Somatosensory and skin temperature disturbances caused by infarction of the postcentral gyrus: a case report

Somatosensory functions are subdivided into 2 large groups: the elementary somatosensory functions, which consist of light touch, pain, thermal sensation, joint position sense, and vibration sense, and the intermediate somatosensory functions, which include 2-point discrimination, tactile localization, weight, texture, and shape perception. In this report, we describe a patient with somatosensory dysfunction after infarction of the postcentral gyrus. On physical examination a month after the onset of the infarction, voluntary movements were skillful, and both the elementary and intermediate somatosensory functions were disturbed in the right hand. The patient also displayed a decrease in the skin temperature of the right hand. The sensory-evoked potential in response to electrical stimulation of the right median nerve was normal, and brain MRI showed that the infarction was located in the posterior half of the left postcentral gyrus. These findings suggested that the lesion was situated at areas 1 and 2, and that area 3b was preserved. Thermography revealed that the skin temperature of the right hand was decreased predominantly on the ulnar side, and that recovery from cooling with ice water was delayed. By comparing the results of our patient with a case report that showed no disturbance of the elementary somatosensory functions with a localized lesion in the postcentral gyrus, we suggest that area 1 participates in the elementary somatosensory functions and that skin temperature may be controlled somatotopically in the somatosensory cortex.     

Role of microthrombus formation in the development of ischemia/reperfusion-induced liver injury in rats

Although tumor necrosis factor-a (TNF-alpha) has been shown to play a critical role in the pathologic process leading to ischemia/reperfusion (I/R)-induced liver injury in rats by activating neutrophils, it is not clear whether or not microthrombus formation induced by TNF-alpha contributes to the liver injury. In the present study, we investigated the role of microthrombus formation in I/R-induced liver injury in rats. Hepatic tissue levels of TNF-alpha were significantly increased after reperfusion, and these were higher in animals subjected to 120 min-hepatic I/R than in those subjected to 60 min-hepatic I/R. Fibrin deposition was observed histologically in the hepatic sinusoidal space only in animals subjected to 120 min-hepatic I/R. Both the decrease in hepatic tissue blood flow and the extent of liver injury in animals subjected to 60 min- and 120 min-hepatic I/R were significantly inhibited by pretreatment with anti-rat TNF-a antibody. Although neutrophil elastase inhibitors inhibited the decrease in hepatic tissue blood flow and reduced liver injury in animals subjected to 60 min-hepatic Y/R, anticoagulants did not show any effects. Both anticoagulants and neutrophil elastase inhibitors inhibited the decrease in hepatic tissue blood flow and reduced liver injury in animals subjected to 120 min-hepatic I/R. Therapeutic effects of anti-rat TNF-a antibody on the 120 min-I/R-induced liver injury were more marked than those of each anticoagulant or each neutrophil elastase inhibitor, and were comparable to those of combined use of anticoagulants and neutrophil elastase inhibitors. These observations strongly suggest that TNF-alpha induces I/R-induced liver injury primarily by activating neutrophils, and it exacerbates liver injury by inducing microthrombus formation when the production of TNF-alpha is further increased.     

Suppressive effect of callosotomy on epileptic seizures is due to the blockade of enhancement of cortical reactivity by transcallosal volleys

The present work demonstrates that the cortical reactivity of the rat, monitored by thalamocortical responses, can be enhanced by repetitive transcallosal volleys (5-20 Hz). This effect can be completely inhibited by callosotomy. We believe that the interhemispheric epileptogenesis and the suppressive effect of callosotomy for intractable epilepsy can be explained by this facilitatory effect of the corpus callosum on the cerebral cortex.     

Oxygen embolism after intraoperative use of hydrogen peroxide

Hydrogen peroxide is widely used for irrigation of surgical wounds. However, its administration has been associated with gas embolism. We report a case of gas embolism after wound irrigation with hydrogen peroxide in a 11-year-old boy undergoing extraction of the extra-traumatic splint under general anesthesia. When 3% hydrogen peroxide 12 ml was applied to wound of the left femur after extraction of the splint, the patient showed clinical signs of pulmonary embolism. Symptomatic treatment was initiated immediately. When the patient awoke from anesthesia, he showed tonic convulsion. But he recovered without any complications. The administration of hydrogen peroxide into a closed tissue is contraindicated during surgery.     

Anesthesia in a patient with relapsing polychondritis

A 46-year-old female with relapsing polychondritis (RP) was scheduled for surgical repair of saddle-nose and peri-chondritic ear. RP is a rare systemic, inflammatory, and destructive disease of the cartilaginous structures leading to multiple functional disorders in the affected organs. Preoperatively, her chest radiogram of the trachea showed narrowing in diameters which altered about 2 mm with expiration and inspiration. Propofol administered intravenously was given as induction and anesthesia was maintained with nitrous oxide-oxygen-sevoflurane with spontaneous ventilation using laryngeal mask airway. The operation was over uneventfully. Anesthesiologic management requires careful preoperative evaluation of vital organ functions, in particular, respiration.     

Awake craniotomy with propofol sedation and a laryngeal mask airway: a case report

A 47-year-old man with brain tumor close to the speech center was scheduled for biopsy under awake craniotomy. Anesthesia was maintained with continuous infusion of propofol and intermittent fentanyl. Airway was secured with a laryngeal mask throughout the surgery. During cortical stimulation, his phonation was clear and there was no evidence of hypoxia.     

