Adult-onset idiopathic hypogonadotropic hypogonadism presented with erectile and ejaculatory disorder

A 37-year-old man who had fathered a child five years previously presented with erectile and ejaculatory disorder. Endocrinological examinations revealed isolated luteinizing hormone-releasing hormone (LHRH) deficiency of hypothalamus, resulting in hypogonadotropic hypogonadism, and no causative abnormality was detected in imaging studies, including magnetic resonance imaging (MRI). Having a diagnosis of adult-onset hypogonadotropic hypogonadism, the patient received pulsatile subcutaneous administration of gonadotropin-releasing hormone (GnRH). Sperm analysis and serum level of testosterone improved to normal in a few months. His wife became pregnant using artificial insemination with her husband's semen 15 months after the beginning of the treatment.     

Post-ischaemic Alteration of Excitatory Amino Acid Transport Sites in the Gerbil Hippocampus

Sodium-dependent [³H]d -aspartate binding as a marker of excitatory amino acid transport sites in the gerbil hippocampus was evaluated by quantitative receptor autoradiography 1 h to 7 days after transient cerebral ischaemia for 10 min. Sodium-dependent [³H]d -aspartate binding in the hippocampal CA1 and CA3 sectors significantly increased in the early post-ischaemic stage. After 7 days, a conspicuous elevation of sodium-dependent [³H]d -aspartate-binding was observed in the hippocampal CA1 sector and dentate gyrus. However, no significant change in the binding was found in the hippocampal CA3 sector. A histological study revealed that transient ischaemia caused severe neuronal damage in the hippocampal CA1 sector and mild damage in the hippocampal CA3 sector. However, no ischaemic neuronal damage was observed in the dentate gyrus. An immunohistochemical study also showed that numerous reactive astrocytes were evident in the hippocampus, particularly in the hippocampal CA1 sector, 7 days after ischaemia. These results demonstrate that transient cerebral ischaemia can cause marked elevation in excitatory amino-acid transport sites in the hippocampus. Furthermore, our results suggest that the post-ischaemic increase in excitatory amino acid transport sites might reflect expression of reactive astrocytes. These findings are of interest in relation to the mechanisms of ischaemic hippocampal damage.     

The Response of Digitalized Canine Ventricle to Programmed Stimulation: A Study on Triggered Activity Arrhythmias in the Whole Heart

Triggered activity (TA) has recently received increased attention as a mechanism responsible for cardiac arrhythmias. However, few studies have shown TA in the intact heart. In an ouabain-treated dog's heart we have shown: (a) overdrive acceleration, (b) a concordant relationship between the postpacing interval (PI) and pacing cycle length (CL), and (c) a discordant relationship between the PI and number of paced beats necessary to induce TA. These findings appear to agree with the distinctive characteristics of TA arrhythmias elucidated in previous in vitro studies and suggest TA rather than a reentrant tachycardia. In addition, it is possible that this heart preparation could be considered as a suitable model for the study of TA arrhythmias. These results were obtained using a programmed stimulation protocol in this dog model: (1) Following single programmed ventricular stimulation during sinus rhythm, a repetitive ventricular response (RVR) of more than 3 beats occurred in only 20% of hearts. The relationship between PI and the coupling interval (CI) of the extrastimulus was concordant in 80% (12/15) and discordant in 13% (2/15) of all experiments. The PI-CI relationship was influenced by the mutual relationship between the stimulating, recording, and originating sites of TA. (2) RVR of more than 3 beats was induced by consecutive overdrive ventricular stimulation during sinus rhythm (78%). In addition, the PI-pacing CL relationship was concordant (100%). (3) The transient termination of sustained VT that occurred spontaneously after administration of a large dose of ouabain was seen in only 15% of the cases after a single programmed premature ventricular stimulation. The return cycle-CI relationship was biphasic in 75% (15/20) experiments and discordant in 25% (5/20) of the experiments. (4) The termination of spontaneous sustained VT by overdrive ventricular stimulation occurred in only 8% of the cases. Transient overdrive acceleration of VT occurred after overdrive pacing (53%). In contrast, overdrive suppression occurred in only 13%. Thus, the characteristics of TA arrhythmias observed in the whole heart preparations differed, in some respects, from those obtained by in vitro studies. These quantitative observations could suggest a differentiation, based on probability, between TA and the reentrant mechanism that would respond to programmed stimulation in a similar manner. The differentiation between reentrant and triggered ventricular tachycardia can be made with reasonable assurance using these programmed stimulation techniques.     

