Multisystem Inflammatory Syndrome in Adults after Mild SARS-CoV-2 Infection,Japan

In Japan, a 51-year-old man had minimally symptomatic severe acute respiratory syndrome coronavirus 2 infection. Multisystem inflammatory syndrome was diagnosed ≈5 weeks later; characteristics included severe inflammation, cardiac dysfunction, and IgG positivity. Clinicians should obtain detailed history and examine IgG levels for cases of inflammatory disease with unexplained cardiac decompensation.     

The osseous structure of the carpal groove

Summary Transverse osseous structure of the carpal groove was studied using serial sections and microradiography. The width and area of the carpal groove were measured in x-ray films of each section. The wrist and carpal region was divided into six levels: 1) radio-ulnar joint level, 2) proximal level of the carpal bones, 3) intermediate level of carpal bones, 4) distal level of carpal bones, 5) the first C-M joint level, and 6) bases of the metacarpal bone level. The width of the carpal groove averaged 32 mm at the inlet and became narrower toward the outlet. Both inlet and outlet areas were small, the largest area was observed at the middle part. Although the carpal bones did not support the body weight, a remnant of the trajectorial architecture of the trabeculae was observed.

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La structure osseuse de la gouttière carpienne

Résumé La structure transversale des os de la gouttière carpienne a été étudiée à l'aide de coupes et par microradiographie. L'épaisseur et la superficie de la gouttière carpienne ont été mesurées sur des clichés aux rayons X de chacune de ces coupes. La région du poignet et du carpe a été divisée en six rangées: 1) la rangée de l'articulation radiocubitale, 2) la rangée proximale des os du carpe, 3) la rangée intermédiaire des os du carpe, 4) la rangée distale des os du carpe, 5) la rangée de la première articulation C-M et 6) la rangée de la base des os du métacarpe. L'épaisseur moyenne de la gouttière carpienne atteignait 32 mm à l'entrée, se rétrécissant en direction de la sortie. Tant la zone d'entrée que celle de sortie étaient de superficie réduite, la superficie la plus importante étant observée dans la partie médiane. Si les os du carpe ne supportent pas le poids du corps, un reste de structure trajectorielle des travées a cependant été observé.

     

Risk factors for hepatocellular carcinoma at baseline and 1 year after initiation of nucleos(t)ide analog therapy for chronic hepatitis B

Nucleos(t)ide analogs (NAs) cannot completely suppress the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). This study aimed to identify the risk factors for HCC development in naïve CHB patients treated with current NA. Patients receiving NA (n = 905) were recruited retrospectively from the 17 hospitals of the Japanese Red Cross Liver Study Group. All treatment-naïve patients had been receiving current NA continuously for more than 1 year until the end of the follow-up. We analyzed the accuracy of predictive risk score using the area under receiver operating characteristic curve. The albumin–bilirubin (ALBI) score was significantly improved by NA therapy (−0.171 ± 0.396; p < 0.001 at Week 48). A total of 72 (8.0%) patients developed HCC over a median follow-up of 6.2 (1.03–15.7) years. An independent predictive factor of HCC development was older age, cirrhosis, lower platelet counts at baseline and ALBI score, and alpha-fetoprotein (AFP) at 1 year after NA therapy according to multivariate analysis. The accuracy was assessed using the PAGE-B, mPAGE-B, aMAP, APA-B, and REAL-B scores that included these factors. Discrimination was generally acceptable for these models. aMAP and REAL-B demonstrated high discrimination with 0.866/0.862 and 0.833/0.859 for 3- and 5-year prediction from the status of 1 year after NA therapy, respectively. Baseline age and platelet count, as well as ALBI and AFP one year after NA, were useful for stratifying carcinogenesis risk. The aMAP and REAL-B scores were validated with high accuracy in Japanese CHB patients.     