The analysis of thymidine phosphorylase examined by ELISA in bladder cancer

PURPOSE: Some reports suggest that the high level expression of thymidine phosphorylase (TP), which is known as one of angiogenic factors, is related to high malignancy and also poor prognosis in the field of gastrointestinal cancer. So the authors investigated the expression of TP in bladder cancer. MATERIALS AND METHODS: The expression of TP in cancer tissues and normal tissues, which were obtained during transurethral resection of the tumor of 66 patients with initial primary bladder cancer, was examined by enzyme-linked immunosorbent assay (ELISA). And relationship of the TP expression and clinicopathologic factors was investigated. RESULTS: The level of TP expression was significantly high in cancer tissues compared with normal tissues (P < 0.0001). About the level of TP expression of cancer tissues, there was a significant difference between G1 and G3 in grade (P = 0.0099), Ta and T2 or greater (P = 0.0059), Ta, T1 and T2 or greater (P = 0.0157) in T stage, papillary and non-papillary in surface form (P = 0.0056), pedunculated and sessile in tumor shape (P = 0.0458), and 1 cm or under and 3 cm or greater in size (P = 0.0267). The level was higher in latter, respectively. About the level of TP expression of normal tissues, the level was significantly higher in the cases with sessile tumor than the cases with pedunculated tumor (P = 0.0078). CONCLUSION: There is correlation between the level of TP expression of cancer tissues and their grade of malignancy, so we can expect that the level of TP expression of cancer tissues will be a prognostic factor. And what does it mean in the fact that the level of TP expression of normal tissues in patients with sessile tumor is higher? It should be clear after accumulation of the cases and collecting the episodes in the follow-up period.     

De novo formation and rupture of an aneurysm. Case report

The authors describe a case of de novo formation and rupture of an aneurysm located at the junction of the left internal carotid artery and the superior hypophyseal artery in a middle-aged woman 2 months after another aneurysm, located on the anterior communicating artery, had been clipped. This case is rare because of the short interval between the last angiographic study performed at the first operation and the diagnosis of the de novo aneurysm; in this case the interval was only 47 days, compared with other cases in the literature in which the intervals were 3 to 34 years. Aneurysms can enlarge considerably in 2 to 4 weeks and can rupture at or soon after their formation. This case provides insight into aneurysm formation and rupture.     

Analysis of homozygous deletion of the p16 gene and correlation with survival in patients with glioblastoma multiforme

OBJECT: One of the most frequent genetic abnormalities found in patients with glioblastoma multiforme (GBM) is homozygous deletion of the p16 tumor suppressor gene. The authors investigated whether this deletion is associated with prognosis in patients with GBM. METHODS: In 46 adult patients with supratentorial GBM, homozygous deletion of the p16 gene in tumor DNA was examined using the multiplex polymerase chain reaction assay. The deletion was confirmed in 14 (30.4%) of 46 patients, eight (30.8%) of 26 men and six (30.0%) of 20 women. Cox proportional hazard regression analysis, adjusted for age at surgery, the Karnofsky Performance Scale score, extent of resection, and the MIB-1 labeling index. revealed that homozygous deletion of the p16 gene was significantly associated with overall survival and progression-free survival in men, but not in women. CONCLUSIONS: The results of this study suggest that p16 homozygous deletion is a significant unfavorable prognostic factor in male patients with GBM.     

Low-protein diet induces oral tolerance to ovalbumin in mice

The suitable development of oral tolerance against ingested dietary foods is of critical importance to escaping food allergy. Using mice as an animal model for oral tolerance against ovalbumin (OVA) as a dietary antigen, we investigated the effects of dietary protein on their immunological tolerance. Female BALB/c mice fed either a 20% or 5% protein diet were orally administered 5 mg of OVA for four consecutive days, then immunized intraperitoneally with 100 microg of OVA. The immunized group of mice were fed and treated in the same manner, except that they received orally distilled water for four consecutive days before receiving intraperitoneal immunization with the antigen. Immunization alone with OVA elevated the total IgE and induced the production of OVA-specific antibodies IgE, IgG, IgG1, and IgG2a in the sera of both the 20% and 5% protein diet groups. The oral administration of OVA to mice before intraperitoneal immunization significantly reduced the total IgE and OVA-specific antibodies in mice fed 5% protein diet, but it had hardly any effect on those in mice fed a 20% protein diet. When spleen cells from these groups of mice were cultured with OVA as a mitogen, they responded substantially to OVA in the immunized groups fed 20% and 5% protein diets and in the presensitized group fed 20% protein, but those from the presensitized group fed a 5% protein diet did not respond. Furthermore, when IL-4 was assayed in the spleen cell cultures of the 20% and 5% groups, mice in the presensitized group fed a 5% protein diet produced a significantly less amount of IL-4 than those fed a 20% protein diet. Moreover, irrelevant to the protein amount in the diet, the production of IFN-gamma from spleen cell cultures dramatically decreased in the group without presensitization and profoundly increased in the presensitized group of mice fed a 5% protein diet. These findings suggest that a low-protein diet leads to an induction of oral tolerance against dietary antigens; this appears to involve a clear down-regulation of Th2 cytokine, IL-4.