Use of plasma-derived factor VIIa in a child with inhibitors of FVIII for the placement of an implantable intravenous access device

We treated a 20-month-old boy with severe haemophilia A who developed a high level factor VIII (FVIII) inhibitor. An implantable intravenous access device (IVAD) was safely placed on the lateral chest under anaesthesia using plasma-derived factor VIIa (FVIIa). Implantation of an IVAD into a haemophilic child with an inhibitor requires considerable care, because the area of subdermal invasion is broader than in the implantation of a central venous line. However, placement of an IVAD provides very convenient access to the central venous line and is an appropriate tool for frequent injection, such as the induction of immunotolerance to FVIII.     

An excitatory response preceding the silent period in masseter electromyographs

A masseteric excitatory reflex response preceding the silent period which appears following tapping movement of the jaw, was investigated in order to evaluate its origin. In the pre-anaesthetic state, the latency of response did not change with the intensity of tapping. However, its amplitude increased depending on the intensity of tapping. The response did not disappear even after the anaesthesia. After the anaesthesia the lighter the intensity of tapping was, the longer the latency of the response, coming up to that of the jaw-jerk reflex. The pre-anaesthetic response had an intricate wave form comparing with the post-anaesthetic one. From the above findings it was concluded that the response must be a complex one in nature originating in the muscle spindle of jaw closing muscles and in a certain receptor of the structures surrounding the tooth.     

Neurodevelopmental outcome of infants with birth asphyxia treated with magnesium sulfate

BACKGROUND: A neuroprotective effect of MgSO(4) has been shown in some animal models of perinatal hypoxic-ischemic brain damage. The aim of the present paper was to determine whether postnatal MgSO(4) infusion (250 mg/kg per day i.v. for 3 days, in combination with dopamine) is safe in infants with severe birth asphyxia, and also observe effects on neurodevelopmental outcome at 18 months. METHODS: Inclusion criteria were clinical history consistent with perinatal asphyxia; gestational age at least 37 weeks; 5 min Apgar score < or =6; failure to initiate spontaneous respiration within 10 min after birth; and symptoms of encephalopathy. On each day MgSO(4) was infused over 1 h in combination with dopamine (5 microg/kg per min). Changes in vital signs, clinical course of encephalopathy, laboratory variables, and adverse events were monitored. Infants were followed for 18 months. RESULTS: Thirty infants were studied. Mean birthweight was 2878 g; mean gestational age, 39.6 weeks, and median 5 min Apgar score, 3. All required endotracheal intubation for resuscitation. Median age at MgSO(4) initiation was 5 h. All infants had moderate or severe hypoxic-ischemic encephalopathy. Mean serum Mg(2+) concentration remained at least 1.3 mmol/L. MgSO(4) caused no change in physiological variables including mean arterial pressure. Two infants died as neonates, while six of 28 survivors had severe neurodevelopmental disability at 18 months; the remaining 22 had no neurodevelopmental disability. CONCLUSION: Postnatal infusion of MgSO(4) with dopamine caused no change in physiological variables. Deaths and severe sequelae were less frequent than in reported cases with the same grade of hypoxic-ischemic encephalopathy severity, and this treatment may improve neurodevelopmental outcome in infants with severe birth asphyxia.     

Serum regulated upon activation, normal T cell expressed and presumably secreted concentrations and eosinophils in respiratory syncytial virus infection

BACKGROUND: The aim of this study was to characterize respiratory syncytial virus (RSV) infection. To do this, the authors evaluated eosinophil counts and chemokines including regulated upon activation, normal T cell expressed and presumably secreted (RANTES) in children with RSV, adenoviral, and influenza virus infections. METHODS: The authors enrolled 80 patients who had been diagnosed with acute viral respiratory infection caused by RSV, adenoviral, or influenza viruses. In total, 35 patients (Group A) had RSV infection, 18 (Group B) had adenoviral infection, and 27 (Group C) had influenza virus infection. The authors evaluated clinical manifestations, white blood cell and eosinophil counts, and serum chemokines including RANTES concentrations in the acute and recovery phases in each group. RESULTS: In recovery phase, eosinophil counts were higher in Group A than Groups B and C. In Group A, eosinophil counts were higher in recovery phase than in the acute phase. In Group A, serum RANTES concentration was significantly higher in the recovery phase than in the acute phase (132+/-76 pg/mL vs 52+/-25 pg/mL, P<0.05). CONCLUSION: The findings suggest that high values of RANTES in children with RSV infection may be associated with the presence of eosinophils and be an important mediator of inflammatory response.