Morphological study on glucocorticoid-induced cataract in developing chick embryo

Nishigori et al. reported a transient cataract model after administering glucocorticoid to a 15-day-old chick. Biochemically, the mechanism of onset of this cataract was thought to be related to damage caused by the formation of oxidative stresses and by a protein-water phase separation. There appear to be no reports on changes in the fine structure. After hydroocortisone succinate sodium was administered to 15-day-old chick embryos, the lenses were removed at 12, 24, 30, 48, 72 and 96 h and put in 4% gluraldehyde. The specimens were examined by light, transmission and scanning electron microscopy. Twelve to 24 h after administration to chick embryos, lens fibers containing electron-dense cytoplasm began to appear in the bow area of the equator and were still present thereafter. Thirty to 48 h after administration, numerous vacuoles of varying sizes began to appear in the lens in sites corresponding to the opaque region. These vacuoles, ranging from 2 to 8 m in diameter, were distributed in the intercellular spaces between the lens fibers. The vacuoles had disappeared by 96 h after administration, but during that period, the height of the epithelial cells in the equatorial region and the elongation of the equatorial lens fibers had become irregular. Transient opacity was due to the presence of vacuoles of various sizes, occurring in the intercellular space between the lens fibers around the lens nucleus. Moreover, the effect of glucocorticoid administration was noted in the lens epithelium and the lens fibers in the equatorial region.     

Efficacy of recombinant human granulocyte-macrophage colony-stimulating factor for chemotherapy-induced leukopenia in patients with non-small-cell lung cancer

To assess the feasibility and efficacy of rhGM-CSF in ameliorating chemotherapy-induced leukopenia in patients with advanced non-small-cell lung cancer, we conducted a double-blind placebo controlled phase III study in a multicenter setting. Patients were eligible if they had cytologically or histologically proven cancer, no prior chemotherapy, stage IIIB or IV disease, an Eastern Cooperativve Oncology Group (ECOG) performance status of 0–2, an age of less than 76 years, and no symptomatic brain metastasis, disseminated bone metastasis, or previous vertebral/pelvic irradiation. The chemotherapy regimen consisted of mitomycin given at 8 mg/m² on day 1, cisplatin given at 100 mg/m² on day 1, and vindesine given at 3 mg/m² i.v. on days 1 and 8 (MVP). If the granulocyte nadir count recorded after the first cycle of MVP was less than 1,000/mm³, patients were randomly assigned to receive recombinant human granulocyte-macrophage colonystimulating factor (rhGM-CSF) or placebo during the second cycle of MVP. The dose of rhGM-CSF was 125 g/m² given daily s.c. for 14 consecutive days starting on day 2. Of the 52 patients enrolled, 45 were evaluable. The nadir of granulocytes was significantly lower in the placebo group (P=0.007). The period during which the granulocyte count was less than 1,000/mm³ was significantly longer in the placebo group (median, 6 vs 10 days;P=0.04). The incidence of adverse effects related to rhGM-CSF, such as fever (38°C) and skin rash, was significantly higher in the rhGM-CSF group (P=0.011). The rate of response to chemotherapy did not significantly differ between the two groups. In conclusion, rhGM-CSF reduced the duration of chemotherapy-induced granulocytopenia. The clinical usefulness of this agent may be deminished because of the adverse effects encountered when it is used in combination with a moderately myelotoxic chemotherapy regimen.Institutions of the BI 71.018 Cooperative Study Group, National Cancer Center Research Institute (N. Saijo, Chairman): Douai Memorial Hospital (Y. Sano), Kanagawa Prefectural Cancer Center (K. Noda), Kantou Teishin Hospital (T. Uzawa), National Medical Center (J. Kabe), Shizuoka Prefectural General Hospital (H. Etou), Teikyo University (K. Mano), Tochigi Prefectural Cancer Center (Y. Saito), Tokyo Geriatric Medical Center (A. Kida), Tokyo Teishin Hospital (T. Morinari), Tokyo Metropolitan Komagome Hospital (S. Kudo), Tokyo Metropolitan Hiroo Hospital (A. Fujikawa), Toranomon Hospital (K. Nakada), Yokohama Municipal Hospital (K. Watanabe), National Cancer Center Central Hospital (K. Eguchi)     

Elevated levels of interleukin-12 and interferon-gamma in patients with human T lymphotropic virus type I-associated myelopathy

