, the angle between the supine position and neutral point was measured in each patient. We also examined other positional nystagmus occurring at other times.

Results

In the heavy cupula type group, we noted positional nystagmus for which repositioning maneuvers were successful, whereas, in the light cupula type group, repositioning maneuvers were not effective. The angle between supine position and neutral point was 26.5 ± 11.6°.

Conclusions

Heavy cupula type may occur as a result of otoconia while light cupula type may be due to the specific gravity of the endolymph. The VOR gain and side of the benign paroxysmal positional vertigo (BPPV) observed suggested that the affected side was that to which the neutral point was deviated.     

Radiologic placement of side-hole catheter with tip fixation for hepatic arterial infusion chemotherapy

PURPOSE: To investigate the technical outcome of radiologic catheter placement with use of a side-hole catheter with distal fixation for hepatic arterial infusion chemotherapy. MATERIALS AND METHODS: Between January 1993 and September 1999, 426 patients were referred to our department to undergo intraarterial infusion chemotherapy for unresectable malignant liver tumors. A subclavian artery was exposed under local anesthesia and a catheter was inserted. After inserting the tip of the side-hole catheter into the gastroduodenal artery, splenic artery, or peripheral branch of the hepatic artery, the catheter tip was fixed to the vessel with use of coils and a mixture of n-butyl cyanoacrylate (NBCA) and iodized oil. The proximal end of the catheter was connected to an implanted port, and the port system was embedded subcutaneously. RESULTS: Placement was successful in 425 of 426 patients (99.8%) in a mean time of 76 minutes. Catheter dislodgement was noted in 12 patients (2.8%). Cumulative patency rates of the hepatic artery calculated according to the Kaplan-Meier method for the entire group were 91.0%, 81.4%, and 58.1% at 6 months and 1 and 2 years, respectively. Complications related to catheter placement were observed in nine cases and included dysfunction of the implanted system (n = 3), significant bleeding around the implanted port (n = 2), improper infusion of NBCA and iodized oil (n = 2), and cerebral infarction (n = 2). CONCLUSION: Radiologic catheter placement via a subclavian artery with side-hole catheter placement with distal fixation for hepatic arterial infusion chemotherapy is a highly successful procedure with a reduced risk of catheter dislodgment and arterial occlusion.     

Dose-range effects of propofol for reducing emetic symptoms during cesarean delivery.

OBJECTIVE: To evaluate the efficacy and safety of propofol at subhypnotic doses for reducing emetic symptoms in parturients undergoing cesarean delivery under spinal anesthesia. METHODS: In a randomized, double-masked trial, 80 patients received lidocaine intravenously 0.1 mg/kg (for injection pain relief) followed by either placebo or propofol at three different doses (0.5 mg/kg per hour, 1.0 mg/kg per hour, 2.0 mg/kg per hour) (n = 20 in each group) immediately after clamping of the umbilical cord. Emetic episodes and safety assessments were performed during spinal anesthesia for cesarean delivery. To estimate a sufficient sample size, it was calculated that 20 patients per group would be required with alpha =.05 and beta =.2. RESULTS: The rate of patients experiencing no emetic symptoms in an intraoperative, postdelivery period was 45% with propofol 0.5 mg/kg per hour (P =.5), 80% with propofol 1.0 mg/kg per hour (P =.011), and 80% with propofol 2.0 mg/kg per hour (P =.011), compared with placebo (40%). No clinically serious adverse events caused by the study drugs were observed. CONCLUSION: Propofol 1.0 mg/kg per hour is the minimum effective subhypnotic dose for reducing emetic symptoms during cesarean delivery. Increasing the dose to 2.0 mg/kg per hour provides no further benefit.     

Inhibition of contact activation by a kininogen peptide (HKH20) derived from domain 5

Contact activation can be initiated by interaction of Factor XII, prekallikrein (PK) and high molecular weight kininogen (HK) with inorganic negatively charged biologic macromolecules, or upon cell surfaces, or interaction with membrane protein derivatives such as aggregated beta amyloid. The latter two examples are zinc-dependent. The interaction with cells is dependent on peptides derived from HK domains 3 and 5 termed LDC27 and HKH20, respectively. We have tested the ability of each of these peptides to inhibit HK-dependent contact activation. HKH20 inhibited activation of prekallikrein when a mixture containing HK, prekallikrein and Factor XII was incubated with dextran sulfate, gC1qR, amyloid beta or endothelial cells. Comparable quantities of LDC27 had no effect. The binding of biotinylated HK or biotinylated Factor XII was inhibited in a dose response fashion by increasing concentrations of HKH20 while LDC27, again had no effect. The N-terminal region of HKH20 (amino acids 475-485) is of particular importance for binding and histidine 485 prominently enhances the reaction as assessed employing overlapping and deleted peptides. Since there is a role for HK heavy chain in binding to endothelial cells and LDC27 can be employed as an affinity ligand to isolate the binding proteins, we increased the LDC27 concentration from 10-fold to 250-fold to determine whether it is functional. Inhibition of endothelial cell-dependent prekallikrein activation required 100-fold greater concentration of LDC27 when compared to HKH20 to achieve significant inhibition. We conclude that the interactions of the light chain of HK via HKH20 is of particular importance for activation of the bradykinin forming cascade in zinc-dependent or independent reactions and is true for all "surface" initiators tested thus far.     

Contribution of CYP4A8 to the formation of 20-hydroxyeicosatetraenoic acid from arachidonic acid in rat kidney

20-Hydroxyeicosatetraenoic acid (20-HETE) has been shown to be an arachidonic acid metabolite of the cytochrome P450 (CYP) enzymes belonging to the CYP4A subfamily and is a predominant regulator of renal vascular tone and tubular ion reabsorption in rat kidney. CYP4A8 is one of the CYP4A enzymes expressed in rat kidney, but its contribution to 20-HETE formation has not been assessed. In order to clarify that the role of CYP4A8, we have developed bacterial expression systems for the expression of recombinant CYP4A8 (rCYP4A8). We also produced an antibody against rCYP4A8 which was used for immunoinhibition and immunohistochemical studies. In a reconstituted system, rCYP4A8 sufficiently catalyzed 20-HETE formation as well as prostaglandin A(1) omega-hydroxylation, a marker activity for CYP4A8. In addition, anti-rCYP4A8 sera significantly inhibited prostaglandin A(1) omega-hydroxylation and strongly inhibited arachidonic acid omega-hydroxylation in rat kidney microsomes. These observations suggested for the first time that CYP4A8 also contributed to 20-HETE formation in rat kidney. Furthermore, immunohistochemstry suggested that CYP4A8 is present in preglomerular arteries, where 20-HETE has been established to be a vasoconstrictor.