Acute scrotum caused by Henoch-Schönlein purpura

Abstract A boy aged 3 years and 11 months with arthralgia and purpuric skin rash was diagnosed with Henoch‐Schönlein purpura (HSP) following an acute occurrence of his scrotal pain and swelling 17 days after the appearance of arthralgia. Immediate scrotal exploration was performed to confirm vasculitis of the left epididymis compatible with a scrotal manifestation of HSP. Postoperative course was uneventful. Twenty‐five cases of HSP with acute scrotum reported in Japan, including this case, are calculated and discussed.     

The outbreak of mumps in a small island in Japan

A major mumps outbreak occurred on a small island, Ikeshima, in Nagasaki Prefecture from August 1994 to February 1995. There were 236 patients with the mumps at Ikeshima Miners' Hospital during that period. The Measles-Mumps-Rubella (MMR, Toitsukabu) vaccination coverage in the 43 children at the nursery school was 65.1% and it was 61.9% in the 21 children aged 4–5 years not attending the nursery school. Coverage was 66.6% in the 63 kindergarten students and 53.7% in 56 first-graders. The overall MMR vaccination coverage among these children was 61.7% (113/183) from 1989 to 1992. Children from the second grade to junior high school received monovalent mumps vaccine, Torii strain. None received Zishakabu MMR. The age of the patients ranged from 1 to 43 years, with a mean of 9.1 years. The majority (77.5%) were primary school children. The attack rates for vaccinated and unvaccinated children in grades one to six were: 6.7% (2/30) and 88.5% (23/26), 25% (3/12) and 44.1% (30/68), 11.1% (1/9) and 64.4% (29/45), 25% (2/8) and 60% (45/79), 22.2% (2/9) and 35.9% (28/78), 0% (0/5) and 24.7% (18/73), respectively. The overall frequency in the primary school was 41.4% (183/442 children). The frequency in the nursery school for children aged 4–5 years was 14.0% (6/43). It was 17.5% (11/63) in children aged 5–6 years in the kindergarten, 5.2% (11/213) in children not attending school with an age range of 1–5 years, and 4.2% (10/237) in junior high school students. Although the frequencies of MMR coverage for the nursery school children and kindergarteners were not high enough to eradicate mumps outbreaks, the MMR vaccination program was thought to have influenced the low frequency of mumps among the children. Close physical interactions among the first-graders would have contributed to their high frequency of mumps. Some patients presented with suspected mumps parotitis several times, but no such serological confirmation of reinfection was obtained.     

Intestinal perforation after cadaveric renal transplantation

We performed cadaveric renal transplantation on a 46-year-old man on long-term hemodialysis. Methicillin-resistant Staphylococcus aureus (MRSA) enterocolitis occurred on the fifth postoperative day and severe intestinal ulceration and perforation followed. Subtotal abdominal colectomy and the simultaneous removal of the transplant were performed. Postoperatively, disseminated intravascular coagulopathy with pancytopenia and cerebral hemorrhagic infarction developed and the patient died 40 days later.     

Effect of Atrioventricular Sequential Pacing on Left Ventricular Flow Dynamics in a Patient with Mid-Ventricular Obstruction

The effect of dual chamber atrioventricular sequential pacing on the intraventricular pressure gradient was tested using Doppler echocardiography in a patient with hypertrophic mid-ventricular obstruction. Atrioventricular sequential pacing with relatively short atrioventricular delays reduced in the left ventricular pressure gradient at the mid-ventricular level. Also, atrioventricular sequential pacing affected the degree and profile of the isovolumetric relaxation flow. These results suggest that atrioventricular sequential pacing affects both systolic and diastolic left ventricular flow dynamics in mid-ventricular obstruction.     

Demonstration of Syncope in Patients After Pacemaker Implantation: Role of Head-Up Tilt Test to Distinguish Neurocardiogenic Vasodepressor Syncope From Pacemaker Syndrome

It is important to distinguish clinically neurocardiogenic syncope from pacemaker syndrome in patients after pacemaker implantation. We report two syncopal patients with AV sequential physiological pacemakers who displayed neurocardiogenic Vasodepressor syncope (VDS) during head-up tilt (HUT) testing. Neurocardiogenic VDS, as a cause of syncope in patients following pacemaker implantation, might be involved in these patients as well as pacemaker syndrome. HUT is a useful diagnostic test in distinguishing neurocardiogenic VDS from pacemaker syndrome in patients with syncope following pacemaker implantation. Careful evaluations for diagnosis of pacemaker syndrome are needed in these patients.     

Expression of nitric oxide and inducible nitric oxide synthase in acute renal allograft rejection in the rat

BACKGROUND: Recent studies have shown that nitric oxide (NO) synthases, particularly inducible nitric oxide synthase (i-NOS), are induced in acute rejection episodes following heart, liver, pancreas and kidney allotransplantation. Furthermore, tissue and cellular injury has been demonstrated to be mediated by peroxynitrite (ONOO-), a metabolite of NO as well as a potent oxidant. However, a detailed relationship between NO, i-NOS and graft injury in transplantation remains elusive. METHODS: The present study used the following models of renal transplantation in rats: allografts (n = 5, Brown-Norway to Lewis [LEW] rats), isografts (n = 5, LEW to LEW) and allografts treated with aminoguanidine (AG), an i-NOS inhibitor (n = 5). Blood urea nitrogen (BUN), serum creatinine (SCr) and urinary and serum nitrosocompounds (NOx) were measured on days 2, 4 and 7 post-transplant. Western blot analysis of i-NOS protein expression and measurement of i-NOS activity were carried out in grafts harvested on Day 7, along with immunohistochemical and histopathological examinations. RESULTS: In the allograft group, both BUN and SCr levels increased markedly on Day 7, in parallel with a sharp increase in NOx. A band stained by anti-i-NOS antibody was detected at approximately 130 kDa, along with high levels of i-NOS activity and diffusely distributed i-NOS-positive cells (macrophages). Histologically, an acute rejection episode was confirmed (Grade 3 according to Banff classifications). In the AG group, reduced renal function and graft injury were significantly less severe than in the allograft group. CONCLUSIONS: In rat renal allograft acute rejection, markedly increased levels of serum NOx were observed, along with enhanced tissue i-NOS activity, together resulting in graft injury. AG administration suppressed the increase of serum NOx levels, with concomitant mitigation of tissue injury and renal function impairment.     

Phase II Study of Oral Administration of 5'-Deoxy-5-Fluorouridine (5'-DFUR) for Solid Tumors

A phase II trial of 5'-deoxy-5-fluorouridine (5'-DFUR), a newfluorinated pyrimidine analog which has been demonstrated tohave potential superiority over 5-FU and tegafur for chemotherapyof murine tumors, was performed in patients with advanced non-smallcell carcinoma of the lung and metastatic pulmonary tumors.5'-DFUR at a dose of 800 mg/m² was given per os every day formore than four weeks. None of 15 evaluable patients with non-smallcell carcinoma of the lung and 15 evaluable patients with metastaticpulmonary tumors showed a complete or partial response. Toxiceffects of 5'-DFUR included anorexia (29%), diarrhea (26%),nausea (23%), vomiting (10%), leukocytopenia (10%), generalfatigue (10%), liver disorder (6%) and thrombocytopenia (6%). ^**Present address: Third Department of Internal Medicine, Schoolof Medicine, Toku-shima University, Kuramoto-cho 3-chome, Tokushima770, Japan.