The levels of interleukin-12 (IL-12) (p70 heterodimer), total IL-12 (p70 heterodimer plus p40 chains), interferon-gamma (IFN-gamma) as Th1 cytokine, and those of interleukin-4 (IL-4) and interleukin-10 (IL-10) as Th2 cytokines in sera and cerebrospinal fluid (CSF) from 22 patients with human T lymphotropic virus type I (HTLV-I)-associated myelopathy (HAM) were compared with those of 22 patients with other neurological diseases (OND), including nine anti-HTLV-I-seropositive carriers. Both serum IL-12 (total and p70 heterodimer) and CSF IFN-gamma, measured by the enzyme-linked immunosorbent assay (ELISA), were significantly elevated in patients with HAM as compared to the patients with OND, including the anti-HTLV-I-seropositive carriers. Serum IFN-gamma also was significantly elevated in the HAM patients as compared to the controls. There was no significant difference in the CSF levels of IL-12 (total and p70 heterodimer) between the HAM patients and controls, whereas, for the Th2 cytokines IL-4 was detected in the CSF of four anti-HTLV-I-seropositive carriers of the 13 control patients but not in any of the patients with HAM. No significant difference was found in the serum levels of IL-4 and IL-10, nor in the CSF levels of IL-10 in the patients with HAM and in the controls. These findings indicate that in patients with HAM, the immunological balance of helper T lymphocytes between Th1 and Th2 is toward Th1 in the periphery and that Th1-mediated immunological status in the central nervous system is involved in the pathogenesis of HAM.     

Glucose intolerance during prolonged sevoflurane anaesthesia

Purpose

The effects of prolonged sevoflurane anaesthesia on insulin sensitivity were investigated by two successive intravenous glucose tolerance tests (IVGTT) in eight patients who underwent prolonged surgery.

Methods

The first IVGTT was administered (25 g glucose as 20% dextrose in water iv) over two minutes 35 min after initiation of surgery. Arterial blood samples were obtained at 0, 5, 10, 30, 60, and 120 min after glucose administration for blood glucose and plasma insulin determination. A second IVGTT was performed six hours following the initiation of surgery.

Results

The disappearance rate of glucose (k-value) for the first IVGTT was 0.887 ± 0.436 (mean ± SD) % · min^?1, and 0.784 ± 0.289 for the second IVGTT. Both k-values are lower than the normal value. The maximum insulin response to glucose (ΔIRI · ΔBS^?1) of the second IVGTT was lower than the first IVGTT (0.124 ± 0.092 vs 0.071 ± 0.056, P < 0.05). The total insulin output of the first IVGTT was higher than the second IVGTT (1,161 ± 830 vs 568 ± 389 μU · min · ml^?1, P < 0.05).

Conclusion

Glucose intolerance is enhanced by diminished insulin output in response to blood glucose elevation during prolonged anaesthesia and surgery.     

Membranous lipodystrophy

Summary The case is described of a 35-year-old housewife diagnosed as having membranous lipodystrophy (as described by Nasu et al. in 1970 and called lipomembranous polycystic osteodysplasia by Hakola in 1972). The main symptom of this patient was a slowly progressive dementia. Skeletal symptoms were not seen. The computerized tomogram of the brain showed calcification of bilateral basal ganglia and the plain roentgenograms of the bones revealed cystic radiolucent areas at the distal end of the bones of the patient's extremities. Histological examination of the curetted material from the right talus revealed a membranocystic pattern. The fatty tissue curetted from the cyst of the talus and the lysosomal enzymes of the white blood cells were biochemically normal. A possible relationship between this disease entity and connective disorders is considered.     

Posterior subtemporal transtentorial approach for a lower basilar trunk aneurysm (author's transl)]

A lower basilar trunk aneurysm is rare and it has been difficult to operate on this kind of aneurysm which is located in so-called "no man's land". We have recently operated on the aneurysm which was located between the vertebrobasilar junction and the origin of AICA. The aneurysm was approached posterior-subtemporal-transtentorially and wrapped with a muscle piece because of its broad neck. After the operation the patient developed amnestic aphasia which, however, disappeared 4 months postoperatively. The advantage of this approach is that it enables a better visualization of the lower basilar trunk, the lateroventral portion of the pons, the distal part (5 mm) of both vertebral arteries and the upper portion of the medulla oblongata than any other approaches hitherto reported. The retraction of the temporal lobe and subsequent brain damage may be minimized by using intraoperative ventricular drainage and microtechnical maneuver.